A lot has been said about ICD-10 over the years, along the winding and surprise-packed road toward the looming Oct. 1, 2015, compliance date. But few have said much about the code set's parallels with one of HBO's biggest hit shows.

[See also: ICD-10 'storm' posing dilemmas for health information management strategies]

Nick van Terheyden, chief medical information officer at Nuance Communications, is one person who sees the battle to finally transition to those 68,000 clinical codes as having some things in common with the intrigue and power dynamics of the Seven Kingdoms.

On Tuesday, Sept. 30, at the AHIMA Convention and Exhibit, van Terheyden offers a discussion titled, "Game of Documentation: Winter is Coming – Surviving ICD-10."

[See also: ICD-10 cost a 'crushing burden' for docs]

Sure, he admits, part of the rationale behind that title is "getting people excited and interested," making a sometimes rather dry topic more engaging to his audience. But the parallels between the move toward ICD-10 – and the clinical documentation improvement upon which it depends – and George R.R. Martin's fantasy epic are real, says van Terheyden.

"As you look at the series and some of the challenges the characters face, it seemed like there were a lot of similarities between the ICD-10 changes that are being implemented," he tells Healthcare IT News.

"I think people's perception of those challenges relate to Game of Thrones and the battling of those folks against adversity, and the need for creating allies within a world that is constantly changing, constantly dealing with challenges. To me, there was a clear relationship," van Terheyden adds.

When van Terheyden first submitted the idea for his AHIMA presentation, he "expected us to be very close" to the original Oct. 1, 2014 switchover deadline, he says. But thanks to the compliance date pushback that surprisingly found its way into the Sustainable Growth Rate/"doc fix" bill on Capitol Hill this past spring, here we are "a little over a year out again," he says.

Indeed, just as – spoiler alert! – Ned Stark and Oberyn Martell discovered, unexpected plot twists have seemed to play a big part in the ICD-10 journey.

But the overarching theme of this momentous, industry-wide transition, says van Terheyden, is that, "much as you see in the Game of Thrones universe, separately we're not as strong, but together we're stronger."

That's especially true when it comes to clinical documentation improvement, on which van Terheyden will focus during in his presentation. He aims to show how CDI strategies can move beyond merely focusing on compliance and monitoring to make sure clinicians are documenting in a manner that fulfills coding and billing objectives.

"What's happened in many instances is that physicians have been left on the sidelines observing – or being asked to do certain things – and don't necessarily feel engaged," says van Terheyden.

"We're all in this together," he says. Docs must be central participants. "Pulling them into the fold, helping them understand why this is important, helping them (with) the modifications in their behavior to adapt to this new coding system" is key to ICD-10 success.

Thankfully, technology is helping make this much easier, he says.