CDI Engage One

CDI Engage One includes all features in CDI Engage as well as what's included here.

Getting Started

To get started, you must install Fluency Direct (FD).  Click on the FD Icon to open the application.

FD11 DesktopIcon

Signing In

If you are signing in for the first time or if you have signed out, the Control Bar will be available for you to sign in.  Enter your Login Name and Password and click the Sign In button to access Fluency Direct. 

FD11 ControlBar SignIn

Clicking the Forgot Password link will open a web page asking for the user's email address. Once entered, they can click the Send account Details button and they will receive an email that includes their Username, Account, and User Type along with a link which will allow them to reset their password."}Forgot Password?

  FD11 ControlBar SignIn ForgotUsernamePassword  

When logging in for the first time, or if you have requested a password change, you will receive a notification and the application will prompt you to change your password.  This does not apply to all users and is dependent on your configuration.  

To change your password, you will be prompted to enter your current password.  You can then enter a new password and confirm that password.  As you enter your password, the Password Requirements will confirm that they are met.  You can then click Save to change your password.

FD11 ChangePassword

Signing Out

Sign Out - Log out of Fluency Direct using the Sign Out option; this option will not exit the application, it will remain running on your desktop but you will no longer be logged in. 

Quit - To exit the application completely (the Control bar will no longer be available on your desktop), select Quit from the Control Bar menu. When you start the application the next time, you will remain signed in. 

Sign Out and Quit - To log out of the application and close it, select the Sign Out option, then select the Quit option.  This will ensure that no other user can login as you. 

 

Workspace

When you open Fluency Direct (FD) you will see the Splashscreen, which also displays the version number that you are running in the lower left corner. You can check this at any time by going to Help > About.

FD11 Splashscreen

FD Control Bar

After opening the Fluency Direct application, the Control Bar will appear on the desktop.

FD11 ControlBar

You can drag the Control Bar to any location on the screen, or you can dock it on any edge of the screen, whichever you prefer. To dock the Control Bar, click and drag to a screen edge (the screen edge will become highlighted when you near it). Drop it where you want the Control Bar to be docked. Fluency Direct will remember the location of the Control Bar and will open in the same position each time you log in.

Ribbon

The Ribbon on the Control Bar is where interactions will occur. The number indicates how many messages are available.  

Engage11 ribbon

New messages will accumulate in real time as they are triggered based on the physician's documentation. A status indicator will notify the user if messages are up to date or currently being processed. Messages can be viewed in two different ways, in the "Drawer" or "Sidebar."

CAPD Drawer

Click the Ribbon to view the available cards. The drawer can be used with the Control Bar in floating, docked, or micro mode. The Drawer can be closed by clicking the ribbon or arrow at the bottom of the drawer.

Engage 11 drawer hcc 11.4 capd drawer

 

Providing CDI feedback in context

Using encounter-based clinical reasoning and automation, CDI Engage One identifies common documentation gaps in specificity at the time physicians create notes using speech, templates and/or typing. The application helps physicians capture complexity, acuity and severity levels before the note is saved in the EHR. It also informs physicians about outstanding queries to prepare them for the next patient encounter.

CDI Engage One provides CDI Feedback in two forms: nudges and queries.

Using nudges

A nudge is displayed as a physician creates documentation in the EMR either through dictation or typing. As text is entered, CDI Engage One uses Natural Language Processing and Natural Language Understanding to reason over the text against a set of rules. To help provides improve the clinical documentation, nudges will appear as cards in the drawer when NLU/NLP finds opportunities for improvement.

Engage 11 nudges

In the example above, the provider has documented "hypertension" and "congestive heart failure," but has not confirmed "hypertensive heart disease."

To resolve a nudge:
  1. Return to the document in question.
  2. Using either dictation or typing, provide the information requested.
  3. CDI Engage One will reason over the new text and, if the nudge is resolved, it will disappear from the drawer.

Using queries

When a CDI Specialist creates a query in 360, it will show up as a card in the drawer. If you are looking at the patient list in your EMR, a single card will display all available queries for any patient.

Engage 11 drawer

If you view a specific patient in the EMR, the context of the card will change. The patient's MRN will appear in the control bar. If there are any queries for that patient, they will be displayed in the drawer.

In addition, a second card will display queries for other patients that are available.

Engage 11 specific card

In either case, clicking View Queries will open the CDI Queries window. From there, you can respond to the query. See Using the query window for more information.

 

 

 

Understanding Nudges

CDI Engage's AI-powered prioritization accounts for labs, medications and other clinical indicators; including vital signs, symptoms, chronic diseases and social history. This process generates prioritized, continually-updated CDI worklists (nudges) to streamline fragmented query processes, manage cases and correct CDI discrepancies. The automated chart review analyzes every encounter document to account for laterality, acuity, severity and episodes of care. Based on the content rules configured at your site, CDI Engage will provide guidance designed to improve the quality of patient documentation at the point of care, eliminating delays and inefficiencies in patient billing.

Once you sign into Fluency Direct, the control bar will display your name and a ribbon along the left-hand side.

In FD 11.1 and earlier, if there are messages, the ribbon will be red and the number displayed shows how many cards are in the drawer.

Engage11 ribbon

If there are no messages, the ribbon will be gray and will display a white check, (see the illustration below).

In FD 11.2 and later, the ribbon has three states.

Engage11 ribbon check

Your messages are up to date. There is no new information for you to act on.

Engage11 ribbon bell

You have new messages to act on. These include, but are not limited to, NLU/AI-generated nudges in CDI or On-demand Provider Notifications in HCC. In general, this is lower-priority information that was computer generated and not communicated by a human being.

Engage11 ribbon bell ring

You have new High Priority messages to act on. These include, but are not limited to, queries sent by a CDI specialist or human-generated provider notifications in HCC.

FD will periodically check for new messages. The presence of three animated dots below the checkmark or bell icon indicates this action.

Click the ribbon to expand the drawer and see the cards for each message.

Note: Illustrations in this article are from FD 11.2 and show the bell icon. However, aside from that iconography, the functionality described is the same as previous versions.

Understanding real-time nudges

As you dictate or edit your documentation, the nudges will be displayed in the Fluency Direct control bar.

 engage drawer

Each card in the drawer will display the title of the rule. Underneath is the physician message with instructions on how to resolve the issue.

As you update the documentation, cards will appear and disappear as the NLU reasons over the document.

If for some reason you want to dismiss the message, click the X in the top right corner of the card.

Additional Information

In addition to viewing the physician message, you can see the evidence underlying the creation of that nudge. Depending on the version in use at your site, you will see one of the following:

engage card evidence hover  engage card evidence icon Engage11 drawer card2

 

Each piece of evidence is a separate line in the snippet.

Using the evidence window

You can see a more detailed view of the evidence by clicking on the "?" icon. Doing so will bring up a details box displaying the document.

engage evidence sheet

The evidence window for a single-document nudge

The evidence supporting the nudge will be highlighted. Close this box and return to the documentation to address the requirements as displayed in the nudge.

If the nudge was displayed as a result of CDI Engage One's encounter-based reasoning, each document will be displayed in a list. The supporting evidence in each document is highlighted.

Engage11 evidence sheet

The evidence window for encounter-based reasoning (multiple documents)

To view the entire document, click Open full document. Close the evidence dialog and return to the documentation in the EHR to make any necessary corrections.

 

CAPD NLU Application - CDI Engage

Part of the M*Modal CDI One solution, CDI Engage is an NLU Application focused on automatically identifying the most common documentation deficiencies at time of documentation capture. By providing real-time feedback to physicians, CDI Engage aims to improve quality of clinical documentation and reduce the number of concurrent (CDI) and retrospective (coding) queries by educating physicians of the documentation requirements at the time of report creation. Feedback will be based on the content of the current document being created. Categories of such feedback includes,

  • Top CDI Conditions
  • Abnormal Lab Results
  • Joint Commissions Do Not Use Dangerous Abbreviations
  • Temporal Copy / Paste Identification 
 

Top CDI Conditions

CAPD messages for the following conditions will be geared towards documentation requirements for ICD-9 and ICD-10 coding and billing requirements.  By providing real-time feedback on best practices, physicians have the opportunity to correct and complete documentation while it is being created, preventing the need for downstream CDI or Coding queries. 

CARDIOLOGY

Acute Coronary Syndrome 

Atrial Fibrillation/Flutter 

Cardiomyopathy

Heart Failure 

Hypertension 

Cor Pulmonale 

RENAL

Acute Renal Failure 

Acute Tubular Necrosis 

Chronic Kidney Disease 

End Stage Renal Disease 

ENDOCRINE

Diabetes Mellitus 

RESPIRATORY 

Pneumonia 

Respiratory Failure 

SEPSIS 

Urosepsis 

Sepsis/Sirs 

Septic Shock

Sepsis Syndrome

Urinary Tract Infection 

NEUROLOGICAL 

Stroke

Level Of Unresponsiveness

Residual Hemiparesis 

Ataxia

Brain Hemorrhage

Hyrdocephalus/Vp Shunt 

Aphasia

Concussion 

NUTRITIONAL DISORDERS

Malnutrition

Obesity 

 ORTHODPEDICS

Fracture

Stress Fracture 

Pathological Fracture 

Spondylosis

SIGNS AND SYMPTOMS

Chest Pain 
Abdominal Pain 
Syncope

SURGICAL 

Debridement 

Transbronchial Biopsy

INTEGUMENTARY 

Pressure Ulcer 

Primary Ulcer

Skin Lesion 

LABORATORY 

Electrolyte Imbalances 

Acidosis/Alkalosis 

HEMATOLOGY

Anemia

Blood Loss Anemia

 

GASTROINTESTINAL 

Appendicitis 

Colonoscopy

 

  

 

Dangerous Abbreviations

The following pieces of content have been created to identify Dangerous Abbreviations that are part of the list of "Do Not Use" abbreviations created by the Joint Commission and the National Patient Safety goal that they approved. Joint Commission requires that all of its accredited facilities comply with this list and its National Patient Safety goal. These abbreviations are identified by our NLP and the rules that have been put in place. Some abbreviations have special rules in place around lab result and vital signs to ensure the accuracy of the engine. The following items are the dangerous abbreviations that we now identify.

CC

UG

QD

QOD

U

IU

MGSO4

MS

SC/SQ

Trailing Zero

 

Temporal Word Copy / Paste

The purpose of this content is to be used, in conjunction with our CAPD functionality, to identify possible inappropriate use of temporal words in copy and pasted text within the electronic medical record. The pasting of temporal words may be overseen and can have an impact on the care the patient receives. The following items are included in the temporal word identification content. These words may have synonyms associated with them that are not listed below. For example, ‘day number’ also would identify ‘day #’, ‘POD’, ‘post-operative day #’, etc.

Today

Tomorrow

Yesterday

This Morning

Last Night

Overnight

Day Number

Extended Time

Tonight

Day(s) Ago

This Afternoon

Currently

Last Weekday Number of Hours