1. 3rd Annual Association of Clinical Documentation Improvement Specialists Conference

2. Understanding the Role of Performance Mapping in Clinical Documentation Improvement
Darice Grzybowski, MA, RHIA, FAHIMA, HIMentors
&
John (JT) Trusten, Knowledge Webb Healthcare

3. Agenda
Who are we?
The story/background
What is performance mapping?
Unique approach at client site & best practice lessons learned

4. Background HIMentors, LLC Knowledge Webb Healthcare
Founded in 2004: Best practice in HIM and revenue cycle operations
Assessments, coding/CDI/data integrity audits
Transition to EHR/EDMS from hybrid records
Knowledge Webb Healthcare
Specializing in performance mapping
Project management/healthcare operations

5. Most organizations recognize they have a need for CDI
The Need for CDI
Most organizations recognize they have a need for CDI
Programs often fail because of:
Lack of dedicated support staff
Lack of adequate education
Lack of adequate measurement
Lack of accountability/discipline
Poor processes & communication

6. A Hospital’s Journey to Improved CDI
Previous program (education only) failed over time due to lack of focus
MS-DRGs provide new opportunity
Sister hospital had a best practice model in place but needed site-specific tweaking
Looking for lower-cost alternative but needed some guidance around best practices
Performance mapping recommended; vendor- neutral approach relative to software

7. Initial Observations
Needed dedicated staff—job description, number of FTEs, skill level & management debates
Need baseline coding audit
Need for PROactive, INTERactive, and REactive balance for querying
Need for up-to-date education for medical staff, coders, administration, and support staff
Need for clear metrics of success

8. Implementation Management
Total Solution
Implementation Management
Business
Process
Product/
Service
Accurate
Knowledge
Change
Management
Communications
Support

9. Processes run businesses, businesses do NOT run processes
Why Performance Map?
Processes run businesses, businesses do NOT run processes
Identify productivity opportunities
Identify best practices
Root cause analysis
Business work flow consistency
Identify ownership and accountability
Consistent education and training

10. Why Improve & Manage Processes?
Processes produce an organization’s products and services
Processes are critical to seizing and maintaining a competitive edge
Processes are the vehicles for meeting customer needs and achieving organization goals
The performance of individuals is only as good as the processes allow it to be
Processes (especially cross-functional processes) are usually
Not documented
Not systematically and continually improved
Not managed
Note from Editorial Services: Last bullet point seems to be missing text / incomplete sentence.

11. ‘CURRENT’ Performance Mapping Steps
“CURRENT” performance map pre-work
Why map?
Scope: How big is the process?
Experts from each key function that touches the process
“Day in the life of”
Develop the “CURRENT” process
Understand opportunities/gaps/constraints

12. Rough CURRENT Performance Map

13. ‘FUTURE’ Performance Mapping Steps
“FUTURE” process map pre-work (with business process owner)
Validate purpose
Develop customized best practice “FUTURE” map
Functional managers

14. Performance ‘Additions’
Vertical segmentation
Root cause
Integration

15. FUTURE Process Function #1 Function #2 Function #3 Function #4
Action 1 A
Function #2
Action 2
Function #3
Action 3 B C
Action 4 ?
Action 6
Yes
Function #4 No D
Function #5
Action 7
end
2 hours
2 days
2 weeks
2 hours

16. ‘FUTURE’ Mapping Implementation Approach
CDI “CURRENT”
Performance Process
CDI “FUTURE”
Performance Process
CDI “Phase 1”
Performance Process
Closed Loop
Process
CDI “Phase 2”
Performance Process

17. Unique Implementation
Building on existing experience & knowledge
Interviewing
Continued coaching—advocacy
Watching variables
Incorporating change management
One step at a time
Focus on best practices

18. Best Practice Takeaways
Ideally—HIM & clinical skill set combination for CDI specialists
Operationally—HIM accountability
Physician-led education
Ongoing education—others
Physician liaison
Metrics

19. Best Practice Takeaways
Ongoing education (proactive)
Discussion liaisons & process (interactive)
Avoid duplication in coding/abstracting
2/3 concurrent / 1/3 (retrospective)
100% response expectation on queries
Connection w/ other PI activities
Focus on the process!
Note from Editorial Services: 4th bullet doesn’t make sense as written. Should be: 2/3 concurrent; 1/3 retrospective?

20. Questions? Presenters: Darice Grzybowski, MA, RHIA, FAHIMA
President/Founder
HIMentors, LLC
La Grange, IL
708/
John Trusten
Chief Operations Officer
The Knowledge Webb Healthcare
Stillwater, MN
651/
Thanks to St. Rita’s Medical Center – Lima, OH
Note from Ed Services: Changed to “Presenters” (plural), okay?