November 19, 2012

Using Algorithms to Identify ICD-10’s Impact
For The Record
Vol. 24 No. 21 P. 5

The deadline for ICD-10 compliance officially has been extended by one full year. That’s 365 additional days to ready your processes and make them capable of handling the post–ICD-9 world. It may seem like a lot of time, but once you get down to the actual execution, you will realize that all of those 365 days are needed to get your ICD-10 project completed.

The first challenge in your ICD-10 compliance journey is to find out who in your organization is impacted by the change. This initial identification of stakeholders is crucial because this group of people and their view of how ICD-10 should be incorporated into their business processes will drive your selection of ICD-10 remediation strategy. As you may know, ICD-10 remediation strategies are generally a mix-and-match of these two basic approaches:

• Complete remediation: You consider each and every business process that references ICD-9 codes and rework them to take advantage of the increased specificity offered by ICD-10. This is considered by many to be the best solution, as it ensures that patient diagnosis and procedure data are recorded and processed with better accuracy and precision.

• Insulation: You avoid systemic changes by introducing a crosswalk or wrapper to convert ICD-9 to ICD-10 codes and vice versa using a general equivalence (or similar) mapper or crosswalk.

Since the identification of stakeholders and the collection of input for selection of ICD-10 remediation are critical to the success of the ICD-10 conversion project, ensure all these influencers and customers are identified properly during the early stages of the project.

While it may be easy to come up with a basic list of stakeholders by interviewing the project sponsors, operational officers, coders, and resident IT gurus, you can never be certain that you have covered all the bases. If you are working for a large organization, there is a good chance there are users producing ICD code-dependent data extracts or reports using some little known process, a local database, or perhaps some other creative manual workaround known to only two or three people in the company.

The question is, how can you leverage technology and algorithms to comprehensively detect all stakeholders impacted by the ICD-10 compliance project? Hexaware suggests these two options:

• ICD-10 source and database crawlers: A crawler searches through all your databases looking for incidences of ICD-10 code usage. They are typically algorithms (a set of repeated program instructions) set up to scan for ICD code patterns in databases and source codes. Once such codes are found, the crawlers recursively chase them up through the systems to spot assignments and usage until they find out which screen and customer/user facing process is impacted by the ICD codes.

A good crawler will give you a comprehensive ICD impact analysis report showing the exact locations at which ICD codes are used in your system and the number of incidences of their usage. It should be able to trace the downstream impact of ICD code usages and come up with a comprehensive inventory of screens, interfaces, and data feeds. Crawlers are one of the most effective means of coming up with a comprehensive list of users or stakeholders whose lives may be changed after the move to ICD-10.

The best ICD-10 impact analysis tools work on multiple technology platforms and include intuitive analytical reports that highlight the distribution of codes, the complexity of the mappings, and the complexity of the transforms.

• Survey robots: The drawback with the crawler tools is that they may not detect creative and manual usage of systems to produce reports and data shared with the external world. One way of finding out about such users is to set up a survey. Get your website administrator to set up a link on your intranet home page to entice ICD-10 code users with some sort of giveaway or other incentive to log in to your survey portal and submit samples of extracts, reports, and anything else you can think of that could potentially be impacted by ICD-10. Run these products through the crawler to see whether they are indeed legitimate candidates for the grand ICD-10 survey prize. Add the winners to your list of potential customers for the ICD code remediation project.

To summarize, you need to go all out to identify stakeholders who are impacted by the ICD code change at the start of your project because the way they use these codes influence the selection of your remediation strategy.

Use technology solutions such as crawlers and survey monkeys to build up a comprehensive database of impacted stakeholders and affected systems interface at the start of the project. The effort is worthwhile because it will help you avoid surprises when you switch off the ICD-9 codes and save you the cost and effort of changing and modifying your ICD-10 remediation strategy at the 11th hour.

— Hexaware Technologies is a global provider of IT and process outsourcing services and healthcare solutions.