CDI Week 2023 Q&A Preview 1: Workflow tools and technology
As part of the upcoming 13th annual Clinical Documentation Integrity Week, ACDIS conducted a series of interviews with CDI professionals on a variety of emerging industry topics. Alyce Reavis, RN, MSN, CCDS, CCS, CDI auditing coordinator at Evangelical Community Hospital in Lewisburg, Pennsylvania, and a member of the Central Pennsylvania ACDIS chapter, answered these questions. She is a member of the ACDIS Furthering Education Committee. CDI Week 2023 takes place September 18-22 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 Associate Editor Jess Fluegel (jfluegel@acdis.org).
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: I think that it is important to include your end users as much as possible on these types of decisions. Those on the “front lines” often have valuable input on the practicality and usability of technology and resources.
Q: When asked what tools their CDI programs provide to help with job functions, “query templates” was the most selected by respondents at 80.44%, according to the 2023 CDI Industry Survey. How have query templates been developed at your organization in the past, and how is their creation and revision managed? For the 19.56% who aren’t provided query templates yet, what advice would you give their CDI departments on finding and creating them?
A: At Evangelical, we utilize the query templates that are available within our CDI software for the most part, but we do have a few that are created from within the department. In my role as auditor, I am responsible for those department-created templates. I review and edit them as needed based on coding and clinical updates and like to confer with our physician advisor to make sure they are provider friendly. I would strongly recommend CDI departments that do not have templates to utilize and create them. They help align documentation and keep providers and CDI on the same page. I find providers like them as well because they have a standard idea of what documentation may be lacking. I also find templates are a great help to new CDI specialists joining the team.
Q: Besides query templates, the next most popular educational tools reported by respondents were vendor-supplied educational resources/sessions (67.51%), online training modules (58.68%), and CDI books (59.62%). What tools are your CDI team provided with to promote education and better workflow, and which would you recommend? Have such resources switched to digital format over the last few years, and if so, how has that affected their efficacy in your opinion?
A: Our CDI software includes a wealth of resources and knowledge. We additionally use online CDI guides to help with our practice. These resources can be great, as the one we utilize offers monthly webinars for CEUs and takes topics directly from the guide. I find online resources are great, particularly when the vendor takes the time to update them based on the latest guidelines, issues of Coding Clinic, etc.
Q: The CDI software solution respondents reported using most often is electronic querying (75.88%), followed by electronic grouper software (75.55%) and computer-assisted coding (CAC) (71.61%). Also, of all solutions with planned implementation in 2024, computer-assisted physician documentation (CAPD) software was most selected at 12.78%. What kind of software solutions would you say have become common practice to use by CDI departments? What type 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 believe that CAPD is definitely going to be adopted by many facilities that have the finances to undertake their implementation. At Evangelical, we utilize electronic physician queries and chart prioritization. Chart prioritization has become a huge help for our small CDI team. I also find this invaluable as the only auditor/educator so I can target education.
Q: When asked how much they trust these solutions, respondents rarely fully trusted CAPD (3.31%), CAC (8.36%), and natural language processing (4.89%) without exception. Given that all three of these solutions are components of artificial intelligence (AI), do you think there is a general distrust in AI software among CDI departments? Why or why not?
A: If there is not some general distrust in AI software, I believe there should be in the CDI community. We utilize auto-suggested codes and procedure codes within our software. Although they can be helpful, it takes a human coder and clinician to really understand the course of a medical record outpatient or inpatient. I do not believe that AI will ever have every scenario of every medical condition mapped out to get to an accurate code or DRG. There are just too many nuances and patients are not robots, so I would not trust an AI solution to interpret their medical documentation.
Q: About 61% of respondents reported that the average full-time inpatient CDI specialist at their facility completes six to 10 new patient reviews per day in reality, level with respondents in 2022. Considering 57.57% of respondents reported the implementation of new technology has increased productivity, do you think the average number of daily patient reviews will rise in future years, or will that productivity go elsewhere?
A: I think that productivity will likely move elsewhere as CDI broadens its scope. There are innumerable ways that CDI can affect other areas such as utilization, quality, provider engagement and education, and so forth. I think that CDI is really moving out of some of those basic KPIs like charts reviewed, CMI, and others.
Q: Among different options of how technology may impact the role of CDI professionals and their work, 14.20% of respondents agreed that some perceive it has decreased the need for CDI specialists to use critical thinking skills. Do you think there should be concern about CDI professionals no longer using critical thinking skills after implementing technology? How are CDI staff in your department encouraged to use critical thinking?
A: I cannot see how CDI professionals would not use their critical thinking skills with technology implementation. Technology can do a lot, but I still strongly feel that you need that human to look at all the pieces of the puzzle. I think of CDI professionals as detectives that need to analyze many pieces, whereas technology needs black and white to come up with an answer—and we know that medical records are many shades of gray. Our CDI staff are encouraged to utilize resources and keep up to date on pathophysiology and treatment of those common conditions seen at our facility.