Case Study: Computer-Assisted Coding Increases Productivity

How do you approach the administration and the coders of an organization who just went through a major encoder change the year prior and get their buy-in for the installation of computer-assisted coding (CAC) software? It could be a tricky endeavor, but one organization did just that—and was successful in the process. Cynthia Gaillard, RHIA, CCS, associate director of HIM, and Amy L. Wood, CPC, outpatient coding manager at Yale New Haven Health System, presented their case study on adopting CAC during Saturday’s Clinical Coding Meeting at the AHIMA Convention and Exhibit in Chicago, IL.

In an effort to stay current with the latest in healthcare, Yale-New Haven Health System consolidated their coding to the corporate office in an effort to standardize the coding process. With this consolidation came a realization that they wanted to investigate tools that could help maximize coder productivity and accuracy that would continue after the implementation of ICD-10. After careful review, their decision was to pilot computer-assisted coding.

Getting Administrative Buy-in Takes Time

As many HIM professionals know, it sometimes takes going the extra mile to get administrative support. The HIM team at Yale-New Haven Health System experienced this as well. There was not much executive-level support when discussions began regarding the possible implementation of computer-assisted coding.

The HIM director presented the benefits for a CAC pilot program and championed it up the chain of command to organization executives. After learning of the impact ICD-10 could have on the facility from the internal ICD-10 steering committee and implementation team, the health system executives were able to see the advantages of computer-assisted coding.

Always Get the Coders’ Input

As soon as they had administrative support, the team took the idea to the coders. “We presented the computer-assisted coding software to our coders as a tool that would help them code, not a product that would code for them,” Wood said.

A major fear with CAC is the loss of jobs. The HIM team calmed their fears by allowing them to view demonstrations of the product and ask questions as to what the product would do or would not do. The coding team members provided a few super-users for the software that helped the other coders understand the product and helped eased the transition.

“Involving coders in the decision making process and implementation of the computer-assisted software seemed to help them overcome their fears,” Wood said.

Before Implementation—Do Your Homework

Once the HIM team had buy-in from their administrative staff and the coders, they chose a vendor and began the implementation process. First step was meeting with their IT department to start working out a timeline.

As the industry has seen in recent years, IT had competing priorities at Yale-New Haven. “At first, we had an unrealistic timeline. Prior to starting the planning phase, you should do your homework,” Gaillard said.

Because the health system wanted to continue to be on the cutting edge, they took on the task of implementing inpatient CAC. By educating the coders during the implementation, the transition was seamless. There was not a decrease in coder productivity, which pleased the executive team since they were planning for a productivity decrease.

In December 2011, the CAC software was functional and Yale-New Haven started utilizing it for their inpatient records. “Not having a paper record was extremely difficult for us,” Wood said.

Monitoring Coder Productivity Important

Coder productivity was monitored closely with measurements and comparisons for pre- and post-implementation values. The results of the first three-month period following inpatient CAC implementation showed an increase of 15 percent in coder productivity.

Ambulatory surgery, interventional radiology, and heart/vascular center outpatient procedures were selected as the types of accounts to be coded utilizing the CAC software for outpatients. This was implemented in January 2012 with the first review being conducted in April 2012.

There was a 10 percent increase in coder productivity for the outpatient surgeries within the first three months following the outpatient implementation. As for the current review, they have increased to 12 percent.

In talking about ICD-10 productivity decreases, Gaillard said, “We as a health system can’t afford that much downtime and we think the computer-assisted coding software will help us prepare for the decrease.”

CAC Implementation “A Fun Ride”

As for lessons learned from the CAC implementation, Gaillard and Wood concur that if they knew the benefits of computer-assisted coding software, they would have implemented the product sooner. “It’s been a fun ride and we still have miles to go with the addition of another facility to the health system earlier this month,” Gaillard said. Wood agreed, with the addition that while there is more work to do, her team is proud of the work they have done to date.

“Yes, but we’ve taken off the training wheels,” she added.

The presenters can be emailed at and


**Follow the news and get insights from AHIMA’s 84th annual Convention and Exhibit being held October 1-3 in Chicago, IL. New articles covering the event will be posted daily. Look for special e-Alert announcements October 1-3 linking you to a full online edition of AHIMA Today, the on-site convention newspaper.

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