ICD-10 coding touches 34 systems from 10 different vendors at Seattle Children's, as well as internally developed research databases at the Seattle Children's Research Institute.
"It's certainly not everything we run—we have 197 applications at Seattle Children's—but it's definitely some of the more major systems that we run," DeFord says.
After making an inventory of any systems using ICD-9 codes, DeFord's team talked with vendors to understand their update timelines and how long Seattle Children's would have to test these updates before going live with ICD-10 coding. In some cases, DeFord's team pushed to get software in their hands "as far forward as possible," he says.
Seattle Children's is currently in the process of selecting a computer-assisted coding vendor that will work well with the Cerner electronic medical record software already in place, DeFord says. "There's a lot of due diligence going on," he adds.
"We know that we need to make a very careful decision here, but we think it'll be one that will really pay off and will continue to drive our ongoing adoption of electronic medical records and especially physician documentation in the electronic medical record," DeFord says.
At the executive level, DeFord's efforts are being led by the chief financial officer and the chief medical officer. "We've really tried to make sure that it's supported from the top by the three major executives that have the biggest effect on their areas, that impact hospitalwide," he says.
DeFord, who also serves as chair of the College of Healthcare Information Management Executives, likes to use a football analogy when talking about ICD-10 preparation. "You get the ball on the 2 [yard line]," he says. "For those folks who are going to sit there and try to throw bombs and score a touchdown some time in 2013, I don't think they're ultimately going to be very successful.
"We're going to gain a few yards every month until we're in scoring position, or maybe have already scored the touchdown before we get to the go-live date."
Seattle Children's is already in the early stages of a clinical documentation improvement project, DeFord says. "Coding-savvy nurses are available on the floors looking at the documentation as it's being created, giving feedback nearly in real time to physicians to make sure that they're doing as complete a documentation as we can possibly get, which is really the key behind being able to code at an ICD-10 level," he adds.
Paired with these efforts is "a lot of education for our physicians on documenting more completely, why it's important, what ICD-10 is, and the level of coding and documentation that's expected," DeFord says.