Abstract
Background Reliable, precise, timely, and clear documentation of diagnoses is difficult. Poor
specificity or the absence of diagnostic documentation can lead to decreased revenue
and increased payor denials, audits, and queries to providers. Nuance's Dragon Medical
Advisor (DMA) is a computer-assisted physician documentation (CAPD) product. Natural
language processing is used to present real-time advice on diagnostic specificity
during documentation.
Objectives This study assessed the feasibility, acceptability, and preliminary efficacy of real-time
CAPD in improving diagnostic specificity and in turn reducing clinical documentation
improvement burden.
Methods This prospective, crossover trial recruited 18 hospitalists employed by Lifespan
Health System and assigned them randomly to two groups. Each group first completed
documentation using either traditional clinical documentation improvement (CDI) methods
or CDI + DMA real-time advice for 8 weeks and then crossed over. Metrics from Epic's
electronic medical record and Nuance administrative tools as well as anonymous surveys
and one-on-one interviews were collected and analyzed.
Results Hospitalists had 29% fewer standard CDI queries using DMA with CDI (incidence rate
ratio [IRR]: 0.71; 95% confidence interval [CI]: 0.37, 1.39). Self-reported ability
to predict clarification requests improved by 1 point on average (IRR: 1.00; 95% CI:
0.32, 1.67) on the Likert scale. This benefit was kept even after DMA was stopped
and the group reverted back to CDI only. Qualitative survey reports indicated overall
ease of use and educational benefits. Additional work needs to be done to determine
if there is significant increase in note-writing time or reimbursement.
Conclusion Hospitalists using DMA spent less time responding to in-basket queries. There was
a strong educational opportunity, and the tool was easy to use. DMA offers promise
for improving diagnostic specification while minimally impacting provider workflow.
Keywords
documentation - natural language processing - computer-assisted diagnosis - Dragon
Medical Advisor - health insurance reimbursement
