Technologies to support improvement (Part 2)
Dr. Jon Elion, Chartwise
In Part 1 of this discussion, we looked at the emerging role that Rules-Based Expert Systems and “Software as a Service” are starting to play in Clinical Documentation. This discussion continues in Part 2 as we move on to look at new applications for Business Intelligence in CDI
The utilization of an electronic CDI program enables data to be grouped, analyzed and presented to the user in a way that isn't possible with paper-based systems. Moving far beyond providing the user with a list of work to be done that day, a well-designed electronic system can provide reporting layers that start with a summary snapshot and drill-down to details and metrics. This can include query response rates, case mix index changes, revenue impact and compliance, both within the individual hospital and across the peer group. Most importantly, it not only monitors the efficiency of the current CDI program, but a good system will also provide insight into improvement efforts still left to be achieved. Dashboards and scorecards help to bring the data to life, putting it in the hands of those who can affect change, and helping to transform the way we deliver healthcare.
As CDI software evolves, we can move from yesterday's world where we looked at old, stale data, into today's world of real-time reporting. Constrained by older technology, some hospital data center aggregate their data monthly, while other more advanced sites are able to aggregate weekly, and very few are able to do so daily. But to have a real impact on using data to transform healthcare delivery, it needs to be run even more frequently - at the “speed of thought." As the data technologies catch up with medical requirements, it is now possible to run your healthcare enterprise based on information from 6 minutes ago, not 6 months ago.
Many hospitals today are satisfied with using stale data for their CDI programs. They might use consultants to process and report on CDI metrics, getting back data that is already months old. By using sophisticated database analytics technology, the best CDI software can give you up-to-the minute, on-demand reports that give you data you can use this minute to make healthcare decisions while the patient is still in the hospital.
With any CDI program, the end result is better (more complete and accurate) clinical documentation. CDI software that utilizes an expert system will help ensure that proper information has been captured to support areas as diverse as Quality Management, Medical Necessity, Resource Utilization, Case Management, Safety Ratings, Revenue Assurance, Critical Pathways, Coding, Severity of Illness, Regulatory Compliance, Risk Management and JCAHO. More accurate coding and documentation will also have significant beneficial impact on Physician Profiling and outcomes measurements that are so central to Managed Care organizations. And, as hospitals struggle to keep up with increasing demands for documentation and reporting, improved technologies for CDI will be vital to provide essential efficiencies and help to assure completeness. Improved data reporting technology will help support concurrent processes, not simply retrospective analysis.
The combination of knowledge-based expert systems and electronic delivery methods stand to transform CDI efforts from paper-intensive programs, into powerful and easy-to-use documentation improvement and analysis systems. These can ultimately be integrated into a hospital's information system, making the expert system even “smarter” as it captures medication, procedure and lab data, and begins gathering diagnostic suggestions and query proposals even before the user logs on.
Just as the original film camera found a purpose far beyond landscape photography, emerging and converging technologies are being applied to purposes beyond their original intent, and will revolutionize healthcare and healthcare documentation.
Jonathan Elion, M.D., FACC, is a practicing board-certified cardiologist in Providence, RI and an Associate Professor of Medicine at Brown University. He is the founder of ChartWise Medical Systems, Inc.