### 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.

### 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.

### 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.”

### 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.

### 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.