Becker's Hospital Review

84 Executive Briefing Healthcare's Second Curve: Is Your Clinical Documentation Ready? H ealthcare and economics have always been entwined. Analogous principles are at play in both disciplines, and the two have cross-pollinated for centuries. But not all economic ideals have played out in the healthcare world — yet. In 1996, economist and futurist Ian Morrison outlined a theory called "the second curve" in a book of the same name. The second curve refers to the point in a market or industry where technology and consumerism meet to generate a big leap forward that most stakeholders never saw coming. In computing, the second curve was the laptop and tablet. For telecommunications, it was the smartphone. "The vital part of this whole concept is, how do you prepare for and make that transition?" says Tony Oliva, DO, vice president and CMO of Nuance. "If you make it too late, competitors will capitalize on what you've missed, but if you make it too early, you may not be prepared to meet the needs of the consumers." Healthcare's second curve is more complex than a single piece of technology. Dr. Oliva says this industry's second curve may ultimately be the shift to a value-based system of care, driven by technology and consumerism. For almost the entire span of medicine's history, physicians and hospitals held the power of knowledge over patients — their consumers. In medicine, knowledge plays a large part in driving both sides of the supply-demand equation. "But consumers today have the tools to ask more questions and understand their medical conditions better than they ever have before," Dr. Oliva says. "We've let in a little light through our armor and we no longer have control of the grail — our consumers can challenge us now." Technology has also spurred transparency, which counters previously held assumptions of care quality. Transparency has shifted power from providers to consumers, driving the volume-to-value shift and requiring hospitals to become more efficient and agile to maintain revenue, while demonstrating the quality performance that increasingly determines reimbursement levels. What does this have to do with clinical documentation improvement? A lot. When care teams do not have effective clinical documentation tools, they are more likely to inconsistently chart information about patients. Inconsistent charting of patients' illness severity can result in incomplete coding, greater predicted mortality rates and a financial loss of millions in one year alone. Over the last 20 years, Nuance has honed its approach to clinical documentation improvement, with services and technology to support clinician efforts across organizations for complete and compliant documentation that puts the patient first. "Every patient deserves an accurate clinical picture of their story," adds Dr. Oliva, 'by enabling CDI teams and physicians to engage in a clinical dialogue about all the patient's conditions and treatments, we develop a much richer patient record." This clinically focused approach coupled with technology creates a truly Advanced Practice CDI program. Through voice-enabled technology and advanced clinical language understanding capabilities, the Nuance approach to CDI maximizes physician adoption and avoids the lack of specificity in clinical documentation that compromises clinical, quality care and financial outcomes. With documentation that reflects the complexity and severity of each patient's illness and risk of mortality — and the resources used to address them — Nuance's approach helps organizations enhance quality patient care, achieve reimbursement appropriate to the level of treatment provided and improve hospital quality ratings. "It fits between the first and the second curve," Dr. Oliva says. "There's almost nothing we do in healthcare that's a pure win- win, but this is one of them." The Connection Between CDI and Quality Clinical documentation is notoriously vexing for many clinicians, but the problem doesn't stem from poor coding, Dr. Oliva says. Nor does the fault lie with the provider. "We as physicians live in an isolated world that is very clinically focused," Dr. Oliva says. "We use clinical terminology — we don't speak in ICD-10 codes, and if we did we'd look at each other with blank faces, because codes don't convey the clinical picture." Outside of the clinical sphere, however, code is the prime language. Under value- or performance-based contracts, most Sponsored by:

• Cover