Ardent Health Services is a large regional healthcare provider organization with 4,300 licensed beds across 30 hospitals and more than 26,000 employees across six states, including Oklahoma, Texas, New Mexico, New Jersey, Idaho and Kansas.

THE PROBLEM

Given the size, complexity and varying levels of staffing across the facilities, Ardent was searching for a solution that could streamline provider workflows within its Epic EHR, improve documentation quality and help the organization make better use of staffing resources across the network of hospitals.

In particular, some of the smaller, more regional facilities – those with fewer than 100 beds – were struggling without a dedicated clinical documentation improvement team and needed a solution that would help fill the gap.

PROPOSAL

Working with the team from voice-IT vendor Nuance, Ardent selected Dragon Medical One, Dragon Medical Advisor and Epic NoteReader CDI, which offered specific advantages, such as greater automation, less alert fatigue and better user satisfaction, said Trevor Snow, vice president of health information management at Ardent Health Services.

"For example, we needed solutions to work across care settings to leverage the power of helping to capture more complete patient stories starting with Nuance Dragon Medical One to create a more consistent and personalized experience for our providers," he explained. 

"It's easy to miss important details that can impact how care is categorized, so Nuance's Computer-Assisted Documentation solution, Dragon Medical Advisor, offered our providers greater automation for documentation guidance while simultaneously reducing alert fatigue."

"The technology armed us with clinical documentation support at smaller facilities and freed our providers' time up to concentrate on more complex cases, maximizing resources and time to focus on patient care."

Trevor Snow, Ardent Health Services

Ardent also needed solutions to introduce proactive improvement opportunities, Snow added.

"Nuance Epic NoteReader CDI is a CAPD solution that runs queries as the patient progresses, making sure our providers don't miss documenting important diagnoses, and [helps] prioritize our clinical improvement efforts," he said. "But collectively, Nuance's real power was helping capture more complete patient stories."

MEETING THE CHALLENGE

During a patient visit, the clinician's first priority is delivering exceptional patient care – not documenting how it was done, Snow observed.

"But the way care is coded and documented can drastically impact how it is reimbursed, driving our organization to search for a solution that could streamline clinical documentation and ensure that care was represented accurately and completely," he said.

The Ardent health information management team developed specific guidance to activate within each market, specialty group and service line to help automate guidance and improve overall documentation, while eliminating post-discharge inquiries that take clinician and staff resources away from patients who need it most, he added.

"For clinicians, it works by identifying clinical indicators within a patient's record that may suggest another diagnosis, and [alerting] physicians to check the specific chart – improving documentation and coding in real time," he said. "Because it's automated, it continues to run queries as the patient progresses to make sure things aren't missed."

RESULTS

In eight months, the team reported a shift in severity of illness and risk of mortality from the extreme level 3 to 4 by 41% and 49%, respectively. Over that same period, staff captured an additional $2.7 million in reimbursement.

"Most important, the technology from Nuance armed us with clinical documentation support at smaller facilities and freed our providers' time up to concentrate on more complex cases, maximizing resources and time to focus on patient care," Snow said.

ADVICE FOR OTHERS

For Ardent, a few things were critical, said Snow.

"First, making sure that we have a technology partner that we trust and is committed to helping us achieve our goals," he advised. "Second, customizing and streamlining the technology with guidance specific to each market and specialty group. Third, investing in a platform that would allow us to harness the full capabilities available to us now, while helping our organization make the most out of its investment in the future."

Twitter: @SiwickiHealthIT
Email the writer: bsiwicki@himss.org
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