- Clinical documentation improvement (CDI) needs are quickly becoming a top issue for healthcare organizations, especially as the push for nationwide interoperability continues to grow. Improving CDI will have long-lasting effects on the industry, impacting both providers and patients.
Clinical documentation in all forms and formats is a problem and challenge for providers, health plans, and other entities that all need the data, WEDI Chair-Elect Jay Eisenstock told EHRIntelligence.com.
“So much of the data is unstructured because so much of it is not in a standardized format, it becomes challenging in order to exchange that information easily and readily,” he stated. “Certainly, a lot of entities are trying to overcome that, but it's still a challenge.”
“Not only is it challenging to get the information from a provider EHR system, for example, but because of the way that the data is transmitted and exchanged, there's often a lot of frustration involved where the provider sends the information,” Eisenstock added. “And then another department within that health plan, for example, will ask for the same exact data.”
Additionally, $9 billion last year was spent in healthcare in faxing information between the entities, he noted. In context of 2018, having faxing as one of the most prominent ways that information is exchanged in healthcare still can be surprising.
Healthcare interoperability has been a key focus for the industry, as well as for the government, Eisenstock pointed out.
“In some ways, [interoperability] is the holy grail,” he said. “If people can come up with this magic sauce of interoperability, then that would solve all ills.”
“I know we've tried to achieve that and been talking about interoperability for a long time, and there's been some government projects as well as some private projects in order to try to address that,” Eisenstock added. "A few years ago the government had required use of the Direct protocol, through meaningful use, as a way to exchange information. It required that all EHR systems were compliant with meaningful use to be able to exchange using that Direct protocol.”
Initiatives like that are baby steps, he explained. It can be difficult because problems arise when the government becomes involved.
For example, unless or until an initiative really becomes regulatory, there still might not be a lot of players willing to invest into a standard or to create a standard, Eisenstock said.
“Often what happens when the government does that, it becomes something that's almost like an accommodation,” he stated “It becomes something that's a compromise as opposed to what is the right thing for the industry.”
“We've seen a lot of examples of that,” Eisenstock continued. “The government can help by encouraging providers, health plans, and other entities to work together. If they get too far into it, it's not necessarily going to push the ball forward.”
Going beyond the technical solution for improved healthcare
There is definitely opportunity for improved clinical documentation efforts through artificial intelligence options, such as natural language processing (NLP), Eisenstock said.
For example, prior authorization, which is part of the health plan cost-control process requiring providers gain approval before performing a service to qualify for payment, is one area that an AI approach is also being considered.
“Led by the AMA and other stakeholders, physicians are potentially up in arms over prior authorization,” he said. “They say it's costly and inefficient, hurts patients, etc. There are solutions that are currently kind of still kind of new, and others that are developing, that use AI concepts in order to determine when authorization should be required, how it should be done.”
“Things like that, it will make sense over time for that to be applied,” Eisenstock continued. “If you think about why documentation is being exchanged and you start looking at the business use cases, some of it has to do with these authorizations and other kinds of clinical needs that are required. If those needs can be supplanted by the use of AI that benefits everybody.”
Healthcare needs to consider the business reasons for clinical documentation, he said. The faxing process in healthcare is essentially being automated.
“Although faxing still happens, now there's technology that does that essentially behind the scenes within a computer system,” Eisenstock stated. “But it's still a fax. At the end of the day, it's an electronic version of the paper document.”
Organizations need to consider why certain healthcare data is needed, and how it needs to be utilized properly.
“Why does a health plan need this data? What are the drivers behind that?” he posited. “I'm not really hearing a lot of conversation about that. It's all about, how do we find technology? How do we try to solve it, rather than understand why we're doing what we do?”
Bringing health plans, providers, vendors, and other constituents together will be crucial, Eisenstock said, which is something that WEDI has been working on doing to understand all stakeholder needs.
“We want to bring everyone together and say, ‘Let's just not talk about technology. Let's understand what this process is and why the process is important to pick it to the plan, to the provider,’” he explained. “Once we understand that, then maybe there's another way to do it. Maybe there's a policy change that is needed. Maybe it's as simple as that.”
Calling back to the prior authorization issue, Eisenstock said that if health plans are always approving a certain type of procedure 90 percent of the time or higher, why are they still asking for authorization?
“We spend all this time trying to figure out how to supply that authorization, but there's a very simple answer that says, ‘Okay, well maybe we just change the policy and we don't even ask for it,’” he concluded.
“The conversation really needs to be more about the business of healthcare rather than just focusing in on the technical solution.”