by Torrey Barnhouse, BS and William “Bill” Rudman, PhD, RHIA
As healthcare reform and technology further define the role and work expectations of the health information management professional, the need for clinical documentation specialists (CDSs) is likely to expand. This article examines the current and potential growth of the CDS profession within a variety of healthcare providers. Findings from this study show that although larger providers are more likely to have a clinical documentation improvement (CDI) program already in place, CDI is becoming ubiquitous within healthcare. It is expected that more than 80 percent of all healthcare providers will have a CDS professional by the end of 2014. For this reason, health information management academic programs need to develop their CDS curricula and training. Investment in this profession may have an important return on investment and will enable coding professionals, clinical specialists, and healthcare facilities to parlay their professional investment into jobs for the future.
Several studies and governmental reports have suggested that the fields of health information management and technology are among the fastest growing of any market sector. 1–14 Data show that few market sectors have grown as much as the health information management and technology sectors over the past five years.15, 16 Data from a 2012 study show that the total number of job listings in healthcare increased a modest 9 percent from 2007 to 2011, while jobs in the health information and informatics field, over that same period of time, increased by approximately 36 percent.17 Furthermore, data from Georgetown University Center on Education and the Workforce forecasts of educational demand note that jobs in the healthcare sector “will have to expand by almost 30 percent overall by 2020,” which represents the most dramatic growth of any work sector of the US economic structure.18
Within the healthcare sector, one role that has experienced rapid growth in the past and is continuing on that trajectory is that of the clinical documentation specialist (CDS). According to a Burning Glass Technologies report,19 the number of job postings for CDS jobs increased from 3,594 in 2007 to 8,039 in 2011, for a 223 percent increase in the number of job postings. As of 2011, the CDS role had the third highest number of job postings, following only coders and health information technicians. Finally, data show that CDS was the second fastest growing job title (633 in 2007 to 1,317 in 2011) in the health informatics area, second only to clinical analyst.20
What Is a Clinical Documentation Specialist?
Although the CDS role is relatively new, it continues to expand. In general, the CDS is responsible for conducting reviews of the medical record and often serves as a liaison to the medical staff to ensure that the medical record is complete and accurate and provides a clear picture of the patient’s clinical record and treatment. Therefore, the CDS is often tasked with obtaining appropriate clinical documentation to ensure that the level of service rendered to the patient and the clinical complexity of the patient’s condition are completely and accurately documented. The CDS helps to identify potential gaps in clinical documentation and ensures that the severity of the patient’s illness, the intensity of services, and the risk of mortality are appropriately reflected in the record.
While the reports cited above show that the number of job postings for CDS positions have significantly increased over the past five to six years, no studies have examined the number of facilities or providers that have actually launched clinical documentation improvement (CDI) programs. In order to better understand the extent to which CDI programs may impact the future job market, it is important to assess the types of healthcare providers that have adopted a CDI program and those that plan to implement one in the coming months. Findings from this study clearly point to the existing and potential growth of CDI as a profession within health information management (HIM).
Data were collected in September and October 2012. From a list of 3,620 hospitals, a stratified random sample of 1,367 was selected to participate in the study. When the contact efforts were terminated, 318 surveys had been completed. Hospitals were stratified by size and type. Size stratifications were based on the hospital’s bed size (larger than 350 beds); type stratifications were academic medical center, teaching versus nonteaching hospital, and critical access hospital. In the initial analysis of the responses, 25 were discovered to be duplicates (multiple responses from the same healthcare facility). The duplicates were the result of either the same respondent taking the survey at two different times or two different respondents from the same facility completing a survey. Data analysis and conclusions were based on the remaining 293 unique facility responses. For purposes of this study, we examined the number of hospitals that already have implemented or plan on implementing a CDI program. Given the diversity of healthcare providers that responded to our survey, we limited our detailed analysis to academic medical centers, community teaching hospitals larger than 350 beds, nonteaching community hospitals larger than 350 beds, nonteaching community hospitals with less than 350 beds, and critical access hospitals (N = 222). For purposes of comparison with the specialty providers (e.g., long term care, behavioral health) 66 percent of those providers noted above had initiated a CDI program, compared to 65 percent of the specialty programs.
The survey results provide data on the number of hospitals that either have or plan to implement a CDI program. Findings show that two-thirds of the hospitals (66 percent) had already implemented a CDI program. Moreover, 41 percent of those that had not implemented a CDI program noted that they plan to implement a CDI program by 2014. If all hospitals that responded with an intent to create a CDI program by 2014 do in fact implement a CDI program, the total number would increase by 30, which would increase the percentage of hospitals implementing a CDI program to slightly more than 80 percent of those that responded.
In order to assess whether the hospitals that currently have or intend to implement a CDI program are differentiated by size and purpose, we stratified our analysis by hospital size or number of beds (350+ beds) and purpose (academic medical center, teaching hospital, critical access hospital). Data on current implementation of a CDI program are presented in Table 1; data on the intention of starting a CDI program by 2014 are presented in Table 2. Data in Table 1 show a strong linear relationship between the size of the healthcare provider and implementation of a CDI program. Of those with more than 350 beds (including academic medical centers), 92 percent have implemented a CDI program. Conversely, of those with less than 350 beds, 49.6 percent have implemented a CDI program. Finally, only 26.8 percent of the critical access hospitals have implemented a CDI program. A similar type of relationship exists between teaching and nonteaching hospitals. Teaching hospitals (including academic medical centers) are more likely to have implemented a CDI program (89.8 percent) than nonteaching hospitals (56.8 percent).
To assess whether the observed values in Table 1 are different than expected given the distribution of responses, a chi-square analysis was conducted. The chi-square value for responses in Table 1 was 69 (p < .00001). This suggests that there is a significant difference between observed responses and expected responses in implementation of a CDI program by size and type (e.g., large hospitals are more likely to have already implemented a CDI program). In addition, to examine whether size alone makes a difference in implementation of a CDI program, we created a 2-by-2 contingency table examining implementation of CDI programs in hospitals with more than 350 beds compared to hospitals with less than 350 beds. The chi-square value for this table was 39 (p < .0001), again suggesting a significant difference between observed and expected responses. (See Table 1)
A similar pattern as shown in Table 1 exists for hospitals planning to implement a CDI program (Table 2); 66.6 percent of the large academic medical centers plan on implementing a CDI program and approximately 29 percent of the nonteaching hospitals plan on implementing a CDI program by 2014. These data do have to be carefully interpreted because only six academic medical centers and only one community hospital with more than 350 beds had not already implemented a CDI program. (See Table 2)
Findings from our study suggest that the role of the CDS will continue to expand. Data from this study suggest that by 2014, approximately 80 percent of hospitals interviewed in this study will have a CDI program in place. The primary job opportunities will come from large hospitals (larger than 350 beds) or in teaching facilities. However, the data also suggest that CDS professionals will be in demand for medium hospitals (less than 350 beds) and even in critical access care facilities (less than 25 beds). As an emerging market within the health information management and informatics field, CDI offers increased opportunities for the HIM graduate.
As healthcare reform and technology further define the landscape of health information management and information technology, the role of the CDS is likely to expand. For HIM academic programs, this finding suggests a need to develop and implement CDS curricula and CDS training. The investment in this profession may have an important return on investment and will enable coding professionals, clinical specialists, and healthcare facilities to parlay their professional investment into jobs for the future while making a measurable contribution to the overall accuracy and utility of health information. The transference of coding skills to the area of CDI will provide an important career option for coders as technology becomes increasingly ingrained in our nation’s healthcare system.
Torrey Barnhouse, BS, is the founder and president of Trust Healthcare Consulting Services (TrustHCS) in Springfield, MO.
William “Bill” Rudman, PhD, RHIA, is the executive director of the AHIMA Foundation and vice president of education visioning and editor in chief of Perspectives in Health Information Management for the American Health Information Management Association (AHIMA) in Chicago, IL.
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- American Institutes for Research. AHIMA National Workforce Assessment Final Report: Deliverable 3: Findings from National Workforce Assessment Survey & Interviews. 2009. Available at http://www.ahima.org/schools/FacResources/AIR percent20Report percent20091509.pdf.
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Torrey Barnhouse, BS and William “Bill” Rudman, PhD, RHIA. “The Growth in the Clinical Documentation Specialist Profession.” Educational Perspectives in Health Informatics and Information Management (Summer 2013): 1-7.