Clinical documentation technology complements staff, fills gaps amid worker shortages

Clinical documentation integrity (CDI) has a direct effect on patient care, and as documentation requirements become more complex, CDI departments are challenged by workforce shortages that are likely to persist.

During the Becker's Hospital Review 12th Annual Meeting, in a session sponsored by Iodine Software, Fran Jurcak, MSN, RN, Chief Clinical Strategist at Iodine, led a roundtable discussion about the high demand for CDI specialists, and solutions to finding, recruiting, and retaining them.

Three key takeaways:

  1. Documentation accuracy is imperative in healthcare's highly competitive market. Accuracy is essential due to health systems' need to account for the full scope of patients' medical records. This is required to ensure quality of care, minimize authorization denials and compliance risks, maximize reimbursement, maintain reputations, and enhance payer contracting. Yet, due to manual processes and a lack of standardization of CDI workflows, inefficiencies and errors lead to annual revenue losses averaging $4.7 million for a typical 250-bed hospital, Ms. Jurcak said, citing data from the Advisory Board.

  2. Technology that identifies CDI opportunities is coming to the rescue. Iodine leverages machine learning models that look at billions of medical records and detect clinical evidence that may not be accurately captured in a patient's medical record, according to Ms. Jurcak. When Iodine's algorithm detects improvement opportunities, it sends an alert that triggers CDI staff to prioritize reviewing those charts and send more targeted verification queries to physicians. Without this tool, clinical documentation specialists (CDS’s) need to comb through reams of patient records to find documentation leakage, and even when specialists review almost 100% of cases they may still miss improvement opportunities. Iodine’s automated workflow minimizes the number of CDI professionals needed, because rather than attempting to review all patient cases, specialists only need to review those cases with the greatest likelihood of opportunity.

    "This is one example where artificial intelligence can come in to not replace staff," Ms. Jurcak said. "We believe in keeping the middleman in there to clinically validate what's happening, but also in having the opportunity as an organization to be reimbursed appropriately and do what you need to do from a documentation perspective."

  3. CDI professionals put a premium on making query generation easier, consistent, and standard. For CDI professionals, sending clarifying queries to fill in missing information and improve patient records is an often-dreaded task. There is a general perception that not all physicians appreciate the value of such queries from a CDI perspective and may feel reluctant to answer them. "When providers get these queries, [some] see them as a penalty: 'I did something wrong, I gotta go fix it,'" Ms. Jurcak explained.

    One roundtable participant noted their organization has a workflow technology in place — albeit not an AI one — that simplifies throughput for queries by embedding them in the EMR, thus making it easier for providers to respond interactively. Another participant said they perceive a general difference among physicians with regard to embracing CDI queries: "The ones who are graduating from residency today are much more apt to accept that. They've lived a life of texting their whole adulthood, so the notion of having disruptions is hardwired."

While the general consensus was that CDI automation technology is not yet fully mature or broadly adopted and does not yet present the full set of capabilities that CDI leaders wish for, attendees agreed that CDI automation technology is definitely coming — and that it can't come soon enough given today's challenging workforce landscape.

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