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Curbside Consult with Dr. Jayne 1/14/13

January 14, 2013 Dr. Jayne 4 Comments

1-14-2013 6-07-02 PM

Just when I thought it couldn’t get any scarier, I had the opportunity to attend a recent presentation on the transition plan for ICD-10 for our ambulatory physicians. It’s been interesting to watch this unfold.

In its infinite wisdom, the hospital created an ICD-10 “task force” that sounded like a good idea at the time. A dedicated team working on a single problem will pull in subject matter experts from various business areas and software teams as needed. Unfortunately, it would have been better described as a “super silo.”

Over the last two quarters, I questioned several times the fact that they haven’t been to see me. I’m on the tip of the spear for our ambulatory physicians, so I expected them to knock on my door at least once. I was told to pipe down and stop micromanaging, so I did.

As the weeks have worn on, however, they’ve been spending more time going directly to the vendors and less time with the actual software support teams. Not exactly a winning strategy in my book. The software teams actually support the users and know their business needs. We know the limits of what they will and will not tolerate as far as workplace disruption. We also know how to effectively use Jedi mind tricks on the users, especially when we have to present something unpalatable.

This week the task force presented the final strategy at our monthly physician meeting. As the presentation unfolded, I was transported back to the college literature class where I first experienced Joseph Conrad’s journey down the Congo River in Heart of Darkness. As more and more PowerPoint slides flashed before my eyes, I felt myself going deep into the wilderness. The physicians’ eyes darted around the room trying to identify which of the department chairs would rebel and which would join the savage oppressors. I buried my head in my hands, grateful that my lack of involvement conferred plausible deniability.

The key points of their transition plan were simple, yet terrible:

  • Since the ambulatory vendor plans to release its ICD-10 software in May 2013, we’ll just plan to upgrade in June. Had they talked to my team, they’d have known that it takes us a minimum of three months to prepare for an upgrade once a new code package is available. They’d also know we have a dozen go-lives that must be completed before any upgrade. These are contractual obligations and cannot be moved.
  • Providers will dual code from the time of the upgrade until the requirement commences in October 2014. Are you serious? Providers aren’t going to do double work under any circumstances (that is, unless they’re paid extra or threatened with termination). The fact that they even suggested this told me that they didn’t talk to the Practice Operations leadership either. A quick look at the ashen-faced VP two rows behind me confirmed my assumption.
  • Provider training will require a full day out of the office and all training will occur during a two-week span. Given the size of our group and the need to stagger training to accommodate various work schedules and vacations and to ensure patient access, this suggestion is simply absurd. Doing the math would conclude that it’s impossible to train all the physicians unless our training rooms run 24×7 during these two weeks.

Those in the group who round in the hospital will receive extra training. Approximately 80 percent of our physicians continue to see inpatients, so failing to include those details in the presentation led to more questions and frustration. Needless to say, the physicians were not pleased and basically handed the task force their heads. Several senior physicians walked out and the more vocal junior physicians started commenting loudly. It reminded me of a raucous session of England’s Parliament, but without the wigs.

The only good thing about the presentation was that it occurred at the end of the meeting’s agenda and effectively ended any lingering comment on any of the other agenda items as well. The first thing I’m doing tomorrow morning is organizing a betting pool. How many days until the application team managers are asked to essentially take this over and start from scratch? My money is on three.

How is your organization planning to transition providers to ICD-10? E-mail me.


E-mail Dr. Jayne.

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Currently there are "4 comments" on this Article:

  1. haha,…oh Dr Jayne…I love your style. I am sorry that you work at an institution that is still embracing the 80’s. Since when can you install an application suite in any area, changing any workflow and not include the people who will be using it – the 80’s of course.
    Also, the dual code idea had to be discussed and then they said ‘ok who is going to tell them?” nervous silence……

    Good luck with that….

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