CDI Involvement with EMR Design

don.cdi.rn@gmail.comdon.cdi.rn@gmail.com
edited May 2016 in CDI Talk Archive
The current on-line poll question really is getting to me
(Are you currently involved in EHR implementation?)

WHY are we not more involved?? -- about 29% involved with EMR design & implementation but 45% are NOT INVOLVED!! The potential for an EMR providing ques, prompts, etc. to support diagnostic specificity along with medical necessity is (theoretically) huge.

Is the value of CDI not recognized on the executive level?
Is there not the vision to recognize?
Is the IT/EMR technology not there yet?
Are the priorities focused on other areas -- perhaps as simple as getting a basic system in place first?
What is it?

Does anyone have an EMR that is robust in these CDI expertise areas?

(darn it, now the itch has started and there just might be a blog post brewing...)

Don


Comments

  • jamiedugan2012jamiedugan2012
    edited May 2016
    We are 100% EMR all four hospitals!
    Jamie Dugan RN
    Baptist Health System
    Jacksonville, Florida

  • robert.hodges2robert.hodges2
    Don,

    I agree with you. Unfortunately I inherited a very advanced EHR, but since I am on the template review team, I have input on what goes on a template which of course directly impacts documentation.

    But my feeling is this. If you don't choose to be involved or don't want to be involved, you don't have the right to complain later when you get what is handed to you. If you want to be involved, and they decline your offer, shame on them.

    Robert

    Robert S. Hodges, BSN, MSN, RN, CCDS
    Clinical Documentation Improvement Specialist
    Aleda E. Lutz VAMC
    Mail Code 136
    1500 Weiss Street
    Saginaw MI 48602
  • tiffany_susantiffany_susan
    edited May 2016

    In response:

    Is the value of CDI not recognized on the executive level? No, we are
    considered a necessary evil.
    Is there not the vision to recognize? If there is, let me know .. I would
    like to work there!
    Is the IT/EMR technology not there yet? It is there, it just does not have
    the support other areas have.
    Are the priorities focused on other areas -- perhaps as simple as getting
    a basic system in place first?
    What is it? Good question!


    Thank You,
    Susan Tiffany RN, CCDS
    Supervisor Clinical Documentation Program

    " You only live once, but if you do it right, once is enough!" Mae West

  • cstukenbergcstukenberg
    edited May 2016
    You realize if this was Facebook I would hit the "Like" button.

  • mdomineseymdominesey
    edited May 2016
    My health system is installing Epic in a staggered schedule. I have been aggressive in inserting myself and inviting myself to all kinds of presentations, workgroups and content discussions. I have seen where CDI is left out of the discussion in many cases, yet they all agree that CDI has much value for the enterprise. That is why I chase after all parties to be sure that CDI has a voice. CDI can help ensure that the clinical content and the order sets created for an EMR build are the most specific, highest quality, and easiest to code by having a presence at the table (I guess it also helps that I was an informatics person for 10+ years before becoming a nurse; IT language can be as obtuse and cagey as any language we encounter in our CDI work).

    Mark



    Mark N. Dominesey, RN, BSN, MBA, CCDS, CDIP
    Sr. Clinical Documentation Improvement Specialist
    Sibley Memorial Hospital

    Information Technology
    5255 Loughboro Rd NW
    Washington DC, 20016-2695

    W: 202.660.6782
    F: 202.537.4477


    http://www.sibley.org


  • gail_marinigail_marini
    edited May 2016

    You are so right and so funny!
  • robert.hodges2robert.hodges2
    I hear you Mark. Being an informatics person myself I know where you're coming from and why I also advocate involvement.

    Robert

    Robert S. Hodges, BSN, MSN, RN, CCDS
    Clinical Documentation Improvement Specialist
    Aleda E. Lutz VAMC
    Mail Code 136
    1500 Weiss Street
    Saginaw MI 48602
  • kshumpertkshumpert
    edited May 2016
    Oh, I have been involved in the EMR implementation here. I have pulled my hair out and lost sleep over it! I have built ordersets, built diagnoses folders, physician education and I am a CPOE superuser-the goal for this was because the physicians are used to me as a resource to them and I am used to providing education to them, I was on a counsel to review all ordersets as well. I am also on a team to place orders the day before go-live.

    By serving on the counsel, I have been able to correct things like the admission order that was erroneous, remove 23 hour discharge criteria from inpatient ordersets (a favorite). I fixed POA status, educated the MDs on the OIG and cloned notes-the education they receive is "click this, click that, now do this..." It is very helpful if you can have someone there that gets the "why". I built diagnoses folders that contain the top 20 (post queried) diagnoses by specialty plus the frequent tag along with...you guessed-the MCCs and CCs commonly used! I was requested to help because the hospital needed assistance to get some of the doctors involved and they knew that they participated in CDI well...then it morphed into the unexpected and uncharted for me! Lessons learned as well!!

    I have learned so much with this endeavor, however my productivity on the floors went down. I am quite certain that when the CFO gets my yearly report next week he is going to need a beta blocker or cardioversion perhaps:)

    Thanks,
    Kathy
    Kathy Shumpert, RN, CCDS

    Clinical Documentation Improvement Specialist
    Howard Regional Health System
    Office 765-864-8754
    Cell phone 765-432-3961
    Fax 765-453-8447

    When something can be read without effort, great effort has gone into its writing. ~Enrique Jardiel Poncela

  • sharon.colesharon.cole
    edited May 2016
    I was told the basic system needed to be built first. I voiced concerns to the HIM director because if they are going to prepopulate things, it needs to include correct verbiage (no Urosepsis), core measures, etc. It's worrisome because from what I understand, our Allscripts system won't interface, so I'm not even sure how the CDI team will be writing/sending queries. Guess they want to "just get something out there" then customize it to fit everyone's needs.

    Sharon Cole, RN, CCDS
    Providence Health Center
    Case Management Dept
    254.751.4256
    srcole@phn-waco.org


  • donna.kentdonna.kent
    edited May 2016
    OMG!!! I have made more noise than I can say in polite company about
    the importance of CDI being involved on the ground floor at my facility.
    As to why this should be necessary, until quite recently at my facility
    we seemed to be viewed as task doers. Not resources, not innovators,
    not anything other than employees who should be told what the plans are
    and then carry it out.

    About six or so months ago I found out that the hospital was planning a
    system wide Cerner implementation. I asked to see the CDI component.
    That seemed to be a big shock, surprise, embarrassment to all involved
    including the head of IT. They knew nothing about it. They sent me the
    questionnaire that Cerner sent out and there was not one word pertaining
    to CDI. At that point I got uncomfortably noisy-that is for senior
    leadership.

    Since then some of the approach has started to change. It is still not
    where it should be. For three years I have pushed my way into any
    meeting or group that I think needs to hear from us. They are starting
    to get the point. However, I am pretty sure I pi**ed some people off
    along the way. Oh well.

    Donna

    Donna Kent, RN, BSN, CCDS
    Manager, Clinical Documentation Integrity Program
    Clinical Quality and Accreditation
    Torrance Memorial Medical Center
    ph.:310 784-6884 fax:310 784-6899
    donna.kent@tmmc.com
  • vdavis2vdavis2
    edited May 2016
    Sharon, what CDI program do you use? We also have Allscripts... -V

    Vicki S. Davis, RN CDS
    Clinical Documentation Improvement Manager
    Health Information Management Department
    Alamance Regional Medical Center
    Office (336) 586-3765
    Ascom Mobile (336) 586-4191
    Fax (336) 538-7428
    vdavis2@armc.com

    "The difference between the right word and the almost right word is the difference between lightning and the lightning bug."- Samuel "Mark Twain" Clemens

  • sharon.colesharon.cole
    edited May 2016
    CDI is based in Case Management and so they purchased the CDI documentation system in Allscripts. Our patient records are in EPIC and last I heard from HIM director and IT, it doesn't interface. Not sure what we will be doing once we go completely live w/CPOE.

    Sharon Cole, RN, CCDS
    Providence Health Center
    Case Management Dept
    254.751.4256
    srcole@phn-waco.org


  • vdavis2vdavis2
    edited May 2016
    Sharon,

    I believe that is correct... the CDI program is very new with Allscripts... we opted not to take the CDI part but have the CM system going live tomorrow! Secure messaging is not 100% with them yet to alert the MD that he even has a query.

    We enter our queries electronically into SCM and do a signature request assigning it to the MD in their signature manager. They open the "Documentation Clarification" and answer it at the bottom. Sign it. And then it becomes one of the notes (CDS queries are part of the legal record.) I can send you some examples and screen shots if you would like them! I can print reports to see which CDS did what query, the compliance (response time) of the MD, and whether or not the query has been completed. I can also "unassign" or "reassign" them to another MD.

    Let me know if any of this would be useful to you!!! :) :)
    V

    Vicki S. Davis, RN CDS
    Clinical Documentation Improvement Manager
    Health Information Management Department
    Alamance Regional Medical Center
    Office (336) 586-3765
    Ascom Mobile (336) 586-4191
    Fax (336) 538-7428
    vdavis2@armc.com

    "The difference between the right word and the almost right word is the difference between lightning and the lightning bug."- Samuel "Mark Twain" Clemens


  • evanspx@sutterhealth.orgevanspx@sutterhealth.org
    edited May 2016
    Vicki - Can you post these to this site? I would like to see how you
    interact and perform your query via the EHR - MIDAS has some limitations
    and your methodology sounds good.


    Paul Evans, RHIA, CCS, CCS-P, CCDS

    Supervisor, Clinical Documentation Integrity, Quality Department
    California Pacific Medical Center
    2351 Clay #243
    San Francisco, CA 94115
    Cell: 415.637.9002
    Fax: 415.600.1325
    Ofc: 415.600.3739
    evanspx@sutterhealth.org
  • vdavis2vdavis2
    edited May 2016
    Paul and Sharon... Might be able to get this up by tomorrow... I will put this in on a "test" client so it is not a real pt.. I will use something standard and short just so you can get a feel for the query itself. I have to say, it works pretty well! Our Clinical Informatics Team really did a wonderful job!-V

    Vicki S. Davis, RN CDS
    Clinical Documentation Improvement Manager
    Health Information Management Department
    Alamance Regional Medical Center
    Office (336) 586-3765
    Ascom Mobile (336) 586-4191
    Fax (336) 538-7428
    vdavis2@armc.com

    "The difference between the right word and the almost right word is the difference between lightning and the lightning bug."- Samuel "Mark Twain" Clemens


  • donna.kentdonna.kent
    edited May 2016
    To answer whom ever asked the question, we use 3M CDIS. No electronic
    queries yet. It does not seem to be able to work it out! Case
    Management uses Allscripts. Again, according to IT, never the twain
    shall meet. So they can't see our DRG and GLOS.

    Donna Kent, RN, BSN, CCDS
    Manager, Clinical Documentation Integrity Program
    Clinical Quality and Accreditation
    Torrance Memorial Medical Center
    ph.:310 784-6884 fax:310 784-6899
    donna.kent@tmmc.com
  • hooter1964hooter1964
    We will be going live with Cerner may 12 2012 . I have had absolutely zero input and have yet to see it. We use 3mm cdis/encoder with paper q's left on the chart that are kept as a permanent part of the record.I have no idea what Cerner looks like or how 3mm will be built into it.
    As far as EMR and CDI I hope there are no templates built in for specificity because I will be out job.
    Is there a Complete System out there that can regurgitate out Medical Necessity or observation from initial encounter, prompt the doctor for all the specificity needed etc.? It seems like an easy task. Certainly the Interqual Criteria can be hovering in the backround as the physicians populate the required fields for the encounter . I am very new to this CDI/ Case management / observation or admission status stuff so pardon my ignorance. I admire the knowledge I have gained from all of you over the past year on this site! I have been locked away in critical care/Cath lab since 1986 and never knew what went on behind the scenes in hospitals.
  • sharon.colesharon.cole
    edited May 2016
    I've been told by several people that Allscripts is so big, they don't HAVE to interface so they won't spend the money. Not sure what that means for us since my hospital is "sold" on Allscripts.

    Sharon Cole, RN, CCDS
    Providence Health Center
    Case Management Dept
    254.751.4256
    srcole@phn-waco.org


  • cstukenbergcstukenberg
    edited May 2016
    Sounds like you and I have had very similar roles with the implementation of the EMR.

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