Clinical Documentation Improvement (CDI) 2018
Workflows and Prioritization Drive Quality and Financial Outcomes

Industry Insight & Context

CLINICAL DOCUMENTATION IMPROVEMENT

All operations within a hospital are impacted by EMR documentation. Ensuring the accuracy of that documentation is a challenge, and the complexity is increasing as healthcare regulations, reimbursements, and care practices evolve. Because of this complexity, provider organizations look to clinical documentation improvement (CDI) vendors to provide tools and services that improve efficiency and drive financial gains (which a majority of customers report achieving). The chart below shows the functionality and services CDI vendors offer and how frequently that functionality is adopted by the customers KLAS interviewed for this study.

A Note about Tackling Outpatient CDI

Across all vendors, provider organizations see significant revenue improvements when they use CDI tools and services. However, there are still major opportunities for development when it comes to outpatient documentation improvement. Provider organizations express high interest in this area, which is made complex by the myriad differences between the various outpatient specialties and the significant volume of outpatient services that most organizations have. This complexity can make it difficult to standardize software or determine where CDI efforts will have the greatest impact, but it also makes outpatient CDI an area of high opportunity. All vendors in this study are currently building out tools and collaborating with customers, but so far only MModal has a GA tool specific to the outpatient setting.

Clinical Documentation Improvement 2018

Nuance, ChartWise Drive Strong Financial ROI; Iodine Drives Efficiency

Customers state that Nuance’s strong front-end education drives positive financial outcomes and that ongoing reporting and metric tracking give them clear visibility into the solution’s financial ROI. ChartWise customers see strong revenue improvement because the vendor is attuned to their needs and because the vendor’s proactive, nimble support helps customers fully leverage and optimize the solution. Iodine Software offers a high level of partnership, and their uniquely automated prioritization tool empowers CDSs to maximize their efficiency. The vendor relationship is lacking for many 3M customers, leaving them to drive outcomes on their own.

Iodine’s Prioritization Tools Disrupting CDI; 3M’s Overhyped

One of the biggest innovations in CDI over the last few years has been the creation of prioritization tools. Initially developed specifically for prioritization, Iodine Software’s robust tool stands out for the high levels of satisfaction it generates, and its highly accurate algorithms allow overtaxed CDSs to maximize their impact. Optum and 3M have seen increased adoption of their prioritization tools; results have varied. Optum customers report that markers help guide CDSs; more tweaking is needed to reduce false positives. 3M customers’ expectations for the new tool were set too high, and they struggle to get needed support when the tool doesn’t work as expected (e.g., it gives numerous false positives). ChartWise recommends customers hire adequate staff to review all documentation rather than use a prioritization tool, and many of their customers prefer to let CDSs determine their own workflows.

For ChartWise, Nuance Customers, Efficient Workflows Stem from Integration and Training

Integration and training can alleviate the CDI workflow challenges of having to work in multiple systems, a persistent pain point for physicians. Though all vendors can improve in this area, ChartWise has done more than others to develop EMR integration and facilitate smooth workflows. Both ChartWise and Nuance customers note receiving face-to-face training that helps them optimize CDS workflows. Nuance, 3M, and Optum offer integration between CAC and CDI functionality, which improves coder/CDS collaboration. Nuance’s broad technology platform (which includes NLP and the no-longer developed CAC solution) helps streamline workflows. 3M and Optum also offer broader platforms, though customers of both vendors want to see more nimble system development and improved issue resolution. 3M customers report lingering implementation challenges due to lack of knowledgeable support resources. MModal customers say the tool is easy to use and that CAPD functionality helps physicians improve initial documentation. nThrive customers report problems with double entry and upgrades that don’t address usability issues.

Claro Healthcare Delivers Value and Satisfaction

For help optimizing their CDI program or to outsource their CDI altogether, provider organizations often engage a CDI services firm. Among these firms, Claro Healthcare stands out for driving value. They do this by keeping promises made during the sales process and providing highly knowledgeable and skilled consultants who drive value through education. Navigant customers see value from highly knowledgeable consultants who help them mature their CDI program. Some Navigant customers feel the tool’s lack of functionality breadth limits the firm from driving value as highly as they could. Broader firms PwC and Huron have knowledgeable consultants with a great deal of CDI expertise that helps drive revenue improvement.