Intro to QDI

Healthcare organizations use the QDI app, which stands for Quality Documentation Improvement, to review patients' medical information for completeness and accuracy.

When clinical providers and their staffs interact with patients through appointments, provider orders, lab tests, or other encounters, they enter information about the patient into the patient’s medical record in a healthcare organization’s electronic health record (EHR) system.

Specialists in clinical documentation improvement, called CDI specialists, review that patient data for completeness and accuracy using the QDI app. This process is a support service for providers, who often have to make diagnoses and decisions about patients' care in emergency situations, in a short time frame, or in cases where care is very complex.

Who uses QDI

CDI Specialists

• Review patient cases to make sure that the data associated with them accurate and consistent with their provider’s diagnoses. This includes reviewing disease processes, diagnostic findings, and whether documentation of diagnoses indicated by the data is missing.
• Identify opportunities for diagnoses that providers have missed.
• Query providers to inform them of apparent discrepancies between patient data and the providers' diagnoses, asking the providers to alter or confirm their diagnoses.

The providers then reply, either confirming their original diagnoses or adjusting them. The CDI specialist accordingly adjusts patients case before closing them

Entering of the documentation is governed by regulations, accreditation requirements, internal organization policies, standardized diagnostic codes, and other rules. CDI specialists, who have experience in both clinical and medical coding, bridge the gap between clinical documentation and accurate coding.

Their goal is to increase the accuracy and thoroughness of medical record documentation and coding to ensure that a patient’s health status is accurately coded. They:

• Help improve patient outcomes by ensuring that all conditions that are clinically supported are reported and can be treated.
• Help identify at-risk patients by aggregating and surfacing data from their medical records so that they can get treatment for comorbidities indicated in that data.
• Validate that documentation of diagnostic codes accurately reflects what the provider recorded, and supports medical necessity for the level of code reported on a claim. This information can be used to support a claim if a payor audits it. This increases reimbursement for clinical services by capturing all clinically supported conditions, and prevents payment denials and amendments because of improper code submissions for services rendered. Improper claim submissions resulting from poor documentation can result in negative audits which require healthcare organizations to pay fines, and/or return money collected erroneously from payers.
• Guarantee that a healthcare organization’s documentation complies with federal regulations regarding fraud, abuse, and compliance.
• Help gather accurate information about an organization’s patient cases that can be analyzed to improve overall care.
• Improve both patient outcomes and Hospital Quality Rankings by reducing hospital readmissions and mortality, and improving patient experience and effective care.
• Assist providers in using more specific terms and including all conditions that are being monitored or treated and that affect medical decisions.

In a hospital setting, a CDI specialist reviews the documentation on an inpatient prior to discharge and queries the provider for updates, clarifications or missing test results in documentation. CDI Specialists also can query for documentation updates post-discharge to prompt providers to clarify a more specific diagnosis regarding data available and the treatment that was required.

In an outpatient setting, a CDI specialist reviews medical record documentation after an appointment. A CDI specialist identifies issues such as that a medication was prescribed but the condition is not listed, lack of documentation on the cause-and-effect relationship between two conditions, or clinical evidence for a higher level of severity of a diagnosis than was reported.

CDI Managers manage teams of CDI specialists. They must have been given a CDI Manager role and permissions in Tendo. They can do everything that CDI specialists can do in the app, plus view, and filter QDI reports on CDI specialists' productivity and their cases.

Data used in QDI

QDI is an important connection between data and action.

A healthcare organizations uploads daily, weekly, or monthly data to Tendo, which processes the data through an online analytical processing (OLAP) system. This system engine analyzes the uploaded data, including patients, encounters, diagnoses, bmi, dietitians, medications, procedures, and labs information to check for current and past comorbidities. The upload frequency is based on the healthcare organization's preference and specifications.

This engine checks for comorbidities/conditions such as obesity, weight loss, chronic and acute renal failure, congestive heart failure, cancer (prostate), hyperneutremia, and hyponeutremia based on customer-specific parameters. Examples of such parameters include number of days to look back, and labs to check for each comorbidity or numerical rule evaluations. 

After the checks are completed, the presence of specific conditions or comorbidities during patient encounters are identified as cases, and a dataset is created with relevant columns and text fields. The comorbidities are weighted using an Elixhauser score. The Elixhauser Comorbidity Index is a measure of overall severity of comorbidities, predicting hospital length of stay, hospital charges, and in-hospital mortality. The higher the score, the higher the predicted hospital resource use and mortality rate are. This weight is calculated based on evidence found in the patient data. 

QDI stores all patient data and transmits it securely in compliance with privacy regulations such as HIPAA. The data is encrypted both at rest and in transit.