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Medical professionals reviewing documentation on a tablet
Rethinking clinical documentation integrity.

3M CDI Innovation Webinar Series

Subscribe to upcoming webinars

3M CDI Innovation Webinar Series

Upcoming and on-demand webinars

For more than 20 years, clinical documentation integrity (CDI) experts have played a key role in the health care industry. As the industry evolves at a record pace, their work has never been more important, or more challenging. 3M is here to support that crucial work through a new 3M CDI Innovation Webinar Series.


Register for upcoming webinars and view past webinars on demand

This series offers in-depth sessions with 3M experts and clients on a wide variety of emerging CDI challenges and opportunities such as: advancing technology, shifting care settings, measuring quality, cross departmental collaboration and much more. As we address each topic, we will share how 3M can help you stay ahead of it. The live webinars include Q&A sessions and polls so you can see what your peers think. Plus, subscribers will receive links to webinar recordings, transcripts and slides so you and your team can access the content any time.

The registration links are updated to archived recording links once the webinars are complete.

Upcoming

Stay tuned for more upcoming webinars!

On-demand

  • Piedmont Healthcare: Taking the CDI game to the next level with priority and impact ROI

    October 2022

    Starting in October 2020, Piedmont’s clinical documentation integrity (CDI) team implemented 3M™ 360 Encompass™ System’s prioritization and impact ROI features. This allowed the organization to review the most impactful cases, improve documentation and simplify the reconciliation process. By July 2022, Piedmont’s CDI team began a second phase to investigate additional opportunities to improve priority worklists and refine impact ROI.

    Learn how Piedmont was able to capture an impressive 15 percent increase in impact. In addition, hear from the team that successfully enabled CDI leadership to report increased comprehensive CDI impacts to administration with individual CDI scorecards.

    Recording coming soon.
     

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    Webinar title slide

    Applying compliant guidelines and M.E.A.T. criteria for appropriate Hierarchical Condition Categories (HCC) diagnoses

    • August 2022
       
    • Applying compliant guidelines and M.E.A.T. (Monitoring, Evaluating, Assessing and Treatment) based on medical record documentation is a key requirement for supporting HCC coding. Join our panel of experts discussing the importance of applying guidelines and M.E.A.T. criteria as part of standard practices to ensure accurate documentation, quality patient care and improve data integrity.
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    Webinar title slide

    Data as a catalyst to CDI program performance and physician engagement: A four step approach

    • June 2022

      In this presentation, attendees will hear how legacy SCL Health, now the Peaks Region of Intermountain Healthcare, leveraged claims data to conduct an in-depth CDI performance reporting and analysis. Participants will learn how legacy SCL Health created a targeted strategy to engage and educate physicians in a four-step data-driven approach focused on key outcomes, early wins, expansion to all payers and increased commitment from leadership.

    • Download the handout (PDF, 2.8 MB)

  • (DESCRIPTION) A slideshow. Slide, New year, new webinar platform! A woman appears on a video call in the top left corner of the slide (SPEECH) Well hello and good afternoon and thank you for joining the first CDI innovation webinar of 2022. (DESCRIPTION) Slide, Housekeeping, a bullet point list (SPEECH) We are excited to have Tami Gomez here with us today. Before we get started, I just wanted to go ahead and go over some housekeeping items. If you were with us last year you may notice that we are using a new webinar platform. We are excited for this new enhanced user experience so before we kick things off, I just wanted to go over some of the new features and layout. There is an engagement toolbar at the bottom of your screen that you can use for the different sections of the portal. You also have the ability to move and minimize those different sections. , Because this is a web based platform there is not a dial in number to participate by phone. If you are having audio issues, please check your speaker settings, clear your cache, and refresh your browser. If you do need closed captioning, we do offer that within the live stream section that you can click on that to enable that feature. As always, we encourage questions throughout the webinar. We have a lot to get through today. So we will personally follow up after but please add all of those questions to the Q&A box below. We do provide a certificate of attendance that you can submit to obtain credits as well as the handouts for the webinar. Those can both be found in the resources section for download. If you would like to learn more about our products and solutions, you can click on the Learn More button under the slides and always, we appreciate your feedback so during the webinar, there is the ability to complete the survey in the portal or it will launch at the end of the webinar. We always appreciate your feedback. But if you do ever have a question, again, with those enhancement tools at the bottom of your screen, there is the ability to contact us. (DESCRIPTION) Slide, 3 M C D I Innovation Webinar Series, February 2022 (SPEECH) All right so before we get started, I do just want to introduce today again we have Tami Gomez as she goes over a global approach to engaging physicians and CDI operations with an AI powered CDI workflow. Tami is an a FEMA approved ICD-10 trainer and director of coding and the director of coding and CDI services at Uc Davis. Uc Davis has been named as a coding and CDI gold standard program for data analytics by Vizient and was awarded for their diversity in 2021 with Actis. And so Tami, I am going to pass things over to you so you can go ahead and get started. (DESCRIPTION) Slide, Meet our speaker. New slide, Agenda, a bullet point list. Tami appears on the video call (SPEECH) Thank you. Thanks for having me today. So today we're going to talk about how to understand or prepare tactics and how we actually leverage the 3M M Modal CDI Engage One for our impatient team. I'm going to talk about ways there is the impact of automation has on some of your key performance indicators, understanding strategies to engage our physicians, how to leverage your data and focus the work through stabilization and understanding our lessons learned in implementation. (DESCRIPTION) Slide, Why are we doing this? (SPEECH) So first we asked, why are we doing this? Leveraging technology to make CDI operations efficient, easy to manage, and partner across departments with ease, technology in many ways is really doing less with more as we are now empowered by artificial intelligence so that was really the goal here. (DESCRIPTION) Slide, Who we are, a bullet point list and a picture of a hospital (SPEECH) So it's just a little bit about who we are, Uc Davis is a 625 bed multidisciplinary academic Medical Center. We are a burn Institute and a children's hospital as well. We are in the process of building a new California tower which will add a 75 additional beds. We serve 33 counties covering about 65,000 square miles, which is an area North to the Oregon border and East of the Nevada border. We're recognized as one of the most wired hospitals in the US. We are ranked Sacramento's top hospital by US News and World report, among the nation's best in 13 medical specialties, and we've been recognized as the best hospital four years in a row in the greater Sacramento area. (DESCRIPTION) Slide, Organizational Chart: Health Information Management (Patient Revenue Cycle) (SPEECH) Just want to give you a little bit of background about the organizational chart so CDI encoding report up through the revenue cycle. There is the CFO, and then an executive director, and then I am the director over coding and CDI services but I also have a team of physician advocates and those individuals actually are physician trainers. They help with documentation integrity by building templates and smart lists and dot phrases. They have a big role in helping to ensure documentation throughout the record. There's a coding manager both on the inpatient and outpatient side, there's an outpatient CDI supervisor and inpatient CDI manager, and then we have a whole data quality integrity program as well that supports all of the analytics to drive KPIs and performance improvement. (DESCRIPTION) Slide, Homegrown auto-assignment & leveraging 3 M (SPEECH) So I'm going to start off by talking about how we were able to create a homegrown auto assignment leveraging 3M. (DESCRIPTION) Slide, Birth of Auto Assignment - No direct integration with 3 M, a list (SPEECH) The starting point to making the most of AI was how could we develop some type of automation with assigning CDI daily cases. As you know, every morning this was a very manual process for us. We would look at our admissions for that day and we'd have to manually distribute them and prioritize which ones we could review, how many people we had off, so it was a lot of manual work. It took about three to four hours to complete on a good day and on Mondays it was much worse as you can probably imagine. We had admissions from Friday, Saturday, and Sunday that we had to consider. It was our goal to fine tune this process. So as we approach going live with CDI Engage One, we also talked about how we could automate assignment for CDI. We did initial reviews, and then we looked at Tableau assignment, and that was the approach that we took. We used historical data to identify the average number of new reviews, and then we used prioritization as a form of what we would do from a hierarchical viewpoint. (DESCRIPTION) Slide, Creating the Logic: How to Start, a list (SPEECH) So how we started is we created logic. We worked with some very talented report writers who created logic where we started with the hospital service and we changed that to the hospital division. We looked back three days with logic to not duplicate. We exclude patients who are discharged so if patients been discharged they're excluded. We also excluded newborns and basically the logic looked for any baby or any newborn admission type and/or a baby girl or baby boy within their name. (DESCRIPTION) Slide, Setting Max Accounts: Eliminating Reconciliation, a table (SPEECH) So what we also did is we set the max accounts eliminating reconciliation has allowed us to assign more cases and I'll talk briefly about what we did is at Uc Davis, we had a really high coding accuracy rate. We had two independent audits done on our coding. Our coding accuracy rates are around 99.96% and I really felt that the time spent trying to determine why there was a DRG mismatch wasn't the best and that there could be a better process in place. And so we eliminated the DRG reconciliation process for the CDIs on the front end. They're not doing any DRG reconciliation but I do have a back end reviewer that takes a look at all the DRG mismatches every day and provides individual feedback with any references, whether it's a coding clinic or if it's something that was documented after their last review and provides a daily feedback to that staff which enabled them to spend about 33% more of their day doing clinical reviews concurrent. What we did is we looked at each day of the week and we decided how we wanted to create the logic to assign cases and this has been tweaked multiple times. So you may start out with saying OK, on a Monday, if we have one person on PTO we're going to assign 10 cases to every CDI but if we don't have anybody out on PTO maybe we'll do 11. So we programmed when there were holidays into the system. We've connected this to an actual Team's calendar where employees put in their time off so the logic recognizes when somebody is off and it doesn't assign a case to them. If we have two or more people out on a Monday than 11 get signed and then so on and so on. You get the gist, Tuesdays 8 and then Wednesday through Friday is 7, and if we have people working on the weekends it's 7. However, we've decided to tweak these numbers a bit and so on Monday it's 11 or 12 depending upon the circumstances. On Tuesday it's 8 or nine depending on the circumstances, and then Wednesday through Friday it's 8 to 7 depending on the circumstances. (DESCRIPTION) Slide, One-Size will not work, Program Flexibility and Triggers are key, a list (SPEECH) So one size fits all will not work. You have to be flexible and triggers are the key. We created a database to check schedules, check when there's holidays or when staff is off, and so we created all of these checkpoints to make sure that the system recognized and the logic created when not to assign a case. (DESCRIPTION) Slide, Auto-assignment & concurrent reviews: Prioritization, a bullet point list (SPEECH) So auto-assignment and concurrent reviews and the prioritization within CDI Engage One made this a little bit easier. So I'll go over that. Our challenge with auto assignment was managing concurrent reviews and organizing our current reviews. The good news is that we had 3M with the key prioritization factor to assist with managing concurrent patients. And so what we did is we customized that prioritization list to look at all accounts that had just a single CC or a single MCC. We Were looking at all mortalities, we're looking at accounts with pending queries, those are reviewed daily. We're looking at malnutrition cases because there's an organizational goal associated with that, we're looking at certain sepsis cases because of the high clinical validation denial rates that we're starting to see. This has been an ongoing and prioritization will be ongoing as our KPIs organizationally change. So digging deeper and prioritizing accounts to maintain a total of 20-40 total reviews per week right now. Our CDIs have anywhere between 36-40, not to exceed 40 total cases that they're reviewing, that includes initial and re-reviews. We also said we don't want priority, we want to remove cases from the priority list if they have two CCs or two MCCs, if they're optimized fully from the SOI and ROM perspective, and then so on. So you can really kind of customize that prioritization list to your needs and your organizational challenges and make changes to align with what you need. (DESCRIPTION) Slide, Leveraging 3 M: Concurrent review prioritization, a list (SPEECH) The current review prioritization so priority scoring four concurrent reviews can provide and assist see opportunity. So anytime there is a PSI it falls on that priority list. Medical or surgical cases without a CC or an MCC, if there's a symptom diagnosis that's driving the DRG, and then the 3M prioritization and scoring so we also can set that customize that scoring as well. If we want to focus on and make certain things a priority, we can do that organizationally. (DESCRIPTION) Slide, Scoring & Priority Factors, a screenshot (SPEECH) This is just a screenshot of scoring and the priority factors, just wanted to share that with you. It's kind of a lot on this slide so I won't go into it but we've created some customization around this so that we can make privatization effective for what our organizational needs are. (DESCRIPTION) Slide, C D I Teams: Prioritizing concurrent reviews, a screenshot (SPEECH) And this is kind of just another snapshot of the CDI Team's prioritization concurrent reviews and how they look on the screen. (DESCRIPTION) Slide, C D I: Evidence sheets - heavy lifting by tool, a screenshot (SPEECH) We also have evidence sheets as part of the CDI Engage One tool so it does a lot of the heavy lifting actually. So what this does is it alerts the CDI if there's a potential query opportunity. In some cases, this may be something your CDI already has on their radar and they're following and so it's just confirmation that they're on the right track. And sometimes it may be something that they had overlooked or missed, and this is popping up to let them know that they should either keep it on the radar and follow it or that there's a query opportunity. So we use the evidence sheets as well. (DESCRIPTION) Slide, Other incentives I P C D I evidence sheets provide, two screenshots (SPEECH) There's other incentives in inpatient CDI evidence sheets that are provided as well and this is what that looks like. So this is just another screenshot of what the evidence sheets and prioritization look like together. (DESCRIPTION) Slide, F Y 2021: Auto Assignment Data. A bar graph comparing 2020 and 2021 shows the numbers for 2021 higher in all categories (SPEECH) We also did a comparison from fiscal year 2021 and you can kind of see the impact we had as we changed to auto assignment and how many more cases we were able to get to when we compare 2020 to 2021. So this is just a slide to show by eliminating your DRG mismatch and then also using your prioritization tools, and auto assigning, and evidence sheets, all of that automation can help with increasing the number of reviews and the number of cases that your team can touch. (DESCRIPTION) Slide, Query Rate: 2020 Compared to 2021, a line graph (SPEECH) This is also a query rate comparing 2020 to 2021 so our query rates also went up as well. So what we did is we used the CDI Engage One evidence sheets, we turned on the auto assignment, and we also used our data to drive some of our improvement metrics to continue to tweak and refine on some of the processes that we put in place. Again, that's going to be ongoing. I think no matter what you're doing there's always going to be an opportunity to continue to enhance and improve on automation or processes that you've put in place or how you prioritize your reviews. (DESCRIPTION) Slide, K P I Improvement Journey: Coding and Clinical Documentation Integrity (SPEECH) I'm going to go over a little bit of our key performance improvement and the journey we had with seeing improvement. (DESCRIPTION) Slide, What we did to improve K P I's, a bullet point list (SPEECH) So what we did to improve our KPIs are we expanded our CDI program, we discontinue the reconciliation process, which I've mentioned, we perform ongoing audits both on the coding and the CDI program, we establish back end reviews and controls to ensure integrity. We've invested in technology, the CAPD, the HCC Management, CDI Engage One which includes those prioritization tools. And we do data analysis, we're big on data. And we've done a lot of work around decreasing one day stays. We found that as an organization, we were an outlier in that area and it did create some opportunities. And then template builds, utilizations of dot phrases, smart lists, et cetera. (DESCRIPTION) Slide, bullet point list continued (SPEECH) Physician buy-in also and education was key. We also had to designate physician champions both on the inpatient and the outpatient side of the house for CDI. We aligned with our physician advisors, our case management team, our quality and safety, our patient financial services, population health, and then we customized data and did an analysis that was actionable for various service lines. So we leverage data to analytics to drive improvement in documentation and operationally. (DESCRIPTION) Slide, Case management and leveraging 3 M, a screenshot (SPEECH) This next couple of slides will show some of what we've done with case management. If you're familiar with the working DRG, we basically send all cases over to case management via an interface when there is a working DRG assigned by the CDI so that they have that geometric mean length of stay to help improve our outcomes with hospital length of stay. But we also realize that, hey, they're not touching 100% of every case and what could we do to get them a working DRG on every case. Well, there is also an auto suggested DRG. So if the CDI doesn't touch the case, the CAC will come in, review the record, auto assign an MS DRG and that will also interface over to the case management team so they have that geometric mean length of stay. We did basically educate them on the fact that this is not a human being touching this, this is all AI, and that things could change by discharging. So they understand that this is just a preliminary look based on documentation in the record but it has really helped that team understand the geometric mean length of stay and how our patients should be managed in terms of trying to find or discharge them timely. (DESCRIPTION) Slide, Epic View, a screenshot (SPEECH) This is just a view of where they can see that in Epic, so again, there's an interface that goes out of 3M into our EHR and that's where they find that information in the chart. (DESCRIPTION) Slide, Case Mix Index, a line graph and two bar graphs. All three graphs show a steady increase over time (SPEECH) So this is just a snapshot of case mix index. While case mix index isn't a great indicator of CDI work, it is something that we have tracked as a KPI for CDI because we do have some impact, especially when we talk about capturing CCs and MCCs to drive that case mix up but you can see right around here is where we implemented our artificial intelligence. And you can see the impact it's had both on our adult population and our pediatric population. (DESCRIPTION) Slide, C C slash M C C Capture rates, two line graphs, two bar graphs, and a scatter plot. All graphs show a steady increase over time (SPEECH) Now while I just mentioned CMI is not always a great indicator for CDI as far as a key performance indicator, in my humble opinion CC MCC capture rates are. And as you can see here, same trend is happening with our adult case mix index or with our adult CC and MCC capture, and our pediatric CC MCC capture. Not only that, but when you come over here on this slide here to the right, you can see the trend from fiscal year 2020 to fiscal year 2021. And you can see over here where it says AMC distribution, basically these gray dots are all academic medical centers and where they fall with regard to their CC and MCC capture rate. And we're this dark blue dot here, so we're technically in the top 10% of all academic medical centers within our benchmark group, and there's 180 or so academic medical centers. And this tells me this is really a direct reflection of CDI work. In fact, I can take this data and I can quantify using some of the data that we have within 3M to show that the CC or the MCC was a direct reflection of either querying, or CAPD, or one of the metrics that we're actually using to touch cases. (DESCRIPTION) Slide, Strategies to engage physicians. New slide, Phase 1: Kicking Off the Project (Initiation of Partnerships), a bullet point list (SPEECH) The next couple of slides will be strategies on how to engage your physicians. It's not always easy kicking off the project, we really had a large group of individuals. We partnered with our system administrator, our service line medical directors, and our physicians, they're obviously key. So depending on your environment, we partnered with attending physicians to meet and kick off the project, and began to establish partnership with clinic managers and physician specialties to leverage physician connections with medical assistance and nursing teams as well. This does work virtually if executed correctly because we had to do it due to COVID so I can say without a doubt that it can be done. Again, when presenting keep it to 15 minutes and always be ready to do a demo that works perfectly. So when we were meeting with them to talk about CAPD, and why it's important, and why we are rolling this product out, there was a lot of questions about why are we doing this? This is one more thing that we have to do and really the education was focused on CAPD captured important and leveraging any data available, RAF scores, MIPS, risk adjustment. So we talked about how this product actually engages with the physician real time at the point of care. Instead of receiving a query two or three days later, this really is something that will ping you real time for you to enhance your documentation. And so you've got to keep at it, you're going to get physicians who are going to be naysayers honestly or are just not interested in hearing what you have to say. And so what we tried to do is get some champions behind us, get physicians to see the importance behind this product, and we kept at it. We kept customizing, and tweaking, and turning things on and off, and doing what we can to make this as meaningful as possible for them because if it's not meaningful for the providers, they're not going to engage with it. My one takeaway here is it was not immediately accepted or physicians weren't readily receptive to this but we kept at it we kept working with them, we kept enhancing things, we kept customizing things, and that's where we really got physician buy-in and engagement. (DESCRIPTION) Slide, Phase 2: How to Engage Physicians (Resources), a bullet point list (SPEECH) Resources are essential. So tools for physicians, tip sheets, videos, we actually sent out a video, we actually have an EMR newsletter and we sent out some information on that. So wherever we could create tools or ways or enhancements we did. Again, we kept it to five minutes. Our last video was eight minutes when we recently launched HCC Engage with our providers and the feedback was it was too long and so we condensed it. Focus on showing physicians how to answer and engage with the tool in these videos. And then your physician, you need to have educators and trainers and people that can be shoulder to shoulder with the providers if they have questions, that can train them how to use this, or walk them through every little nuance. It may be something like, how do I dock this and get it out of the way, while I'm doing my charting. And so that that's what we did is we made sure that we had somebody available for these physicians whenever they had a question or a concern. (DESCRIPTION) Slide, Phase 3: Continuous Partnership, a bullet point list (SPEECH) Again, continuing to partner. We believe in continuing partnerships with key stakeholders to leverage technology to ensure successes. We identify key stakeholders and design workflows for automation and we leverage data to facilitate engagement. Using data, going through meaning behind the nudge, and inviting physicians to the table has been extremely helpful. So when you're creating a knowledge, especially a custom nudge with the CAPD, you want to look at that clinical content to make sure that the nudges firing and it's meaningful to the providers. For example, there was some ad hoc out of the box nudges within the content guide that 3M provided, one of them was on sodium and hyponatremia and it fired when there was just one abnormal lab value and our physicians said no, we don't want that. This is what we want. We want there to be two abnormal lab findings and we also want to know this, this, and this. And so what we did is we worked with the content team at 3M. And we said we'd like to revise the current nudge that you have on hyponatremia and we want to customize it to something that is a little more meaningful to our physicians. And getting their buy-in on all of that, especially on the pediatric and the children's hospital and different things like that has really been key. So having a physician that's willing to go over the clinical content that's going to fire that nudge will be key for your organization. Again, I can't stress it enough, be flexible. Data may change, workflows will change but keep working this, the plan, and keep on making this something that is meaningful for the providers. How can we help? How can we change things? What would make this better? And getting that feedback and making those tangible changes will have impact. (DESCRIPTION) Slide, C A P D (Computer Assisted Provider slash Physician documentation) (SPEECH) So data focus and insights on rollout with physicians, so I'll go over some of that on the next slide. (DESCRIPTION) Slide, Define C A P D focus and nudge definition: Ongoing, a bullet point list (SPEECH) So focus on clinical conditions and the procedures turned on. Define what a nudge means to your provider, your community, a clinician diagnosis procedure that has clinical evidence and a physician message. Always review the data and always provide an overview of all nudges. The rule, and physician message, and then the customization as I talked about, that is really the key for us, especially with the children's hospital. There is not a whole lot of clinical content in the clinical content guide that 3M offers on the pediatric side of the house and so we really have been successful with customizing those nudges to make them meaningful for that population of patients. (DESCRIPTION) Slide, C A P D - The Why on Streamlining Physician Engagement, a list of goals (SPEECH) So the why on streamlining physician engagement. So physician documentation, guidance using evidence based clinical definitions, having a virtual conversation, to add the critical details that impact treatment and outcomes, engaging physicians at the point of care to reduce queries, and then overall quality improvement in patient care outcomes. That's your clinical decision arm really so those were the goals. But also engaging physicians at the point of care to reduce queries, what we found is that by turning on some of these nudges which are things like CHF acuity, or acute blood loss anemia, are things that physicians have been queried on routinely at our organization and have done a really good job at addressing. And so we don't have a whole lot of opportunity there. But what we found was that there was opportunity with certain things, we ran a lot of data, we looked at what our number one query was organizationally, and by service line, and got really granular, and we were very specific and deliberate about what we turned on and where we turned it on and for who. (DESCRIPTION) Slide, What is required for a nudge to fire? (Repeat slash Rewind), a picture of a fire in a fireplace (SPEECH) And then using the data that we have has really, really, really been key so that we can go back to providers and say, here is your capture rate on this diagnosis for this patient population, and here are the rest of your peers within an academic medical setting that are capturing this. And when they can see a tangible like, hey, I'm only capturing this diagnosis 5% of the time compared to my peers who are capturing 25% at a time, they're very engaged and interested in what they can do to be better at documenting this specific condition or whatever it might be. (DESCRIPTION) Slide, A Nudge Requires, a bullet point list (SPEECH) So this next slide will be basically what's required for a nudge to fire and then you really just kind of going to be on a repeat and rewind from here on out. So a nudge requires one specific criteria, a rule that points to a clinical evidence or documentation. So here's the rule, clinical evidence and documentation, we want the tool to reason over before firing. For example, clinical note says sodium is 128. The program fires this nudge for clinical diagnoses as it relates to clinical evidence. Evidence of hyponatremia, sodium level, with explicit mention of and/or physician mention or a physician message will populate in the fluency direct pill and that's part of the CAPD. And it will say something like, we have identified electrolyte imbalances, if appropriate please document the associated diagnosis. The diagnosis is hyponatremia. A clinician can replace the sodium. There really is, again, a content guide that's provided to you out of the gate from 3M and you'll have to take a look at that clinical content to see if it's actually something that you would query a provider on. And if it's not, you're going to want to tweak it and customize it to your organizational needs. (DESCRIPTION) Slide, July 2021 C A P D Data: Top 4 clinical conditions reviewed for accuracy and review. Data source: 3 M C A P D utilization reports. New slide, line graphs for five conditions (SPEECH) So this next is just a data source. This is where we're at today with the Uc Davis CAPD utilization. And I just looked at the top five nudges that we have turned on, which is diabetes, respiratory failure, a-fib, kidney disease, and cardiovascular congenital conditions. So you can see the overall compliance rate for those right now is 77% but mind you when we first went live, we were in the 25%, 30%, and so this is significant improvement in less than a year and I think if you stick to the program, you'll start to see compliance rates up there in the 80% to 90% which is where you ideally would like to be. (DESCRIPTION) Slide, a table showing diagnosis, rule, message, and evidence (SPEECH) This is just a snapshot of what the nudge rule looks like. So anemia specificity, you're going to look for the clinical diagnosis, you're going to look for the clinical rule, what the physician message looks like. We updated this for surgery because it would show up as a blood disorder and so the physicians were kind of confused about, what do you want from me? A blood disorder could mean something like pancytopenia, it can mean something like leukemia, so what is it that you want from me? So we worked to address that issue and created a custom nudge that actually said anemia. So you can see same thing for hyponatremia, acute respiratory failure, and what's actually being used in terms of the clinical rule physician message and the supporting evidence. And these are all things that can be customized. If it's not applicable to you, the content guide that's being offered to you through the vendor 3M, you can customize those which is, again, key for us because we found a lot of things that really made a difference for us when we customize them and that's where we started to see more compliant rates. (DESCRIPTION) Slide, an excerpt from the table for Heart Failure Specificity (SPEECH) This is just another snapshot of what heart failure looks like, the clinical rule, the physician message, and some of the supporting clinical evidence for the nudge to fire. (DESCRIPTION) Slide, Lessons Learned, a hierarchical data tree (SPEECH) When we talk about lessons learned, I think I've gone over some of those already. But focus on which physician groups you want to start with. We were very deliberate about that, we actually piloted a group of physicians. We had one surgeon, we have one pediatric physician, we had a hospitalist, and I think we had maybe a specialty physician as well. And we looked at all of the data that we had on our current queries and the percentage of queries we were sending, and what the top queries were, and we turned those nudges on. And we piloted it and we got a lot of feedback, and we got a lot of information that we were able to take back and improve things, and tweak things, and customize things. And before we went live, we made sure that we had all of those things, and all of that feedback was taken into consideration to improve outcomes. CAPD can work but be patient and don't give up. I mean, that was our thing as we have about 3,000 physicians turned on now. And of those 3,000, I think five were absolutely adamant that they wanted it turned off. They were great documenters already, they didn't feel they needed this, it was just one more thing that they didn't want to deal with. And so we think that's successful in our eyes. We worked with them to try to convince them about the value of this tool but at no avail so I think you have to really work with physicians and make this meaningful to them and customize it to their needs. Always acknowledge a physician when they're providing feedback, especially if they're complaining. What I like to do is say, hey, all your points are valid, what can I do to make this better? How can I help you document better? What can we do? And then we take their feedback and we work with them individually. I think when they are involved or feel like they have a voice, there are a lot more open to working with you and to engaging with the tools. (DESCRIPTION) Slide, a screenshot of a diagnostic form (SPEECH) Again, customization, know the documentation, keep things in perspective. Remember this is a computer but you can make it work. Again, customization for us, I can't say it enough, has been key. We're going to continue to customize, we are just basically scratching the surface with customization and I think we're at a point in time where we can be very deliberate and very meaningful about what we turn on or providers to ensure engagement continues to go up and the product continues to be meaningful and we continue to see impact on our overall key performance indicators. And I think that is my last slide. (DESCRIPTION) Slide, Q & A (SPEECH) It is thank you so much, Tami. The information is just incredible and what your team was able to stand up. We do have a couple questions that I think would be maybe good for you to address. We do have a little bit of extra time, just want to be cognizant of the time for everyone but the first one, thank you Deanne, who said that they really enjoyed your presentation and then also asked, is there any work you have done on the day one stays? Yes. For the one day stays, excuse me I flip-flop that. Yeah, so I'm glad you asked that question. So as you know, CDIs really can't even sometimes get to the one day stays and so we've excluded them from the reviews that are being done by the CDI team but what we did is we went to leadership and we acknowledge that when we ran data we found that we were an outlier for one day stays in terms of the percentage of patients that were here one day and went home and were counted as an inpatient admission, we were an outlier compared to our peers. And so I think it was 25% of our patients were here one day. We noted that it diluted our case mix index and diluted our CC MCC capture. It diluted our mortality and it artificially inflated our length of stay metrics. And so we went to leadership and said, it also impacts throughput, we took these numbers to our case management team and said, could they be better served in an observation status or an outpatient bed to determine appropriateness of admissions? And the other thing we said is, we can't get to them from a CDI perspective to try to optimize them. And so we took a different approach with how we were going to address one day stays and we ran data on the top DRGs for the one day stays both on peds and adults. We found on peds it was asthma and we found that there was a best practice at NYU where they created a clinical pathway in the Ed for pediatric patients and observed them at 2, 4, and 6 hours and if they had improved after six hours they were put in observation and if hadn't they were admitted. And then we found on the adult population it was something like gastroenteritis and seizures and we'd created a similar clinical pathway for those. And so the CDI team really took that information back to the clinical teams and said, here's what it looks like. Here's your top DRGs, could there be something like NYU did here at Uc Davis. And what we saw was immediately a correlation between an increase in CC MCC capture and an increase in our CMI as well as our mortality metrics. So we don't look at one day stays because the documentation, there's a delay, obviously with physicians getting documentation on the record and there's not a whole lot a whole lot of opportunity for the CDI to review them. And as you know, it's almost meaningless to review the case on day one without that documentation in there and then if they go home the next day. So that was the approach we took was operationally, could these patients be removed from our review process and from the observed outcomes and what could we do better organizationally? I hope that answered your question. Yes, absolutely. And we do have a bunch actually coming in that kind of stirred some questions so we will get to a few more here. How many nudges do you have active for each service line and how did you select which nudges to turn on? So we were very deliberate about that, again, we pulled data. So for example we pulled the hospitalist group data and looked at the top five queries for that group. And then we turned on. We were very specific about not turning on a ton of nudges, we were very deliberate about making sure that it was meaningful. So about five to seven per service line and it was driven off of the data we pulled to see which nudges were already or which queries we had already been sending from a CDI perspective. But I would urge everybody to keep it to no more than seven be deliberate about how you turn them on. So look at your current data, look at your current query patterns, look at your service lines. There are things that aren't going to be meaningful to surgeons that are meaningful to hospitalists and so that's how I would approach it. Fantastic. Before we get to the next one, I just want to answer one question quickly from Jessica who asked if CDI Engage One is available and it is. And so if you would like someone from our team to contact you, in that middle button in the portal, if you click on that, that will take you to a form to complete and we can follow up with you to talk about it. Let's go ahead if we do have time for a couple more. How will this process evolve to help with prior authorization and denials? So I think I'm not sure yet, but I do believe that there is an opportunity for us to work with making sure that we get the documentation on the record, especially with sepsis, specifically that core criteria that we're seeing denials on now. My goal is to eventually try to use this in a way where we can get documentation on the record to demonstrate medical necessity and also the clinical evidence to avoid some of those clinical validation denials that we're seeing now for things like sepsis and malnutrition. Great. We have a question that said how long after admit do you do your first review? So initial reviews are done two to three days after the admission. And then our re-reviews are done every two to three days as well, depending upon the complexity of the case and what it is they're looking at. So we give our CDI a choice. So yes, that's our current state. All right. I think this kind of goes along with it, how long should a chart be on hold for a query reply? So we have processes in place where we have query escalation. So after 48 hours, concurrently if CDI has sent a query and there's not an answer within 48 hours and the patient's still in the house, there's a query escalation process where we escalate to our physician advisors through a portal we created on Microsoft Teams. If it's a retrospective query and it's something that's being held for a CC or an MCC or procedures that will drive your DRG or change your DRG, we hold up to 10 days retrospectively only in the events where it's maybe a portable outcome for quality like I said or a procedure question. But we typically don't ever have to hold for 10 days, I will say our physicians are pretty good at getting back to us within 72 hours, retrospectively anyway. Perfect. With the nudges, how often do you evaluate the response improvement to documentation and adjust nudges to continue to target the top diagnosis? So we look at this monthly. Yeah. Wow, that's a lot. And probably a lot of work for your team. Rhonda asked, we cannot lead to a diagnosis and a query, isn't providing a diagnosis in a nudge leading in our nudges visible to others and a part of the permanent record? So we don't lead either so that's the rules that we were talking about. There must be that clinical evidence, that risk factors in that treatment, and you build the nudge to make sure that it has those things in place so that you don't lead. And what it does is it tells the provider that there is a diagnosis based on this treatment, this lab value, this X-ray finding, whatever it might be and they document that in the record. And so we're very careful about not leading the providers and having that clinical evidence to ensure the accuracy and not leading. So we are compliant with that. This is a product that only will nudge when there is clinical evidence risk factors and treatment that exist. And that's one of the things I was talking about, is sometimes the clinical evidence may be just one nudge and I wasn't-- I'm sorry, one abnormal lab finding like the sodium that we talked about earlier. And in my opinion, that could be dilution from surgery or that could be something completely unrelated to a true diagnosis of hyponatremia. So we weren't comfortable turning that on and we made deliberate changes to the clinical evidence for this to fire. So it will require some work on your end to make sure that you are not leading the provider. So our queries are a permanent part of the record, our nudges fire for the physicians basically, and they see it as they're firing and they documented in the record. Fantastic. Well, what I'm going to do is we do have a couple more questions that we will follow up with after. And so Tami I do want to thank you for your time today. (DESCRIPTION) Slide, That's a wrap! (SPEECH) We've had a lot of comments even just within just to say how great the information was and how great the presentation was so we greatly thank you for that. Just a reminder to attendees today, the certificate of attendance can be downloaded. If you do want to submit that for credits to an association you can to obtain CEUs, and we did provide the handout in the resources section, those are both there. If you are interested in learning more about the CDI Engage One, excuse me, that was discussed today, you can click that button in the middle and let us know and we'll follow up with you. The archive of this recording will be on our website in the next couple of weeks. So if you do want to go back and listen, you can. And lastly, we will be here again. And we're doing these every other month and I can't believe that it's already almost March so in April we will be back with another CDI innovation webinar so be on the lookout to register. And we appreciate your feedback so please complete that survey at the end. And so again, Tami, cannot thank you enough for your time today and so we welcome you back anytime. So have a great rest of the day and to everybody else that joined we thank you.

    Webinar title slide

    Leveraging technology to engage physicians and improve CDI operations with AI-powered CDI

    • February 2022

      UC Davis Director of Coding and CDI Services Tami Gomez and her team have a mission: Build a gold-standard CDI program, with streamlined workflows that allow physicians to focus on patient-centered care. To support this goal, UC Davis implemented 3M’s advanced AI and NLU technologies, automatically embedding clinical intelligence into normal physician and CDI workflows.

      Join Tami for an inside look at UC Davis’ operations and transformation strategy. You’ll learn how the team laid the groundwork for new technology, how they’re using automation to drive key performance indicators, and how they approach physician engagement. Tami will also cover lessons learned to date, along with how the organization is using data to continually improve and optimize.

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