Q&A: Secure texting with physician advisors
Q: We have physician advisors who assist care management with observation cases and converting those cases to inpatient status when appropriate. They also do peer-to-peer reviews in real time. We’ve also started to incorporate the physician advisors into the CDI process. We review cases with them and discuss the issues associated with the documentation, and they take that back to the physicians for peer-to-peer discussion, which creates a more substantial impact.
The CDI staff does have the ability to access secure texting with the physician advisors. Is it appropriate for the CDI staff to text a question to the physician advisor instead of placing a query in the medical record? While the CDI staff are remote, these texts promote conversation between the physician advisors and the attendings with CDI input and our response rate is much better with this practice.
A: I do know that many organizations use these types of texting systems through tablets/iPads to communicate with different departments throughout the hospital. Personally, I don’t have experience using them. Regardless of how you present a query, however, whether it is written or verbal, they have to be memorialized in the same manner.
Based on your question, I’m guessing that you’re having casual conversations with the physician advisors and then they are speaking with the physicians to make sure there are no issues with their documentation in the record. If you are just having a casual conversation regarding documentation and not specifically discussing a particular patient, then that conversation can be a casual sort of education on the side.
If you are speaking about a specific patient and you’re asking a query, however, then it needs to be memorialized like any other written/verbal query. You’ll need to formally record these queries somewhere and include the patient information, who you sent the query to, who asked the question, how the query was answered, and who answered it.
The best practice would be for your organization to develop a policy for these types of queries that addresses where the records will be kept and for how long. We’re entering a new world of CDI technology, but we still need to make sure we’re following the guidance included in the 2019 ACDIS/AHIMA “Guidelines for Achieving a Compliance Query Practice” brief. If you haven’t before, I highly suggest you give the practice brief a read in its entirety and then have an open discussion about the material with your coworkers, coding staff, HIM staff, compliance staff, and any department managers, liaisons, and advisors.
Additionally, I would suggest taking your questions to your CDI peers through the ACDIS Forum and your ACDIS local chapter or networking group. There may be others out there dealing with the same conundrums who can offer some firsthand advice.
Editor’s Note: Sharme Brodie, RN, CCDS, CCDS-O, CDI education specialist and CDI Boot Camp instructor for HCPro in Middleton, Massachusetts, answered this question. For information, contact her at sbrodie@hcpro.com. For information regarding CDI Boot Camps, click here.