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We’re excited to share some background behind one of the four case studies presented as part of the 2016 Davies award presented to Mercy last month. The Davies award recognizes the “outstanding achievement of organizations that use health information technology to improve patient care while achieving cost savings.” To focus our content, we’re sticking with the STAR format that you’ve seen in some of our other posts.  To see more detail, check out the full case study from HIMSS.


Prominence partnered with Mercy, a multi-state health system, to change the way they use data to make clinical documentation and coding decisions. As they say in their case study, “as long as there are inaccurate charts, there is work to be done”. In 2014, a Clinical Documentation Improvement committee noticed several potential opportunities:

  • Documentation wasn’t consistently as accurate as it needed to be to represent the true nature of a patient’s stay
    • Hospital providers were focusing their documentation on the primary reason for the admission, often missing documentation of secondary conditions
    • Clinical indicators in physician notes often lacked the level of detail necessary for coding specialists to accurately code the encounter
  • The processes for addressing documentation problems weren’t efficient
    • Medical Documentation Specialist (MDS) staff often spent a half hour (or more) reviewing a single chart, limiting the impact they could have on improving accuracy across patient encounters
    • The communication workflow between an MDS staff member and a physician was cumbersome and time-consuming
  • ​The turnaround time for resolving chart issues was too long to enable thorough follow-up
    • Messages conveyed to providers were inconsistent, causing frustration and disengagement
    • Coding issues are easiest to address when brought up before the patient is discharged, but that requires increased coordination

Together with Prominence, Mercy’s coordinated clinical and analytic teams designed and built an innovative solution that addressed these areas of focus. The ideal solution required:

  • Feedback from everyone involved in the workflow – both MDS staff and physicians, to ensure that the workflow improvements met everyone’s needs
  • An analytical tool with near-real time data available and automation to maximize staff review time
  • A dynamic way to identify and prioritize encounters with the most opportunity to improve documentation, increasing the impact of the efforts
  • Actionable workflows to integrate with from analytic solutions to patient charts

We worked with our colleagues at Mercy to identify and define the highest priority measures, to be brought living within the first 30 days. After successfully launching the solution on-time, we worked to establish an iterative optimization process which enabled the team to quickly improve and build upon the live application, prioritizing by user group and impact. ​




As a result of this clinical documentation improvement project, Mercy realized over $65,000,000 in revenue due to the increase in accuracy and improved workflow efficiency. Provider documentation improved in accuracy and MDS follow-up on charts became more efficient, which resulted in improved quality in the patient record and improved compliance with ICD-10 codes and documentation detail. This solution is utilized more than 150 times per week by the Mercy’s MDS team. By streamlining the MDS users’ workflow, they are able to review more patients, act more quickly upon their review and provide more feedback on documentation to providers. Providers benefit from the MDS staff access to detailed analytics that improve their communication.

Some additional highlights of the benefits of this project include:

  1. $1,000,000+ increase in revenue opportunities, per initial evaluation
  2. 40% increase in MDS staff efficiency by implementing automated report delivery, instead of manual chart review
  3. 36% increase in Complication and Co-morbidity (CC) and Major Complication and Co-morbidity (MCC) rates
  4. 0% increase in staffing levels
  5. Thousands of fewer clicks per month by aligning processes and streamlining of workflows for both physicians and the MDS staff
  6. Automated identification of high-value secondary diagnoses via the ability to leverage discrete data elements within the EHR
  7. Bi-directional integration between business intelligence tools and EHR to expedite chart reviews and action
  8. Transformation of communication methodologies between MDS and physicians to encourage face-to-face non-leading dialogue from traditional queries
  9. 2015 Analytic All Star for the category of revenue-cycle project by Health Data Management due to outstanding work
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