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CDI Week 2017: Celebrations nationwide

Last week, ACDIS celebrated our seventh annual CDI Week, recognizing professionals across the country for the incredible work that they do. Facilities and local chapters nationwide joined the fun, embracing the 2017 theme, “The Wild West: New Frontiers in CDI,” fully.

We were lucky enough to get our hands on a few photos from last week’s activities. Please enjoy this little slideshow we put together. Thanks for another great CDI Week!

CDI Week Q&A: CDI and Technology

Wall, James

James Wall, RN-TN, BSN, MBA

As part of the seventh annual Clinical Documentation Improvement Week, ACDIS has conducted a series of interviews with CDI professionals on a variety of emerging industry topics. James Wall, RN-TN, BSN, MBA, the senior director of clinical documentation improvement at LifePoint Health in Brentwood, Tennessee, and a member of the 2017 CDI Week Committee, answered these questions on CDI and technology. Contact him at james.wall@lpnt.net

Q: How long have you had electronic health records?

A: I am a systems Senior Director of CDI. Since LifePoint has acquired many hospitals, we have assumed a variety of different EHR systems. While there is not a standard EHR, LifePoint uses three main Health Information Systems. Many of our hospitals are totally electronic while others are a hybrid of EHR and paper.

Q: Have there been any real sticking points with the transition to full electronic systems? [more]

CDI Week Q&A: CDI and Quality

Ignatowicz

Nancy Ignatowicz, RN, MBA, CCDS

As part of the seventh annual Clinical Documentation Improvement Week, ACDIS has conducted a series of interviews with CDI professionals on a variety of emerging industry topics. Nancy Ignatowicz, RN, MBA, CCDS, a remote/traveling CHI nurse with MedPartners, based in Bourbonnais, Illinois, and a member of the 2017 CDI Week Committee, answered these questions on CDI and quality. Contact her at nrmignatowicz@comcast.net.

Q: Can you describe the relationship of CDI to quality initiatives, and how CDI can make a difference?

A: CDI and quality can have a variety of relationships. For instance, CDI can offer concurrent notification of actual or potential issues to the quality department. CDI can assist with concurrent data collection and quality interventions. CDI queries can also address present on admission status, cause-and-effect relationships, surgical puncture/laceration specificity, risk of mortality, and severity of illness. For example, CDI can help capture pressure ulcers, catheter-associated urinary tract infections, pathological fractures (which may have been diagnosed intra/postoperatively), surgical lacerations integral to the procedure, and diagnoses that were present on admission but not previously identified in the documentation.

Q: Has reviewing for quality measures hindered your department’s “traditional” CDI chart reviews or overall productivity? [more]

CDI Week Q&A: CDI Expansion

Peppers, Rhonda

Rhonda Peppers, RN, BS, CCDS

As part of the seventh annual Clinical Documentation Improvement Week, ACDIS has conducted a series of interviews with CDI professionals on a variety of emerging industry topics. Rhonda Peppers, RN, BS, CCDS, a CDI specialist at Care Coordinators, MedPartners, in Tampa, Florida, and a member of the 2017 CDI Week Committee, answered these questions on CDI expansion. Contact her at rhondapeppers@benefis.org.

Q: When did you first get involved in CDI, and what was your CDI program’s focus?

A: I started working in CDI in 2011, and our program’s focus was on earning money. We were given monthly monetary totals on the queries we wrote. We were very competitive. Our goal was to see who could make the most money. As a matter of fact, I was told when I first started that we were not to write the query if it was for severity of illness (SOI) or risk of mortality (ROM), just write the ones for MCCs and CCs.

Q: How has the focus of your CDI program changed over the years? [more]

CDI Week Q&A: Career Advancement

Ng, Brenda

Brenda Ng, MS, RN, CCDS, CCS

As part of the seventh annual Clinical Documentation Improvement Week, ACDIS has conducted a series of interviews with CDI professionals on a variety of emerging industry topics. Brenda Ng, MS, RN, CCDS, CCS, a CDI consultant at MedPartners in Greenwood Lake, New York, and a member of the 2017 CDI Week Committee, answered these questions on CDI and career advancement. Contact her at ngbrnd@yahoo.com.

Q: What, in your mind, does the “typical” CDI specialist role entail?

A: The typical CDI specialist role entails knowledge of best practices, quality reviews, continuity of care, and ensuring that patients are receiving the right communication.

Q: As CDI programs advance, they begin to branch out into other review areas. What areas do you think programs should move into first? [more]

CDI Week: Only 11 days till 2017 kick-off

CDI Week committee

Meet the members of the 2017 CDI Week committee!

Every year, facilities across the country celebrate the efforts of their CDI teams for one week in September. Though ACDIS believes CDI professionals deserve accolades throughout the year, CDI Week is a time to pull out all the stops.

This year’s festivities take place September 18-22 and the theme is “The Wild West: New Frontiers for CDI.” Don’t forget to let ACDIS know what you’re planning for this year’s celebration and send plenty of pictures! We’d love to celebrate with you!

One change this year is the incorporation of the CDI Week Committee. As the ACDIS community and activities grow, ACDIS includes more of its members in planning festivities. [more]

Tip: Show your ACDIS and CDI pride

With CDI Week 2017 only 74 days away, it’s time to get planning as to how you’ll show your CDI pride. In the past, CDI programs have taken whole team pictures together, thrown lunch parties, held after-hours get-togethers outside of the office walls, extended thanks to the most helpful physicians, and worn CDI-themed outfits to work.

[more]

Note from the ACDIS Editor: Help identify CDI industry trends

LA-new headshot

ACDIS Editor Linnea Archibald

By Linnea Archibald

As you read last week, the theme for CDI Week 2017 will be “The Wild West: New Frontiers in CDI.” Though the theme offers numerous opportunities for fun CDI Week activities (cowboy hats and boots, anyone?), the theme also speaks volumes about the CDI industry as a whole.

As with any industry that’s been around for a while, things change. With more and more updates, regulations, and payment methodology changes, it seems the CDI field changes more rapidly than others. And ACDIS always seeks to keep its finger on the pulse of those changes.

To aid in this purpose, ACDIS undertakes a CDI industry survey each year to accompany the festivities of CDI Week. The survey analyzes trends in CDI, helping us report on the direction of the profession, new areas of expansion, and any other developments on the frontiers of this field.

This year’s survey consists of 38 questions spanning seven distinct sections, each probing a different area within the CDI profession. Click here to take the 2017 survey. [more]

CDI Week Update: Caption contest

It is time for our last CDI Week Caption Contest. Here are the rules: post your (tasteful and respectful, please) suggested captions for the following picture. At 3 p.m. today, the ACDIS team will select a favorite to win a prize. We will announce the winner in the comments below so make sure to check back this afternoon to see if you’re our lucky winner!

shutterstock_3398434(1)

Q&A: Technology

Ask your question!

As part of the sixth annual Clinical Documentation Improvement Week, ACDIS has conducted a series of interviews with CDI professionals on a variety of emerging industry topics. Joy Coletti, MBA, RN, CCDS, system services director for clinical documentation improvement at Memorial Hermann in Houston, Texas, answered these questions on electronic health records. Contact her at Joy.Coletti@memorialhermann.org.

Q: How long has your facility been using electronic health records? 

A: It was phased in at each hospital over a one to two-year timeframe in early 2000. Two of our smaller community hospitals took the lead with engaged physician champions.

Q: What role did you personally play in the transition? How big a role did the CDI team play?

A: CDI did not really play a role in initial EMR adoption, unfortunately, other than [providing input on] how physicians are electronically prompted when they have a query, and where those query responses reside in the EHR.

Q: What was the impetus for the transition initially (ICD-10? Government imitative?)?   

A: HIPAA was likely a large factor in speeding up the transition. E-queries were implemented in 2010. By 2010 the EMR was more electronic than paper, but still a hybrid of the two.

Q: Can you describe the different systems you use for your EHR and e-Queries? 

A: EHR is a Cerner platform, but also has Intelligent Medical Objects which allows us to search diagnoses. For e-queries, CDI specialist and coders software were developed by Meta Health, now part of Streamline Health.

Q: Has EHR use led to remote CDI capabilities?  

A: Yes, but within each hospital. Records are reviewed from an office location rather than within the units. This has significantly improved productivity levels. Records can also be reviewed across hospitals for coverage capabilities when a CDI specialist is out of the office or when census is very high at certain facilities. I hired three regional float CDI specialists who support multiple hospitals remotely from their offices on one hospital campus. Each CDI float supports multiple facilities and provided backup coverage.

Q: What has been the biggest benefit from EHR implementation in your opinion? 

A: Legibility of documentation, the ability for many disciplines to access the record simultaneously, remote access, and quicker order entry with fewer errors.

Q: What has the CDI team struggled with most in terms of reviewing records in the EHR and helping physicians with their documentation?

A: First, fragmentation of the EHR, which makes it challenging for physicians to “tell the patient’s full story” in an accurate and efficient manner. Providers sometimes produce a lot of copy-and-paste generated notes, which are challenging for CDI specialists and coders to follow and understand the patient’s story.

Second, there are no central diagnosis or problem lists managed by physicians that can be used by CDI specialists and coders.

Q: What advice would you give to CDI specialists who might be just starting EHR implementation or struggling through the process?

A: Continue to use paper queries until the EHR is at least 50% electronic, or at least a majority of history and physicals and progress notes are electronic. Once you transition to e-queries, while the health record is still hybrid, place a paper query “prompter” in the paper record to alert providers they have an electronic query, the basic steps for how to answer that e-query, and, of course, the CDI specialist’s name and contact information.

Q: What contingency plans are in place for when the power goes out or internet goes down? (you can skip this question if you want, I’m just curious in light of the flooding in LA and the fires in CA and knowing what happened in NYC after Sandy.)

A: Luckily, our back-up generators have always kicked in. All generators were moved out of basement level years ago due to the history of flooding in Houston area. Our IT emergency plans kick in when the EHR goes down and “all hands on deck” until the issue is identified and the EHR is back up and running. In the past, we were able to be back up within two hours.