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Some folks have determined that their already-started initiatives into ICD-10 can be placed on hold with the delay in start dates for the conversion of ICD-9 to ICD-10. Forward thinking facilities have determined that they can make positive moves which would have been tougher for them to complete with the original drop dead date of 1 October 2014. To these, I say “Congratulations on foresight.” To the others, I warn that much of your investment up until now will be thrown away and it’ll cost you SO much in the long run.

What are some of the benefits of continuing the course?


The medical staffs of many hospitals, of many group practices are overwhelmed with conversions to electronic versions of health records, learning new daily routines that interfere with their practice, overwhelmed with learning about the Accountable Care Organizations and the various models of change in the system in their communities and their hospitals that a concerted effort to learn a new diagnostic language on top of that would be burdensome.

With the additional time available, one doesn’t have to burden the medical staff with Computer Based Learning modules, which are not designed for their particular need and take them away from patient care more than before, but can little by little insinuate terminology and specificity into your existing or new CDI programs. With 18 months’ time to get familiar with these requirements, they’ll be used to it all by the time it becomes mandatory. They’ll already be there.

Besides, there is no software package ready for the individual practitioner or even the hospital based practitioner that is clinically friendly, so with the lack of support for those who don’t have an EHR to the inadequate support for those who do, it’s a strain on the docs. The processes in the existing EHRs aren’t too physician friendly to begin with – yet.


And, regardless of how many courses a CDI specialist takes from Computer Based Learning modules, it’s not until the teams actually get to practice for months and months that they’ll ever get it – and you don’t want to turn CDI folks into on-the-fly book-dependent practitioners. Their productivity would reduce massively and there would be no measurable effects of their efforts as there has been with many of them until now. Getting them indoctrinated into the same specificity and terminology and working with them to use it over time, by 1 October 2015, they’ll already be there. And the expensive program won’t be necessary.


A holistic approach to diagnostic considerations will enable the whole patient to be prepared for discharge and not only the one condition for which they were admitted. Those facilities that concentrate only on the acute MI, CHF and pneumonia and ignore the patient's diabetes, kidney disease, hypertension, are going to leave themselves open to avoidable readmissions - and the short sighted view is destructive.

Now is the time to charge forward rather than turning back. To be able to get physicians familiar with terminology and specificity they will hear about the rest of many of their professional careers, the earlier without pressure, the better. To be able to get existing CDI members trained, specialty by specialty, disease by disease rather than by coding module by coding module will permit them to learn, assimilate, become familiar and work with this system painlessly with the medical staff and with live charts.

The modifications the docs will encounter over the next year and a half will be easy to swallow. With the conversion spread over a longer period of time, it will hardly be noticeable and will not be a distraction. And the sooner it gets started, the less difficult it will be in the long run, when it really counts for billing. And the new words are still billable! The worst thing with starting this all now is that you’ll have better information in the charts regarding the patients. And, in my mind, that’s “meaningful use.”

For those facilities that don’t have a CDI initiative, THIS is the time to get it going – to get the training over time – to get the support over time – to get the familiarity over time. And the fear goes away. For those that do have a CDI program, this is the time to get the team upgraded to the needs of the future and not dwell on the no longer valuable models of the past.

Yes, someone will come out with a physician-friendly software package. One that will work in the hospital, in the office and will really be able to communicate properly for the patient, which none of the programs currently do, no matter how many bells and whistles you hear about. And when that comes to pass and when we do graduate to 10th Grade, we’ll all be ready for college. Those that drop out of school will have to take additional night courses later and nobody will be happy.

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