In Search of Intelligent Workflow Solutions for Physicians

Now that it looks like ICD-10 implementation will be postponed only one year, the already hot-topic of computer-assisted coding will get even more attention. Hospitals obviously need to ensure they have a strategy in place to deal with ICD-10 and the highly anticipated, but often misunderstood, ramifications of ensuring appropriate reimbursement under the new coding standard. Most hospitals I’ve come across have an “ICD-10 Committee” working overtime to determine what the right strategies, solutions and processes are for their organization.

With all of this focus on how to add intelligence and automation to the coding workflow, and mainly the output of that workflow, there has been a lack of attention given to inputs that feed the coding workflow: physician clinical documentation. ICD-10 at its root is a documentation problem. The best computer-assisted coding solution in the world is still dependent on the content of the documentation that it analyzes for the quality of codes that it produces. If key information is missing, you’ll never achieve appropriate reimbursement or accurate profiling and reporting.

If you believe that documentation is as important as I believe it is, then why aren’t there as many intelligent “computer-assistance” applications for physicians to aid them in their documentation as there are to assist coders with coding?  There is a huge market for clinical documentation improvement (CDI) services and solutions that address coding and documentation accuracy under ICD-9. The problems and issues addressed by these CDI services and solutions today aren’t going anywhere with ICD-10 and will only increase.

Part of the problem is the complexity and level of personalization in the clinical documentation workflows of physicians. This has led to a chronic lack of focus on physicians and their needs, which are often unvoiced. The gap between how physicians document, and the specificity in diagnosis terms required for coding purposes isn’t going away, so what is the answer?

I anticipate that over the course of the next year we’re going to see a huge increase in the number of vendors offering documentation improvement solutions and “computer-assistance” products for physicians. A lot of these will probably miss the mark due to a lack of truly understanding the needs of physicians. The truly impactful solutions will successfully bridge the gap between documentation and coding, bringing truly customized, intelligent solutions that speak to the physician in their own language.

Jeremy Zasowski is the Marketing Manager for 3M Health Information System’s Emerging Business Team.

3 responses to “In Search of Intelligent Workflow Solutions for Physicians

  1. Since the topic here is hospital care, here’s a maybe-naive question:

    For best reimbursement documentation, wouldn’t some cohesion between complex medical diagnoses and the attendant labs/tests, progress notes, from the physician’s side plus the documentation throughout the patient’s stay from NCPs and nursing care documentation be key to improving reimbursement, especially in minimizing delays or reduced reimbursement?

    I understand the focus on implementing ICD-10 for physicians but when a great deal of both care and charting is via nursing staff, there seems to be little in the way of implementing computer charting in a way that facilitates more thorough documentation of nursing problems-which must ultimately be related to at least one of the patients’ medical diagnosis. There’s little cohesion within the charts I’ve seen between staff members, many nurses provide patient care in understaffed units (and may resent the focus on profit), and charting is seen as less critical than the actual patient care. Nurses can’t easily use speech-to-text charting for privacy issues, ‘paper-towel’ charting at the end of hectic shifts doesn’t translate well to computer charting, and “if it wasn’t charted, it didn’t happen” remains.

    Is there any focus on addressing cohesion throughout patient charts at the staff nurse level, but Not through care management or utilization review? I would think that unless nurses can be good patient advocates first, and document care within the nursing process/ICD-10 second, reimbursement will still lag because both physicians and nurses are, and should be, care-givers first and foremost.
    Laurie H

    • Jeremy Zasowski

      Hi Laurie,

      You bring up some interesting and valuable points. The focus of physicians, nurses and other care providers is on delivering the highest quality care possible in order to achieve the best outcomes possible. Documenting on the patient and the care provided is a corollary to this, but not the prime driver for what physicians and nurses do.

      Your comments highlight a key opportunity that I think could help to improve communication and coordination among care providers, which would in turn help to improve patient care. With electronic records allowing more real-time access to the documentation created on a patient from nurses and physicians, I think there is an opportunity to use the same type of NLP technology that helps with computer-assisted coding to computer-assist all care providers. This could allow diagnoses and problems contained in multiple sources in the patient’s record – nursing notes, physician documentation, lab and test results – to be brought forward for all of the patient’s care providers to view. This could also highlight when procedures or medications are lacking a corresponding diagnosis in the chart.

      All of the care providers for a patient in a hospital setting could then be working from one cohesive view of the patient. Perhaps this could help to align physician and nursing documentation, ensuring that all of the relevant diagnoses and problems that were being addressed during the patient’s stay are adequately documented. The question I have is how this could be done in a way that eases the documentation burden that care providers face today, while also helping to achieve a complete and accurate record for coding to ensure timely and appropriate reimbursement? How could this cohesive summary of the patient be used within a nurse’s workflow today? What format would be most beneficial?

  2. Jeremy, I’ve been paring down my thoughts since they overlap into related issues. It might help to know what clinical background you have; mine is mostly hospital nursing–Some was ‘floor nursing”, the bulk was an intensive care area. Also, do physicians from client companies generally do in-service training, or is it optional for them. I’m considering job-hunting in fields related to nursing and this area has interested me for Some Time, hence the blog reading I was doing when I found this one.

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