Preparing for the new normal of ICD-10: Cerner

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Mike Hourigan was a floor nurse at a community hospital in Kansas City prior to joining Cerner in 1999. It happened to be the year of Y2K, so he ended up as an analyst. He worked his way through Cerner’s consulting organization, managing several consulting teams, and then moved into the regulatory area four years ago. Currently, he has a team of about 45 people working on regulatory issues, in particular Meaningful Use and ICD-10.

I had the opportunity to speak with Hourigan to learn how he and his team are working with Cerner clients to prepare for the lead up to, and for doing business after, the approaching October 1st mandate of ICD-10.

(Editor’s note: To hear audio excerpts of this interview, click on the media player buttons that run throughout this article.)

Free: How would you characterize the typical Cerner client?

Hourigan: We run from anywhere from a one doc practice to a 10-bed, critical-access hospital all the way up to hundred doc practices, large IDNs (integrated delivery networks), academic. So, we pretty much have every size [client] possible, I guess.

Free: How has your background as a nurse impacted your work with compliance issues?

Hourigan: Well, I think it helps tremendously, just having lived in that world and having regulations come down, and you’re asking [yourself] the questions of, “How does this fit into my workflow? What kind of impact is this going to have on the patient?” and, those types of things. I think I always try to keep those in mind when I’m being updated on regulations, or trying to figure out is there a workflow change that’s going to have an impact that could be a potential impact to either a clinician’s workflow or a patient’s overall outcome. 

Free: As a vendor, what would you say is currently the biggest impact upon workflow coming from the regulatory field?

Hourigan: It’s hard to say. It depends on how a vendor actually translates a given regulation in terms of its use at a client’s site. It can run the gamut. 

There’s obviously instances of positive impact on workflow and overall patient outcomes. And then, I wouldn’t say there’s negative [impacts] as much as there’s just challenges with some of the workflows that maybe weren’t completely baked at the time of inception when the regulations came down, or maybe there wasn’t a already predefined product or set of standards that hadn’t been used prior to that point.

Free: Let’s talk more about regulations not being “completely baked.” Most of the time, these instances are based upon regulatory approaches that don’t fully appreciate day-to-day clinical workflows. If you were to speak to a group of government officials creating compliance regulations, what would you impart to them that you think that they miss at times? Whether it be a mindset, whether it be a practice, how could they go about creating compliance measures that aren’t so half-baked?

Hourigan: That’s a good question. I’m not exactly sure what I would say in a meeting like that, other than if there’s a standard that’s already been set and is in full practice and use, then that is probably something that is going to be more widely adopted within the industry and not have as much of an impact on workflows. I think it’s the,  “I’m coming out with a new requirement that doesn’t have a full set of standards already identified,” where you can have many different options of doing it in different ways. That’s the part that’s probably a little challenging and also on the flipside of that, that’s the innovation piece, too, so it allows for more innovation. So I can see both sides of it. I think they are trying to play both sides of the coin.

Free: You recently hosted a Twitter chat on ICD-10. Can you tell me about Cerner’s day-to-day efforts helping its clients to prepare for ICD-10?

Hourigan: My team and I have been working on ICD-10 for nearly four years.

We’re taking the approach that we actually recommend to our clients, which is: do an assessment of all of the different areas within your organization to see if there’s any impact from ICD-10. At least, then you’re getting awareness and putting a plan together to ensure that you have contingency plans in place if certain things were to fall badly as they might, because until you engage the process, it really is kind of an unknown to everyone in your organization.

Some of the things that we’ve been doing with our clients is every year we have regulatory summits. We do those at the beginning of the year, usually. For the last three or four years we’ve done these, and it is a full day of education and then a full day of individual planning with our clients. We do these summits at no cost to our clients.

We also have what we call “Review Board Calls.” If you weren’t able to attend the summit, but you still needed to have that information, we would go through one of these calls and spend an hour and a half or so with you to make sure that you have your plan in place and know what you have to execute moving forward from an ICD-10 perspective.

 I’d say the last thing, and it’s actually had a lot of positive responses to it, is we had three mock cut-over testing events and we’re planning to have another one in August of this year, so, and we’ve aligned those with the CMS acknowledgment testing events, so as you go through that process, prior to the event happening, once you’ve registered, we’ll assign a liaison to you. That liaison will go through the cut-over plan with you and make sure that you understand how it’s going to work and ensure that you have the right people assigned to the different tasks. And then, of course, we support all clients going through that at the same time during that testing week, and it gives them a way to practice and understand their own operations and support and work through the different scenarios that they anticipate will happen during the actual transition.

For the clients that participate, they get a report card, giving them a gauge of their current level of preparation. When we deliver that evaluation, we ask for their input and how they felt the testing event went so that we can make sure we are communicating clearly and effectively the information that they believe is important to their preparations for ICD-10.