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Nurse Execs Shouldn't Fear ICD-10

 |  By Jennifer Thew RN  
   August 25, 2015

Bedside nurses and nurse executives will be less affected than others by the advent of ICD-10 coding on October 1. It may take time for their organizations to adjust, but ICD-10 will eventually give nurses the data to make timely adjustments to healthcare delivery rather than simply being reactive.

For all of the wailing and gnashing of teeth over the impending conversion to ICD-10, you would think the fate of the entire U.S. healthcare system hinges solely on this update of diagnostic codes. But as far as nurse leaders go, it's safe to pack up "The End is Near" signs.


Susan Marino, RN

"I think that the good news is, for nurse execs, it's not a direct hit unless they have ownership of their advance practice nurses or they are, obviously, managing large physician practices," says Susan Marino, RN, chief nursing informatics officer at Hartford (CT) HealthCare. "In a hospital scenario, it will be fairly seamless to direct care nurses because [ICD-10] is really about two groups—the providers who are doing the documentation and then the coders."

Still, nurse executives should be aware that there could be some short-term operational bumps in the road as their colleagues get their arms around ICD-10 requirements.


ICD-10: A Checklist for Implementation Readiness


Short-term Strife

"One of the key elements of ICD-10 is that it's a fairly significant learning curve for our providers. It means a lot more detail in their documentation," Marino says, "which means chances are good at go-live that there's going to be a curve of learning that will potentially hit their productivity."

Marino, who is also co-chair of HIMSS' nursing informatics executive workgroup, explains that nurse executives should be aware of patient flow in areas like the emergency department, nursing units, and operating rooms so they can identify any issues arising from the new requirements in provider documentation.

"We don't want our patients' length of stay to increase because our providers can't discharge as quickly and get their documentation done," she says. "You don't want a drop in our revenues because we're not documenting as well or it's taking longer."

Encouraging interprofessional unity is one way to help soften the edges of the stress brought on by the ICD-10 documentation requirements, says Marino.

"[You want to be] making sure that the folks out on our floors and our different areas are aware that the physicians may be frustrated at some level," she says.

She also recommends other disciplines step up their documentation game during the transition. "The more that we all play well with our systems and document more accurately, the better off our physicians will be in their ability to achieve their goals," says Marino.

And nurse executives would do well hold off on launching their own major projects until ICD-10 has become part of the documentation norm.

"Making sure that [ICD-10] is successful within the confines of your operational areas is important," says Marino. "So any major initiative that a nurse executive knows is coming down the pike, you want to make sure that you don't have competing initiatives going on so that any one thing won't be as successful as you'd like it to be."

Long-term Gains

Is all the ICD-10 angst necessary? Most likely not.

An analogy, Marino says, is "Did we freak out when we got our new iPhones and we stopped using the phone book? You know, you bring in new things, we change in our environment, and there's just natural transitions that are going to happen."

Despite the trepidation, there are benefits to doing things in a new way. In the case of ICD-10, Marino says the specificity of the diagnosis codes will help collect stronger data.

"This all kind of relates back to where we're headed in relation to our dependence on data, and accuracy in data in particular. … [We are] trying to catch up with medical terminology and really getting to a different granularity in data so that our data can help us drive improving quality of care, measuring our outcomes, the cost of care," she says. "If you don't have good data, you just can't plan, you can't improve upon on your environment."

Marino says ICD-10 has the potential to support the federal meaningful use incentives for healthcare IT, the move towards value-based purchasing, and payment reform.

For patient care, ICD-10 can help healthcare professionals better understand a condition, possible interventions, length of stay, and outcomes. Take, for example, a patient with a pressure ulcer.

"There'll be a lot more data in how a wound is measured, how it's treated, the cost of our wounds, and whether we, upon admission, were able to identify whether the patient had a wound or not," she says. "And so we can watch all these interactive pieces of data day-to-day and be much more able to make immediate impact on changes that are necessary rather than waiting a month or a quarter out to receive our data and say, 'Oh geez, we've lost a quarter in the opportunity to fix things quickly versus retroactively reacting to things.'"

Marino looks forward to having the flexibility to make clinical changes based on more robust data.

"We're in an environment now that anything we can do to make changes quickly helps every one of us," she says. "It's all these little things that add up to the ability to get us to better managing populations of our patients and being able to better manage the risk within our healthcare environment. That's really how we're going to be successful long-term. That should be on the minds of all of our nurse executives."

Jennifer Thew, RN, is the senior nursing editor at HealthLeaders.

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