CDI: Compliant Technology Adoption and the Role of Clinical Documentation Specialists

AHIMA and Artifact, an Iodine solution convened a panel of experts from across the healthcare industry for a roundtable discussion exploring best practices in CDI and how advances in artificial intelligence (AI) technology are transforming clinical documentation integrity (CDI) and the role of clinical documentation specialists (CDSs).

CDI Solution Drives Documentation Excellence and Improves Revenue Performance

R1 RCM and Iodine Software’s comprehensive clinical documentation integrity solution connects managed services and intelligent technology

R1 published the following on October 16, 2023 announcing R1 and Iodine Software as solutions partners.

CDI can lead to improved patient outcomes as well as increased reimbursements for healthcare systems. But up until this point, CDI solutions have been siloed as separate approaches: Consulting and managed services are one approach; technology solutions are another. But what if these approaches joined their strengths together? How could that improve the completeness, accuracy, and specificity of the medical record and reduce documentation, coding, and billing errors?

CDI Total Performance, powered by Iodine, does just this. A joint solution, CDI Total Performance combines the domain expertise and deep data insights of R1 RCM clinical documentation specialists with the Best in KLAS AwareCDI platform from Iodine Software.

The need for a new CDI approach

Efforts to codify clinical care are as old as documentation itself, with the first “modern” disease classification system developed in the early 18th century. With quantum leaps in specificity and complexity of medical coding in recent times, CDI becomes more important than ever as a driver of revenue performance.

A strong CDI program is a critical imperative that comes with challenges

Released earlier this year, the 2023 Revenue Intelligence Data and Insights Report unveils some of the RCM issues most profoundly impacting healthcare providers. Of the 13 revenue cycle stages covered, seven have clinical documentation integrity as a key enabler for process and outcome improvement. From determining appropriate patient status and capturing legitimate charges to recovering underpayments and reversing denials, CDI plays a foundational role in facilitating and improving mid-cycle and back-end revenue processes.

There are several barriers that can hinder the effectiveness and sustainability of a CDI program. One is the industry perception of CDI programs as cost centers rather than revenue drivers. In fact, a national study of CDI leaders conducted last year by the Association of Clinical Documentation Integrity Specialists (ACDIS) for Iodine Software found 91% of CDI leaders track financial impact as a measure of success, while 68% track severity of illness (SOI)/risk of mortality (ROM) impact, and 53% make note of the observed-to-expected mortality rate. Even providers that do recognize CDI’s revenue opportunities can struggle to make headway because their programs lack transparency, accountability, or focused leadership, often due to strained resources. Additionally, many providers are reluctant to make changes to their CDI programs because they worry about the potential for disrupting regulatory compliance. Other factors preventing CDI excellence include:

  • Constant regulatory and coding changes
  • Difficulty measuring program effectiveness
  • Technology limitations and integration
  • Inefficient and low-quality physician queries

Ideally, CDI programs should align with the Quadruple Aim – improving the experience of care, improving the health of populations, improving physician satisfaction, and reducing per capita costs of health care. A key role for CDI leadership, then, is to determine program priorities considering the aim, anticipate the potential barriers to achieving documentation excellence, set the table for appropriate expectations, and ensure that CDI program performance is assessed on a rational basis.

Professional development drives CDI performance improvement

The strength of any quality CDI program is a well-trained and educated team. Unfortunately, with ongoing staffing shortages, budget constraints, and cost-cutting priorities, hospitals often struggle to make the investment necessary to support their staff and, thus, see real improvement. Additionally, it can be difficult to quantify and therefore justify a return on investment from staff education and training.

R1 CDI Total Performance engagements provide a caring, high-touch onboarding experience with new education and career development opportunities for the CDI team. These include monthly education sessions on clinical topics, quarterly coding clinics, regular quality audits of each CDI specialist and an annual review of Inpatient Prospective Payment System (IPPS) updates and rules. The model enables CDI teams to operate at top-of-license and just as important, reduces stressors that can lead to team and physician burnout.

Introducing a new kind of CDI partnership

R1 CDI Total Performance, powered by Iodine, brings to market a transformational solution built upon shared responsibility for collective CDI goals, deep clinical documentation expertise, and clinically intelligent technology. As an accountability partner, R1 invests in the success of their clients because their success depends on it. That begins with career growth for the team – R1 transforms CDI programs with best practices education gleaned from CDI engagements with leading hospitals and health systems that opens new professional opportunities for staff. Then R1 further empowers that team with Best in KLAS clinically intelligent technology to drive measurably better results and revenue.

“We’ve been in this market a long time and know CDI is a big driver of success in our partnerships with leading hospitals and health systems,” said Kyle Hicok, Executive Vice President and Chief Commercial Officer at R1. “From our vantage point, we see an unsolved need for a more holistic approach to CDI and a real opportunity to innovate in this space. CDI Total Performance allows us to serve more hospitals and health systems wherever they are on the CDI journey and help them achieve documentation excellence that improves the quality of care and captures more earned revenue.”

“CDI Total Performance is a unique comprehensive solution capable of delivering exceptional value to clients. Together, R1 and Iodine bring proven performance management prowess, documentation expertise, and impactful technology to deliver the financial, quality, and productivity gains demanded by health system executives at a speed that will set a new benchmark for industry expectations – right when health systems need it most,” said Troy Wasilefsky, Chief Revenue Officer for Iodine Software.

Achieve CDI excellence with best practices and Best in KLAS software

With 95 of the top 100 hospitals in the U.S. as customers, R1 is unique in its ability to develop, aggregate, and replicate CDI best practices at scale to improve clinical documentation performance. Iodine’s Best in KLAS AwareCDI technology provides new insights to CDI teams by strategically identifying and prioritizing cases for review and streamlining the query process to simplify and improve CDI, Coder collaboration, and physician response. As solution partners, R1 and Iodine deliver the only offering of its kind on the market, the closest thing there is to an easy button to fast-track CDI excellence.

To learn more about R1 CDI solutions, visit

Impact Amplified: Exploring Success Stories from the Iodine Cohort

Key Takeaways:

  • Each year Iodine conducts multiple cohort studies, focused on productivity improvements and overall impacts to performance experienced by clients throughout their journey with Iodine
  • In 2022, 94% of facilities experienced a lift in productivity with Iodine, with the average facility seeing a 136% lift in normalized query volume
  • With Iodine, physician response rates either stay steady, or significantly improve in cases where Interact has also been deployed, even in the face of increased queries
  • Iodine also measures the impact queries have, including CC and MCC capture volumes, CMI, and GMLOS. The vast majority of facilities experienced an improvement in MCC capture with Iodine, with a median of a 27% increase in the number of cases that have an MCC
  • The increase in MCC capture resulted in significant financial impact: an additional $3.5 million in annual reimbursement

Iodine Intelligence tackles a new challenge in healthcare’s mid-revenue cycle every month, shedding light on problems and solutions and sharing valuable insights from industry experts. Listen to Episode 15 Impact Amplified: Exploring Success Stores from the Iodine Cohort to learn more.


Iodine’s Cohort Studies started as an internal initiative in 2017 in an effort to understand the impact clients saw with AwareCDI and how certain key metrics were trending. Each year Iodine conducts multiple cohort studies, some focus on productivity improvements, others report on overall impacts to performance clients experience throughout their journey with Iodine. Cohort studies are completed by comparing pre-Iodine data as a baseline against the most recent CMS fiscal year’s data with Iodine. Every facility for which there is at least two months of baseline data and two months of measurement data is included in the study. Only like months are compared to account for seasonal variety (i.e. January-March of 2021 is compared to January-March of 2022) and for DRG based cohort studies, only that year’s CMS DRG tables are used.

The intent is to examine: if a CDI team performed at the same level as they did pre-Iodine, what would that performance have been, and what is the difference between that modeled performance and what was actually observed with Iodine.


Iodine examines productivity through two main means, unique case query rate and normalized query volume. Iodine measures both query rate and query volume to provide as complete a picture of CDI performance as possible. Since unique case query rate is an indicator of whether CDI specialists are looking at the right cases, it is possible to have a high query rate by only reviewing those cases that you feel confident you will query, but as a result your query volume will drop. Conversely, you can drive up your query volume by increasing staffing, but that’s not very efficient. Examining both query rate and query volume ensures that Iodine has positive impacts on both and is driving as much value for clients as possible.

Many health systems use query rate as a measure of success of their CDI program, although methods of calculating this metric can vary between organizations. Iodine examines query rate as a measure of the percent of cases that have been reviewed and resulted in a query – from an efficiency perspective it measures if CDI specialists are looking at the right records. In 2022, the average Iodine client more than doubled their query volume, as compared to their performance immediately preceding the adoption of AwareCDI.

Iodine measures normalized query volume as a measure of the overall output from a CDI program, as more queries lead to more accurate documentation which has a variety of downstream affects including accurate reimbursements, quality reporting, and more. Iodine adjusts for changes in CDI staffing over time, and compares the incremental queries sent in the fiscal year 2022 against the baseline period, the year immediately prior to a facility adopting AwareCDI.

With Iodine, 80% of facilities saw an improvement to their unique case query rate, with the median hospital experiencing a 42% lift in query rate. So, if prior to Iodine a CDI program was querying 32% of the cases they reviewed, and they experienced the median impact with Iodine, they’re now querying 45% of review cases.

Higher productivity and more efficient and effective processes enables clients to expand the scope of their programs and accomplish more with their existing staff. One client had a team of 17 CDIS and after implementing Iodine they increased their query rate from 21% to 35% using only half of their staff, enabling the remaining staff to be redeployed to performing retrospective reviews. Other orgs have leveraged the freed up man-hours to increase collaboration with other departments like coding, implement second-level reviews on mortality or PSI cases, and improve job satisfaction as CDI specialists work at top of license.

Physician Response

Administrative burden is already at an all time high for many physicians, which means the prospect of a CDI department suddenly sending twice as many queries, if not more, can be a daunting one for providers. However, Iodine’s cohort studies show that with Iodine physician response rates either stay steady, or significantly improve in cases where Interact has also been deployed.

When reviewing and responding to a query is no longer a burden for physicians, response rates and times can improve, even in the face of additional queries. On average, there is an almost 17 hour savings in response time, with CDI specialists waiting 31 hours or less for a physician to answer a query, meaning CDI specialists don’t have to spend as much time and energy chasing down responses. The average physician spends 60 seconds or less reviewing and responding to a query, and the median physician response rate for an Iodine client with Interact is 94%.

Impact of a Query

In addition to lifts in productivity, Iodine also measures the impact those additional queries have, including CC and MCC capture volumes, CMI, and GMLOS, with the theory that as documentation gets addressed, it more accurately reflects the true acuity of the patient population, and as a result these measures naturally go up. The more the productivity of CDI teams improves, the more one can expect MCC capture to increase, as well as CMI and GMLOS to a certain extent.

In line with our productivity metrics, the vast majority of facilities, 90%, experienced an improvement in MCC capture with Iodine. On average, their MCC capture volume improved by almost seven percentage points, which ultimately resulted in a 27% increase in the number of cases that have an MCC – more than one out of every four cases.

While CMI is a common metric across the industry, especially for CFOs, it’s influenced by a wide variety of factors, many of which are outside CDI’s control. This includes things like changing patient populations, shifts in med/surg volumes, changes to service line volumes and more.

Almost as many facilities experienced a lift in GMLOS as MCC capture (84%). GMLOS is a good indication as to whether or not a hospital is getting credited for how much effort it takes to care for a patient. If a patient is under documented, it will appear that they should have a short hospital stay, and then there can be a gap between expected LOS and actual LOS.

Financial Impact

Iodine utilizes two different methods for calculating financial impact, a “bottoms up” approach based on the value of a query, and a “top down” approach based on increase in MCC volumes.

The bottom’s up approach is calculated by examining: what are the number of queries issues by a hospital, how many of those queries are likely to have a financial impact, what was that impact measured in CMI MS-DRG relative weight points. Using this approach, a fictional hospital with 10,000 discharges, a 30/70 med/surg split and a $6,000 base rate would see an additional $2.4 million in appropriate reimburse.

Using the top down approach, looking across our entire cohort (which includes everything from hospitals that have been with Iodine for just the minimum two months to hospitals who have been an Iodine client for seven years) the average is $3.5 million in annual additional reimbursements based on improved MCC volumes.

Interested in Being on the Show?

Iodine Software’s mission has been to change healthcare by applying our deep experience in healthcare along with the latest technologies like machine learning to improve patient care. The Iodine Intelligence podcast is always looking for leaders in the healthcare technology space to further the conversation in how technology and clinicians can work together to empower intelligent care. if that sounds like you, we want to hear from you!

Triumphing with Tech: Empowering Staff and Maximizing Results 

Key Takeaways:

  • Documentation integrity is the foundation of good quality rankings
  • OhioHealth was able to expand their scope and implement new workflows even at historically low staffing levels due to efficiencies introduced by Iodine’s Concurrent
  • Improving documentation accuracy and capturing all patient conditions led to improvements in SOI, ROM, and Vizient quality rankings, including OhioHealth jumping from 112th to 14th in the nation for Trauma Care

Iodine Intelligence tackles a new challenge in healthcare’s mid-revenue cycle every month, shedding light on problems and solutions and sharing valuable insights from industry experts. Listen to Episode 14 Triumphing with Tech: Empowering Staff and Maximizing Results to learn more.

In the world of healthcare, hospital quality rankings hold immense weight, guiding consumer decisions on where to receive care, impacting hospitals’ reputations, and influencing the language healthcare providers can include in contracts with payors. Ultimately, the foundation for achieving good quality rankings lies in capturing accurate and complete documentation. Documenting patient care and medical procedures accurately and comprehensively directly impacts the assignment of codes, which, in turn, affects risk adjustment and external metrics.

As CDI programs shift their focus to quality, they must also shift their processes and workflows. Whereas in the past CDI specialists might have focused exclusively on capturing CC’s and MCC’s, it is now increasingly important to capture all conditions and treatments, regardless of whether they qualify as a CC or MCC, because many of these conditions ultimately impact risk adjustment. “It becomes important to know not only did it happen, but when did it happen?” said Fran Jurcak, Iodine’s Chief Clinical Strategist “Was it something the patient brought in with them, either from a previous encounter or something that happened to them in the outside world of the hospital? Or is it something that actually happened during the inpatient encounter? Which is what we’re really trying to capture with some of these quality metrics.”

Tonya Motsinger is the System Director of Clinical Documentation Integrity at OhioHealth, and her program has instituted a variety of workflows with the intent of completely capturing all patient conditions and improving their quality. She echoed Fran’s sentiment, relating that her CDI department found instances where HACs and PSIs were being driven by documentation, not the care being give. “If we could change the words in the chart, there wasn’t really a PSI or a HAC that happened” said Tonya, “It was just that it was documented incorrectly.” In today’s world, it’s not enough for health systems to provide good care, they also need to document the care they’re giving accurately.

OhioHealth is a nationally recognized, non-for-profit health system based out of central Ohio, composed of 14 hospitals and over 200 outpatient and physician offices, and has been recognized as one of the top five large health systems in America by IBM Watson Health six times. The CDI program at OhioHealth has 54 full-time positions, including a director, two managers, an educator, and an informaticist, although currently the program has positions open and is down ten staff. They originally invested in Iodine out of a desire to increase the efficiency in their workflow; they had found that they were performing a lot of re-work and weren’t seeing a ton of benefit from that work. Continuing, and improving upon, the success that they had seen in the financial and quality spaces was also key – around three to four years ago OhioHealth’s CDI program had ramped up their focus on quality, including instituting some new processes and workflows, and wanted to sustain that progress. OhioHealth felt that Iodine’s product Concurrent, with it’s artificial intelligence and prioritization, could help them achieve their goals without comprising their already established success.

As a quality focused program, it’s very important that Tonya’s team is not only accurately capturing the patients’ severity of illness and risk of mortality, but also ensuring the chart is explicit on what occurred with a patient so coders can accurately capture all diagnoses and treatments. As part of this effort, OhioHealth has a number of workflows in place, including an extensive second review process for expirations, DRG mismatches, and low acuity which can help ensure complete capture of how sick a patient truly was. “I believe that these practice are really essential growth avenues to drive the success of any CDI program, and I think Iodine really helped us to expand on these” said Tonya.

 We’re about ten CDS down…but we’ve been able to, even at our very lowest staffing ever in the history of our department, take on more work and meet the organization’s board goals as a result of the help that Iodine’s provided for us through the prioritization.

– Tonya Montsinger

While post implementation OhioHealth’s overall review rate has stayed the same, their query rate, especially among high priority cases, has increased. Despite spending time writing more queries, their workflow is so much more efficient they’ve been able to maintain their collaboration with coding, and took on even more work from a quality perspective, implementing additional workflows. This led to an improvement in their O:E ratio, their SOI and ROM, and their Vizient ranking. In 2019 OhioHealth was ranked 112th in the nation for trauma care, and they knew that wasn’t reflective of the care they were delivering. Today they are 14th in the nation, and number one in the state of Ohio.

Tonya noted that job satisfaction has improved as well. By enabling CDIS to review the right case at the right time and saving them from unnecessary review, OhioHealth has freed up staff for additional workflows like using the Vizient calculator, performing mortality reviews, and collaborating with coding and other departments. Describing the impact of the increased efficiency and effectiveness of their program due to having a prioritization tool, Tonya said, “I believe it creates a higher competence level in the CDS team, a little more of a strategic lens, because they can see the impact of their work beyond just case review, and they can sometimes even connect it with patient care.”

This expansion of skillset also gives CDI specialists opportunity for career advancement. As Fran noted, “We now have clinical ladders in the CDI space where five, seven years ago, there was no such thing.” In a world where hiring new staff can be challenging, retaining the staff you already have is key, and ensuring CDI specialists are satisfied and have room to grow within your organization can entice them to stay within your program.

Interested in Being on the Show?

Iodine Software’s mission has been to change healthcare by applying our deep experience in healthcare along with the latest technologies like machine learning to improve patient care. The Iodine Intelligence podcast is always looking for leaders in the healthcare technology space to further the conversation in how technology and clinicians can work together to empower intelligent care. if that sounds like you, we want to hear from you!

AwareCDI Recognized as Best in KLAS CDI Software for Second Year Running

Iodine Software is thrilled to announce that for the second year in a row, we have been named the market leader for CDI Software by KLAS in their 2023 Best in KLAS: Software and Services Report. Iodine ranked #1 in Clinical Documentation Integrity Software in KLAS 2023 Report with a score of 90.0; this achievement follows AwareCDI™ winning Best in KLAS in 2022.

KLAS is an independent, third-party organization known in the market for honest insights informed by robust research; a Best in KLAS award is a true marker of excellence, and Iodine is proud to be the leader in our industry with KLAS Research’s highly coveted distinction. In their 2023 report, 96% of respondents stated that Iodine “avoids charging for every little thing” and that AwareCDI was “part of long-term plans,” with 100% of respondents saying they would purchase Iodine again. We take our client partnerships very seriously and are honored to be part of their journey towards complete and accurate clinical documentation.

All rankings are a direct result of the feedback of thousands of providers over the last year. “Winning Best in KLAS two years in a row is a true indication of our commitment to continuous product innovation, and putting the needs of our customers first.” said William Chan, CEO and co-founder of Iodine. “KLAS bases their awards on direct customer feedback, making this award a true reflection of the exceptional service and support we at Iodine strive to provide to our clients every day.”

Iodine’s groundbreaking AwareCDI solution is a game-changer for organizations looking to unlock the full potential of their workforce in the face of staffing shortages. By automating time-consuming clinical tasks, AwareCDI enables CDI staff to work at top of license, achieving unprecedented levels of efficiency and productivity. Hospitals who have leveraged the AwareCDI suite to boost output, see a median lift in productivity of 134%[1], and increase earned revenue capture, with $1.5 billion in additional appropriate reimbursement annually.[2]

According to KLAS Research President Adam Gale, “The 2023 Best in KLAS report highlights the top-performing healthcare IT solutions as determined by extensive evaluations and conversations with thousands of healthcare providers. These distinguished winners have demonstrated exceptional dedication to improving and innovating the industry, and their efforts are recognized through their inclusion in this report.”

KLAS Research will honor Iodine and the other segment winners for 2023 in a ceremony held at HIMSS Global Conference April 17th in Chicago, IL.

About KLAS Research:

KLAS has been providing accurate, honest, and impartial insights for the healthcare IT (HIT) industry since 1996. The KLAS mission is to improve the world’s healthcare by amplifying the voice of providers and payers. The scope of our research is constantly expanding to best fit market needs as technology becomes increasingly sophisticated. KLAS finds the hard-to-get HIT data by building strong relationships with our payer and provider friends in the industry. Learn more at

[1] 2020 Iodine Cohort Study

[2] 2021 Iodine Cohort Study

Unlocking the Power of Concurrent

Key Takeaways:

  • Concurrent can be a disruptive technology requiring some key shifts in thinking and processes to unlock its full potential
  • Auto-assignment allows for complex cases to be distributed evenly across a team and for better coverage when there’s a gap in staffing
  • When setting quiet periods, shoot for a time range that’s appropriate 80% of the time
  • When artificial intelligence and machine learning are leveraged to provide a prioritized list of cases for review, priority review rate is a more important metric than number of initial reviews and re-reviews
  • In healthcare’s ever changing landscape, it’s key to periodically reassess your configurations to ensure they’re still best fit

Iodine Intelligence tackles a new challenge in healthcare’s mid-revenue cycle every month, shedding light on problems and solutions and sharing valuable insights from industry experts. Listen to Episode 10: Unlocking the Power of Concurrent to learn more.

Concurrent is Iodine’s flagship software, and it leverages artificial intelligence and machine learning to prioritizes cases for CDI teams to review concurrently before patients are discharged based on misalignment between the clinical evidence and existing documentation.

In this month’s episode we sat down with Iodine’s Client Services Operations Manager, Justin Gerardot, and Iodine’s Clinical Product Consultant Manager, Diana O’Connor, for some tips and tricks for our users to get the most out of Concurrent. Concurrent, and it’s prioritization, can be referred to as a “disruptive” technology, and there are some key shifts in thinking and processes required to unlocking the full potential and return of Concurrent.

1. Auto-Assignment

Concurrent distributes cases to CDS’s for review using auto-assignment, which can be a shift for CDI teams who are used to cases being distributed by location or service line.

Iodine advocates for a “generalist” rather than a “specialist” approach. Some service lines are, by their nature, more complex than others, and auto-assignment allows for those complex cases to be distributed evenly across a team. It also helps when a CDS is on vacation or there’s a gap in coverage: everyone is able to cover and review those cases.

2. Quiet Periods

A Quiet Period is the amount of time a case must “incubate” before it can be considered for auto-assignment. It can be a delicate balance walking the line between a quiet period that is too short, and CDS’s receive cases for review with very little information, and a quiet period that is too long, and the patient is discharged before the case gets a chance to be prioritized and reviewed.

When selecting a quiet period, Iodine recommends shooting for the 80/20 rule: 80% of the cases are prioritized at the appropriate time or within the appropriate window.

3. Metrics

Concurrent provides teams with an intuitive, prioritized work-list in order to get the right cases in front of CDS at the right time, and because of this, Iodine is not as concerned with how many initial reviews and re-reviews a CDS does on a given day or during a given week. Instead, Iodine focuses on priority review rate: how many high priority cases did you get to.

It can be difficult moving away from longstanding, traditional KPIs, especially when they’re used for projections and staffing needs. Iodine has a robust reporting platform to support these new metrics, allowing CDI teams to easily track their progress.

4. Reassess

Healthcare is an ever changing field, and as a result it can be very helpful for hospitals and healthcare providers to reassess their Iodine configurations on at least an annual basis. Changes to the size of a CDI team, adding additional service lines or payors, and software updates within Concurrent itself can all impact the way CDS interact with Concurrent. Reevaluating your configurations, especially once you have six month’s to a year’s worth data to help with your evaluation, can help ensure you’re staying at top functionality.

Interested in Being on the Show?

Iodine Software’s mission has been to change healthcare by applying our deep experience in healthcare along with the latest technologies like machine learning to improve patient care. The Iodine Intelligence podcast is always looking for leaders in the healthcare technology space to further the conversation in how technology and clinicians can work together to empower intelligent care. if that sounds like you, we want to hear from you!