Health Information Management

Column: Defining 'failed' CDI programs

CDI Strategies, July 7, 2011

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By Donald A. Butler, RN, BSN

I previously started a conversation on CDI Talk entitled “Failed Programs,” hoping there might be someone willing to divulge an account of how and why their program “failed,” perhaps even how they were able to “save” or “reinvent” it.  While the post generated quite a bit of conversation (there were upwards of 36 responses at the time), no volunteers came forward. The online discussion on CDI Talk helped me realize there is not a clear definition for what might be considered a “failed program” in the first place.

I understand this is a very sensitive subject. There might be real reluctance to participate in such a discussion. In my (humble) opinion, however, recognizing program problems can help us seize a genuine “opportunity for improvement.” Understanding how an individual program found potential success amidst the rubble of seemingly insurmountable obstacles may help us all learn something from each others’ schools of hard knocks.
So, I request input (100% private and confidential) from anyone who might be willing to share their experiences of a CDI program that has either failed or come close. For now, let’s focus this conversation around the variations of “failed” programs and think about potential underlying causes.
Before we can consider failures, maybe we should outline what the industry has come to view as CDI program standards and basic functions. To help provide a framework for my reflections, please review these two quotes from the AHIMA Guidance for Clinical Documentation Improvement Programs (May 2010):
“The focus of most CDI programs is on improving the quality of clinical documentation regardless of its impact on revenue. Arguably, the most vital role of a CDI program is facilitating an accurate representation of healthcare services through complete and accurate reporting of diagnoses and procedures.”
“A successful CDI program can have an impact on CMS quality measures, present-on-admission conditions, pay-for-performance, value-based purchasing. The documentation in the medical record becomes data that is used for decision making in healthcare reform, and other national reporting initiatives. Improving the accuracy of clinical documentation can reduce compliance risks, minimize a healthcare facility’s vulnerability during external audits, and provide insight into legal quality of care issues. In a successful program, the CDI professional works to facilitate the overall quality and completeness of clinical documentation to accurately represent the severity, acuity, and risk of mortality profile of the patient being treated.”
I also encourage review of the ACDIS White Paper “What Every CDI Program Needs to Succeed is Structure, Staff, Process,” by Lynne Spryszak, RN, CPC-A, CCDS, CDI education director for HCPro, Inc., in Danvers, MA.
Editor’s Note: This article was first published on the ACDIS Blog. Butler is the CDI manager at Pitt County memorial Hospital in Greenville, NC. Contact him at

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