hyperlinks in queries?

katysuegood@gmail.comkatysuegood@gmail.com
in CDI Talk Archive
One of our new CDS’ had what I consider to be a fabulous Idea. I want to run it by you all to see if you think there are issues with it from a RAC/Audit standpoint or if anyone is already doing this.

We were discussing the need to put education in the queries for specific dx (ex: malnutrition staging) and she suggested we put a hyperlink in the query (they are electronic) so that the Dr. could just click on the link for more information.

This sounds wonderful as it would allow the MD to quickly access information without us inserting it into the query, making the query long, wordy, etc (we have received complaints about this). It also would help eliminate the issue of coming to agreement with medical staff about definitions as such as we could just link to a trusted source chosen by the hospital (I am thinking we would generally use UpToDate).

One of my concerns is whether this would cause any issues when charts were requested by auditors because the info would no longer be in the query. What do you think?

I’d love any thoughts.

Thanks!

Katy Good, RN, BSN, CCDS, CCS
Clinical Documentation Program Coordinator
AHIMA Approved ICD-10CM/PCS Trainer
Flagstaff Medical Center
Kathryn.Good@nahealth.com
Cell: 928.814.9404

Comments

  • katysuegood@gmail.comkatysuegood@gmail.com
    edited May 2016
    It’s hard. Some want the info others complain that the queries are long and that they have to “scroll” to get to the check boxes (yes, this was a recent complaint ☺). So while many will not click on it, some might.

    Great idea for RAC. I think both those would be easy and would make sense in the event of an audit.

    Thanks for the feedback!

    Katy Good, RN, BSN, CCDS, CCS
    Clinical Documentation Program Coordinator
    AHIMA Approved ICD-10CM/PCS Trainer
    Flagstaff Medical Center
    Kathryn.Good@nahealth.com
    Cell: 928.814.9404

  • vdavis2vdavis2
    edited May 2016
    I do like the idea of using a hyperlink as a reference in certain situations. It seems that no matter how easy we make it for the physicians; we still see the most benefit from one-on-one interactions. The physicians are able to comprehend “why” clarification was needed when we approach him/her individually.

    Here are my thoughts regarding compliance/audit defense related to using a hyperlink:


    · I would not use the link to provide “education” on conditions that specifically increase the DRG. The physician may be insulted that you attached clinical information regarding toenail fungus, even if your query is in regards to a toenail fungus. The physician should know the basics, right?



    · In order to make sure your query did not appear to lead the physician, you would have to provide a link for every possible condition that could be an option.

    Example: I would not attach an article specifically about Sepsis, if my query related to the clinical significance of positive blood cultures, fever, and tachycardia.


    · I would only use a hyperlink to provide supportive material for query rationale.



    Example: Attach a coding guideline or a coding clinic that supports the need to ask for clarification


    · I would also think a link could be used in cases that require further specificity for a documented condition.



    Example: Stage of CKD

    I would love to see a hyperlink in our query, that when clicked would allow the physician to make the clarification right on his/her progress note. The answer would then live in the physician’s note, which would increase the likelihood that the condition would be addressed by all providers.

    Dreams…. One day… J-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

  • katysuegood@gmail.comkatysuegood@gmail.com
    edited May 2016
    Good thoughts Vicki,
    I was primarily thinking about situation where we are looking for additional specificity like staging of CKD or malnutrition.

    I agree about your idea to make it ‘live’ in the progress notes. We can dream…. ☺

    Katy Good, RN, BSN, CCDS, CCS
    Clinical Documentation Program Coordinator
    AHIMA Approved ICD-10CM/PCS Trainer
    Flagstaff Medical Center
    Kathryn.Good@nahealth.com
    Cell: 928.814.9404

  • vdavis2vdavis2
    edited May 2016
    Katy,

    I wish our doc’s would just agree on the “stages” of malnutrition so we could add a link to the information!!!!

    We need an app that does all of this for us!

    ;P-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

  • katysuegood@gmail.comkatysuegood@gmail.com
    edited May 2016
    We just refer them to the dieticians staging information. It changed recently so we’ve been passing out cards with the info but it would be way simpler to have it in the query.

    Katy Good, RN, BSN, CCDS, CCS
    Clinical Documentation Program Coordinator
    AHIMA Approved ICD-10CM/PCS Trainer
    Flagstaff Medical Center
    Kathryn.Good@nahealth.com
    Cell: 928.814.9404

  • Unknown
    edited May 2016
    I would like to hear what others are doing also. I am currently working on this idea as we have started our own web page for CDI and want to provide a link in the query to the education on the web page but are having problems with the link. I think the issue could be the firewall on the electronic medical record where our query resides. Any suggestions would be greatly appreciated!

    Linda Haynes, RHIT, CCDS | Manager, Clinical Documentation Improvement | Legacy Health
    1919 NW Lovejoy | Portland, Oregon 97209 | 503-415-5609 | lhaynes@lhs.org


  • terrierprideterrierpride
    I think this is a fantastic idea as well! I know our system has an electronic reference system that the providers access for their use. I wonder if it would be more feasible to link the query that system if it's available. Ours resides on our Intranet and I'd think that would be more secure and easier to link through the EMR. I'm just thinking out loud since we're still doing paper queries but I love the direction this could go. Especially a link to Coding Clinic or the Coding Guidelines.

    Kevin O'Neil, RHIT
  • katysuegood@gmail.comkatysuegood@gmail.com
    edited May 2016
    We haven’t made it this far. We are asking IT about it next week.

    Katy Good, RN, BSN, CCDS, CCS
    Clinical Documentation Program Coordinator
    AHIMA Approved ICD-10CM/PCS Trainer
    Flagstaff Medical Center
    Kathryn.Good@nahealth.com
    Cell: 928.814.9404


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