How One Hospital System Advances Clinical Documentation Improvements with Augmented Intelligence

Editor’s note: This article is based on a 2022 Healthcare Analytics Summit session entitled “Augmented Intelligence and a Physician-Forward Strategy Improve Quality Metrics and Transform Clinical Documentation.” The panelists included Kearstin Jorgenson, MS, CNC, COC, and Kory Anderson, MD, CHCQM, FACP, both at Intermountain Health.

In the complex and ever-evolving landscape of healthcare, ensuring accurate and comprehensive clinical documentation is imperative for delivering high-quality clinical services. Clinical documentation improvement plays a pivotal role in patient care, as it serves as the foundation for diagnosis, treatment planning, decision-making, and reimbursement processes.

To that end, clinical documentation integrity (CDI) is a vital aspect of modern healthcare management that fosters improved patient outcomes and enhanced communication among interdisciplinary care teams, and it promotes quality improvement initiatives while ensuring financial stability within the healthcare system. Yet, healthcare systems are met with numerous challenges when aligning clinical documentation improvement and physician documentation workflows.

Intermountain Health had experienced the following challenges in its clinical documentation improvement efforts:

• Low response rates
• Lack of leadership engagement
• Disengaged physicians
• Archaic workflows

“We had very archaic workflows—excel spreadsheets, pen and paper, people chasing physicians down the hall trying to get them to answer a query …. to clarify something in the [patient] record,” said Kory Anderson, MD, CHCQM, FACP, Medical Director of Physician Advisor Services, CDI, Intermountain Health, during the Healthcare Analytics Summit in 2022. “Things were inefficient and ineffective, and we didn’t have any physician involvement in the structure of the clinical documentation team.”

Concerted efforts to improve their Clinical Documentation Integrity (CDI) program by leveraging augmented intelligence (AI), however, yielded positive outcomes. The technology facilitated physicians’ access to relevant clinical information, enabling more accurate diagnoses and personalized treatment plans. Automating tasks also reduced administrative burdens and repetitive processes, allowing clinicians more time for direct patient interaction.

Integrating Augmented Intelligence in Healthcare with Physician Leadership

Initially, Intermountain reported low physician engagement in non-clinical work like documentation, leading to incomplete and inconsistent records that did not accurately reflect the patients’ experiences. Documentation workflows weren’t streamlined, and providers dealt with tedious follow-up requests to update patient charts that were missing critical clinical information.

To address these complex challenges, Intermountain initiated a two-year project to upgrade its clinical documentation systems by employing a dual-pronged approach. The first prong focused on integrating AI solutions into streamlined documentation workflows with a focus on reforming its computer-assisted physician documentation (CAPD). The second part leveraged physician leadership on the CDI team and equipped those physicians to educate front-line physicians on how the new processes had the potential to improve patient care.  Indeed, Intermountain stressed the importance of physician leadership and a well-executed provider engagement strategy. The CDI team enlisted physician “champions,” who shared clinical success stories with peers to illustrate how the AI-poweredCAPD could improve patient experiences and outcomes.

Augmented Intelligence Functionality Enables Clinical Documentation Improvement

A cornerstone of Intermountain’s AI integration strategy was digital “nudges,” which were developed for both physician and advanced practice providers (APPs). These subtle prompts and alerts in the CAPD occurred in real-time and cross-referenced all notes during the patient encounter. For instance, the AI tool does not alert the provider if, while inputting clinical information, a suspected condition is already documented elsewhere in a patient’s electronic health record.

However, if additional documentation is necessary, the CAPD alerts providers immediately as they are charting, allowing them to improve the health record and document the patient encounter correctly. Real-time nudges have led to exponential growth in provider engagement, with an average 96 percent engagement rate at the end of the two-year implementation period.

Key Indicators Showed Improvement Across Financial and Quality Metrics

Intermountain’s new CDI program demonstrated significant outcomes across financial and quality metrics. Between July 2021 and February 2022, the health system reported a total financial impact of $784,167 solely by incorporating physician nudges in heart failure cases. According to their findings, across all tracked categories, including encephalopathy, malnutrition, low blood pressure, and others, the financial impact of the nudges amounted to about $1.4 million. 

The advantages of AI integration extended beyond financial results and significantly contributed to patient safety. The implementation of the AI-powered CAPD, including physician and APP nudges, resulted in the following improvements:

• Clinical documentation timeliness, with 73 percent of all resolved nudges happening within two days of patient admission.
• Increased analytic efficiencies and improved charting accuracy with more than 4,700 active nudges.
• A 19 percent reduction in improperly coded patient safety indicators (PSIs) compared to pre-implementation levels. 

The initiative streamlined clinical documentation improvement processes with significantly reduced charting revisions.  Also, their CDI reforms demonstrated how the fusion of human expertise with AI paves the way for a more efficient and value-based healthcare system as it freed up physicians to provide higher-quality care and engage more meaningfully with patients.

Learn more about the power of augmented intelligence and its critical role in today’s delivery of value-based care through best practices and hands-on experience. Register today for the 2024 Healthcare Analytics Summit™️ (HAS^®️) and be a part of the future of healthcare!

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