Cleveland Clinic is running patient charts through a cycle of analytics during hospital stays to look for indicators of potential complications that could arise. The initiative is called DERT, for Documentation, Extraction, Reporting and Transformation.

Starting with heart patients in April 2011, teams from the coding, quality and coding documentation improvement units began manually entering diagnosis and treatment codes and other data elements from the charts into clinical document improvement software from 3M Health Information Systems, Salt Lake City.

The software searches for inconsistencies and patterns, and flags all diagnoses for review. The draw the attention of physicians so they can clarify the chart or treat any potential complications quickly, says Lyman Sornberger, executive director of revenue cycle at Cleveland Clinic. “The closer you can get to real-time care, the better you can enhance clinical outcomes,” he said during an interview at the AHIMA 2011 Convention & Exhibit in Salt Lake City.

The key to early detection is to include more detail in the charts, and to have the charts cleaner, while patients still are in the hospital. The stakes are high: When a hospitalized patient develops a complication, there often are two or three more complications that arise. “An infected central line might migrate to fever, then sepsis,” Sornberger said.

Cleveland Clinic submits quality measure data to University HealthSystem Consortium and started DERT by using its most recent UHC quality measurement scores and additional data, such as readmission rates, as baseline measurements. The hospital expects to receive its third quarter scores in late 2011 and may get its first documented look at the success of the program, although patient populations may still be too low to draw definitive conclusions.

But the clinic knows it is finding discrepancies in charts earlier, fixing them and preventing complications before the patient leaves the hospital and the treatment is billed for, Sornberger said. It also now knows just how many people handle a single patient’s chart. “When DERT started, we found an average of 28 people touch the chart, but they all are looking at it through their own world.”

The clinic now is implementing 3M’s 360 Encompass suite of computer-assisted coding, reporting and performance monitoring software, which includes an updated clinical document improvement application that enables the importing of the chart for analysis rather than manual entry of data. While putting in the computer-assisted coding module, “the light bulb went off for all of us that it’s reading the chart and could help with DERT,” Sornberger said.

DERT recently has expanded to the urology department at Cleveland Clinic and to the urology and cardiac departments of an affiliated community hospital, to see if similar results are found when treating patient populations with lower severity levels.


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