By Kristi Fahy, RHIA
Buzz words—they are everywhere, and they are always changing, especially in healthcare. And thanks to the COVID-19 pandemic, “digital transformation” and “automation” are two buzz words that aren’t going anywhere anytime soon.
In the wake of the pandemic, an organization’s ability to quickly adapt to supply chain disruptions, market pressures, and rapidly changing customer expectations has become critical, according to the Enterprisers Project’s article, What is digital transformation? The pandemic exposed weaknesses in the healthcare landscape (e.g., telehealth, cybersecurity, compliance, revenue cycle), giving executive leaders a new perspective on why digital transformation is essential to address these challenges going forward.
The Enterprisers Project states that digital transformation is the integration of digital technology into all areas of a business, fundamentally changing operations and the delivery of value. They also cite the top reasons that business and technology leaders decide to pursue digital transformation:
- Operational agility
- Improving business processes
- Culture and leadership
- Workforce enablement
- Digital technology integration
Organizations that concentrate on these outcomes will be better positioned for success than their competitors who do not prioritize the benefits digital transformation offers. This is because digital transformation establishes a new culture of enterprise-wide cohesiveness through technology and automation that cuts costs and brings new levels of consistency, speed, and scalability to business processes.
Digital transformation also provides access to new, untapped data that can be filtered and trended to pinpoint opportunities or risks for the organization. This will allow leadership teams to make more informed, strategic decisions backed up by data.
Digital Transformation in Health Information
With the shift to value-based care, many healthcare organizations are facing new challenges surrounding patient care, quality, and reimbursement. Each of these areas are dependent on high-quality documentation and a seamless, all-inclusive patient story. Yet the lack of automation and technology integration has become a barrier to achieving this.
The health information (HI) profession is responsible for a broad range of initiatives that require a lot of resources. When you really take the time to think about each HI process, how much are they costing your organization from operational, financial, and quality standpoints? Is there an opportunity to further streamline these processes?
This is our time to take a closer look at everything we do, determine what needs to change, establish our goals and priorities, and work toward a better future state/workflow by leveraging technology to automate HI processes.
Example of the Benefits of Automating Processes
One example relates to coding and clinical documentation improvement (CDI). Each team plays a critical role in value-based care by ensuring provider documentation accurately reflects the clinical status of a patient and the quality of services provided. Inaccurate or incomplete documentation means that the highest degree of coding specificity cannot be captured, leading to missed revenue opportunities and/or increased coding denials. It also means the true patient story is not accurately captured, leading to potential quality concerns.
Jill Choi, MBA, RHIA, CHPC, director of HIM, CDI and utilization review at Nationwide Children’s Hospital, is evaluating computer-assisted coding technology that will streamline her organization’s coding and CDI processes by using artificial intelligence (AI) to identify and automate targeted reviews for specific diagnosis and procedure codes, length of stay variances, and query opportunities, etc. These targeted reviews, paired with AI-driven code suggestions, “will allow the teams to work more efficiently, improve documentation quality, and ensure the appropriate codes are captured before a chart is sent to billing,” Choi says.
In this scenario, there are quite a few factors to consider in how technology can benefit coding and CDI from operational, financial, and quality standpoints.
- Automating coding and CDI worklists eliminates the time spent determining which charts to review and when.
- Maximizing CDI case coverage by using AI to identify and automate targeted reviews ensures CDI teams are focusing on charts with the greatest potential CDI impact.
- Using AI-generated code suggestions to cut down manual code lookups and quickly add codes to be factored into working and final DRGs (diagnosis-related groups) improves productivity and leads to more charts accurately coded/reviewed per hour.
- Utilizing one singular, collaborative workspace for all coding and CDI activities (coding, CDI reviews, query process, audit process, denials management, reporting, etc.) improves productivity and eliminates the time spent toggling between disparate systems or applications to complete work.
- Improved clinical documentation and coding quality leads to appropriate reimbursement and fewer denials.
- Automating and streamlining each process leads to higher productivity and the ability to submit charts to billing quicker. These productivity gains will improve key performance metrics such as an organization’s DNFC (discharged, not final coded) and AR days (accounts receivable days).
- Accurately capturing more codes with a higher degree of specificity will improve CMI (case mix index) to reflect a more complex patient population.
- Utilizing one singular, collaborative workspace allows organizations to eliminate or consolidate disparate and/or legacy systems that are no longer needed. This frees up financial resources from the IT budget that can be reallocated toward other digital transformation initiatives.
- Improving clinical documentation and coding quality ensures a patient’s severity of illness is consistent with what is documented, and the care provided.
- Using AI to automatically identify patient charts with possible quality indicators such as patient safety indicators (PSIs) or hospital acquired conditions (HACs) will allow quality teams to proactively intervene while the patient is still in house, improving care outcomes.
- Leveraging data to report on quality indicators and key performance metrics can be used to identify trends and vulnerabilities in current processes that are negatively impacting value-based care outcomes.
This is just one scenario of how automation fundamentally changes operational agility and delivers value to an organization. Calculating the total annual costs of current processes (factoring in IT and labor costs as well as the costs associated with potential missed opportunities) will demonstrate just how many resources, both time and money, are used to complete this work. The total annual costs compared to the expected return on investment by automating these processes will help determine what needs to be prioritized.
Finding the Right Vendors for Your Digital Transformation Journey
So, now let’s talk about the “how” of digital transformation. This is the pivotal moment where your pain points, your vision, and your priorities are primed and ready to cross paths with vendors who specialize in specific HI functions.
When it comes to technology and vendor selection, the due diligence process is a must. The array of vendors you can choose from span far and wide, good and bad, so taking the time to do your research can make all the difference in achieving the outcomes you expect. If you are looking for unbiased reviews of any healthcare-related technology, KLAS Research is an excellent resource.
In addition to evaluating vendors that will offer your organization new capabilities and functionality, digital transformation also includes eliminating outdated processes or legacy systems that lack flexibility and hinder future innovation. Often, legacy solutions don’t integrate well with other systems, are costly to maintain, and don’t support real-time analytics.
Do your research and your due diligence to determine which vendor is the right fit for your organization. And, ultimately, partner with vendors that directly align with your organization’s strategy toward digital transformation.
In the words of AHIMA Board President and Chair Katherine Lusk, MHSM, RHIA, FAHIMA, from the AHIMA21 Virtual Conference, “You won’t know until you look.”
Digital transformation and automation aren’t just buzz words anymore; they are the tickets to the future of HI and healthcare. HI professionals have always proven to adapt and evolve with the times, but now, with documentation and quality at the forefront of value-based care, we have the opportunity to leverage technology to redefine and solidify our roles in healthcare.
Let’s take advantage of the benefits and possibilities technology can offer by bringing new levels of consistency, speed, and scalability to HI processes, directly impacting value-based care outcomes. It’s time to elevate our potential and never forget that health information is human information.
To learn more about computer assisted coding (CAC) technologies, view the AHIMA webinar, Bridging the Gap Between Coding and CDI with Technology.
Kristi Fahy (firstname.lastname@example.org) is an account executive with DVS, a premier partner of Dolbey.Leave a comment