All Entries Tagged With: "CDI"

CDI specialist orientation (more CDI Talk inspiration)

One of the repeated conversation themes on CDI Talk is how to orient a new staff member (within an existing program), or how a small program can start its own CDI efforts and train its own staff. Parallel to those conversation threads are participants’ real hunger for more avenues and sources of education.

Let’s look at some of ACDIS’ online poll data to set the stage:

July 2011: How many total years of professional experience do you have in healthcare (CDI, plus other)?

20 years or more, 60%

November 2009: How long did it take you to get up to speed as a new CDI specialist?

3 to 6 months, 32%
6 to 12 months, 34%

June 2011: How long do you think it takes to achieve an “expert” level of proficiency as a CDI specialist?

2 years, 35%
3 years, 22%.

And here’s one final on-line poll data point to help me answer the question as to whether CDI managers are actually providing enough training to new staff members:

January 2011: How long is your training period for new CDI specialists?

12%, 2 weeks
22%, 30 days
30%, 31 to 60 days
20%, 61 to 120 days
12%, approximately 6 months
3%, less than 6 months

It seems to me that those who indicated that it takes six months or more to get up to speed need more training than what I commonly consider necessary as part of orientation. This data suggests that what is these new CDI specialists need is more of a mini-college training program.

Obviously there is a rather significant challenge—how to provide the level of knowledge and training along with the

(Image via Homeclick) It is a sink that is made so fish swim in it. Get it? Sink or swim.

appropriate mentoring to actively promote and support the new CDI specialists so they can succeed. Of course, there is always the consultant option which proves to be relatively expensive. Plus, a ‘mature’ program should not need to rely on such an expensive option for new staff orientations. At the opposite end of the spectrum is the ‘sink or swim’ method.

Thankfully, home grown and self-supported possibilities exist to constitute a middle ground between these two options. At the very least, facilities should implement an orientation or mentoring process where the experienced individual’s guidance can make a huge impact.

I believe the biggest challenge facing those hoping to implement a CDI orientation program comes from a lack of targeted, written learning resources. I consider one of the largest draws for ACDIS membership stems from the need for learning, resources, and accessibility to a community of knowledgeable and supportive peers. ACDIS provides such a community, with a quickly growing resource base. (If you’re a member, you ought to know. If not, go look at every part of the ACDIS home page).

In addition, ACDIS offers a few helpful handbooks and guides that can be re-purposed for orientation, such as:

Furthermore, the only independent (i.e., not part of a consulting package) seminar I’ve found is HCPro’s CDI Boot Camp. While the total cost (fee, travel, hotel) may be prohibitive for many there is also the online version as an option. Again, a mature CDI program ought to be able to handle at least some of the orientation process internally.

Even with the valuable resources of ACDIS, some holes in new staff orientation remain. AHIMA and AHA’s Coding Clinic for ICD-9-CM provide further guidance, but even those resources do not cover everything. Several major elements of an orientation program are not addressed by the resources mentioned. Just to get started, how about:

Creating a tool that outlines in detail basic competency and knowledge expectations for the novice CDI specialist. This tool should also list areas for mid-level and advanced achievements to give new CDI staff a set of expectations for continued professional growth. There are some examples in the Forms & Tools Library, in the policies and procedures section (search for “staff orientation checklist), but not at the detail I envision.
Curating a collection of vital subject articles and references. (Review the CDI Journal archives, the ACDIS Blog, and the Helpful Resources links just to get started on this collection. Add in other professional organizations and their publications such as the National Institutes of Health, AHIMA, AMA, and others and this would be a one-stop database of useful CDI knowledge.)
Creating an outline of topics that the new CDI specialist needs to master before achieving their initial competency. Further, this outline ought to provide enough detail and referenced sources to serve as a complete training program guide.

Sources would likely include the books and articles mentioned immediately above, along with sections of widely accepted texts such as coding guidelines, Faye Brown, and medicine texts like the Merck Manual.

Before starting to collect all those articles and tools, though, I should probably determine the basic elements of an orientation program! Below I’ve listed a few resources online which discuss this, including:

After reviewing these, I must confess that my definition of orientation varies from those discussed above. Still, several points are important to keep in mind to successfully bring a new staff member up to speed in the CDI world:

Provide structured, purposeful training
Offer a straightforward sequence of topics or activities to enable learning
Give new staff members a written agenda complete with goals and measurable objectives
Provide ongoing, two-way feedback and evaluation
Supply appropriate resources and support
Actively integrate the new person into the team
Celebrate and welcome the individual and his/her accomplishments as they gain proficiency in their new role
Pair new staff with an experienced mentor and provide oversight of their engagement
Offer engaging, interactive, as well as some self-directed education

However, as mature and professional learners, CDI specialists must be responsible and accountable for their education and success.

Honestly, for a new or developing program that has to add or replace staff, the right consultant is worth the money.

At some point CDI programs need to be able to hire new staff and train them in-house. Creating a comprehensive training program does require a lot of effort and maybe it is work that some of you have already done? If so, why duplicate work? Let’s see if we can compile a “best of” list of what program components others have found successful and create a tool that we can share. Post your information here to the blog, e-mail me, or contact Associate Director Melissa Varnavas mvarnavas@cdiassociation.com

February 23, 2012 | Donald A. Butler | Comments 0

Successes and flops

What efforts earn a thumbs-up from your facility?

By Heidi Hillstrom MS, MBA, RN, CCDS

After reading Penny Richards’ blog post, “Do you know who I am?” I wanted to expand on relationship building with physicians.

At my facility, we have a formal introduction process with all of our physicians and resident groups. During this time, we meet with new physicians to explain our CDI program. In addition, we regularly attend physician group meetings, staff meetings, physician quarterly meetings, etc.

Beyond that formal presentation, I find it is our informal interactions which have proved to be invaluable to our program.

I perform medical record reviews on the patient care floors, even if it is an electronic record review. This allows me to see and interact with many physicians on a daily basis. I have conversations with them and it’s not necessarily about documentation. Physicians are people too. Discussions do not always have to be about business or patient care or what is or is not in the medical record. Talk about sports, kids, or upcoming events. Build those bridges to enhance professional relationships.

“The difference between an interaction and a relationship is a matter of frequency. It is a product of quality, depth, and time you spend interacting with another person.” (Bradberry, Travis and Jean Graves. Emotional Intelligence. San Diego: Talent Smart, 2009.)

Relationship building has enhanced our CDI program. We have seen an increase in response rate, physician collaboration, and overall physician support.

By building bridges and relationships, a physician query becomes more than a nagging piece of paper or electronic note and the query’s author becomes more than a nag—he or she becomes a colleague. The achievement of this camaraderie enhances the ability to develop a documentation partnership between physician and CDI professional.

Penny Richards responds:

Thank you, Heidi, for sending in your comments on my original post.

I know I promised to give readers “five-minute speech” prep ideas, but I’m not a CDI and have little to offer by way of building relationships with the physician team. I can give you plenty of advice about breaking the ice and kicking off a conversation (I’m a talker and as a former newspaper reporter, have a lot of experience getting people to chat back to me).

When it comes to teaching points with the physician team, however, I bow to your expertise.

I hope ACDIS Blog readers will take a page from Heidi’s book and share suggestions and techniques. What have you done to train physicians and the clinical team on better CDI practices? What worked? What didn’t work?

Send me an email (prichards@cdiassociation.com) and I’ll compile your comments. Yes, this is like an extension of the CDI Week Success Stories that many of you sent. It’s important to share successes. It’s also important to share the efforts that aren’t as successful. Maybe we can come up with a couple of Top 10 Lists… Successes and Flops. Sometimes you learn more by what doesn’t work than by what does!

Editor’s Note: Heidi Hillstrom is a CDI specialist at St. Luke’s Hospital in Duluth, MN, and the co-leader of the Minnesota ACDIS Chapter. Contact her at hhillstrom@slhduluth.com.

Read more in “Celebrate CDI Success.”

November 22, 2011 | Penny Richards | Comments 1

Open dialogue is the most valuable tool we have to grow the CDI profession.

I see strong evidence that ACDIS is involved with the broad project of defining and expanding effectiveclinical documentation improvement (CDI) practice. For our association to thrive in this endeavor, however, a chorus of voices and perspectives from the CDI community are needed.

In the course of this discussion we must actively maintain a communal understanding of what CDI encompasses. We must continuously ask each other:

What do CDI specialists do that sets them apart?
What kinds of activities identify a CDI staff member?
What knowledge, skills, and abilities do the majority of practicing CDI professionals demonstrate?
What are the characteristics of strong CDI programs?

To keep our profession (and our professional organization) strong, we need to participate in respectful, professional debate. We need to foster discussions surrounding philosophy, growth, ethics, new projects, and/or fundamental focus areas not just for ACDIS as an organization but for all of us working in the industry. Through this dialogue we will be able to find additional ways to effectively promote the fundamental aspects of CDI, to continue to grow and adapt professionally.

I believe ACDIS offers great resources toward fostering this discussion including:

This blog and CDI Talk are two outstanding venues that I feel are particular venues which promote fast, interactive conversations.

I absolutely love reading the ACDIS Blog. I find the posts informative, thought provoking, reflective, introspective, and challenging. I expect (and consistently observe) well written and cogently argued viewpoints. In my opinion, the ACDIS Blog provides:

Important news items that highlight information, events, activities, or resources that all practicing CDI specialists ought to know and understand
A venue for the expression of individual thoughts and concerns by those with enough courage to explore and share what they feel to be the heart and soul of a CDI professional’s life
An arena where we, as CDI professionals, can truly look forward to what the future of CDI might be
Thought provoking content which challenges us (and allows us to challenge others) to uphold the highest expectations for ethical behavior
A wonderful group of posts that entertain and delight, which bring a smile and a laugh when we need it the most.

I’ve found inspiration along with practical tips from shared individual experiences on the ACDIS Blog. And I’ve found that the discussions about challenges we all face have provided me with support, encouragement, and new strategies for growth that I have been able to implement in my own program. What’s more, the content on the ACDIS Blog is free, open to any interested professional.

Though the blog is important, the CDI Talk listserv forum which is available to ACDIS members provides a faster method for CDI specialists to reach out, ask a question, and be assured of responses. CDI Talk offers smaller bits and pieces of the more formalized discussions found on the blog, as well as all of the opportunity for individual interactions and questions. It is really is a fun community to belong to.

To me, the growth of our CDI profession and of its professional association, ACDIS, often feels like a process of discovery. Our profession will only continue to improve as long as we listen, reflect, and discuss the viewpoints everyone offers. I encourage everyone to discover their own interesting, exciting or passionate topic and write an original blog post, or start a CDI Talk conversation.

I’d love to see broad participation from everyone in these conversations and explorations. Thank you to the wonderful folks who currently contribute! A vision for CDI that includes professional growth and development needs a great variety and wealth of participation, of voices and perspectives, so please, join the conversation.

November 07, 2011 | Donald A. Butler | Comments 1

CDI Week Team Slide Show

Over the past few weeks we have been gathering photos from CDI teams across the country. Big or small, from those one-person-bands to those larger multi-disciplinary CDI programs, the photos came pouring in. We’re happy to present this CDI Team Slide Show as part of our CDI Week celebrations. If you have a team photo that didn’t make it into this post, please send it along to ACDIS Associate Director Melissa Varnavas at mvarnavas@cdiassociation.com. If we continue to get enough photos we’ll post a follow-up show next month.

September 21, 2011 | Melissa Varnavas | Comments 0

The art of clinical documentation improvement

I feel like saying a little bit about why we do what we do, or at least why I do what I do. In the course of my 26-year nursing career, I worked in many venues. For about 14 years, I was an ICU nurse, and although many patients have merged in my memory, there are those whose memory will always remain as fresh as yesterday. Somehow, I seem to remember everything about these chosen few, as if they had been painted in my mind.

The painter of the old harbor.

I no longer provide direct patient care. In fact, these days I rarely see a patient in the flesh. Yet, every day I come to know anywhere from 40 to 90 individuals who come to the hospital in varying states of health. I know them through their charts. I know them because I am a clinical documentation specialist.

For me to do my job effectively, I must insure that the artists—the bedside caregivers—paint the most strikingly vivid picture possible of each and every one of these unique individuals.

When I read their charts, I visualize that patient in the bed. I see them complete with a face and a body. I see family members, monitors, tubes, medications. I see the physicians establishing—and sometimes struggling with—the big picture, and I see the nurses working as they provide hands-on care.

I read about the 32-year-old new mother with metastatic cancer and I feel her worry and her pain. I read about the noncompliant dialysis patient on his 10th admission for fluid overload and wonder what conditions could possibly lead to inpatient hospitalization being preferable to outpatient compliance. I read about the 90-year-old woman with a lump on her breast and I know she’s been agonizing over whether a mastectomy is worth it.

I see symptoms and I anticipate diagnoses. I see diagnoses and anticipate procedures. I see procedures and anticipate paths to recovery. Clinical documentation improvement is about making sure that the words match the reality. I need the physicians and nurses to write exactly what they see, what they think, and what they do. And I need them to say it in a way that satisfies government and managed care regulators.

Sometimes, I think of physician documentation in the context of the Blind Men and the Elephant. The Blind

A 17th Century Ukiyo-e print of blind monks examining an elephant.

Men and the Elephant is an old tale from India in which six blind men each take hold of a different body part, unaware that they are touching an elephant. One man touches the tail and thinks it is a rope; another grasps the trunk and thinks it is a tree branch; a third thinks the tusk is a solid pipe, and so on. The reality is that they are all right and they are all wrong; it’s a matter of perspective.

As clinical documentation improvement specialists, we take the findings of the nephrologist and the cardiologist and the surgeon and the internist and we try to bring them together to understand the health concerns of the whole person so that everyone can recognize them. When we only see evidence of a tree branch or a rope instead of an elephant, we intervene.

When I was a nursing instructor, I used to tell my students that their path to becoming a nurse was not linearly following a series of tasks, but rather, slowly solving a complex jigsaw puzzle. Every new experience allowed them to add another piece, but the pieces might not be found in the order in which they looked for them. In time, though, one should eventually have a vision of the nurse taking shape, and fewer white spots on the table.

So it is with patients. A patient comes in with a vague complaint, and they expect the doctor to make a diagnosis. In the current status of healthcare’s revolving door, the physician has less and less time to make those determinations; determinations which nevertheless must be made. At times, a physician resists writing a possible diagnosis for fear of being wrong. I encourage doctors not to fear the diagnosis. A differential diagnosis, honestly considered, does not hurt either the patient or the physician. It merely shows the level of effort expended by the physician and the healthcare team in trying to solve the puzzle, and often that effort will be rewarded with greater severity of illness scores and perhaps even higher reimbursement.

A painting by impressionist Claude Monet.

I will help the physician understand how to write the diagnosis in a compliant manner that protects the patient, the physician, and the hospital.

The portrait has to be painted with some consistency. When one physician writes, “CHF,” while another writes, “pulmonary edema,” and a third writes, “fluid overload,” regarding the same set of symptoms experienced by the same patient, it’s the equivalent of three artists each trying to paint a perfectly pink dress with three different tubes of paint. One uses red paint, one uses white paint, and one uses orange paint. Without working together, none of them gets the color quite right. In the end, sometimes it isn’t even clear that the painting is of a woman in a dress, much less a woman wearing pink.

So, I help hand them the right paint, explain about the various rules of shading and perspective. In this metaphor I give them the right paint brush to use, offer up the appropriate words—acute systolic heart failure—and let them add it to their paintboxes. With the correct verbiage, everyone reading that chart, not only the regulators, sees the woman in her pink dress, sees the patient with acute systolic heart failure, and understands the diagnosis.

Nurses like to talk about the art and science of nursing. There is much science in the clinical documentation improvement role, but a lot of art, too.

September 20, 2011 | Linda Renee Brown | Comments 8

A change in perspective may help build better physician relationships

I’m an old (and I do mean OLD) ICU nurse. As a working nurse, my relationships with physicians usually centered on getting them to listen to my assessments: Yes, you need to get out of bed and come see this patient who has stopped breathing! And getting them to do what they should to care for the needs of their patients: Yes, I could really use a new central line for the 17 vasoactive infusions you’ve ordered!

I respect their level of education and their place on the food chain, but each physician operates on an individual plane of competency and personality for which I sometimes had to make adaptations in my approach.

Twizzlers. Yum.

When I worked in ICU, there isn’t much I wouldn’t do for a nice, polite doctor who showed respect to me and the patients. I knew how hard it is to become a doctor, and how really hard it is to become a good doctor, so I used to try to help the physicians by writing out a verbal order and having it ready for his or her signature. I would try to have all the necessary supplies ready ahead of time and if something additional was needed, I’d be the first to run to get whatever else was needed. Nice physicians got to sit in my space to write their progress notes. I even shared my Twizzlers.

Conversely, if you were a mean, crotchety doctor who didn’t show respect to nurses or patients, I wouldn’t be necessarily unkind but I certainly wouldn’t go out of my way to make your day better. I probably wouldn’t have your orders written and ready for your signature, I would show you where the supply closet was rather than get your materials ready for you, and I’d most likely not let you use my spot at the nurses’ station to write your notes. And no, no Twizzlers for you. Ever. Because you have to be a nice person, first and foremost.

In 2008 I left ICU and became a CDI specialist. Nobody knew what that meant, least of all the doctors. They just knew that I left on Friday wearing a white uniform and stethoscope and came to work on Monday in street clothes, pushing a computer on wheels.

When I was no longer running cardiac outputs or sending off specimens for C.difficile, they could no longer comprehend my new role against their earlier vision of who a nurse is and the role nurses play in patient care. I had to create a new identity and that meant redeveloping my existing relationships.

[more]

August 22, 2011 | Linda Renee Brown | Comments 3

What severity-adjusted payments mean for documentation improvement

Editor’s Note: Ready to take a trip in your way-back machine? I was scanning through articles on JustCoding.com when I came across

The journal Medical Records Briefing celebrates its 25th anniversary this year.

this article from the November 2006 edition of Medical Records Briefing which is celebrating its 25th anniversary this year.

In the article Robert S. Gold, MD, discusses the dawning of a new day in Medicare reimbursement—Severity-Adjusted Diagnosis Related Grouping (DRGs). No doubt seasoned CDI professionals will recognize some familiar themes in his now five-year-old piece.

For example, Gold states, “if physicians have been doing it right up until now, they won’t have to change how they validate their billing and the levels to which they are entitled.” Haven’t CDI specialists and the HIM department been saying the same thing in regard to the switch from ICD-9 to ICD-10? Haven’t CDI specialists and the HIM department been saying the same thing about the coming shift to “value-based purchasing”?

And Gold offers a tongue-in-cheek early assessment of CDI programs calling them “so-called documentation improvement” programs, pointing to the early implementation efforts which focused primarily on capturing additional CCs and MCCs and increasing the relative weights for which a facility could bill the government. Then our beloved soon-to-be ACDIS Advisory Board member touts what he believes are better goals for the then-fledgling CDI profession.

Without further ado, enjoy.

By Robert S. Gold, MD

First, the good news: something reasonable is happening in Medicare-severity-adjusted payments. It started last year for hospitals, will increase this year, and will be pervasive next year. Medicare has been practicing for severity-adjusted payments for the past two to three years with physicians and, undoubtedly, will roll it out to physician payments in the near future. Between that initiative and pay-for-performance, a lot of change is in the future.

But if physicians have been doing it right up until now, they won’t have to change how they validate their billing and the levels to which they are entitled. Unfortunately, most hospitals around the country are going to go wild, starting new initiatives for “documentation improvement” in order to validate their increased (or sustained) revenues.

Hospital billing, which has been the driving force for the myriad of so-called “documentation” programs, has for years had the wrong outlook. Hospitals have been seeking a higher paying DRG. And members of the medical staff have had the right outlook-that, traditionally, it’s just been for the hospital. Unless the program has been designed for accurate representation of what is totally wrong with the patient to drive accurate and specific code assignments. And there have been few of these programs out there.

A true “clinical documentation improvement” program is something directed toward leadership by the medical staff, not something aimed at the medical staff. It helps the physicians provide documentation in the medical record that will:

convert easily into ICD-9-CM codes that will describe what’s wrong with their patients
demonstrate severity of illness and risk of mortality
provide the medical necessity that utilization nurses are so passionate about
validate quality of care as well as professional billing through CPT codes

What do the changes mean?

Starting last year with cardiovascular conditions and extending this year to gastrointestinal disorders and some changes in neurology and urology, hospitals will receive severity-adjusted payments. A bunch of new DRGs have been created that differentiate payment levels based on the presence or absence of these severity issues.

Some will be based on diagnoses, some on procedures. But hospitals that don’t know how to deal with this change will be scrambling to bug the physicians for changes in documentation practices so that they can bill at a higher level. Hospitals that have been doing it right until now won’t have to change anything.

Well, folks are planning to deal with MS-DRGs the same way that they did with the original DRG system. That didn’t work then and it won’t work now. It’s not only what will affect the MS-DRG assignment that ultimately makes the difference. It’s the identification of all clinical entities that affect the health of the patient that counts. It’s the patient that matters, not the hospital finances. Finances will follow logically.”

From my perspective, the physicians and staff who deal with patients everyday need to have the support they require to make it easier, not harder to document properly so that everybody’s needs are met: especially, the patients. The physicians need facilitation, not roadblocks. They need helpers, not interferers. They need education, not rebuke, such as: “Get your patient out of the hospital,” or “Write ‘Cannot rule out aspiration pneumonia’ on the chart.’”

There have been some changes in the past few years such as reporting of mortality rates, utilization profiles, and cooperation with quality initiatives at the hospital. These may not be what you want to see in the environment of medical practice, but they are a reality. Medical staff can ignore them, certainly, but they won’t go away.

Well, public reporting of mortality and morbidity is there. Financial profiles are there. And the next step, which can only be helped if providers participate in a true documentation improvement initiative, is going to be variable payments for physician billing based on severity of illness and pay for performance.

Should providers learn the new MS-DRG coding system?

No. But it couldn’t hurt. At least be aware of what makes a difference. Let’s look into a few examples of what makes quality documentation and what doesn’t.

ICD is a system of sorting diseases by pathogenesis so that you can tell what kills patients. As there are many different causes of an outcome, ICD has specific code sets for many of them and, in the absence of a specific cause documented, will default to the most commonly occurring in the world (not just in the Medicare population in the U.S.).

If a provider documents that a patient has Charcot foot and are not specific as to the cause, it will default to “due to tertiary syphilis.” If a provider states that it was due to diabetes with autonomic neuropathy, syringomyelia, or whatever the cause was, coders will assign specific codes.

If a provider documents that a patient has cardiomyopathy because it’s easy to write down three letters, and he or she doesn’t specify what is causing the sick myocardium, it defaults to congenital, the number one cause in the world—not in the Medicare population in the U.S. And what are the chances that this properly represents the patient?

Every diagnostic entity that a provider treats and works up, needs documentation of the symptoms (in the outpatient arena) or the diagnosis (when you have determined that in the inpatient arena), and it should be as accurate and specific as possible. Someone in the office or hospital has to know that there are specific codes for specific situations and, if the provider supplies the words that make the difference, the codes, severity of illness, utilization review, and documented quality will take care of themselves.

Whether a provider is in a DRG environment, a severity-adjusted environment, a fee-for-service environment, a per diem one, or dealing with ICD-9 or the upcoming ICD-10, if he or she thinks that way, they’re there already and won’t have to change anything.

If a hospital is helping its providers get there, they’re okay. If a hospital has been directed toward “what’s in it for them,” then providers will need help. It’s a shame that so many folks have been misdirected so long. And it’s a shame that the people in the medical schools didn’t recognize decades ago that this was coming and prepare us all with standardized nomenclature that meets the needs of the ICD.

Editor’s note: Dr. Gold founded DCBA, Inc., in Atlanta, a consulting firm that provides physician-to-physician programs in clinical documentation improvement. The goals are data accuracy, profile management, and compliance, either in the inpatient or outpatient arenas. He can be reached by phone at 770/216-9691 or by e-mail at DCBAInc@cs.com.

This article was excerpted from the November issue of Medical Records Briefing.

July 25, 2011 | Robert S. Gold MD | Comments 0

What are your professional expectations? How do you define CDI expertise?

I have a question for all of the CDI professionals who feel they have achieved a genuine level of expertise (be it after two, three, or even five years): What do you consider as avenues for continued professional advancement, satisfaction, and development?

I’ve been thinking a lot about this question and musing on the idea of “expertise.” Specifically, I’ve been thinking about Patricia Benner’s book “From Novice to Expert: Excellence and Power in Clinical Nursing Practice (Commemorative Edition).” In her book, Benner says the “expert” no longer relies on an analytic principle (rule, guideline, or maxim) to connect her or his understanding of the situation to an appropriate action. The expert nurse, with an enormous background of experience, now has an intuitive grasp of each situation and zeroes in on the accurate region of the problem without wasteful consideration of a large range of unfruitful, alternative diagnosis and solutions. She writes:

“Capturing the descriptions of expert performance is difficult, because the expert operates from a deep understanding of the total situation…” (p. 31-32).

This is not to say that the expert never uses analytical tools. Highly-skilled analytic ability is necessary for those situations in which the “expert” has no previous experience. Analytic tools are also needed for situations in which an expert perhaps receives inaccurate information or doesn’t have a grasp of the situation. When alternative perspectives are not available to the expert (in this instance, the clinician) the only way to resolve the issue of the incomplete/inaccurate grasp of the situation is by using analytic problem solving (Benner, p. 33).

An ACDIS poll asking the question, “How long did it take you to get up to speed as a new CDI specialist?” shows 34% say it can take anywhere from six months to a year to reach a comfortable level of proficiency in the role.

A more recent poll dug a bit deeper into the question asking, “How long do you think it takes to achieve an ‘expert’ level of proficiency as a CDS?” Many say it takes about two years but the majority suggests that an “expert” level of proficiency can be reached with one to three years of experience. This is not to suggest that achieving “expert” level should be an end-goal. Continued learning should never be stopped or even slowed, as there are always new and interesting tidbits to soak up. To the same “expert” poll question cited above, 32% responded: “Never, the rules are always changing.”

At some point, however, I suspect CDI core activities may become largely routine (dare I say even boring?). After reaching an “expert” level of proficiency, how does one maintain personal or professional interest, engagement, and excitement in their job?

Of course, one can challenge oneself by considering the component of team growth, by expanding CDI program goals and focus, and by focusing on building a better CDI program and team. (For some ideas on possible areas of program growth and expanded roles, read the related blog posts: “Finding a definition for failed CDI programs,” and “Commit to your own personal and professional achievement.”) However, at this point, I am thinking more about the perspective of the individual CDI specialist. [more]

July 20, 2011 | Donald A. Butler | Comments 2

Your input counts! Participate in the CDI Week outlook survey.

Dear ACDIS Blog Readers,

The Association of Clinical Documentation Improvement Specialists (ACDIS) is sponsoring the industry’s first Clinical Documentation Improvement Week on Sept. 18-24, 2011. As part of the week’s offerings, we are providing an industry outlook survey on a handful of hot topics in the CDI industry. The results of the survey will be made publicly available.

Please take a few minutes to complete the survey by clicking here.

If you cannot access the survey, please copy and paste the following link into your web browser:

http://www.zoomerang.com/Survey/WEB22CLLVQG99K/

Thanks for your participation, and if you have any questions about the survey or Clinical Documentation Improvement Week don’t hesistate to e-mail or call.

Take care,

Brian

781-639-1872, ext. 3216
bmurphy@cdiassociation.com

July 18, 2011 | Melissa Varnavas | Comments 0

Commit to your own personal and professional achievement

There have been numerous posts on the ACDIS CDI Talk list serve regarding frustration with daily duties and responsibilities of a CDI

Everyone wants a gold star for their accomplishments. The question is what are you willing to do professionally to earn it?

specialist. Many, it seems, see their role primarily as cashier and banker for hospitals. Unfortunately, the underlying premise of most (but not all) CDI programs is increased reimbursement for the hospital. As a hospital’s CDI program evolves and matures, it frequently migrates away from strict reimbursement focuses and begins to incorporate other vital elements of CDI including reporting quality and other data elements that directly depend on clinically relevant information—information that eventually gets translated into ICD-9 code assignment.

Naturally, any job can become mundane from time to time as the individual develops strong core competencies and masters the position. I certainly can understand that type of “boredom.” I was the manager of a Burger King restaurant, once. It was my first job out of college. I earned $24,000/year. I thought I was going to be rich. Then I did the math. I added up how many hours I worked and lamented saying, “Welcome to Burger King, may I take your order” at 1 a.m.

I remember a similar frustration with the day-to-day grind of my next job—a bill collector. “Hello is this Mr. So and So? I am calling because I see a balance on your account, can you send me a check today to clear up the balance?” Sometimes the debtor would tell me he/she had just sent the check. I knew they hadn’t. I can’t tell you how many times I wanted to tell them so. Soon, I knew, I’d see his or her name back on my call list. Talk about a mundane day-in and day-out type of job. It just wasn’t for me. Soon I’d had enough. I expanded my horizons, explored other career options, decided on a profession in health information management, and here I am today.

Expanding your horizons

I attended boarding school since third grade. The average class size was five or six students. At the end of each quarter, the students’ grades were posted on the blackboard for all students to compare. The motto was: “If you are not getting straight As, you have more homework to do.” If there is anything I learned during that time, it was that in order to be successful you must challenge yourself to be the best in any project or endeavor you are involved in.

Although no longer competing for the best grade in class, I still adhere to the same principle. Instead of challenging myself to achieve good grades, I am challenging myself to continually learn and identify how I may become more valuable to the organization I am involved with, be that as a consultant or as an active CDI specialist on the hospital floor. I always ask myself:

“How can I make this job more interesting?”
“What additional areas can I incorporate into my present duties?”
What new responsibilities can I tackle that will make the position more valuable to me personally, as well as to the organization and co-workers I interact with?”
“What other areas can I see myself potentially growing into as I advance my career?”

This philosophy has served me well and I am convinced this same philosophy can be applied to the larger CDI profession, as well.

The evolving CDI role

So what can the individual CDI specialist do to advance the role of his or her CDI program? What can you do to challenge yourself beyond the traditional role of clarifying clinical documentation through written and verbal queries?

Plenty!

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June 20, 2011 | Glenn Krauss | Comments 1