About University of Tennessee Medical Center (UTMC)
UTMC is a 710-bed hospital nestled in the beautiful mountains of Knoxville, Tennessee. The coding team comprises 8 inpatient coders and 17 outpatient coders. There are 9 clinical documentation improvement (CDI) nurses who primarily focus on inpatient reviews. They use the TruCode encoder, Cerner electronic medical record and have HealthQuest as their billing system.
The Medical Record Department Director, Coding Manager, and the CDI Nurse Manager were looking for a way to move their teams to the next level of excellence by improving operational efficiencies and outcomes and leveraging technology.
Himformatics, LLC, (www.himformatics.com) was engaged to assist them in their quest to identify a single solution for both computer-assisted coding (CAC) and clinical documentation improvement (CDI). These technologies would help to improve performance and outcomes and make it easy to measure excellence through reporting. The single platform would also promote a transparent relationship between the teams and improve overall communications. With their legacy encoder contract due to expire, they were looking for this single platform to include an integrated encoder.
The Decision Was Easy
It was apparent to the UTMC management team, after seeing a demonstration of Dolbey Fusion CAC with TruCode, that this was the single solution that would help them improve efficiencies, productivity, and promote collaboration between the Coding and CDI teams.
Project Planning and Implementation
The planning phase for the Dolbey Fusion CAC system build and implementation kicked off, with members representing IT, HIM, and CDI Management coming together from Dolbey and UTMC.
Weekly remote conference meetings took place. This remote approach to implementation proved to very effective. The Dolbey project management and implementations team worked with the UTMC team to stay focused and on task and keep the timeline moving to meet UTMC’s go-live targeted dates.
The project scheduled was defined during the initial phase. Review of the project scope and kick-off are major milestones during this initial phase.
The designing phase began once the schedule was set. Requirements for interfaces and system design were gathered. Dolbey understands that every organization has different needs and demands, so customizing a system to meet those demands is one of the many things that differentiates Dolbey.
The Dolbey subject matter expert (SME) team spent a lot of time with management during this phase. Existing processes for coding, CDI, and provider querying were documented. Dolbey encourages clients to approach this phase with an open mind and think out of the box for new ways to do things by leveraging the technology. Dolbey offered recommendations for process changes and best practices to ensure the optimal design of the system. Servers were set up and interfaces were built and tested.
Once the system design was complete, the Dolbey team carried out extensive testing before the UTMC team started user acceptance testing. UTMC and Dolbey mutually agreed on the criteria to measure successful testing.
Concurrent Training and Go–Live
Detailed training guides were written and distributed to Coders, CDI nurses, and administrative staff. A four-hour training session was scheduled for each group. They separated inpatient and outpatient coders into customized sessions based on specific patient encounters and chart types. They trained all CDI staff members at the same time.
At the end of each formal “classroom” session, the coders and CDI staff worked on charts. The Dolbey team was on standby in separate virtual meeting rooms to meet with individuals if necessary. In the weeks that followed, Dolbey closely supported the UTMC staff to ensure they were optimizing the use of the system.
Six Months Later – Benefits Recognized
Six months following go-live, the UTMC Coding and CDI teams were already recognizing the benefits of the Fusion CAC/CDI single platform solution.
The average weekly DNFB for UTMC prior to go-live was approximately $43 million. Within the first two months and consecutively thereafter for each of the next four months, the DNFB dropped by $6 million.
The most important benefit, improved coding productivity, was immediately achieved. The real-time reporting and dashboards gave management the ability to identify any workflow gaps. With the power of automation and the ease of adjusting workflows on the fly as needed, management could identify and correct any gaps. Productivity was consistently higher than prior to go-live and even higher than goals originally set by UTMC.
- Inpatient increased by 158%
- Inpatient OB/Delivery increased by 98%
- Outpatient Surgery and Observation increased by 45%
- Outpatient Diagnostic increased by 22%
It thrilled the UTMC Physician Advisor and CDI Manager to have access to real-time reporting for all CDI activity including physician query activity. Having better insights into the data allowed them to make some changes and measure the impact of those changes in their program. This was something they never could do with previous solutions.
Productivity for the CDI nurses increased, allowing the review rate and percentage of CDI coverage to improve. The physician query average response time went from 72 hours to 19 hours. The average response rate increased to 95% within six months of go-live. There was a definite return on investment and positive financial impact with their queries.
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