CDI to change and become vastly different from today – are you prepared?

Is Artificial Intelligence the alarm for CDI professionals?

What will the CDI (Clinical Documentation Integrity | Improvement) landscape look like 5 to 10 years from now? For those immersed in daily CDI work (and one does not argue the Value and Integrity), an individual might fail to see the sunrise on the horizon. A step back is required to survey the landscape of CDI, why CDI exist and need for the CDI domain.

History of CDI | UM/CM —

The CDI function grew out of the Utilization Management and the Case Management (UM/CM) functions. With the escalating and increasing cost to healthcare occurring in the 80’s and 90’s, the need for management of healthcare services – and to some extent – management of the provider, grew. In addition, CMS regularly and consistently regulates and mandates requirements for healthcare providers, with which the hospital must comply to be reimbursed thus increasing healthcare cost.

Soon hospitals realized the need and value for the medical record to support accurate and timely clinical documentation. The need for a specific skill set, to complement the UM/CM function, (ICD10Monitor) became apparent and, the CDI credential was born. AHIMA leaders recognized the need and value of CDI and was an early adopter in providing the CDI certification.

Need for CDI function —

The need for the CDI function is active and alive in hospitals as the function not only impacts overall patient Care Management but, is directly linked to Revenue Cycle and Quality Metrics Management. Accurateness and completeness in the EHR are paramount. AHIMA’s comments for CDI state, “Successful clinical documentation improvement (CDI) programs facilitate the accurate representation of a patient’s clinical status that translates into coded data. Coded data is then translated into quality reporting, physician report cards, reimbursement, public health data, and disease tracking and trending.” (https://www.ahima.org/topics/cdi ) To achieve these objectives, communication with physicians is critical and distinguishes the CDI role from other disciplines especially, UM/CM.

AHIMA’s descriptive analysis is relevant for today’s environment however, little information in the profession or academia is addressing the future of CDI and how the CDI professional can best prepare. And ICD10Monitor notes in 2017 that “CDI as a profession has an undisputable role in fulfilling its duties to impact positive change in documentation quality, recognizing that data-gathering in the form of focusing on diagnoses only is outdated.”

CDI complements UM/CM - both vulnerable

CDI future —

My ideas for CDI are different and may strike you as “too radical”, “unbelievable” and “too hard to imagine”. While I do not disagree with this logic, I find it limiting in scope and value – especially for individuals creating a career devoted exclusively to CDI.

One reason supporting my position on the future of CDI is the pervasiveness of AI (Artificial Intelligence). If (that is, if) AI is going to significantly impact healthcare, as is believed at this time, and is well documented by respected industry leaders such as, Dr Mesko, The Medical Futurist, and the World Innovation Forum, then the CDI function will become mostly a "check-list", a yes/no response, and the system (AI) will perform the function behind the scenes in the electronic medical record. The EHR system will perform a yes/no function – asking, was this attribute charted – the procedure performed and documented, the medication given, does the documentation (key words) support classifying the patient’s medical condition to a specific disease?

The system (the AI function) will know if the physical finding is charted in relation to the requirement; example – reimbursement will require documentation in a particular format. Quality metrics might require the documentation to be slightly different however, AI will determine each requirement and the physician will respond in the documentation to fulfill both requirements.

CDI function will be owned by AI

The CDI professional —

Of course, the CDI professional must ponder “how do I fit in – this AI world” and “how do I prepare” but most importantly, the CDI professional must ask, “how does one recognize if and/or when the change to the CDI function is imperative?”

This question is not easy to answer. Overall, one must stay current, locally and globally, with industry leaders – those in healthcare and those in other industries that are positioning themselves as disruptors. For instance, the partnership of Amazon, Berkshire Hathaway and JP Morgan Chase (https://havenhealthcare.com) – an entity outside of healthcare – will bring changes to healthcare impacting the delivery of care, the payer and ultimately – the individual.

One must also be current with factors affecting life on a global scale – not only healthcare but also industries undergoing rapid change. It is the technology function that can be applied to the mundane task (as is defined in AI) that will impact the daily CDI function.

Key Thought: The CDI certified professional must also stay diligent with their credentialed organization. We have seen the demise of significant certifications at AHIMA. It is a given that the CDI function will change, but we must remain alert to best application for healthcare, the EHR, the consumer and our individual career.

Share your thoughts – is CDI changing at your facility?