ChecklistGuro Clinical Documentation Improvement Workflow
Optimize clinical accuracy and revenue integrity with our streamlined Clinical Documentation Improvement (CDI) workflow. Master the lifecycle of medical record review, physician queries, and coding precision to reduce denials, ensure regulatory compliance, and enhance patient care quality through standardized documentation excellence.
Start
Start of the Workflow/Process.
1. Retrieve Patient Encounter Record
Fetch the clinical encounter data and patient demographics from the Patient Encounter data model.
2. Fetch Physician Documentation
Retrieve the recent clinical notes and discharge summaries written by the attending physician.
3. Calculate DRG Complexity Score
Execute a formula based on diagnosis severity and procedure intensity to determine the complexity level.
4. Identify Missing Clinical Indicators
Scan the retrieved documentation for missing required clinical elements (e.g., acuity, comorbidities).
5. Flag Documentation for Review
Update the status of the clinical record to 'Pending CDI Review' in the Encounter data model.
6. Assign CDI Specialist Review
Create a task for the assigned Clinical Documentation Improvement specialist to audit the chart.
7. Retrieve CDI Audit Checklist
Fetch the standard audit checklist template for the specific specialty being reviewed.
8. Create Query Record
Create a new entry in the 'Physician Queries' data model to track requests for clarification.
9. Update Query Status
Update the query record status to 'Open' once the specialist has identified a discrepancy.
10. Notify Physician of Query
Send an email to the attending physician containing the specific query details and a link to respond.
11. Retrieve Physician Response
Fetch the physician's clarification or amended note from the clinical documentation model.
12. Update Encounter with Clarified Data
Update the original Encounter record with the newly clarified diagnoses or severity of illness.
13. Calculate Monthly Query Response Rate
Aggregate all query entries for the current month to calculate the percentage of queries answered within 24 hours.
14. Final Coding Validation Task
Create a task for the Medical Coding team to finalize the codes based on the improved documentation.
15. Generate CDI Productivity Report
Create a report summarizing the number of charts reviewed, queries sent, and revenue impact identified.
End
End of the Workflow/Process.
Start of the Workflow/Process.
Fetch the clinical encounter data and patient demographics from the Patient Encounter data model.
Retrieve the recent clinical notes and discharge summaries written by the attending physician.
Execute a formula based on diagnosis severity and procedure intensity to determine the complexity level.
Scan the retrieved documentation for missing required clinical elements (e.g., acuity, comorbidities).
Update the status of the clinical record to 'Pending CDI Review' in the Encounter data model.
Create a task for the assigned Clinical Documentation Improvement specialist to audit the chart.
Fetch the standard audit checklist template for the specific specialty being reviewed.
Create a new entry in the 'Physician Queries' data model to track requests for clarification.
Update the query record status to 'Open' once the specialist has identified a discrepancy.
Send an email to the attending physician containing the specific query details and a link to respond.
Fetch the physician's clarification or amended note from the clinical documentation model.
Update the original Encounter record with the newly clarified diagnoses or severity of illness.
Aggregate all query entries for the current month to calculate the percentage of queries answered within 24 hours.
Create a task for the Medical Coding team to finalize the codes based on the improved documentation.
Create a report summarizing the number of charts reviewed, queries sent, and revenue impact identified.
End of the Workflow/Process.
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