How clinical documentation improvement helped one hospital boost speed, efficiency
Staff at Montefiore St. Luke’s Cornwall in New York City was faced with a complex and timely physician query process.
Queries often would be left unanswered, as providers were challenged by varying manual workflows, unclear deadlines, and multiple steps required to access the information they needed to answer queries. The overall process had become so cumbersome that coding staff sent very few queries.
“Moving to an electronic record, the old process of putting a paper query on a paper patient record to get it in front of a provider to review and answer became obsolete,” said Laura Berberich, director of health information management at Montefiore St. Luke’s Cornwall.
“At the same time our providers were seemingly spending less time in the hospital, quickly rounding and running to their offices, making it difficult for clinical documentation improvement specialists to have face-to-face interactions,” she said.
Montefiore St. Luke’s Cornwall knew it needed an electronic solution. Its first attempt was creating queries via a scribed progress note directly in the EHR. There were a few issues with this solution. First, there were no alerts or “to-do” lists to let the provider know it was there, so staff had to continue to reach out to every provider every time to draw their attention to the query.
“The second issue was the provider had to be logged into the EHR to answer the query, which wasn’t always convenient for the providers,” Berberich said. “We tried to make tweaks to our homegrown solution using mandatory fields and linking the scribed note to the medical record deficiency process.
“Using the deficiency process,” she continued, “we would eventually get query responses but they were not timely. Tracking the process was a huge headache. We knew this was not a long-term solution but we didn’t have anything better.”
Berberich networked with a colleague at an educational seminar and told him of her frustration with the query process and that she did not know of any vendors that had any better solutions. He mentioned IT vendor Artifact Health to her and she contacted them right away.
“When I saw the first demo, I really thought it was too good to be true,” she remarked. “The solution was so simple to implement and use. They had dashboards to get real-time status updates on anything you would need to know about the query process. The system auto-alerted providers of a query via their mobile app.
“Queries could be answered from literally anywhere via the app,” she added, “and the response interfaced directly into the patient record, alerting the clinical documentation improvement specialist of the activity.”
There are various clinical documentation improvement software vendors on the health IT market. Some of these vendors include ChartWise, ezDI, Iodine Software, MModal IP, Nuance Communications and Optum.
MEETING THE CHALLENGE
Berberich was thrilled to get buy-in from the leadership team to move forward with the Artifact Health technology.
“The hitch was the ease in which the provider could answer queries, the user preferences that the providers can set to make the technology work with their schedule, and the ability to customize their own setting as to how they wanted to receive their alerts either email and/or text alerts,” she said.
“Our leadership team challenged us to get the product up and running quickly,” she added. “Our IT folks worked with the vendor to create the provider dictionary and we used a simple transcription interface to get the responses to flow into our Meditech EHR.”
To get providers to download the app, IT staff presented the technology at a medical staff meeting and began signing on providers that night. The providers were all very interested in getting the new app. The biggest hurdle was that some providers did not know their Apple ID password, Berberich commented.
“Once the app was downloaded, there was a mock query they were able to test drive,” she said. “For the next several days in the hospital providers were stopping in the clinical documentation improvement specialist office with their Apple ID or wanting to get whatever app their colleague had. We went live just one week from that medical staff meeting and one month from contracting with the vendor. We were able to do this because the solution is truly just that simple to implement and begin using.”
In the first month using the new technology, Montefiore St. Luke’s Cornwall moved from an 84% query response rate to a 100% query response rate, which it has maintained.
“Our clinical documentation improvement specialists love how easy it is to use, and we saw a 36% increase in the volume of queries asked by our clinical documentation improvement specialists,” Berberich said. “We also rolled Artifact Health out to our coders, who now have a reliable process to ask concurrent queries and obtain timely responses.”
In addition, Montefiore St. Luke’s Cornwall took the time to review and standardize query templates using several of the templates offered by the technology vendor.
“Prior to Artifact Health, we did not track provider responses in days but we estimate it was several days to upwards of three weeks,” Berberich said. “With the new technology, our average response time is 1.4 days. In the hospital, we actually see responses within minutes.”
ADVICE FOR OTHERS
“I have used a few different clinical documentation improvement vendors and I have always asked for a query solution,” Berberich advised. “The vendors never seemed interested in exploring this avenue. If you can’t get the query to the provider in a way that it is easy for them to answer and document in your medical record, it doesn’t matter how good your clinical documentation improvement software is.”
Montefiore St. Luke’s Cornwall struggled rolling out a mobile messaging app, she added. The providers felt they were being barraged with messages and alerts and several refused to use it, she said.
“What is different with the Artifact Health app is the provider can schedule their alert to go off any time of the day that is convenient for them so they are not interrupted when they are busy,” she explained. “They can receive it via text, email or both, and because the alerts do not contain PHI, they can choose any email that is convenient for them.”
Montefiore St. Luke’s Cornwall has had its providers tell it they answered queries while on a plane awaiting takeoff overseas and while attending the U.S. Open, and it has had doctors who used to avoid the clinical documentation improvement office who now stop down to tell staff they answered their query.
“Our providers like it because it is so easy to use,” Berberich concluded.