When Pamela Lane, state director of HIE for California, recently asked a CFO of a healthcare organization what he was doing about ICD-10, she realized quickly that ICD-10 conjured entirely different images. “‘No,’ I said to the CFO, ‘that’s an airplane.'"

Lane told abour her encounter at an education session at the AHIMA Convention and Exhibit this week.

That particular CFO is certainly an outlier. Nonetheless, the top takeaway from attending multiple sessions and conducting numerous interviews is that — with the deadline less than a year away and even after the one-year delay — the industry’s readiness still comprises all the points between not-knowing and already prepared.

One of the questions that LaTonya O’Neal, senior manager of revenue cycle at Deloitte, said her firm frequently gets asked is where a client stands in comparison to the rest of the industry.

“There’s a good portion that is ready,” O’Neal said; “there’s a good portion that isn’t ready.”

[See also: ICD-10 starts at clinical documentation.]

Among the federal government and state health units, O’Neal added, this time they weren’t ready at all. But there are signs that’s changing. Deloitte puts many of the vendors in the category of not ready. In general, larger health organizations are in better states of readiness than smaller counterparts.

Yvonne Dawdy, an executive consultant with Beacon Partners, has a large health system and a smaller one as clients of its ICD-10 consulting services. The big system, she said, has already remediated software for the seven-digit codes and conducted gap analysis. The smaller one, with fewer resources, has moved along the recommended timelines more slowly.

From the larger system, Dawdy said, Beacon has found what many in the industry have been anticipating to be all-too-true. “The coding lies everywhere in an organization,” she said. “Probably 65-70 percent of employees need to be trained.”

Which is why O’Neal urged attendees to look not just at the places one might expect to find ICD-10, such as the revenue cycle, EHRs, practice management systems, but in the less obvious software nooks and crannies. 

Sutter Health is among the frontrunners, with plans to go live in May 2014 rather than wait for October 1, so that clinicians can start using the codes well ahead of the mandated deadline, according to ICD-10 program manager Danielle Reno -- a process that Sutter started in 2011 and kept pace with despite the compliance date shifting.

[See also: Health system ICD-10 ready months early.]

“It’s been a long three years,” Reno answered in response to a question about what she might have approached differently. “I probably would have done a lot more clinical documentation review of the EHRs earlier on. You get a lot of value from the data and you can use that to calculate financial impact. It will help in contracts with commercial payers, it will help your CDI program globally as they know where to focus their efforts.”

Reno added that Sutter has seen an approximately 50 percent decrease in productivity thus far because ICD-10 is a whole new world for the doctors, the staff, the resources focusing on coding and billing.

She also noted that based on Sutter’s experience, there remains time enough for even laggards to comply. “If you haven't started you can still get all the things done,” Reno said. 

For those healthcare organizations, Deloitte’s O’Neal recommends getting senior management involved immediately.

“There’s going to be a need to push barriers down faster. You’re now in a sprint, it’s no longer a marathon,” O’Neal explained. “Put together a really, really good project plan because you don't have as much room for slippage as you did two or three years ago.”

During a different session at the same conference, Cindy Seel, director of education and training with consultancy HRS, said: “The time to panic is not now, but it’s getting close.”