3 lessons Canadian healthcare can teach us about ICD-10 implementation

Carl Natale
by Carl Natale

When you ask healthcare professionals what scares them about ICD-10 implementation, many of them point north.

Canada's single payer system staggered ICD-10-CA/CCI implementation across its provinces from 2001 through 2004. That's not the scary part.

Last year, Cynthia Grant, director of Canadian consultancy Courtyard Group, said that productivity in Canada, never bounced back to ICD-9 levels. Why not?

The obvious answer is all the extra codes and complexity. But it's a bit more complicated than that.

More than medical coding changed

Before ICD-10-CA/CCI, medical coding was done on paper according to  No World Borders.

"A somewhat interesting challenge that Canada had was that when they rolled out the ICD 10 system, Windows-based computer software was just making the scene. Not only were Canadian coders faced with a new code set, but they were also faced with the challenge of changing from using hardbound books to desktop Windows-based applications for their reference materials. The Canadian government provided free code selection software and provided it to hospitals to aid in training and accurate code selection."

  from Global Lessons: Planning and Preparation are Keys to ICD-10 Success

More work needed to be done

According to an Edifecs white paper, 5010 & ICD-10: Testing Strategies to Achieve Compliance, Canadian authorities severely underestimated the work required to implement ICD-10 codes.

  • "Underestimation of how much work was involved in preparing for the new technology environment and what additional cost would be incurred."
  • "Both Timelines and Budgets were grossly underestimated due to unavoidable delays and unknown variables that were not planned / anticipated."
  • "As business process’ were reviewed, variation in practices, process redundancies, and inefficiencies where identified. Magnitude of change was underestimated."

 More training needs to be done

Chris Wierz, who used to be a consultant with the Courtyard Group in Toronto, has talked about the training needed. The "five day self-learning package and two day in-person training was found to be insufficient for the acute care coders."

 The United States needs more

Mostly training. If U.S. providers don't want to repeat the Canadian mistakes, they need to focus on training and preparation. And the training goes beyond just learning the codes. These resources should help you get started: