Guest post: Technology in CDI, a necessary evil but wait a minute…

By E.S. Damalie, MD, FACHE, FHFMA, RHIA, CCDS, CDIP, CCS

Oh, how the world has changed! To think that it keeps changing and we, those working in the CDI profession, have only really just begun to discover what this role can accomplish can be a scary thought. In reality, we should focus on how we can get better, continuously improving until we come as close to perfection as possible.

Every aspect of human endeavor has seen a significant transformation through the application of technology—for good or bad. The healthcare landscape is no exception. We are continuously bombarded with new technology on a regular basis. Ignoring technological benefits does us and the industry a disservice.

From the glorified Excel sheet marketed by some vendors to elaborate CDI programs which integrate with the EHR and come with all the bells and whistles, there’s a technology for every sized CDI program no doubt. Technology is here to stay and we need to figure out what is applicable to our healthcare system/organization, work environment or whatever hospital we work at.

In travelling through the length and breadth of this country, as I have done, and witnessing CDI programs at various levels of development, I found that those making decisions on technology deployment often do not understand the day-to-day workflow of the CDI team or the infrastructure needed to effectively and efficiently employ such technology.

For instance, what is the value of deploying computer assisted coding (CAC)/natural language processor (NLP) in a hybrid organization with heavy paper-based medical records? Should organizations adapt CAC just because a senior executive found out a nearby facility used it? Deciding to use any technology needs to be justified by the value and productivity it can provide. Anything short of that is tantamount to just having another ‘shiny toy’ in the organization’s ‘collections.’

Before embarking on a large technological purchase, consider the following questions:

• What is the effect of this technology on the current CDI workflow process; better or worse (user friendly or not)?
• What is the effect of this technology on productivity; more staff, same staff or less staff?
• What is the effect of this technology on CDI performance metrics; better, same or worse?
• What is the analysis from other organizations using the system?
• What is the cost involved? Is it really value for money?
• What is the organization really trying to address by rolling out this technology?

If signing up for CAC with NLP engine will reduce staff productivity to only 1,500 cases (both old and new) per CDI specialist per year when they currently do multiples of this number, rethink your plan. Assuming each staff takes four weeks’ vacation per year, these annual 1,500 reviews will work out to about 31 reviews per week which then translates to about 6.25 cases a day. Considering such technologies don’t come cheap, is it worth spending all that money for a CDI staff to end up seeing only seven cases per day? The counter argument one hears often is that with the CAC, the CDI specialist performs other tasks in addition to the traditional CDI role. What we should be aware of is that CDI programs are at different levels of functionalities across many organizations. Some may be at the rudimentary level whiles others may be highly functional programs. A highly functional CDI program should be holistic in approach addressing many (and more) of the issues CAC with NLP engine addresses. The question then is will deploying CAC with NLP engine in a high functional CDI program be worth it if such staffs end up reviewing only seven cases a day?

Interestingly enough, sometimes administrators get carried away by technology’s reporting capabilities. And the quest to “get that report” becomes one of the deciding factors obtaining technology without deep consideration of other factors.

Over the years, I’ve reviewed many CDI tools at many organizations. I have to conclude that for all the reports administrators thought they wanted, some of the technologies caused CDI specialists to spend about 45 minutes to an hour per case. Yet in some of these organizations, the same executives were complaining about the CDI team’s productivity.

My point is that you hold your own destiny in your hands. Decision making regarding acquisition and deployment of technology to any CDI program should be made by multiple teams including those who understand the CDI process and have a practical first-hand experience of CDI, its workflow, processes, and scope. Doing so will help the organization select the right technology that can be of benefit to them.

Ultimately, having the right technology should be a significant plus to any CDI program. Using technology as a cover up is a disservice to any organization and only goes to hurt the organization in the long run.

Editor’s note: Damalie, a physician and CDI specialist, is currently affiliated with Serenity CDI+ Solutions, which offers CDI, appeals and denials management, coding and auditing, and other revenue cycle services. Currently a fellow of both the America College of Healthcare Executives and Healthcare Financial Management Association, he also serves on the ACDIS CDI Practice Guidelines Committee, and as chairman of the Certification Committee for the Southern California Chapter of HFMA. The opinions expressed do not necessarily reflect those of ACDIS or its advisory board. Contact Damalie at serenityCDIplus@gmail.com.