What does CDI mean for Quality?

Quality, Clinical Data, OPPEYou work in Quality, your job isn’t in technology and you’re not overly comfortable with all the technical jargon – or ‘tech talk’. That’s alright; you don’t have to be. Your knowledge and understanding of clinical quality data is what’s important and will help bridge the gap when it’s time to discuss terms like interface, platforms, b2b, file specs, etc. Nevertheless, here’s a little “Tech Talk 101” for when the time comes…

Let’s begin with what you know – clinical data, the fundamental data utilized to evaluate patient care and provider performance. In order to harness clinical data you need it loaded in the system used for processing and analysis. For simplicity, let’s say you utilize Medkinetics for Peer Review and Focused/Ongoing Professional Practice Evaluations (F/OPPE). In order to perform Peer Review or F/OPPE, you need the clinical data from your EMR/EHR or billing system loaded into Medkinetics without having to manually enter the information; hence, the need for a Clinical Data Interface (CDI).

File Specs

CDI is simply the process set by the software company (in this case Medkinetics) allowing files to be loaded into their system. These files are formatted in a pre-determined format by the receiving/uploading company (Medkinetics). These files are generally referred to as “File Specs” or “Tech Specs”. The file specs outline necessary fields and format to ensure the data works correctly in the new system. Your organization’s IT Team will obtain the necessary data from the medical/billing system and format it to meet Medkinetics’ file specifications.

Validation

The newly created file is sent by your IT Team to Medkinetics to upload into the system. Once the information has been loaded, you will be asked to login, run reports and review information for accuracy – often referred to as “validation”. Your expertise of clinical data is imperative at this stage because it isn’t about whether all the fields are populated with information; it is about the data making sense. For example, do the procedure counts, readmission rates, and mortality rates seem in line? And does your OPPE Report by Provider give you accurate information regarding procedures performed for both in-patient and out-patient?

Generally speaking, the validation process can be a time consuming and sometimes frustrating process as it may take multiple attempts to get it right. Involving team members such as the quality director, medical staff administrator, billing or coding staff, IT member and a physician to review the information will ensure data is reviewed from multiple perspectives. This team will run the necessary reports and work with a technical analyst to validate the data until all members of the team are satisfied that the data is accurate.

Processing

After validation is complete, a file with 2-3 years’ of historical clinical data will be uploaded, followed by a new file every week or month depending on your organization’s needs. Generally, these files will contain an overlap in date parameters that will allow any changes in billing status to be overwritten for complete and correct reporting.

Clinical Data Integration is less about the technical aspect and more about your knowledge of information. Don’t worry that you may not understand all the tech talk with CDI because what you know, clinical data, will be the most important aspect in ensuring a successful transition.

Provider Credentialing


Melissa Outlaw

About the Author
Melissa Outlaw

Melissa Outlaw is a Vice President, Customer Success with symplr. Melissa and her team assist clients in learning and implementing our provider management software - credentialing, privileging, peer review, quality and event reporting applications. She supports clients in benchmarking current internal practices, identifying potential efficiencies, then driving the integration of technology with process improvement to reduce time of service and operating expenses. She works extensively with decentralized, multi-facility organizations in transitioning to a shared service center as well as assisting healthcare organizations bridge the gap between procedures performed by a provider and their privileges granted.

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