Health Information Management

Heal the divide between HIM and CDI

JustCoding News: Inpatient, March 17, 2010

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Divisions between HIM and clinical documentation improvement (CDI) staff members are common. But in actuality, everyone needs to work together for the success of the whole.

“It’s not an us vs. them concept, it’s a we concept,” says Colleen Stukenberg, MSN, RN, CMSRN, CCDS, clinical documentation management professional at FHN Memorial Hospital in northern Illinois and author of Successful Collaboration in Healthcare: A Guide for Physicians, Nurses, and Clinical Documentation Specialists. “Our successes, our failures, all are ours together.”

In reality, it may take significant time to develop a respectful relationship between both groups of staff members. So how do you effectively promote collaboration and partnership in your facility?

Getting started

If you don’t already have a CDI program, take the opportunity to prevent potential problems by being selective in who you hire to be your CDI professionals. Decide in advance whether you want someone with more clinical or coding experience.

“I think the key is that you need both. You need a very strong clinical knowledge base, but you also have to have some good understanding of coding rules and how those guidelines work,” Stukenberg says. If you decide to choose someone with a strong clinical background, make sure he or she has some coding experience, or at least choose someone you believe can learn the coding rules, she advises.

And don’t forget that they need to have strong communication skills. Not only will they need to interact with coders and other CDI professionals, but they’ll also have to interact with the physicians.

“When you’re working with physicians, you have to understand where they’re coming from,” Stukenberg says. “The last thing they may think about is documentation and what it means for coding. They’re thinking of taking care of the patient and giving the patient the best outcomes. So you have to have someone who can talk and work with the physicians concurrently.”

In other words, look for CDI professionals with strong clinical experience, a solid knowledge base of coding, and the right personality to be able to work and communicate with others. When all three of these come together, it’s a good sign you’ve found the right person.

In addition, make sure you prepare staff members well in advance as you implement a CDI program.

“When you launch your CDI program, make sure HIM is at the table and is helping design the program equally as partners,” says Gloryanne Bryant, RHIA, CCS, CCDS, regional managing director of HIM at Kaiser Foundation Health Plan, Inc. & Hospitals in Oakland, CA. Keep your coders in the loop and make sure HIM staff members have a way to voice their opinions, suggestions, and concerns.

Tamara A. Hicks, RN, BSN, CCS, CCDS, manager of care coordination at North Carolina Baptist Hospital in Winston-Salem, notes that preparing coders for the change is necessary. When her hospital began its program more than 10 years ago, the coders weren’t prepped adequately, and as a result, they never felt like they were an important part of the team. “I would advise folks who are building these programs to keep it in the front of their minds that if they are going to put nurses and coders together, they have to build that team from the beginning and prepare the existing staff for these new people who are coming in,” Hicks says.

Bridging the gaps

If you already have a CDI program at your hospital but are experiencing problems between HIM and CDI staff members, consider taking the following steps to bridge the divide:

  • Assess the situation to make sure that process issues aren’t causing the problems between staff members, Stukenberg suggests. Check your work flow from beginning to end and see where your gaps are. Issues seemingly related to poor communication between the staff may actually be due to faulty processes or work flow. “You need to have meetings with the team to find out where the gaps are,” she says. “Where did one person not understand what the other person was doing? Where was the disconnect?”
  • Make sure that everyone spends some quality time together. “One of the things that I was very adamant about was making sure this group met regularly,” Hicks says. “Even if we just sat in the same room and looked at each other, at least we had the forum.” This allows both CDI and HIM staff members the opportunity to meet and air concerns, such as when a coder feels as though a CDI specialist is stepping on his or her toes or a CDI professional believes coders are just being nitpicky about a particular coding rule.
  • In addition, when educational opportunities arise, invite both groups to participate, Bryant suggests. Chances are, when educating your CDI staff members, HIM inpatient coders will benefit from that education as well, she says.
  • Take advantage of hospital resources that may help heal bruised egos. “I jokingly tell people that we went through therapy together,” Hicks says. “We used the employee assistance program here at the hospital and we went through ways to talk to each other appropriately, disagree with each other appropriately, and did team building exercises.” Doing so can help reinforce the respect that various staff members need to have for each other and the different background knowledge and experiences each brings to the table.
  • Consider the effects physical space may have on the program. If your coders are sitting in cubicles in a tiny room, they may feel like their personal space is being invaded when CDI staff members come into the space to review charts, says Hicks, who experienced this firsthand. She says carving out some space to meet and place records was incredibly helpful. “It sounds silly, but when you’ve got eight or nine people coming into your itty-bitty space, it’s a problem.”
  • Look at how staff members communicate with each other. The ability to communicate effectively is critical to the program. If CDI staff members are visiting your coders’ cubicles regularly, the coders may become resentful because it slows them down and affects their productivity. Hicks’ facility developed a communication worksheet that the CDI staff can fill out and give to the coders instead. “Now they are writing each other notes and sending each other e-mail, and that has helped a lot because now they’re not in each other’s faces,” she says.

Although it may take some effort to successfully bridge the gap between the CDI and HIM staff members, stay positive. Think of it as a wonderful opportunity, says Bryant. “Typically, we see the sort of finance side, which includes HIM, being very separate from the clinical side, but this is a chance to blend together,” she says. “This way we can promote the best of both worlds—showing the kind of quality care we give through the data that supports it and the reimbursement we receive as a result.”

Editor’s note: This article was originally published in the March issue of Medical Records Briefing. E-mail your questions to Senior Managing Editor Andrea Kraynak at

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