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How Providers Use Clinical Documentation Improvement Tools

Providers use a handful of key clinical documentation improvement functionality to increase revenue and clinical efficiency.

Most providers use query templates and NLP for clinical documentation improvement (NLP).

Source: Thinkstock

By Kate Monica

Clinical documentation improvement (CDI) tools can help healthcare organizations accurately represent information about patient health events, clinical status, and office visits in EHRs as coded data.

This coded data is used for quality reporting, reimbursement, disease tracking, and other administrative and clinical processes. Using CDI to increase the accuracy and ease of translating necessary patient and administrative information into coded data can help healthcare organizations boost clinical efficiency, reduce the burden of data entry on providers, and realize gains in revenue.

These gains can be significant. According to a 2016 Black Book Market Research report, nearly 90 percent of hospitals with more than 150 beds utilizing CDI tools saw an increase of at least $1.5 million in appropriate healthcare revenue and claims reimbursement.

But how do healthcare organizations use CDI tools to achieve these benefits?

A recent KLAS report surveyed almost 200 unique CDI users over the past 12 months about their level of satisfaction with CDI tools, as well as the kinds of CDI functionality and services healthcare organizations most often use to yield clinical and financial improvements.

According to the report, the most commonly used CDI functionality among surveyed healthcare organizations were query templates, with more than 75 percent of ChartWise, Nuance, Optum, MModal, 3M and nThrive users implementing and utilizing the functionality.

Natural language processing (NLP) – a tool that leverages artificial intelligence (AI) to identify key information from unstructured spoken or written input — is the second-most frequently utilized CDI functionality, according to respondents.

Other functionality commonly implemented by CDI users include integrated computer-assisted coding (CAC) and prioritization. Prioritization is the process of developing worklists that identify CDI tasks in order of importance. 

“Ideally, the goal of any CDI program should be to enable the review of every chart,” KLAS authors said. “Many organizations strive to do this by increasing CDI staffing, and some provider organizations are skeptical that vendors’ prioritization tools can be as accurate as CDSs.”

Vendors take different approaches to prioritization. Some leverage AI to process clinical evidence from multiple data sources, while others use markers or notifications to identify high-priority documentation for clinical documentation specialists (CDSs).

“Like vendors, customers run the gamut in how they approach prioritization,” stated authors. “Still, there is an appetite in the market for tools that can help with prioritization, and vendors differ in how thoroughly they have developed their functionality and/or rolled it out to customers.”

Computer-assisted physician documentation (CAPD) was the least popular CDI functionality implemented by surveyed healthcare organizations.

In addition to implementing and utilizing prioritization, NLP, query templates, and other CDI functionality, boosting clinical and CDS workflows is also top-of-mind for surveyed healthcare organizations.

Surveyed users reported high rates of satisfaction with their vendors’ CDI workflows, with Iodine Software, ChartWise, Nuance, Optum, and MModal achieving user satisfaction scores of 7 or higher on a scale of 1-9. 

Integrating CDI solutions directly into provider EHR systems can further boost clinical and CDS workflow efficiency. Ongoing training and education from vendors can also help to improve clinical efficiency and reduce snags related to early workflow-related challenges.

“Several vendors who offer their software alone also offer services to help with these challenges,” wrote KLAS authors. “Vendors who manage to tackle all the aforementioned challenges drive the highest satisfaction with CDI workflows.”

Some vendors — including Nuance — offer training services at cost.

While vendors offer several CDI services, some healthcare organizations enlist CDI services firms to drive improvements in clinical and financial outcomes.

CDI services firms assist with CDI program setup, CDI software vendor selection, CDS education and training, physician education and training, software optimization, metric tracking and improvement, outsourced CDI program management, and CDS staffing services.

“By and large, customers are generally satisfied with their CDI services engagements,” wrote authors. “The type of work that a firm does is less relevant to the customer experience than the knowledge and expertise of the firm’s resources, and most firms bring highly knowledgeable physicians, nurses, and other consultants to the table.”

Overall, satisfaction with CDI solutions and services is high with 53 percent of surveyed providers across vendors seeing an increase in revenue since implementing the solution, and 38 percent seeing improvements in clinical workflow efficiency.



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