Guest post: Keeping technological options open
by Lucia Skipwith Lilien, RN, CCDS, CDIP, C-CDI, CP-DAM
Our CDI program is a very old one. We first started in 2002 when it was called “concurrent coding” and when leukocytosis was a CC. For quite a few years, there was a struggle to find a home for our group. We started in case management and then got flung to quality outcomes, revenue operations, nursing and then finally to our current home as a shared department with coding.
During our years of development, we went from an in-house, manual process of collecting data, to more and more advanced programs, some of which were attached to CDI software. Our query process was paper at first, and of course it’s now electronic. Our clinical record flows into our permanent EHR record and then to our computer-assisted coding/CDI software, but our query process is separate. This has enabled us to develop a query in our clinical record that we have perfected over the years. This separation has been a wonderful opportunity to fine tune the query, with the assistance of IT and some very engaged physicians that had the power to suggest certain query functions that we could not have foreseen.
Although the company that provides us our coding and CDI application has a built-in query function, we have elected not to use it. We also have kept our previous grouper as an addition to the built-in grouper provided with the software. There had been some concerns about the software that was strongly dictating our workflow rather than the other way around. After all the years our CDI team has been in existence, we felt that we should be able to mandate how we wanted it to work.
Unfortunately, we ended up succumbing to the CDI application as were not able to find good workarounds with the vendor and we were met with a lack of cooperation. There were and are some concerns about understanding how the data is gathered and the criteria used to collect it. In certain situations, the company cited proprietary information. It has been a struggle and we continue to work with the company to make sure we can, at least, check our work and validate it. As we all know, the Office of Inspector General has made it clear that we are responsible for our applications and software doing the right thing.
Since we’re using a separate query tool and a secondary grouper already, if we decided to make a change to a new software application in the future, we wouldn’t be starting from scratch and changing all our solutions at once. At least in theory, this gives us some freedom that we are not locked into anything and have some leverage when it comes to evaluating new technology.
Often, I wonder whether CDI programs who’ve bought an entire software suite worry that they won’t be able to easily transition to a new tool in the future if their needs change.
Editor’s note: Skipwith Lilien is the manager of CDI at Health First Inc. in Rockledge, Florida. Contact her at lucia.lilien@hf.org. Opinions expressed are those of the author and do not necessarily reflect those of ACDIS, HCPro, or any of its subsidiaries.