2024 CDI Week Q&A preview: Query metrics and technology

As part of the 14th annual Clinical Documentation Integrity Week, ACDIS conducted a series of interviews with CDI professionals on a variety of emerging industry topics. Kelly Benson, BSN, RN, CCDS, CDI regional manager at Memorial Hermann Health in Houston, Texas, answered these questions. Benson is a member of the ACDIS Furthering Education Committee. CDI Week 2024 takes place September 16-20 and ACDIS will publish daily Q&As just like this one on a variety of topics as part of the celebration. For questions about the committee or the Q&A, contact ACDIS Editor Jess Fluegel (jess.fluegel@hcpro.com).

Q: The majority of respondents reported they have a 91%–100% physician query response rate within their facility’s required time frame (69.44%), according to CDI Week industry data. What is your response rate, and what tactics has your CDI program found successful over the years to improve and/or maintain a good response rate? What advice would you give a program struggling to encourage physician query responses?

A: Our response rate is 96%. We educate regarding the “why” to create understanding of the collaborative and support nature of our work. We also utilize an escalation process through the service line leader up to the chief medical officer to assist with query responses.

Q: Of respondents whose organization tracks physician query agree rate, the results were a bit more varied: 48.76% reported a 91%–100% agree rate, 39.75% reported an 81%–90% agree rate, and 6.36% reported a 71%–80% agree rate. When providers do respond to a query, about 34.21% of respondents reported that the provider said “clinically indeterminable” (or a similar option). What efforts has your CDI program made, if any, to have a higher physician query agree rate? Do you have any advice on query wording, organization, policies, etc., to help CDI professionals construct effective queries?

A: We offer options that are clinically supported by the indicators and have minimized the use of “clinically unable to determine.” Instead, we use the following options:

• Other - I will add my own diagnosis
• Dismiss - Not applicable/Not valid

Q: When asked if their organization has an escalation policy or other policy requiring physicians to respond to queries/CDI clarifications, 87.72% of respondents said they do, but many open-ended responses added that they are in the midst of creating one or that their current policy is ineffective. Does your CDI program have a query escalation policy, and if so, what have been your struggles and successes while using it? What advice would you give a CDI program wanting to improve or create such a policy?

A: We do have an escalation policy, though there is a struggle still with certain providers that continue to not be engaged. For the providers who are engaged, it works well. My advice would be to escalate to providers who are well known and respected by their peers.

Q: While most respondents report that an average inpatient CDI specialist completes 6–10 patient reviews per day, about 19% of respondents report that the average is 11–15 reviews, a notable increase from about 15% of respondents in 2023. Considering 56.58% of respondents reported the implementation of new technology has increased productivity, do you think that the number of organizations reviewing more per day will continue to rise? Have you noticed a correlation between new technology and productivity levels at your organization?

A: I believe new technology has supported the work of CDI and thereby increased productivity. I also believe that new technology will increase productivity further.

Q: When asked how technology has impacted the role of CDI professionals and the work they perform, most respondents agreed that it’s allowed them to perform work more remotely (63.60%). In your experience, how has remote work impacted CDI reviews and the querying process, both for better and for worse? What role has technology played in these changes, and how would you recommend utilizing it to help with querying?

A: The electronic health record has allowed for remote work. Certain [technologies] now have the capability of supporting CDI work, though if CDI professionals do not use these technologies properly, they could potentially stop critically thinking or miss opportunities by not reading the record closely. Auditing our CDI team’s work and coaching to communicate expectations and quality of work is key to ensure they are using technology appropriately.

Q: This year, the spot for the most-used CDI software solution by respondents was nearly tied between computer-assisted coding (77.93%) and electronic querying (77.49%), followed by electronic grouper software (76.61%) and chart prioritization (75.88%). What kinds of software solutions would you say have become common practice to use by CDI departments, and what types have you found helpful for your own team? Which solutions, if any, have you noticed becoming more popular over the last few years in the CDI profession?

A: I am waiting on prioritization, though learning of this new data is definitely helpful. I have seen electronic querying and nudges become common, some of which I don’t think are appropriate, though we have developed practice to review these. I am also looking forward to how we will work alongside artificial intelligence in the near future.

Q: As the CDI profession grows, more workflow tools and technology options are becoming available for CDI departments to choose from. While that is an exciting development, it can also be overwhelming. Do you have any advice for those choosing from various tools and/or software on how to decide what’s best for their department?

A: My preference in making a choice is “demo, demo, demo.” I would take my time in choosing and not jump to anything right away without solid comparisons between my options.