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CAPD Top of Mind in Vegas

By Jon Elion, MD, FACC

On the occasion of its 10th anniversary, the annual conference of the Association of Clinical Documentation Improvement Specialists, held in Las Vegas May 9–12, boasted record attendance.

One topic that received plenty of attention was “CAPD 2017: An Early Look,” the newly released KLAS report, which describes the various product offerings in computer-assisted physician documentation (CAPD). It has been interesting to see this field develop. An early collaboration several years ago was a technological success but a marketing failure, as two major companies combined their efforts to come up with a system that interrupted physician dictation to make suggestions on how to clarify one point or another. It turns out that physicians do not take kindly to being interrupted during their dictation, leading to the marketing failure and the subsequent dissolution of the fledgling partnership.

As a physician (albeit one that is highly computer savvy), I have always been a fan of the CAPD approach—beautifully implemented by at least one vendor—of displaying the fully transcribed dictation with suggestions as to how various highlighted phrases could be improved (typically through increased specificity). It’s an intuitive workflow that allows improvements to be made quickly, smoothly, and in the context of the entire document.

The concept of ambulatory clinical documentation improvement (CDI) was a common theme at the conference, both as a topic for discussion and in formal presentations. The field is still trying to define its requirements as reimbursement and quality issues can differ greatly between inpatient and outpatient settings. Unlike inpatient, where CDI reviews are concurrent, much of the activity for ambulatory CDI takes place before the patient’s clinic visit and/or after the visit (just before billing). Hierarchical Condition Categories and Risk Adjusted Factors are where inpatient meets outpatient, and much of the ambulatory CDI focus has been there. The ambulatory work is still quite labor intensive, as the automation common in the inpatient venue has yet to be smoothly applied in this setting.

I cannot report on the activities at this energizing conference without one strong negative observation: The “marketeers” are back in full force. Or perhaps they never left. I am referring to the jargon-filled word salads put together by marketing departments, thinking that this can substitute for absent or lagging technologic innovation. Population health, machine learning, artificial intelligence, fully integrated, and the ever-popular user friendly were terms that were pervasive in the vendor displays throughout the exhibit hall.

Attendees were told that artificial intelligence in medicine was essential, and that all organizations needed was a healthy dose of CAPD along with natural language processing. Guess what products that vendor claims to have?

There were plenty of “solutions” to go around (I guess if you’re not part of the “solution,” you are part of the “precipitate”), but few had a matching problem. The reputedly fully integrated solutions turned out to be nothing more than Alt-Tab implementations (in a Microsoft Windows implementation, Alt-Tab switches the view from one window to another; hardly integration in any sense of the word).

Posters, pamphlets, and pomposity are still no substitute for product.

— Jon Elion, MD, FACC, is founder/president of ChartWise Medical Systems.


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