'Crazy and creative' tools fuel population health in new ways, revenue cycle expert says
BALTIMORE – Call them “physician whisperers.” Not every hospital is using tools such as computer assisted physician documentation and clinical documentation improvement workflow platforms – but they should be.
That's according to Leigh Williams, administrator of business systems at University of Virginia Health System and an assistant professor University of Mississippi Medical Center, explained how health information technologies can help identify target populations, as well as enhance clinical decision support to enable more effective and efficient population health management.
UMMC has been able to realize some substantial gains in cost efficiency and care quality by making use of computer-assisted coding and physician documentation, workflow platforms, master patient index and more, she said.
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"There are crazy and creative tools that can change the way you do things," Williams said during the AHIMA Convention and Exhibit here. "Whatever you can do to move your organization to better and more correct documentation and coding can help with better outcomes."
Computer-assisted physician documentation
On the clinical documentation improvement front, computer assisted physician documentation software has been especially valuable, she said, giving docs "real-time support" as they document at the point of care.
The software, which aims to bring clarity to the medical record by suggesting more complete terms, looks for missing words and generally helps physicians "get what's in their head into the EHR" has been an "amazing step forward in our ability to collect complete, accurate and timely information," Williams added.
Going back to document a visit after the fact is far from ideal of course – assuming a doctor can be convinced to do it, there's a good chance some bits of clinical data will be forgotten or misremembered. This tool – "the physician whisperer," she called it – enables correct documentation in real time.
"The better the terminology in the note, the easier it is to add a code," said Williams. "That enables you to do all types of analytics, risk stratification and more. This is some of the coolest emerging technology we have."
CDI workflow platforms
Another useful approach at UMMC has been to tap into CDI workflow technologies, which can "assist you with knowing which people to prioritize." CDI specialists "have 800 possibilities of charts they can review," said Williams. "Where to focus?"
As it makes a concerted effort to fully eliminate harm events (CAUTI, CLABSI, sepsis, pressure ulcers), the CDI platform has enabled UMMC to "look through the EHR and find patients who have indicators" of those events.
It has "led to more efficient workflows, and getting to patients who really need it," she said, by "shining a light on 800 things and making the 80 I need to focus on stand out."
MPI and CAC
Two other essential tools are the master patient index and computer-assisted coding, said Williams. The former enables UMMC to have one identifier across the system which greatly facilitates data analytics. Reducing patient risk from misidentification is a clear safety goal, too, of course.
MPI is also of great value when integrating disparate IT platforms, she said: Being able to quickly identify patient matches enables more seamless data sharing and "serves as a foundational piece to better systems integration."
As for computer-assisted coding, it's "probably not the panacea we thought it would be – but it's cool and has a lot of promise," said Williams.
By suggesting codes and identifying gaps, CAC is useful for more complete and accurate coding. The challenge, however, is that it "takes a ton of fine-tuning to get CAC to be accurate." She mentioned a Doctor Wolff, all of whose patient records showed them diagnosed with Wolff-Parkinson-White syndrome.
The software was so unreliable that one of her colleagues complained: "If it was a coder, I'd fire it," Williams said.
That said, CAC "is making people more efficient," she said. "It can get where it needs to be."
Williams, in fact, recommended combining CAPD with CAC. The two together allow for a much fuller and more accurate clinical picture. It's just a matter of "putting in the time in to teach the system how to do the job right," Williams said. "It takes a lot of human elbow grease."
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