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Does Mobile Health Affect Clinical Documentation Improvement?

By Vera Gruessner

- As the healthcare industry continues to expand its use of technologies, more healthcare providers are able to connect with patients remotely and utilize mobile health strategies to support clinical documentation. Telemedicine is one method that Swedish Health Services, which spans five hospitals, used to connect clinicians to their patient base regardless of where either one is located.

Clinical Documentation Improvement

“We have a huge telehealth program within Swedish Health Services, specifically our Neuroscience Institute,” Jennifer Woodworth, Director of Clinical Documentation Integrity Program at Swedish Health Services, told

“They have telehealth all through the states of Washington and Alaska. Our Neuroscience Institute has been a huge asset in the management of stroke and neuro conditions within the state of Washington. We also have an eICU where we have electronic ICU monitoring systems. We have a physician and a nurse that sit and look into all the different ICU campuses and be that second and third eye. That’s rather unique.”

When asked about any mobile tools that physicians at Swedish Health Services use for clinical documentation, Woodworth answered, “I know that there are some apps. We have different apps for ICD-10. I think what physicians want are tools right at their fingertips and they want to click with their mouse. We have our eyes on anything that would be a helpful resource. We utilize systems with capabilities like pulling up smart lists and smart phrases. We’re building ICD-10 terminology into the system for physicians to have at their fingertips as well.”

In addition to mobile health tools, remote monitoring, and telehealth applications, Woodworth discussed an analytics suite that allowed the medical entity better track clinical documentation improvement throughout the five hospital systems.

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“My background is cardiothoracic ICU for thirteen years and in 2006, I transitioned to a CDI (clinical documentation improvement) position,” Woodworth explained. “We know what drives best practice, which is clinical data. Clinical data comes from codes, which comes from physician clinical documentation. The CDI program is the perfect place to get that data and bring it forward to providers who can affect best practices.”

“When we started using the new analytics system from Nuance and Jvion, we were able to start putting different metrics together and start pulling up data at a physician level and do comparative analysis between physicians within similar specialties. Within the same specialty, we can look at the CMI case index. We can look at physician CMI profiles against national benchmarks.”

“When we want to look at our most high-risk specialties for ICD-10 like gastrointestinal, we can go into our analytics database and pull up GI physicians with the highest volume. We can then look at the different CMI case indexes between different providers and see who looks like they’re treating the sickest patients,” she continued. “Then we can pull a case sample of their patients and see if there are any opportunities that have been missed. If the opportunities are going to be in effect with ICD-10 that could help develop a risk model for high-volume specialties like GI. To be able to look at the data and answer questions, that’s the only way that one’s CDI program can continue moving into the future.”

“There is plenty of focus on hospital initiatives around quality patient safety indicators. We need that data now. We don’t want to look at data that’s six months old or a year old,” she mentioned. “When you bring data to physicians that is accurately coded, they do listen. It’s not just about revenue reimbursement anymore. It’s about the quality like hospital readmissions.”

Woodworth spoke about doctors in their cardiology department noticing many readmissions. The physicians were concerned about potential coding problems.

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“When metrics don’t look ‘green,’ providers go to coded data and think the coding was wrong,” she explained. “There’s a misconception that coding is based on data, but the coders base it on physician clinical documentation. The coder data comes from the doctors’ words.”

“We can go into our database, do a query, look at all the diagnoses, and provide feedback to the cardiology team. One of those pieces of feedback is that a lot of these readmissions were actually coming in for food overload because of diet noncompliance,” she stated.

Woodworth also spoke about how clinical documentation improvement affects revenue streams and reimbursement among the multiple hospital systems at Swedish Health Services.

“We’ve maximized our DRG reimbursement. The Medicare coding rules state that we need to do that to get to the highest level of payment that we can for the highest area of illness. We do a lot of work making sure the most appropriate DRG is in a spot that we can pay for,” Woodworth confirmed.


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