Not the most exciting project and perhaps the most underestimated is the redesign of forms to accommodate the transition to ICD-10. Those of particular concern are those critical for clinical documentation by doctors, nurses, ancillary departments and others. Beware, this will take much longer and cost much more than you anticipate. On the surface, it appears to be an easy task. But the level of detail and granularity required by ICD-10 will expand the size and content of your forms. This will require clinicians to provide more information and change their clinical documentation practices. We all know how easy it is to change physician behavior and how well they react to requiring them to spend more time doing “paperwork.”
Luckily, CMS has extended the live date of ICD-10 by one year giving HIM and Clinical Documentation more time to initiate the process of forms revision.. This means you have more time to get it done right, not more time to procrastinate. There are two problems to resolve. The first is to take an accurate inventory of which forms are being used now in ICD-9. The second problem is to know the detail of ICD-10 so that you can develop or revise the forms needed. In other words you need to know where you are and where you are going. Once these two hurdles are crossed you can plan the process to get you there. Best practice suggests that you do it over a period of time in small easily digested bite size modules. Also, it is essential to have physician champions to feed the modules to other physicians.
HIM professionals are already adept at forms design and should take a leadership role in the process. . The future challenge poses a shift from an existing forms hard copy library to forms that may be electronic and embedded within your EHR.
Clear steps should be followed. This starts with re-convening your forms committee. This multi-disciplinary group with physician involvement should drive the process. Secondly, complete an inventory of all paper forms and their lifecycle. Identify those scheduled for electronic conversion and time frame for implementation. If new IT systems are planned, get involved early with IT to design and develop the new forms. This is much preferable to implementing the new system with the old forms and then reworking them. Finally, identify which forms are most commonly used today and start with those. Target high volume specialties and make design changes that are specifically related to that service. Orient clinicians in a focused manner and you will improve your probability of success. Finally, do not forget that there are other sources of documentation that coders use that require attention as well.
Plan the work and work the plan. What are your thoughts? We are open to suggestions or comments on this subject.