Few things instill more anxiety and fear in business and IT executives than regulatory and compliance issues. Ensuring that an enterprise complies with government requirements to the letter of the law is daunting—even with the best IT systems in place. In the health care arena, the challenges are even greater.
Miami Children’s Hospital (MCH), a 64-year-old not-for-profit medical provider that’s rated among the top pediatric care facilities in the nation, recently found itself staring down the barrel of changing regulatory and compliance rules. “Like many facilities, we were faced with ICD9 to ICD10 conversion,” says Edward Martinez, senior vice president and CIO. “We knew in advance that the task needed to be addressed, but it presented significant technical, operational and behavioral challenges.”
At the center of the challenge: ensuring that staff, business processes and information systems complied with the new coding protocol required for medical diagnoses and insurance billing. MCH turned to Xerox to provide a framework for handling the task, which must be completed by October 1, 2015.
Martinez says that MCH looked for a single source of expertise to reduce the probability of errors before and after the transition. The hospital also wanted to avoid costly and time-consuming duplication. Xerox offered a streamlined methodology, along with a comprehensive assessment, implementation and stabilization approach through a series of checklists and branching process trees.
“The system has forced us to do a lot of analysis and better understand how processes work and what needs to change in order to achieve compliance,” Martinez says. By answering a series of questions, documenting how things work and comparing that to the compliance framework, MCH is able to document and map how to address processes that involve a fivefold (or more) increase in codes. The system guides physicians through every component that creates risk and exposes gaps that need to be addressed.
One of the biggest challenges, Martinez says, is helping doctors change their behavior. Since many long-time physicians are accustomed to handling tasks with a coding standard they have used for years—or decades—there’s “a huge delta in terms of knowledge transfer and education,” he points out.
Getting systems, forms and processes in sync with the process changes is a formidable task. The ICD-10 Complete solution also offers simulation technology, training systems that match individual departments’ needs, video tutorials and project management tools to identify where the organization is at any given moment.
Martinez reports that the transition has not presented any significant business and IT challenges. During a three-year span that has involved migrating to electronic medical records and more sophisticated patient billing and accounting systems, the risks and complexities of running the business have grown.
“We had to ensure that we had a system that could span our IT systems and produce the desired results,” Martinez explains. “We had to make sure that we could standardize our practices while changing our workflows. We now have an end-to-end solution that mitigates risk and produces significant time and cost benefits.”