Meet a Member: ‘There is no one-size-fits-all for CDI’

Sona Buchanan, MBA, BSN, RN, CPHQ, CPC, CRC, is the system HIM manager—CDI and TV IRF-PAI, at St. Luke’s Health System in Boise, Idaho, a member of the Idaho ACDIS local chapter, and a member of the ACDIS CDI Leadership Council.

ACDIS: How long have you been in the CDI field, and what did you do before entering CDI? 
Buchanan: I’ve been in CDI for seven years now. I am a registered nurse. My area of specialty was trauma and emergency medicine. I transitioned from bedside nursing to work in quality.

ACDIS: Why did you get into this line of work? 
Buchanan: With my work in quality, I had exposure to external reporting based on claims data. From there, I began to work with coding and the very small CDI team in our health system. I was intrigued with how the work was mentally challenging and supported data integrity for our patients and organization. During this time, I had the opportunity to move into the role of CDI manager and begin the journey to grow and develop the team.

ACDIS: What has been your biggest challenge? 
Buchanan: When I first came to the CDI team, our organization was still in the fee-for-service mentality. Then our health system embraced becoming an accountable care organization (ACO). Over those first years as our organization began the journey towards a value-based care model, the “messy middle” was challenging. The challenge was to have key stakeholders and providers understand how interwoven CDI is for a successful value-based health system. Our team felt like we were doing a lot of uphill hiking with many steps back. As our health system has pushed out of the “messy middle,” our teams’ spirit of determination and commitment to documentation integrity has paid off and has resulted in many rewards.

ACDIS: What has been your biggest reward?
Buchanan: The biggest reward has been being a part of the tremendous growth our health system has gone through to embrace value-based care and fully understand the importance and value of documentation integrity. With this culture change, our CDI program is growing, and team members have had the opportunity for significant professional development. It is an exciting time to be a CDI within our health system!

ACDIS: How has the field changed since you began working in CDI?
Buchanan: Healthcare has made a significant shift from a narrow focus of managing sick patients to managing populations of patients with accountability for outcomes. The scope of CDI has rapidly evolved to meet these changes. CDI has progressed from fee-for-service review activities surrounding CC/MCCs to quality focus surrounding severity of illness/risk of mortality, patient safety indicators, hospital acquired conditions, etc., to the current state focused on a holistic patient centered medical record that accurately reflects a true illness burden.

ACDIS: Can you mention a few of the "gold nuggets" of information you've received from colleagues on The Forum or through ACDIS?
Buchanan: The CDI Journal is an amazing resource. It provides industry best practice, risk concerns, and foreshadowing CDI changes and growth.

I love the Forum too! We could not have started CDI reviews in our Children’s hospital without it! We were able to connect with other pediatric programs for lessons learned, tips, and query templates.

ACDIS: What has been your favorite part of participating on the ACDIS Leadership Council? Why do you think networking with fellow leaders is important for CDI leaders? 
Buchanan: There is no one-size-fits-all for CDI and when you combine that with the rapid changes in the field, it can be very overwhelming to sort through it all and make evidence-based, informed decisions. The ACDIS Leadership Council network of leaders across the nation has been an invaluable wealth of resource to provide input, feedbac,k and ideas. It keeps a leader up to date on the industry standards and potential risk. It ensures that your CDI program does not become stagnant and stays relevant. 

ACDIS: If you have attended, how many ACDIS conferences have you been to? What are your favorite memories? 
Buchanan: I’ve been to five conferences. My favorite memory was Z-Dogg—what an inspirational speaker! He speaks about the truth of healthcare with a compassion and solutions for change.

ACDIS: What piece of advice would you offer to a new CDI specialist?
Buchanan: It’s perfectly normal to feel overwhelmed and in over your head. This job is the most mentally challenging job I have ever had, but also one of the most rewarding. When you first start out, it is so much to learn and the business of healthcare is rapidly changing. But if you embrace the newness and take time to look back each week at your successes, you will learn this exciting job and find it very professionally rewarding.

ACDIS: If you could have any other job, what would it be? 
Buchanan: I have only ever wanted to be a nurse—it is who I am. I can’t imagine not working in healthcare.

ACDIS: What was your first job?
Buchanan: I worked for my family’s scuba diving business during the summer and a local hamburger drive thru in the winter.

ACDIS: Can you tell us about a few of your favorite things? 

• Vacation spots: Any place that is in nature and outdoors
• Hobby: I love to read
• Foods: TACOS!!!
• Activities: Hiking, biking, and camping

ACDIS: Tell us about your family and how you like to spend your time away from CDI.
Buchanan: I have been married to my husband for 30 years. For 28 of those years, he was active-duty Airforce which gave me the opportunity to live and work all over this beautiful world. We have a 26-year-old daughter and a 20-year-old son. We’re empty nesters now—which we filled by getting a puppy! Even though our family is spread out, we still all make sure to spend time with each other as a family. We all love to camp or hang out on the beach; we are an “outdoor” family.