Artifact platform proves faster and easier for physicians, giving them more time to care for patients while improving clinical documentation

### The Challenge
A Mid-Atlantic based health system operates under Maryland’s All-Payer Model and faces the challenge of accurately capturing performance measures to participate in the Centers for Medicare & Medicaid Services’s (CMS) Total Cost of Care (TCOC) Model. Under Maryland’s evolving payment models, capturing accurate clinical documentation for coding episodes of care is vitally important, especially with regards to quality measurement.

The health system’s traditional physician query methods faced a number of challenges, primarily centered around physician engagement and process standardization. Physicians were responding to queries about 60% of the time, and on average it was taking them 12 days to respond. For the query authors, tracking and following up on non-responses also presented a challenge.

The organization wanted a clinical documentation improvement (CDI) tool that would promote engagement, achieve physician satisfaction and drive standardization of query templates and methods.

### The Solution
The health system chose Artifact Health’s mobile query solution to realize its vision for reducing burden on physicians and easing the hospital revenue cycle teams’ documentation improvement efforts.

“We are committed to quality improvement and Artifact’s technology will give us the opportunity to grow and scale our clinical documentation improvement efforts reaching all of our providers with an easier, more efficient way of handling documentation clarification requests,” said IT leadership for the health system.

Further, the health system must ensure quality-based reimbursement metrics are accurately coded and reported because they are heavily weighted in Maryland. Artifact would give CDI specialists and coders a faster and more convenient way to communicate with providers about the quality of care provided.

>”This was the best go-live preparation and smoothest go-live that I have been involved in over my many years of working in a HIM environment!”
– Coding Leadership for the Health System

### The Results
The Artifact platform proved to be faster and easier for physicians, giving them more time to care for patients while improving the accuracy and quality of the health system’s clinical documentation. Within two months of going live on the Artifact system, physician response rate jumped from 60% to 99% and response times dropped from 12 to 5 days.

An added benefit of the near-perfect response rate over the same time period was that the case mix index (CMI) increased significantly. “We know our CMI is only as good as our documentation, so having these responses is critical,” said HIM leadership for the health system.

Artifact also standardized the CDI and coding teams’ approach to delivering queries and significantly reduced their follow-up workload. The real-time reports available in Artifact made the query process transparent, allowing them to see who was not responding and address gaps with focused education.

“This was the best go-live preparation and smoothest go-live that I have been involved in over my many years of working in a HIM environment!” said coding leadership for the health system.

Baystate Health in Western Massachusetts transitions to remote CDI program during COVID-19 with Artifact

### The Challenge
Baystate Health, a 5 hospital system in Western Massachusetts, faced a number of challenges with their existing query process. By far the greatest pain point was asking providers to navigate multiple steps and systems in order to respond to queries.

An unforeseen challenge was the COVID-19 pandemic. Baystate’s clinical documentation improvement (CDI) team was transitioned to work from home in early March of 2020,at the same time the Artifact platform was going live across the entreprise.

>”In the midst of COVID, with our team moving from working physically in a hospital to now working from home… for our providers to still maintain a contact and a touchpoint with us with ease, made all the difference in the world”
– Jennifer Cavagnac, CCDS, Assistant Director of CDI at Baystate Health

With an influx of critical care patients following in the weeks and months ahead, Baystate’s CDI and HIM leadership wondered if providers would adopt new technology during a pandemic.

### The Solution
Baystate wanted a technology that would simplify query workflow for providers and allow CDI staff to review more patient records for accuracy and quality improvement.

Artifact Health’s HIPAA-compliant, cloud-based, mobile query platform was integrated with Baystate’s Cerner EMR and deployed across their 5 hospitals in March of 2020.

Baystate providers could now respond to queries compliantly from a mobile app with as few as three taps on their smartphone. CDI specialists and coders could now create, send, track and collaborate on queries quickly and easily.

Baystate also leveraged Artifact Health’s relationship with HCPro/ACDIS, utilizing their comprehensive library of CDI physician query templates to create and send queries in a consistent and compliant format.

### The Results
LISTEN – 37:52 ACDIS Podcast, COVID-19: Queries and front-line workflow, June 24, 2020. During the deployement of Artifact, the COVID-19 outbreak unexpectedly spiked across the country, and Baystate’s leadership ordered all non-essential staff to immediately begin working from home.

“In the midst of COVID, with our team moving from working physically in a hospital to now working from home… for our providers to still maintain a contact and a touchpoint with us with ease, made all the difference in the world,” said Jennifer Cavagnac, CCDS, Assistant Director of CDI at Baystate Health.

Within the first month of implementing Artifact, Baystate’s query response rates jumped **from 94 percent to 100 percent**. Physician response times dropped from **over 4 days to under 40 hours on average**.

“With our [CDI] team moving remote, I lowered my expectations to give my [providers] some time to answer. We have a great team and have been able to achieve our goal of a 48-hour response time. Artifact has made our jobs easier during COVID,” said Dr. Nageshwar R. Jonnalagadda, MPH, FACP, FHM, Hospitalist and Physician Advisor at Baystate Health.

Prior to Artifact, it took Baystate providers roughly 10 minutes to respond to a query. Today, it takes under a minute, **giving providers back over 2,600 hours of administrative time to focus on patient care**.

In addition, CDI and coding productivity increased significantly. **Query volume increased by over 50%** because the query process became simple and providers responded readily. CDI and coding teams could now focus on reviewing documentation and education, instead of following-up on unanswered queries.

“Our CDI and coding teams have continued querying providers remotely, and our providers are responding, even during this challenging time, because the mobile technology is fast and easy,” said Walter Houlihan, FAHIMA, Senior Director of Health Information Management and Clinical Documentation for Baystate Health.

With strong physician engagement achieved using the Artifact platform during the initial months of the COVID pandemic, the CDI team now remains a remote workforce for Baystate.

Artifact mobile query solution engages clinicians in clinical documentation improvement initiatives across a national community hospital system

### Challenge
Committed to quality, community and people, this hospital system operates more than two dozen acute care and critical access hospitals across the US. Seeking novel solutions to help reduce costs and increase clinical documentation efficiencies, they partnered with Artifact Health in August of 2018 to deploy a standardized mobile query platform across all facilities.

Faced with manual, multi-stepped, paper-based processes, clinical documentation improvement (CDI) and coding staff spent considerable time preparing, delivering, tracking and following-up on physician queries, especially the system’s corporate coders who work remotely. Providers were not fully engaged in the process, so response rates to queries were low. With these challenges, the hospital system was not capturing full and proper reimbursement for the services provided.

### Solution
Leveraging a phased go-live approach, Artifact’s cloud-based solution was deployed across all facilities in three months, integrated with each facility’s electronic medical record system.

CDI and coding staff self-trained in approximately thirty minutes on Artifact’s online training module. Providers were able to download the user-friendly mobile app to their smartphones ahead of go-live and complete an example query, which was enough to prepare them for receiving real queries.

>”I find it very easy to use. It has reduced our turnaround time on responses to queries considerably.”
– Physician

### Results
Deploying the Artifact mobile query platform drove many benefits for this national community hospital system. Queries are sent in a consistent format so providers quickly understand the context and can often respond in less than one minute. Providers answer queries when convenient for them from the Artifact mobile app or website. As a result, coding query response rates improved, increasing from 78% to 99%. Average query response time dropped to within a day or two across the hospital system.

With average response times under two days, corporate leadership reported a significant reduction in the system’s DNFB days, positively impacting cash flow. Real-time reports and dashboards allow them to monitor all facilities and identify providers, coders and CDI staff who require more education.

CDI and coding staff reach off-service and locum physicians in a timely manner. They also spend less time manually tracking queries and more time reviewing charts. Query volumes have already increased by 11% for facilities with active CDI programs.

Perhaps the greatest impact noted by leadership is the heightened physician engagement and satisfaction around a traditionally burdensome process. One hospitalist remarked, “I find it very easy to use. It has reduced our turnaround time on responses to queries considerably.”

How a large national health system deployed mobile technology to simplify query workflow for physicians

### Challenge
An over 60-hospital national health system had many motivations for seeking a new physician query solution.

To begin with, the health system’s inefficient query workflows were having a direct and negative financial impact. For example:

* Significant dollars were on hold because of unanswered queries, costing the health system hundreds of thousands of dollars in interest per month.
* Clinical documentation improvement (CDI) and coding staff spent inordinate amounts of time following-up on unanswered queries, and the cost was reduced productivity and the loss in additional charts that could be reviewed, queried on and coded during that time.
* Most critical, low query response rates at many hospitals negatively impacted accurate quality reporting and full reimbursement.

From a technical perspective, the health system operates different EHR systems across the enterprise. Each EHR system supported its own unique query process for providers, CDI and coding staff. Therefore, there was no easy way to view or measure query activity across the enterprise. Further, CDI and coding staff tracked queries in different software systems, creating silos of information and hindering collaboration between the two groups.

> Despite COVID, query workflow improved. Physicians reported high satisfaction with the easier process. CDI staff, who had been transitioned to working from home because of the pandemic, achieved even greater physician engagement and higher productivity by using the Artifact platform.

Perhaps the greatest challenge was satisfying providers. Providers were extremely unhappy about query workflow. They felt queries were time-consuming and interfered with patient care. As a result, the health system’s average query response rate was less than desirable with significant room for improvement.

Lastly, an unforeseen challenge emerged. In March of 2020, the COVID-19 pandemic hit causing unprecedented upheaval for hospitals across the globe.

### Solution
With various challenges and motivations, the large national health system had to find a solution that would fit their complicated environment and achieve the following goals:

* An effective solution would need to sit across all EHRs, have a shared interface for CDI and HIM staff to collaborate on queries and be accessible to all providers across the health system.
* Providers needed to find the technology easy and convenient so they would adopt it and become engaged in the query process.
* Query volume, response rate and response time measures needed to be tracked accurately across the enterprise and show significant improvement to justify a financial return on improving the process.

The health system selected Artifact Health’s HIPAA-compliant, cloud-based, mobile query platform because the technology checked all the boxes to be effective in their complex environment. Also, with many different EHR systems, the implementation and deployment approach would be critical to success. So, the health system valued Artifact’s focus and strong commitment to customer support.

### Results
The implementation kicked-off in early February of 2020 and the project team brought 20% of the health system’s over 60 hospitals live on the Artifact platform right before COVID hit in mid-March. At that point, the project was paused for three months due to the pandemic.

Because of positive results from the initial group of hospitals, the health system made a decision to restart the implementation process in June, and by September **all 60+ hospitals were live on Artifact**.

The initial group of hospitals live on the Artifact platform before the pandemic hit demonstrated the following results:

* Average monthly query volume climbed 36% by September due to efficiencies gained and the reduction in CDI time spent following up on unanswered queries.
* Average physician response time was cut in half, down to less than a day. The vast majority of physician responses were coming in within the first hour from the time the query was sent.
* Accounts on hold for these hospitals decreased by 69%.

Despite COVID, query workflow improved. Physicians reported high satisfaction with the easier process. CDI staff, who had been transitioned to working from home because of the pandemic, achieved even greater physician engagement and higher productivity by using the Artifact platform.

### Summary
Without knowing it, the large national health system had proactively positioned themselves for the “new normal” setup by the pandemic:

* They relieved providers of a time-consuming administrative task when providers need more time to care for patients.
* They increased the productivity of hundreds of CDI and coding staff working remotely by giving them a tool that engages providers.
* They put an effective query process in place to help financially recover from the disruption caused by the pandemic capturing proper and full reimbursement for services and reducing accounts on hold.
* Finally, at a time when hospitals have a paramount public health responsibility to document and report patient data accurately and comprehensively, they collaborated with experts at AHIMA to provide a standardize compliant query template library to ensure high-quality, comprehensive clinical documentation.

Montefiore St. Luke’s Cornwall leverages mobile technology to streamline query workflow process and improve clinical documentation

### The Challenge
The Montefiore St. Luke’s Cornwall (MSLC) team was faced with a complex and timely physician query process. Queries would often be left unanswered, as providers were challenged by varying manual workflows, unclear deadlines, and multiple steps required to access the information they needed to answer queries. The overall process had become so cumbersome that coding staff sent very few queries.

### The Solution
Laura Berberich, Director of Health Information Management for MSLC, sought out Artifact Health to simplify the query process and improve performance. “Our legacy system didn’t allow us to track and monitor the query responses, and we needed a way to make the process straightforward and compliant for the provider,” says Berberich.

Artifact’s cloud-based, HIPAA-compliant solution was quickly and easily integrated with the hospital’s Meditech Electronic Health Record (EHR) within two weeks of executing an agreement. Within four weeks, MSLC’s entire CDI and coding team was trained and began electronically querying providers via Artifact.

Prior to go-live, MSLC providers were introduced to Artifact and they each downloaded Artifact’s mobile app to their phones to complete an example query. Providers reported that the process was simple to learn.

Artifact’s standard query templates enable MSLC’s coding and CDI staff to create and send inpatient, outpatient and pro-fee queries in a consistent format. Standardizing query formats and leveraging compliant, multiple-choice questions where appropriate, have helped reduce decision fatigue for providers. Additionally, providers can now answer queries from their phones or from any browser, allowing off-service physicians to respond quickly and when convenient.

>”I receive the notification via the Artifact app and I can answer quickly, usually within 15 minutes. The process is easy and everything I need to answer the query is right in the app – I don’t have to log into our EHR system separately anymore.”
– Dr. Ketul P. Vora, MD, hospitalist at MSLC

### The Results
Since implementing Artifact, MSLC query response rates jumped from 84 percent to 100 percent in the first month. Response times for concurrent queries improved from 3 days to less than 38 hours on average.

Further, MSLC was able to expand its program to include retrospective queries because the process was so simple and providers were responding readily.

Prior to Artifact, the team sent an average of 125 concurrent queries each month. Within the first month of Artifact’s implementation, query authors sent 170 concurrent and 98 coding queries, a 114 percent increase in total volume.

OU Health standardizes physician query workflow and achieves positive results

### The Challenge

OU Health, a three-hospital academic health system based in Oklahoma City, faced several challenges with their existing physician query process. OU’s CDI and coding teams were tasked with creating and sending queries to providers using multiple systems and different delivery methods. (HPF, MEDITECH, Iodine, email, fax and in-person) The disconnected workflows caused significant delays, impacted cashflow and made it impossible to accurately track and report query metrics.

### The Solution

OU Health was looking for a way to streamline and standardize their query workflow for both CDI/coding and providers. Ultimately, they wanted to improve the quality of the medical record and reduce the increasing DNFB dollars held for queries.

> “The implementation of the Artifact Health platform allowed us to completely transform our query process. Not only have our financial and quality metrics improved significantly, but also our CDI and coding staff and providers love it!”
– Jennifer Dhooge, RHIA, CCS, CDIP, CRC, Administrative Director of HIM, Coding and CDI for OU Health

Artifact Health’s HIPAA-compliant, cloud-based, mobile query platform was integrated with OU Health’s MEDITECH EMR system and deployed across their three hospitals in June of 2020.

The OU Health CDI and coding teams could now utilize one platform to create, deliver and track all queries. They could collaborate on concurrent and retrospective queries because of the shared interface in Artifact. OU Health providers were responding to queries in Artifact quickly, often in less than 30 seconds from their mobile device or desktop.

To ensure they were sending queries in a consistent and compliant format, OU Health also leveraged Artifact Health’s relationship with AHIMA, licensing AHIMA’s comprehensive library of compliant physician query templates.

### The Results

Within the first couple of months of implementing Artifact, OU Health’s query response rate jumped **from 87 percent to 98 percent**. Physician response time decreased from **over 7 days to under 48 hours on average**.

The increased response rate allowed OU Health to appropriately recognize the revenues they were entitled to for the services provided. The faster 48-hour response time significantly **decreased DNFB by over 70%**, allowing the health system to reduce A/R days and improve cashflow.

In addition, CDI and coding productivity increased significantly. **Query volume nearly doubled** because the query creation process became faster and providers responded readily without the need for excessive follow-up. The CDI team could now focus on reviewing documentation and providing education.

“The implementation of the Artifact Health platform allowed us to completely transform our query process,” said Jennifer Dhooge, RHIA, CCS, CDIP, CRC, Administrative Director of HIM, Coding and CDI for OU Health. “Not only have our financial and quality metrics improved significantly, but also our CDI and coding staff and providers love it!”

OU Health recently asked Artifact Health to remain in place to facilitate query workflow with the health system’s conversion to the Epic EMR system in 2021.

National community hospital system expands usage of Artifact’s mobile query platform to ease burden on physicians and capture proper reimbursement

### Challenge
One of the nation’s largest operators of general acute care community hospitals identified their physician query process as responsible for lost revenue, physician burden and widespread inefficiencies for Clinical Documentation Improvement (CDI) and coding staff.

CDI leadership sought an innovative query solution to streamline this critical revenue cycle process, and they had many requirements including:

1. **A “standalone” application** able to integrate with multiple EMR and coding systems that existed across their network
2. **A fast, convenient workflow for providers** not causing them to incur additional time in their day
3. **Real-time reporting** to ensure visibility and accountably with query tracking down to the provider, CDI specialist and coder levels
4. **Standardization of query templates** that could be shared across all facilities and written compliantly according to industry guidelines and best practices

### Solution
Artifact’s HIPAA compliant, cloud-based mobile query solution was first deployed to 5 pilot facilities, and after 3 months, rolled out to more than half their facilities in 4 waves over 5 weeks.

After this initial large-scale deployment, the hospital system continued to expand Artifact across all facilities with either the full platform or the Artifact *Light* version, so all facilities shared one compliant template library.

>”This is the best software this hospital has ever purchased.”
– Physician

### Results
Over the last two years, the health system has completely revamped the query process, most especially by engaging providers with a solution they find easy to use. One hospitalist said, “This is the best software this hospital has ever purchased.”

Providers at all facilities are now held accountable for responding to queries and individual performance is easy to identify through Artifact’s reporting. Leadership monitors key performance indicators and targets providers with education where needed. Response rates for the health system increased from 94% to 99% and average response times dropped from 6 days to 2 days.

Productivity greatly increased for CDI specialists and coders by eliminating the time-consuming, manual efforts to get queries answered. As a result, they began to review and query on more charts. Overall, query volume increased by 125% across the health system. A CDI specialist remarked, “Artifact saves me so much time because it’s really simple to write and send queries and get quick responses from physicians.”

Artifact’s mobile physician query tool helps Western Maryland Health System accurately code episodes of care in a quality-based reimbursement program

### The Challenge
The state of Maryland operates under the unique All-Payer Model with a strict quality-based reimbursement program, where hospital payment is dependent on accurate performance measurement. Because of this, hospitals must be meticulous in capturing and coding episodes of care in order to accurately determine hospital revenue and avoid financial penalties.

Western Maryland Health System was lagging in physician query response rates, which were hovering between 62-65%, and affecting performance measurement.

### The Solution
Previously, the clinical documentation improvement and coding teams at WMHS were using disparate systems to query physicians. The varying query formats and processes confused providers and limited accountability and tracking. Furthermore, the query process was manual and paper-based, relying on faxing and scanning, resulting in response times ranging from 4 to 28 days. Without an easy way to consistently and compliantly clarify physician documentation for accurate coding and billing, WMHS was losing revenue on proper reimbursements.

WMHS determined it needed to invest in a mobile platform that would automate physician queries to improve the quality of patient records and ensure full reimbursement for services. According to Tracey Davidson, MSN, RN, Director of Quality Initiatives at WMHS, “Among the hospital’s goals were to better engage our physicians, decrease response times, and increase response rates. We also wanted to send physician responses directly to the chart and support more accurate coding for better quality patient records, use a standardized, compliant query template library, and ensure proper reimbursement for our services performed.”

In 2018, WMHS selected Artifact Health, which provides the first and only mobile platform that streamlines the physician query process. With Artifact Health’s mobile platform, WMHS had an easy-to-use mobile app for physicians to answer queries quickly and view supporting documentation right on their smartphones from wherever they chose. And because of Artifact’s partnership with American Health Information Management Association (AHIMA), WMHS has access to a standardized set of industry templates that are up-to-date and fully compliant.

>”This first year with Artifact Health has been a major win for our hospital. We are seeing drastic improvements in response rates and response times, more complete patient records and more charts getting reviewed and queried, all which have a direct effect on reimbursements. Artifact’s partnership with AHIMA also ensure our queries are compliant and current.”
– Tracey Davidson, MSN, RN, Director of Quality Initiatives at WMHS

### The Results
Within a year of implementing Artifact, WMHS saw dramatic improvements and time savings for its staff and providers:
* Physician response rate peaked at 100%, up from 62%, indicating fully engaged physicians.
* Physician time to respond to concurrent and retrospective queries went from typically 4-28 days down to 1 day.
* The hospital’s discharged, not final bill (DNFB) dropped by 27% in the first six months after the Artifact go-live.
* The average time for the CDI and coding teams to create a query went from 30 minutes to 5 minutes on average – a time savings of nearly 1,700 FTE hours for the hospital.

Davidson remarked, “More charts are getting reviewed and queried. Coders are getting final code sooner, improving the hospital’s cashflow, and we’re giving physicians back valuable time in their day to treat patients.”

Children’s National Health System increases response rates to 99 percent, query volume by 200 percent, with Artifact mobile app

### The Challenge
For years, Children’s National Health System’s CDI team relied primarily on email to communicate with providers about queries. Physicians would often have multiple steps to go through to complete a request for patient record documentation clarification, including having to login separately to the EMR to look up information in medical records.

“We needed a better way to reach physicians and communicate with them, as well as an easy and compliant way for them to answer queries, given all of their other responsibilities,” says Stephen Wood, Director of Revenue Analytics for Children’s.

### The Solution
The Children’s CDI team learned about Artifact Health’s mobile physician query solution and realized it provided exactly what they needed – a seamless interface for physicians to quickly and compliantly answer queries.

Now instead of relying on email, calls, and face-to-face communication, hospital CDI staff can go directly to providers through Artifact’s mobile platform and reach them right on their smartphones. Physicians can complete queries from anywhere with just a few taps on their phone, reducing their administrative burden.

Children’s integrated Artifact’s mobile query platform with its Cerner EHR system. That integration means physicians no longer have to dig through medical records to answer queries; they can see the relevant records right on their phone within the query. Further, physicians’ query responses immediately populate the patient chart in Cerner. “Getting the EHR and Artifact mobile platform connected was crucial,” says Wood.

>”Artifact helped us take a process that was burdensome for the CDI and coding teams as well as providers and replace it with easy, compliant access to queries. Now, providers can answer these queries compliantly right on their phone from wherever they’d like, making the process fast and less disruptive and time-consuming; giving them more time to focus on patient care.”
– Stephen Wood, Director of Revenue Analytics at CNHS

### The Results
According to Wood, since implementing Artifact Children’s has achieved a 99 percent response rate, with 80 percent of the responses coming within two days of being sent. The average response time for concurrent queries is just one day (two days for retrospective queries). Importantly, Children’s has also seen a dramatic increase in overall query volume – a 200 percent increase in three months.

The hospital is also seeing changes in physician behavior. There are some items CDI staff used to regularly query for that providers are now proactively addressing in documentation, leading to more accurate and comprehensive charts. “This is the ultimate goal, and we’ve leaned on the Artifact tool and our CDI Educator to drive this,” says Wood.

### Looking Ahead
Children’s finds the Artifact communication platform so effective that it wants to expand its use for other workflows, such as automatically notifying physicians about patient readmissions.

Johns Hopkins Medicine eases documentation burden on physicians with mobile technology that expedites accurate coding of patient records

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### Challenge
Johns Hopkins Medicine, headquartered in Baltimore, Maryland, is an $8.5 billion integrated global health enterprise and one of the leading health care systems in the United States.

Like many hospitals and health systems, Johns Hopkins asked its physicians to participate in a time-consuming, burdensome documentation task – the physician query process. The multistep, cumbersome query process for Johns Hopkins physicians included: fielding emails, phone calls and texts, logging into the EMR, searching for the query within the in basket, finding the patient’s chart, creating an addendum to the record, and responding back to the clinical documentation specialist or coder – all of this taking 15 to 20 minutes to address a single query. **Consequently, physicians were responding to anywhere between 50% to 84% of queries, depending on the hospital**.

Physician responses to documentation queries are important. They ensure hospitals and physicians receive proper reimbursement for services and report quality measures accurately. In general, unanswered queries lead to claims that cannot be processed, bad debt and inaccurate quality measures.

At the time, Johns Hopkins physicians were not the only ones dissatisfied with the query process. Clinical documentation improvement (CDI) specialists and coding staff were overwhelmed by the significant time and effort required to manually track and follow-up on unanswered queries. One CDI specialist commented, “Typical physician response times are anywhere from weeks to never.”

Adding to these challenges, Johns Hopkins operates under Maryland’s unique All-Payer Model and must accurately capture performance measures to participate in the Centers for Medicare & Medicaid Services’ (CMS) Total Cost of Care (TCOC) Model. Under Maryland’s payment model, capturing accurate clinical documentation for coding episodes of care is critical to maintaining CMS quality measure targets.

Johns Hopkins Medicine needed an innovative physician query solution that would solve multiple problems:
1. Increase physician engagement and accountability
2. Standardize and automate the process for CDI and coding staff
3. Remove the unnecessary burden on physicians

>”Under Maryland’s unique all-payer system, we thoroughly understand the importance of strong physician engagement in CDI programs to support quality-based reimbursement models. We welcome opportunities to enhance our efficiencies in ways that are convenient to physicians.”
– Peter Greene, M.D., Chief Medical Information Officer for Johns Hopkins Medicine

### Solution
In 2016, the Johns Hopkins Technology Innovation Center (TIC) collaborated with startup, Artifact Health, to bring to market a cloud-based, HIPAA-compliant, mobile physician query platform. The Artifact platform would give Johns Hopkins physicians an easier and faster way to respond to queries about their documentation allowing the health system to add greater specificity to patient records and improve coding accuracy.

Artifact Health and the TIC conducted a successful pilot at Johns Hopkins Howard County General Hospital in Columbia, Maryland with the guidance and support of physicians and the hospital’s CDI and coding staff. **The physicians’ enthusiasm for the tool, along with an immediate increase in response rate, decrease in response time, and enhanced CDI productivity, were primary factors in the decision to deploy the technology across the enterprise.**

### Results
[LISTEN – 5:42 Johns Hopkins CDI Leadership reporting query results, June 2020](https://www.youtube.com/watch?v=gQr_hFvllg0).

By spring of 2017, Johns Hopkins launched Artifact across its five hospitals in the Baltimore/D.C. region as a give-back to physicians under the “Joy of Medicine” program, an initiative to promote physician wellness by helping providers rediscover the joy that comes from caring for patients by removing unnecessary administrative burdens.

As part of the Joy of Medicine program, Johns Hopkins physicians insisted on a reduction in notifications received in the in basket. They considered the overwhelming number of items in the in basket a contributor to physician burnout. Other physicians began reporting the same, as described in this article published in November 2018 by Dr. Atul Gawande.

After deploying Artifact, Johns Hopkins **query response rate increased immediately and has remained between 95-100 percent for the last four years**. The increase in physician engagement around queries resulted in higher-quality documentation and more accurate publicly reported quality outcomes.

The most striking result was the immediate improvement in provider satisfaction around query workflow. A physician leader remarked, “Getting a true baseline measure of physician satisfaction is difficult, but I can tell you the difference [with Artifact] is palpable. It’s the only technology I can recall adopted voluntarily by Hopkins physicians because they liked it.”

For that reason, **average physician response times for both concurrent and retrospective queries dropped to 48 hours or less, with many providers responding within 1 hour of receiving the query in Artifact**. This is compared to a 14-day average response time recorded previously.

>”It’s very easy to use and providers love it. Many wanting to be the provider with the quickest response rate!”
– Johns Hopkins CDI leadership

**In addition, CDI leadership reported a significant increase in query rate**. CDI specialists gained more time to review charts because they no longer had to track down physicians with unanswered queries. The efficiencies gained resulted in increased query volume.

Coding staff became more confident that queries would be answered quickly. Consequently, the number of retrospective queries increased as well. The faster response times reduced accounts receivable days and **DNFB dollars by 65% at The Johns Hopkins Hospital** when Artifact went live.

Reported for 2018, Artifact helped Johns Hopkins Medicine **realize over $6.6 million in increased revenue** due to the ability to obtain timely and accurate responses to queries related to potentially preventable complications.

### Expansion
By early 2019, Johns Hopkins expanded Artifact to streamline documentation clarifications across two new areas – professional fee billing and outpatient physician practices. The decision to expand to professional fee billing was driven by physician demand. Physicians requested all documentation clarifications be delivered via Artifact.

Johns Hopkins created the first pro-fee query template library within Artifact to facilitate queries across twelve departments. As seen in the inpatient environment, response rates to pro-fee queries increased and response times dropped significantly. Previously, charges were not finalized until providers created an addendum to the note in the EMR and emailed the coder that it was done, often taking weeks to complete.