ICD-10-CA: What really went wrong in Canada

By Carl Natale
09:10 AM

A benefit of being one of the very few countries in the world to not implement ICD-10 coding yet is that we can learn from how the other countries did it. Canada is one of those countries where we can find lessons.

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Canada's single payer system staggered ICD-10-CA/CCI implementation across its provinces from 2001 through April 2005. And Gillian Price, currently Project Director Canada at QuadraMed, was a consultant doing operational reviews for Canadian healthcare organizations during that time. She was a part of the ICD-10 implementation at hospitals and said it got easier as she learned from each ICD-10-CA implementation.

Here are some of the problems that Canadian healthcare professionals encountered implementing ICD-10-CA:

There wasn't enough time for training

Price contends training will never be enough. There is nothing any organization can do to make any person 100 percent ready for ICD-10 coding. There is a point that medical coders need to take personal responsibility for their development and learn what they need to learn.

She had an interesting analogy about the attitudes she encountered while planning ICD-10 projects. She compared medical staff to:

  • Ducks: They are always quacking and choosing to resist change.
  • Pigeons: They are quick to flee (retire).
  • Swans: They are Price's favorite. They chose to adapt, take the time to learn and swim gracefully through the choppy waters of transition.

There was a lot of learning. In addition to medical codes and physiology, medical coders needed to learn new standardized procedures and how to communicate better with physicians. Price said the people who took "responsibility for their careers" were able to learn and adapt. They went from librarians who automatically wrote down numbers to active parts of their practices. The complexity of their work gave them a chance to be more professional.

Price also said that a lot of the resistance was institutional. That some hospitals and unions were managed by "ducks." In that kind of environment, it was hard to embrace the change and do the work necessary to create a smooth transition.

It's not just a systems problem

How many times have you read that ICD-10 isn't just about software or medical coding? That's probably because Canadian healthcare figured this out the hard way.

Price described hospitals that contracted vendors or got their IT departments to create tools that accepted ICD-10 codes and thought the job was done at that. There wasn't enough consideration for how the physicians worked or how the codes flowed downstream into billing systems.

Crosswalks? Forget about it

Price said they abandoned their crosswalk because there were too many variables for them to work well. She said it was easier just to learn ICD-10 codes.

Medical coders went digital

Until ICD-10 implementation, medical coding was a paper-based job. But healthcare organizations went to Windows-based software to report codes. Combine that with the fact that Canadian healthcare IT was predominantly DOS based, medical coders had another learning curve to master.

And due the complexity of the coding, medical coders needed bigger computer monitors. Some went to dual monitors. Figuring out issues like that took time and productivity.

Productivity never recovers

Speaking of productivity, it tanked. The reduction ranged from 23 percent to 50 percent. And Price said productivity never fully recovered. There was no way it could given the complexity of the new codes and the changes needed in the healthcare organizations.

Remember, the medical coders became more professional members of the staff. Their work involved more analysis and investigation. That meant they couldn't be as fast as the workers who added numbers from rote memorization.

What do we do in the United States then?

Today, we concentrated on what went wrong. It makes ICD-10-CA look like a disaster. But the key is they learned their lessons and made it work. Tune into Wednesday's post about Price's advice for implementing ICD-10-CM/PCS in the United States, and how Canada benefits from ICD-10-CA implementation.

Carl Natale blogs regularly at ICD10Watch.com.