The 2015 meeting of the Association for Clinical Documentation Improvement Specialists (ACDIS) just wrapped up in San Antonio, Texas. This was the largest ACDIS meeting yet, reflecting the growth in the industry. This year was characterized by the Four Ds: a greater DOCTOR presence, an interest in better DATA, frustration with hospital DECISION makers, and DISAPPOINTMENT with the constraints of many CDI tools and EMR systems and delays and broken promises from some of the large HIM vendors.
The popular “Physician Advisor’s Role in CDI” session was held the day before ACDIS began, setting the stage for physician participation. One issue mentioned repeatedly was confusion over how queries could and should be integrated into the EMR. While many hoped that placing queries directly into the EMR would speed responses, they can get lost in a physician’s “In Basket.” Answering a query inside the EMR doesn’t typically result in the response getting entered into CDI tracking tools. Conversely, answering a query outside of the EMR doesn’t always result in that response ending up back in the EMR.
Many stakeholders are beginning to realize the power of analyzing the data that comes from a comprehensive CDI tool. Especially interested are the CFOs, CMOs and Quality Managers. CFOs are traditionally interested in financial results and increased revenues. But they and their colleagues are starting to appreciate the secondary non-financial benefits. These include using CDI data to help optimize length of stay, reduce costs, and improve patient safety and quality measures. Many expressed dissatisfaction with lack of timely reports from their CDI system, and about the lethargy among some vendors in responding to requests for better reports.
This year many front-line CDI professionals expressed a great deal of frustration with the disconnect that exists between those who need CDI tools to carry out their mission and the decision-makers and signers of purchase orders who don’t share the same priorities. Despite an urgent need, CDI managers find themselves unable to get their organization to support the purchase of advanced CDI tools, or even to involve the users in the decisions.
In addition to the disappointments already discussed, many had high hopes for Computer-Assisted Coding (CAC), hoping that the new technology would help with CDI and the ICD-10 transition. Instead, there have been delays in installation, and a growing recognition that CAC finds what is already on the chart, and not what is missing. Further, CAC is generally used post-discharge, while CDI is moving to a more concurrent workflow, creating mismatched expectations.
This year’s ACDIS conference highlighted the growth and the growing pains of the CDI world. Greater visibility and physician involvement within their institutions shows the importance of these programs and the reporting that can come from them, especially as the shortcomings of CAC have become apparent. However, convincing administrators of the need for better tools remains difficult. Will we be able to create that sense of urgency as we get closer to October?
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