Rethinking The Role Of CDI


A clear indication that something might be wrong is when the same types of problems keep surfacing, even after you fixed them. Why? Could it be that the individual problems are being rectified but the root cause of the problem still exists? Think about it.

What is CDI’s purpose? When I Googled “Purpose of CDI Program” this is what I got:

CDI (Clinical Documentation Improvement) has been described as the process of improving healthcare records to ensure improved patient outcomes, data quality, and accurate reimbursement. … The overall goal of a CDI program is to improve clinical documentation, coding, and reimbursement.

I realize the word “Improvement” has been replaced with “Integrity”. However, in my limited knowledge of the CDI process, I’ve learned this explanation is reasonably close.  I’ve heard things like that CDI leadership needs to change and the KPI’s need to change from tasks to results. I am not disputing either suggestion as they can be a good change agent for improvement. But again, does it rectify the root cause?

Let’s look a little deeper. Could it be that CDI is doing a better job than we think? I believe they are fixing the records and everyone in CDI is trying their best. But they keep falling behind. But why? Could it be that the root cause of these problems still exists? I think that could be the case.

In my career, I always focused on the process and not the product. In this case, the product is the medical record. If I put my emphasis on the process to produce an effective and efficient product or service, shouldn’t the quality of the product improve? Most definitely.

There’s an old saying “Catch a fish for a person and you feed them a meal. Teach a person how to fish and you feed them for life”. You can take that same philosophy in creating accurate medical records.

CDI still needs to fix the medical record but don’t stop there. Take the next step and find the root cause and fix that as well. Implement changes to the process. When you implement changes to the process, in essence, you are implementing preventative action.

Many times, I heard people are blamed for the problem. But before I blame people, I also made sure that they had the right tools and procedures to do the job. Then I would make sure they were properly trained. Only when all other avenues have been exhausted, would I consider the person.

The next issue is that we don’t have the time. Really? You have the time to keep doing the same thing over and over, yet not enough time to fix the root cause.

Another issue is that we don’t have enough staff. Well, the company needs to make money. Adding more people just erodes any margin. So, adding people isn’t the solution. The solution is to make the process run efficiently and effectively.

A great example of what I am referring to is the scrubbing of medical records. So many mistakes are made throughout the process, that companies have developed software packages to fix these problems. It’s amazing that hospitals are willing to spend additional funds to correct the errors but don’t fix the actual problem. I realize scrubbing is necessary. However, I would take that one step further and find out where these problems are occurring and prevent it from happening. How can this be done? By properly empowering teams.

What I am suggesting is a culture change. Instead of focusing on correcting the problem, focus on preventing the problem. Implementing a culture change is difficult. However, I challenge you to work on prevention 1 hour a day. Then take it to two. This problem is an elephant. And how to eat an elephant? One bite at a time.



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