CAC challenges and the potential for computer-assisted physician documentation

By Tom Sullivan
01:48 PM

Deborah Kohn kicked off a Monday morning session at HIMSS13 by asking for a show of hands.

“Of the providers and payers in the room, how many of you have plans to deploy a [CAC] solution?” asked Kohn, principal, Dak Systems Consulting. Most hands went up.

She followed that by asking how many are in the process of implementing a CAC tool, to which about half of the attendees rose their hands.

And how many are in production?

“That’s exactly what I thought,” Kohn said, “nobody.”

Yet the rising tide of computer-assisted coding tools has created what Kohn described as “a cacophony of choices,” during a HIMSS13 session titled, consistently enough, “A Cacophony of CAC Solutions: How's an Organization to Choose?”

During the session, more lively group discussion than presentation, the highest hurdles to adopting and making use of a CAC system to emerge from the attendees include: accuracy of coding, integration, testing and timing.

With ICD-10 on the horizon, for instance, does it make sense now to select a CAC tool, or would it be better to wait and do so post-compliance?  

A number of participants agreed that it depends on how much data a particular healthcare organization has to run through the system during pre-ICD-10 compliance testing. Recommendations on Monday included testing with your own data and archiving those ICD-9 test sets for future use with analytics.  

“The goals of CAC are obvious, we want to enhance physician coding,” Kohn explained, adding that “we want to home in on exchange and mining data as required by meaningful use.”

Before that, though, healthcare organizations must meet a number of integration challenges, including tying their CAC tools into encoder systems, Clinical Documentation Improvement (CDI) systems, voice/text/speech and coding workflow applications.
While attendees questioned the accuracy of coding tools, saying that vendors tout 98 percent accuracy rates but in practice the rates bounce around the 90s, Scott Killingsworth, a sales representative at EMR vendor One Healthcare Solution, explained that accuracy is more than anything else “a matter of removing the garbage. What kills you is the acronyms.” Once you can remove those, Killingworth said, accuracy rates are far more stable.

To an orthopedist who said what he really wants is a 4-in-1 tool that integrates all those pieces much like the copy/scan/print device, Kohn pointed to what she sees as the emerging trend of computer-assisted physician documentation tools.

“It’s not here yet,” Kohn said, “but keep your eye on it.”