Yes, ICD-10 preparation is very important. Healthcare providers have a renewed focus on clinical documentation integrity as they must be ready for the increased complexity in ICD-10 coding. Right around the next corner, hospital professionals face the increasing challenges of payment reform, value-based purchasing and accountable care.  Clinical documentation integrity is vitally important for all of these national initiatives. I believe healthcare providers need to prepare for population health management, which is the key to an organization’s success in the future.

Population health management goes beyond treating only those patients in need of immediate care; instead it helps providers assess their entire population and stratify it into various stages across the continuum so they better understand who they are treating, for what conditions, where, when and how. When providers know all this information about patients because of the accuracy and completeness of clinical documentation, they can better report and improve quality, and can expect optimum reimbursement.

Organizations that do the best job of identifying, understanding and managing their patient populations will be positioned to deliver high-value healthcare and will shoulder the least risk. Information is the cornerstone of the future and it will be the health information management (HIM) professionals that embrace and deliver population health management. However, the HIM team is just one player in the entire collaborative effort. Today, leaders from revenue cycle, medicine, quality and many other departments need to track and analyze information because it impacts both clinical and financial performance.

What will be most critical, in my opinion, is to enable the providers with the right training and technology to create accurate and complete clinical information at the point of care.  Clinical documentation integrity at the point of care not only enhances quality and patient safety, but also ensures that the same clinical documentation will be used for coding compliance and then shared across the continuum of care enterprise-wide.  It is the front end design of aligning the right tools and techniques from the beginning of the patient encounter throughout the hospital stay that will deploy your fail safe clinical documentation integrity program.  It is truly the necessary factor that will allow the right people to have access to the right information, at the right time.

Population health management will have many purposes and all of these require ICD-10 coded clinical data as sources and uses for inputs and outputs.  Providers will utilize all existing data repositories and access/retrieve the clinical data via ICD-10 codes. All of after-care and care across the continuum will be monitored, measured and trended according to the following:

Patients who are:

  • Well: are well need and need health wellness & prevention
  • At-Risk: have health risks and need screening and life-style changes
  • Chronic: have chronic conditions and need to prevent further complications

Tracking chronic disease patient populations within the region will be critical to better manage population health and minimize risk in an accountable care organization (ACO) model. Providers will need to analyze the causes of admissions and re-admissions to create preventative strategies, such as frequent monitoring of at-risk patients and intervention by primary care physicians. Since all of this historical information resides in the HIM department, these leaders will be key to developing tracking processes, combined with other departments who help identify caregivers’ clinical outcomes and best practices for care coordination, disease management and to promote better health of their patient population. Look for your HIM professionals to be emerging as the population health information management experts!

What will be used to streamline and ensure the integrity of clinical information in light of ICD-10 and population health? Tools that help clinicians improve the accuracy of clinical documentation up front, along with  quality management and clinical analytics tools, just to name a few. What tools and strategies do you see helping in the future?

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Bonnie Cassidy

About Bonnie Cassidy

This was a contributed post by Bonnie Cassidy. Bonnie serves as the 2015 Chair of the Commission on Accreditation for Health Informatics and Information Management (CAHIIM) Board of Directors, is a Fellow of AHIMA, an AHIMA Academy ICD-10-CM/PCS Certificate Holder and ICD-10 Ambassador, and a Fellow of HIMSS. Bonnie also served as the vice president of HIM product management & innovation at QuadraMed, and served as an executive with the Certification Commission for Healthcare Information Technology (CCHIT), Ernst & Young and the Cleveland Clinic Foundation. Bonnie was the 2011 President/Chair of AHIMA, recipient of the 2014 AHIMA Distinguished Member Triumph Award and the 2015 (Georgia) GHIMA Distinguished Member Award. Bonnie received her graduate degree from Cleveland State University and her Bachelor’s Degree in HIM from Daemen College. Bonnie grew up in Buffalo, NY, lived in Cleveland, OH and has been a resident of Atlanta, GA for 17 years. She considers the Bills, the Browns and the Falcons her hometown teams.