Want to energize a room full of clinical documentation improvement (CDI) specialists? Try poking holes in physician documentation on a complex Medicare Advantage patient. Keynote speaker Lisa Campbell, PhD, MHA, MPM, RHIA, CDIP, CCS, CCS-P, CPC, COC, knew her audience and on the second day of AHIMA’s CDI Summit, intuitively led her panel through Advancing the Documentation Journey, an interactive presentation that enlivened attendees.
Campbell gave a detailed handout covering the case of a 96-year-old female presenting to the emergency department from a skilled nursing facility (SNF) to each attendee at her presentation, “The CDI Process When Dealing with a Complex Clinical Scenario.” The handout included the patient’s diagnosis upon admission, her vital signs, medication list, medical history, physician orders, and progress notes for day two and three of the inpatient admission.
Based on information in the handout, Campbell encouraged the session’s panelists and audience members to provide feedback about CDI opportunities that could paint a more accurate picture of the patient’s baseline condition. As expected, the CDI specialists in the room were frustrated by the lack of detail surrounding the patient’s “embolic cerebrovascular accident” that left her with “cognitive deficits including lack of concentration and dysphasia.” Also suspicious to audience members was a foot ulcer that wasn’t noted in the documentation until the patient’s second day in the hospital.
“This lack of documentation is really prevalent in many hospitals and clinics I’ve worked at,” said panelist Armando Silva, RHIA, director of revenue integrity and reimbursement at South Shore Hospital in Chicago. “It’s unclear and the timing of the documentation of the foot ulcer is trouble. But the consequences [of poor documentation] validates why a CDI program should exist.”
Query Automation Changes the Game
Getting physicians to respond to queries had been an ongoing struggle at Western Maryland Health System, which serves select residents of Maryland, West Virginia and Pennsylvania. In early 2018, query response rates were lagging at an average of 62-65 percent, putting hospital revenue on the line. To top it off, CDI queries were paper-based and involved faxing and scanning. Query response times could range anywhere from four to 28 days.
Tracey Davidson, MSN, RN, director of quality initiatives at Western Maryland, knew something needed to change. When she learned about a vendor that automated physician queries on a mobile smartphone app, called Artifact, it took less than a week to convince her facility’s leadership to invest in the product, who then took a hard line to ensure its implementation.
“Administration told our physicians, ‘You do this or you don’t work here,’” Davidson said during her presentation, “The Impact of Mobile Physician Query Workflow Married with AHIMA-Compliant Templates at Western Maryland Health System.”
The Artifact app was implemented quickly and seamlessly. In fact, Davidson said the hardest part was getting physicians to remember their login credentials, a small hurdle considering the payoff resulting from Artifact’s implementation. Within the first six months of adopting the tool, response rates jumped from 62 percent to 100 percent while the response time improved, on average, to just one day. One surgeon, who had never responded to a single query using the old paper-based system, responded within 20 minutes using the mobile app.
“I was very skeptical when I first heard about this, but now I am very pleased,” Davidson said.
[Editor’s note] This article was updated 7/18/19 to reflect the name of the CDI template mobile application.