More than ever, CDI teams make high-quality patient care possible

Each September, CDI Week provides a great opportunity to recognize the professional skill that the Clinical Documentation Improvement Specialists (CDSs) and their Health Information Management (HIM) cohorts bring to clarifying “what matters” for a complete clinical story. This’s years CDI Week takes on an added dimension that deserves our attention.

Beyond handling the growing volume of queries, CDSs are actually enabling all healthcare professionals to measure “what matters” based on accurate clinical documentation. The horror of COVID-19 drove that point home and highlighted the true essence and importance of CDSs striving for accurate documentation. In fact, as a mark of their dedication, many CDSs returned to the bedside and off-service clinical areas as they helped capture complete and accurate data to inform current and future epidemiology statistics and research.

We recently partnered with ACDIS for their COVID-19 Summit. As part of the event, we hosted a panel discussion that featured Nuance CDI clients from Hartford Healthcare, TriHealth, UCSF Medical Center, and Universal Health System. It’s worth watching a replay of the panel, CDI Lessons and Practices During a Time of COVID 19, to hear how CDI clients are managing current challenges and capitalizing on their CDI program strengths throughout these challenging times.

Donna Hays, Director of Clinical Documentation Integrity at UCSF, shared how her team utilized their strengths during an unprecedented challenging time. “We developed a patient-facing call process which was really nice for the RNs and the team to have that opportunity to go back to calling patients that had negative results, then providing the documentation of the records. We called it building the plane while flying it because it was very challenging and it required a lot of changes and flexibility. The RNs who did this during that time were really remarkable.”

As the Association of Clinical Documentation Improvement Specialists (ACDIS) celebrates CDI Week, we at Nuance recognize and honor all the CDI specialists who truly are stars. Thank you for all you do, and enjoy the well-deserved recognition!

Melinda "Mel" Tully

About Melinda "Mel" Tully

Melinda (Mel) Tully is the vice president of clinical services and education for Nuance Healthcare, overseeing the development and expansion of clinical documentation programs and clinical education best practices. Mel joined Nuance in 1998 and has more than 25 years of experience in multiple healthcare arenas as a provider, clinical manager in a large academic facility, and as an expert in clinical documentation improvement (CDI). Mel attended Emory University, where she earned her Master’s degree in Nursing. She has been certified through the Association of Clinical Documentation Specialists (ACDIS) as a clinical documentation specialist, as well as by the American Health Information and Management Association (AHIMA) as a documentation improvement practitioner.