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Innovation Offers New Avenues for HIM

Innovation continues to present opportunities for HIM professionals to share their data management expertise, which is critical to support ongoing clinical documentation improvement (CDI) initiatives, patient matching efforts, and the rollout of new analytics tools.

As a partner in innovation, HIM professionals should master ICD-10 codes, enhance their clinical acumen, and learn how they can support an industry adapting to new quality reporting requirements and payment methodologies.

Focusing on CDI, Here and Abroad

Demand for CDI specialists in outpatient facilities is on the rise, driven in part by changing payment models, says Wilbur Lo, MD, CDIP, CCA, CDI consultant, Jzanus Consulting Inc., Floral Park, NY.

“Due to the value-based and quality measures inherent in managed care, there is a movement to shift patient care from the inpatient to the outpatient setting,” Lo says. “For instance, surgeries with minimal risk of complication are being scheduled in ambulatory surgical centers, rather than hospitals. Also, there is a consensus that proper documentation practices in the outpatient setting will have an impact on how patients are managed in the inpatient setting.” As such, CDI will become more important not only in physician offices but also in surgery centers, skilled nursing facilities, and even home care settings. 

To navigate comfortably through the medical record and better understand the patient’s story, Lo suggests that HIM professionals strengthen and maintain their clinical acumen. “Ideally, CDI specialists and coders should be well versed in the pathophysiology, diagnosis, medical management, and surgical treatment of diseases so they can appreciate the documentation nuances of physicians,” Lo says. “Specifically, HIM professionals should be able to glean pertinent clinical information from the medication list, laboratory reports, microbiology reports, operative reports, pathology reports, imaging studies, and consultations in the medical record.” Resources such as AHIMA’s newly updated CDI toolkit , upcoming query toolkit, CDI Academy,  and self-paced online courses  can provide guidance specifically for CDI specialists and coders.

Another transformative trend is the emergence of computer-assisted CDI (CACDI) tools, which help physicians document andtranslate diagnoses and procedures into specific ICD-10-CM and ICD-10-PCS codes, respectively. “CACDI can engage physicians in an EHR platform, while minimizing disruption of the physicians’ workflow,” he says. “Ultimately, the most important beneficiary of CACDI and other EHR tools is not the physician or the facility, but the patient who receives optimal care.”

The need for CDI extends beyond borders. In fact, AHIMA is leading global CDI and HIM initiatives encompassing many regions, including Southeast Asia, Europe, and the Middle East.

Lo has traveled twice to Saudi Arabia as part of AHIMA’s CDI initiative in the Gulf Cooperation Council (GCC) states. “Every country faces challenges in documentation practices,” Lo says. Specifically, he believes gaps exist between the clinical language and the coding vocabulary, regardless of the code set.

As a result, Lo believes global interest in the Certified Documentation Improvement Practitioner credential, which demonstrates proficiency and establishes credibility in proper documentation practices, is rising. “HIM directors from several countries have suggested that the AHIMA CDIP credential should be a prerequisite for employment as a CDI specialist in their respective facilities,” he says. “Even though reimbursement methodologies in these countries may be different from the United States, patient care and proper allocation of resources is still contingent upon proper documentation practices. This is precisely why every facility in the world needs CDI.”

Assessing Opportunities with Outpatient CDI

Lisa L. Campbell, PhD, RHIA, CDIP, CCS, CCS-P, president, Physician Practice Resources Inc., Matteson, IL, also believes that interest in outpatient CDI is growing, driven in part by hospitals’ continued acquisition of physician practices.

“Physician offices have historically not had coding or CDI support, so it can be a challenge for hospitals that already know how to improve documentation in the inpatient setting,” she says. “There is a real need for collaboration between the facility CDI team and the provider on documentation improvement in both inpatient and outpatient settings.”

The growing need for CDI in outpatient settings presents a unique opportunity for HIM professionals, Campbell says. For example, some HIM practitioners may choose roles as “documentation detectives” who track down bad data. Campbell says that she personally loves helping providers improve their physician office documentation.

“There is a misconception among hospital C-suite executives who are of the mindset that you have to be a nurse to do CDI,” says Campbell, who presented at the AHIMA CDI Summit in Washington, DC, in August. “As our reimbursement model changes, HIM professionals can and should contribute to the team approach to CDI.” She adds that HIM professionals have managed health record documentation since 1928.

Prior to the ICD-10 conversion, Campbell decided to retake college classes in medical terminology, anatomy, disease processes, and pharmacology. She recommends that other HIM professionals who are interested in CDI take classes or seminars to enhance their clinical knowledge.

“Outpatient/physician CDI has not been given the attention it deserves,” Campbell says. “Now is the time to make that change, and we are moving in the right direction.”

To support HIM professionals in their efforts to improve CDI in outpatient settings, AHIMA is developing the Self-Paced CDI Outpatient Academy.

“When HIM professionals collaborate with clinicians, we are able to achieve quality documentation,” she says. “But that collaboration has to be ongoing.”

Addressing Analytics and Patient Matching

Innovative analytics tools also are opening doors for HIM professionals, says Beth H. Just, RHIA, MBA, FAHIMA, president and CEO, Just Associates, Centennial, CO.

“In the era of big data, healthcare executives are looking for analytics tools that will help them better understand their patients as well as their reimbursement opportunities,” Just says. Specifically, organizations are leveraging these tools to determine patient severity, manage population health, predict readmissions, and lead other initiatives.

Yet as the accuracy of data continues to be disputed, HIM professionals can lend their expertise to help their organizations ensure data integrity. “The fear is that leaders will make important strategic decisions based on inaccurate data, and it could cost them,” Just says. “HIM professionals should be involved in the selection of analytics tools because they bring an understanding of different kinds of data that are captured. They also need to be involved in the ongoing education of their executive team on the data quality challenges that they are seeing on the frontline and how those might affect the analytics results.”

To improve their acumen on analytics, Just suggests that HIM professionals seek the Certified Health Data Analyst (CHDA) credential. She also suggests attending conferences, such as the AHIMA Data Institute.


Other innovations in areas like patient matching also present an opportunity for HIM professionals to help guide their organizations. Although most organizations leverage their electronic health record (EHR) software for patient matching, they still miss many matches, Just says. “It is the false negatives that are a problem,” she says.


To help remedy this concern, HIM professionals should report issues related to inaccurate data and provide constant staff training to help “close the loop,” Just says. They also should learn more about the technology. “Not every record matching algorithm is created equal, and the performance of those algorithms is highly dependent

on the accuracy and completeness of the data capture,” Just says. She also suggests that HIM professionals look at articles and practice briefs in the AHIMA Body of Knowledge (BoK) to become more familiar with solutions for patient matching issues. “HIM professionals should understand how these initiatives relate to broader data governance and information governance initiatives in their organizations,” she says.

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