Coding
Medical coding is challenging and time intensive work. If you are wondering how to help support your HIM department, technology may be front of mind. Learn how AI will help increase efficiency and accuracy, and evaluate if your department is ready to take the leap.
Artificial Intelligence (AI) has permeated and innovated most industries, but healthcare has traditionally lagged behind. This is, in part, because the stakes surrounding healthcare (human life) are uniquely important and should be adjusted with sensitivity. However, following clear advancements and maturity of AI, hospital stakeholders have significantly increased their interest in adopting AI, especially in the backend and operational side of healthcare.
AI promises significant advantages when it comes to increasing coder efficiency and improving data quality.. Understanding what AI is can help clarify its relationship with automation and how it can help. In its most simple terms, AI is a computer system that continuously learns from data in order to predict future data points. This means it is particularly useful when there is abundant data to make sense of. So, when we start looking at healthcare, and particularly health information management processes, there is a clear opportunity to apply AI.
In the coding process, for example, there is a significant amount of patient data that has been collected by hospitals for many years. Health information management (HIM) professionals have also worked tirelessly to code that data. With this meaningful combination of data sources, Health Information Departments can apply AI software that will look at the data that has been coded and learn how to start predicting those codes in the future. This is a transformative process for HIM professionals: all the data they have worked so tirelessly to code can now help reduce the time and effort needed in the future.
The other piece of the puzzle, is what happens after the data is coded. Before coded data can be submitted to the Ministry or CIHI, you must ensure that the data is accurate. How do you do this now? Some Canadian hospitals have a team of auditors to review the record and look for coding and data quality errors, but many do not. Either way, AI-assisted auditing poses a meaningful efficiency and accuracy opportunity to have technology take the initial pass for instances of overcoding, undercoding, and documentation deficiencies.
Not every hospital or environment is the right fit for AI. Organizational readiness is dependent on where you are in your data and IT journey. Whether or not you are considering Semantic Health or another vendor, there are a few key considerations to evaluate fit:
On the data and IT side, one of the biggest signs of readiness is a hospital’s level of digitization. As a result, a key indicator is if you have adopted a modern EHR and store documentation in digital-first format. There has been a massive shift towards digitization in Canada, as many hospitals have adopted Epic, Cerner, or Meditech Expanse. If you have, you’ll have more digital documentation, which is best for the software.
It is also worth noting that no hospital is truly 100% digitized. A hybrid environment is still a good fit for AI. Really, readiness is about being on the roadmap to full digitization rather than already having achieved it.
Canadian hospitals are increasingly showing interest in using the cloud for data-intensive work. This would allow them to get AI/ML algorithms up and running much faster, cheaper, and more reliably. Right now, it is not essential for providers to be on the cloud to embrace AI, but your Health Information Department will see the benefits if you are.
If you want to learn more about how the technology behind AI-assisted coding and auditing software integrates hospital infrastructure, read How Will Semantic Health Fit in My Data Pipeline?
As you consider your current coding and auditing processes, HIM Managers and Directors should consider these questions to evaluate if the core value of AI coding and auditing technology will benefit them:
Do you have large backlogs, rely on a few key coders, anticipate retirements, see churn in your team, or feel like your coding processes are like a house of cards? In this type of environment, technology can be particularly helpful by making your current team more productive. This also means that your team will be increasingly resilient to change.
Auditing coded data takes significant effort. As a result, having the bandwidth to ensure data integrity is a challenge for most hospitals. While some have CDI, auditing, and data quality professionals to manage this workflow, many hospitals are forced to put this additional challenge onto coding and data support. While both types of hospitals would benefit, the later challenge would suggest an increased need for technology to support current workflows. Thus, if you’re suspicious of data quality errors but don’t have the capacity to temper these concerns, AI may be an important next step for your team.
If your team is moving (or has recently moved) from a legacy process to an EHR system, you’re a prime candidate for AI. Adopting an EHR will increase (1) documentation deficiencies as physicians start taking more notes and (2) coding errors as the new process is adapted. If you’re going through that transition or envision going through that soon, there is significant room for technology support.
If you’re playing catch up with coding, suspicious of data quality errors, or/and recently adopted an EHR system, then your Health Information department is a prime candidate for AI.
Want to know what other signs you should be looking for to assess a time-sensitive need for AI? Read 6 Signs You Should Adopt AI-Assisted Medical Coding in the Next 6 Months.
Who needs to be at the table to ensure that AI adoption in health information management is effective? Every hospital is different. But consistently, we’ve seen that the Coding Manager or Director HIM needs to be clear about how this technology will help their team. Additionally, those who are looking at the hospital from a technical and financial perspective, the CIO and CFO, must understand the effort involved and the impact of the technology to see a smooth roll out.
As part of this, the coding team and people who will use this technology daily should be involved in the decision. When people say “AI,” the idea of automation comes in very quickly. It can get scary! This is an important reminder: AI technology is not here to automate the work; it is here to help take coders and auditors to the next level by reducing the significant pressure they face every day. At the end of the day, the relationship between humans and technology is key. The more harmonious the relationship, the better the outcome in the end.
AI-assisted medical coding and auditing can provide tremendous efficiency and accuracy gains for providers, but not every hospital is the right fit. As you ask, “Is my HIM department ready for AI?” it’s important to evaluate your data and IT environment, assess your current coding and auditing processes, and ensure you have buy-in from the right team members. With this framework in mind, your Health Information Department can prepare for and adopt a solution that best fits your team. If you have any more questions, please email us at contact@semantichealth.ai, and a member of our team would be happy to answer them!
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Semantic Health helps hospitals and health systems unlock the true value of their unstructured clinical data. Our intelligent medical coding and auditing platform uses artificial intelligence and deep learning to streamline medical coding & auditing concurrent with patient admission, improve documentation quality, optimize reimbursements, and enable real-time access to coded data for secondary analysis.
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