March certainly was a lion for most of the month, we had a couple more nor'easters here in New York, and the cold didn't let up! Fortunately the Hiteks team was traveling most of this month, starting with the Midwest for sales meetings and Vegas for HIMSS. With most health care providers getting tired of working between back-end systems and front-end EHR workflow, many are now adopting an EHR-only workflow approach to CDI and coding. We are also emphasizing our command of gender-specific and Pediatrics diagnoses in our CDI knowledge base. Enjoy this month's newsletter as we head into Spring, and we hope to see you May 21-24 at the annual ACDIS meeting in San Antonio!

Hiteks' Funnel Approach to CDI: 3 Workflow Solutions
One of the biggest challenges for healthcare is how to efficiently review billions of charts per day (nationally), which translates to hundreds of documents per day per administrative resource. We've created a funnel approach to solve this problem, where through combined use of multiple software-aided workflow solutions, providers can reduce the funnel of charts that need to be reviewed manually to 10% of the total.

How can we possibly do this? First, we've shown that simply by providing additional intelligence in the EHR's Problem List Management tool which asks doctors to add in missing specificity and severity of illness modifiers, 50% of downstream queries can be reduced and those charts or parts of the notes within those charts can become exempt from human review. Second, automated queries for physicians which form prioritized CDI lists for CDI and HIM functions (for timely review of responses), can reduce query burden by 30%. This is accomplished by suggesting text to be inserted and review of evidence for missed or vague diagnoses.

Third, timely identification of quality conditions like Sepsis, with often conflicting diagnoses (SIRS vs. Sepsis vs. Severe Sepsis vs. Septic Shock) based on the evidence, prompt the physician to reconcile the data and documentation, and also suggest interventions which meet the 3-hour and 6-hour windows. Up to 10% of CDI queries can be reduced through this approach and keep all the caregivers and CDI/HIM on the same page due to the concurrent nature of the surveillance programs.

Finally, few but highly prioritized charts remain for manual review, estimated to cover 10% of the total amount of queries compared to workflows which do not use Hiteks' software automation. These last groups of charts, or document sections within the charts, are the highly technical and complex ones, with multiple co-morbidities and coding rule considerations that are not amenable to computerized logic. The 3-pronged software approach promoted by Hiteks enables this manual review to occur integrated within the EHR's tools so that complex interfaces are not needed, thereby preserving data and document integrity. The Funnel Approach also allows prioritization of the total and remaining charts so that efficient review of Insight-suggested problems, queries and quality surveillance can be accomplished within minutes by a CDI Specialist as opposed to hours.   VIEW THE HITEKS FUNNEL APPROACH
Pediatrics CDI
So much work that we do in healthcare is disease specific, and for many providers these diseases that we treat are grouped into areas of Adult care, Geriatrics, OB/GYN, Pediatrics and Neonatal, amongst others. For many years there was limited guidance from the payers on how to properly account for many of the less common but important Pediatrics cases.

By applying a structured approach to categorizing these cases and determining which ones are more prevalent and valuable in terms of resource utilization, we've created a Pediatrics-specific Knowledge Base to support our work. We placed into our software configurable parameters (this means that no software code or version changes are needed) to identify Pediatrics conditions in a way that can be used to quickly find the cases which need strengthening of the clinical descriptors and associated reasons for choosing one diagnosis over another.

Age ranges, insurance types, organ-specific review, metabolic disorders, electrolyte irregularities, hormonal problems, injuries, pain, infections, allergies and asthma are all important to consider for younger patients. In addition, Past Medical and Family History are also important because they may indicate genetic conditions which manifest as acute disorders that need the appropriate care and coding attention. Here is a small sample of the Pediatrics-specific diagnoses which require a tailored CDI approach:

Acute Asthma Failure to Thrive Abdominal Pain Acute Bronchitis Acute Pharyngitis ARDS Allergic Nasal Inflammation Chest Pain Diabetes Headache Otitis Media Pain in Limb UTI/Cystitis Atopic Dermatitis

Finally, there are over 250 Children's Hospitals nationally in the U.S. and very few Pediatrics-trained CDI Specialists. This puts even more emphasis on the efficiencies available by introducing software support and automation into the CDI Query process. Hiteks' 3 solutions to reduce workflow burden on manual chart review has a large impact in Pediatrics and for Epic users this is a benefit since the Epic Children’s Hospital user community is quite large, with Hiteks playing a prominent role in helping Epic users do all their CDI work within Epic.   VIEW HITEKS' PEDIATRICS CDI APPROACH
News on our ConcurDI For NoteReader CDI product in Epic
We wanted to give you an update on ConcurDI For NoteReader CDI in Epic. Hiteks is currently implementing this physician and CDI Specialist query solution within Epic in 15 Academic and Community Hospitals nationally, with the estimated completion on April 30th.

The significance of this work is that now, for the first time, in Epic versions 2017 and 2018, Epic users will be able to access Hiteks-powered workflows that support coding, CDI Specialist queries, and physician suggestions in the context of their Notes. They no longer need to use back-end systems for coding and CDI, which require complex and costly interfaces and result in communication and data integrity issues. The providers who use Epic are now supported through Hiteks' Insight intelligence in the cloud, allowing all the value-added analysis to be sent to Epic for easy access and review. So, both front-end workflow and back-end HIM/CDI are covered, with each organization able to select their Encoder and NLP engines.

We predict that those organizations who move away from their back-end coding and CDI systems sooner, will benefit financially on the order of millions of dollars per year per average size health system due to the more timely suggestions provided to documenting physicians, with higher compliance and less time required to address documentation issues. The IT burden will also be significantly reduced because of the rigor placed on pre-qualifying vendors to work in the Epic App Orchard environment.

Hiteks leads the industry with the most products in Epic's App Orchard, with all products supporting Computer Assisted Physician Documentation (CAPD) and quality surveillance for physicians, resulting in prioritized CDI Insight lists for better resource management and oversight into the responses provided by doctors who receive automated suggestions to improve documentation.   VIEW CONCURDI FOR NOTEREADER CDI
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