During the first quarter of 2014, Congress enacted a one-year delay in the implementation of the ICD-10 code sets, extending the implementation date from Oct. 1, 2014 to Oct. 1, 2015. This delay initially was met with uncertainty, and various organizations (providers and payers) deployed different strategies – alternately pausing, slowing down, or continuing their preparations as planned. This delay has cost organizations untold sums in funds and affected matters ranging from resource allocation, to retraining, to contract terms and conditions, etc.

As we move into 2015, Congress has not delayed ICD-10 yet again, so the October 2015 deadline appears to be set.

Setting a schedule is one of the steps that is key to project management. The schedule tells us where we are and where we would like to be on any particular date. Formulating a schedule is dependent on activities, sequences of events, task duration, start dates, and end dates.

Beginning now or in early 2015, many project managers will modify their ICD-10 project plans to meet the compliance date. The aim is to produce a realistic ICD-10 project schedule. Many project managers will set the completion date close to the ICD-10 compliance date. The key issue is how to arrive at a scheduled target date. There are many challenges associated with accomplishing this, but the most frequently overlooked method is the program evaluation and review technique (PERT). The PERT method suggests that for every task there is a:

  • Safe estimate
  • Most likely estimate
  • Most opportunistic estimate

For ICD-10, deploying PERT may be cost-prohibitive, but a reduced-cost version is feasible. The estimates are derived from the data on hand (prior experience in dealing with vendor, test sequences, etc.).

All the tasks on the ICD-10 project plan are composed of sub-tasks. When your people are asked how long it will take to complete each task, they will quote an estimate in which they have a certain degree of confidence. As a project manager, data and information is the key to derive the completion date. If the completion date is derived from data, then the probability of the event happening by the completion date is greater. Similarly, if the completion date is derived from inaccurate data, then the probability of the event happening by the completion date declines.

Let’s take an example: 
All the sub-tasks are dependent on additional sub-tasks. The sequence of the sub-tasks can be affected by technical, resources, budgets, or intangibles.

  1. The test environment is dependent upon the hardware and software being used. If the organization is planning an upgrade to the software, the project team will have to work with the vendor to determine the best testing environment and the plan to go live with ICD-10.  
  2. The “test activities” sub-tasks include developing scenarios and assigning resources. In developing scenarios, all application functionality should be included. If a particular test fails (due to the software changes, for example), then when the tasks will be delayed until?
  3. If new software is not going to be delivered by target date, then an alternative should be chosen. An analysis of the vendor can provide a rough estimate.

The key is to have data for every task to derive the task estimate.

The collection of the data at every sub-task and at the overarching task level is key to arriving at a realistic project schedule because:

  • Using an estimate, the probability of the ICD-10 project completion date can be determined
  • It would identify additional tasks or task dependencies
  • It would allow scenario analysis (alternative, complementary, etc.)
  • It would allow for altering the sequence of work or modifying the plan
  • It would weed out the bad data or estimates

For many projects, the typical allocation of time between planning and acting is 10 to 90 percent. For ICD-10 projects, due to the inherent complexities (and remember that failure is not an option), the typical allocation of time between planning and doing should be somewhere in the range of 30-40 percent to 60-70 percent. In summary, the ICD-10 project plan needs to be a “work in process” document.

As our former President Eishenhower said:

“In preparing for battle, I have always found that plans are useless, but planning is indispensable.”

About the Author

Paresh K. Shah is president of MindLeaf Technologies, Inc. in Bedford, Mass. He is also a member of the HIMSS ICD-10 Taskforce and co-chair of the HIMSS Playbook.

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