Leveraging the EMR to Enhance CDI · Rishi Bakshi, DO Medical Director, Clinical Documentation...

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Rishi Bakshi, DOMedical Director, Clinical Documentation Improvement

Assistant Professor, Physical Medicine and RehabilitationMichigan Medicine

Ann Arbor, MI

Leveraging the EMR to Enhance CDI

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Michigan Medicine

• 1000 beds

• Academic structure

• 20 FTE CDS

• Epic site

Photos © University of Michigan: mediabank.med.umich.edu

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Outline

• Brief introduction to structured problem solving

• EMR strategies to enhance CDI

– Focus on primary documentation

• Easy and advanced options

– Enhancements to CDS workflow

• Discussion and next steps

2017 Copyright, HCPro, an H3.Group division of Simplify Compliance LLC. All rights reserved. These materials may not be copied without written permission.

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Learning Objectives

• At the completion of this educational activity, the learner will be able to:

– Identify opportunities within progress notes and the discharge summary to improve primary documentation

– Develop EMR‐based strategies to strengthen CDI reviews

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Structured Problem Solving

• Problem identification

• Determine goals

– S.M.A.R.T.

• Understand primary causes

– Emphasis on firsthand knowledge

• Consider countermeasures

– Standardized work

– Error proofing

– Minimal disruption to workflow

• Develop operational plans/reassess

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Traditional CDI Interventions

• Provider education

• Tip cards

• Queries

• CDI specialist interaction

• Physician advisor

– Teach

– Query enforcement

Photo provided with permission by J. Billi, MD


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Why Is CDI Difficult for Providers?

• Barriers

– Knowledge that this is a problem

– Busy treating patients

– Don’t know what to document, where to do it, or how to do it

• “I’m not a coder!”

• No standardized processes

• Solutions are typically outside of provider workflow

– Results in queries

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EMR‐Based Interventions

• Streamlined, within workflow

– Epic smart tools (e.g., “dot phrases”)

– Standardized notes

– CDS clinical indicator worklists

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Malnutrition

• Dietitian

• Provider

– Types “.nutritiondx”


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Outcomes

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Documenting Coexisting Diagnoses

• Two new sections in the Discharge Navigator

• Pertinent Results and Coexisting Diagnoses were added to allow providers to easily document a patient’s comorbidities

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• Pertinent Results section displays information needed for decision support to address the Coexisting Diagnoses section


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• Pertinent Results – a closer look

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• Select Coexisting Diagnoses from within the Discharge Navigator

• Select the appropriate Patient Type – this drives the comorbidities/diagnoses options for selection

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Example: Nutrition Diagnosis and CKD

• Click the appropriate diagnosis button to select it – the selected option(s) appear highlighted in blue

• The selections made here are pulled into the discharge summary


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Use Two Sections Together for Decision Support

A. A prompting reminder is displayed when pertinent results are available

B. Use the displayed information for decision support when selecting items in the Coexisting Diagnoses section

C. Selected option

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Use Two Sections Together for Decision Support

• Example using chronic kidney disease

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• Click Close when complete. Scrolling down may be necessary to locate the Close button.


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Appearance of Coexisting Diagnoses in the Discharge Summary

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Context of Coexisting Diagnoses Within the Signed Note

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If the Patient Does Not Have Select Comorbidities


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What if the User Skips the “Coexisting Diagnoses” Section?

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Coexisting Diagnoses Tool Use

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Coexisting Diagnoses Tool Reporting

Coexisting Diagnoses Section Audit ReportFor discharges from 01/29/2017 to 02/04/2017

Discharge Service Discharge Date

MRN Name Coexist Nav Used (Yes/No)

Discharge Note Created By

Discharge Note Signed by

Surgery Trauma Orthopaedics 02/02/2017 No VADER, DARTH REN, KYLO

Surgery Trauma Orthopaedics 02/03/2017 Yes SKYWALKER, LUKE SOLO, HAN

Surgery Trauma Orthopaedics 02/03/2017 Yes COSTANZA, GEORGE SEINFELD, JERRY

Surgery Trauma Orthopaedics 02/03/2017 s Yes BURR, AARON HAMILTON, ALEXANDER

Surgery Vascular Adult 01/29/2017 Yes MADISON, JAMES JEFFERSON, THOMAS

Surgery Vascular Adult 01/30/2017 Yes BACCA, CHEW KENOBI, OBI‐WAN

Surgery Vascular Adult 01/30/2017 F Yes FLANDERS, NED SZYSLAK, MOE

Surgery Vascular Adult 01/30/2017 Yes SCHUYLER, ANGELICA SCHUYLER, PEGGY


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CC/MCC Capture

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Can We Use the EMR to Help CDS?

• Yes! We provide patient lists with query opportunity based on presence of clinical indicators.

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Cardiac Reports


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Renal Disease Reports

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Next Steps

• Consider provider, ancillary staff, and CDS workflow

• Connect with an EMR analyst

• Connect with an EMR report writer

• Don’t take “that’s not possible” for an answer

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Thank you. Questions?

In order to receive your continuing education certificate(s) for this program, you must complete the online evaluation. The link can be found in the continuing education section at the front of the program guide.


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Leveraging the EMR to Enhance CDI · Rishi Bakshi, DO Medical Director, Clinical Documentation...

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