Clinical Documentation Improvement for Children's Hospitals

In the recent past, Children's hospitals throughout the nation are realizing that they need help with physician documentation, too - but they have a different incentive.

Traditional CDI programs have been dedicated to improving reimbursement for Medicare patients since the advent of the Inpatient Prospective Payment System (IPPS). Consultants learned what they thought would be beneficial to adult acute care hospitals and sold their products to them.

With the recognition that the advent of ICD-10 will influence the effectiveness of capturing data in pediatric institutions and recognizing that severity adjusted reimbursement is on its way to the children's hospitals of this country, these facilities are recognizing the importance of getting the data right - and one of the most important ways is through clinical documentation and the capture of data.

Kids are not adults. Neonates and geriatric patients are not the same animal. For consulting companies who have had experience in the Medicare world to think that they can be effective in a children's hospital is a joke. The thought process of the pediatrician, the neonatologist, the pediatric surgeon is different.

Many CDI programs out there are directed toward training nurses (usually Case Managers "who are in the chart anyhow") to hassle medical staff and hassle coders to get optimized DRG assignments and Major Comorbidities. This is NOT the pediatric world. This isn't where they live and isn't what they need. Naive folks at children's hospitals who think that these companies can provide them with the panacea are just that - naive.

What is needed in a pediatric hospital is clinicians to talk to clinicians, specialty by specialty about the things that affect their practice in the world of PEDIATRICS and to help them with the recognition that quality of care and the measures of quality of care depend on information flow. You don't need nurses flitting around bugging these physicians for "acute kidney failure because it meets the RIFLE criteria." You don't need people in the charts putting in plugs for "possible, probable or likely gram negative pneumonia." You need clinicians who understand diseases talking to clinicians who are dealing with the diseases.

Whether we're in the paper world, the electronic world or a hybrid, information flow is dependent on diagnostic and procedural data being accurate. If a physician is not going to utilize the methodology of documentation in his hospital effectively, nothing else matters. Getting it right is what counts.

Children's hospitals need CDI - but they need PEDIATRIC CDI. They need direction and help - but they need direction in the pediatric world.