Posts about

CDS

Engaging the Reluctant Clinician: Making Clinical Documentation Improvement Relevant for All Doctors

Sophie De'Ambrosis July 3, 2025
Clinical Documentation Improvement (CDI) programs are designed to enhance the accuracy, clarity, and usefulness of clinical records—not just for..

Reflecting on ACDIS Inspire 2025: Lessons for the Evolving CDI Landscape in ICD-10-AM Countries

Mike Kertes May 21, 2025
As the curtain closes on ACDIS Inspire 2025, held in Orlando, Florida, it’s an opportune moment to reflect - not only on the impressive scale and..

An Opportunity to Increase Awareness

Sophie De'Ambrosis May 15, 2025
Doctor Engagement with CDI: An Opportunity to Increase Awareness Despite the critical role that clinical documentation plays in healthcare delivery..

Beyond Nursing Checklists

Nour Alatari April 3, 2025
Beyond Nursing Checklists: Why Comprehensive Nursing Documentation Matters In modern healthcare, nursing documentation is a fundamental aspect of..

Remote CDI- Is It Really Effective?

Glenn Krauss March 7, 2025
Onsite Clinical Documentation Improvement (CDI) programs are designed to enhance the accuracy, completeness, and specificity of medical..

CDI: It's Not About Who

Mike Kertes January 28, 2025
At a recent conference, I was exposed to several thought-provoking conversations about who should ‘own’ clinical documentation improvement (CDI). Who..

Celebrating CDI Week: The Importance of Certification and Career Progression

Nour Alatari October 25, 2024
Clinical Documentation Improvement (CDI) Week is a time to reflect on and celebrate the incredible contributions of Clinical Documentation..

Securing the Future: The Imperative of CDI in Healthcare

Mike Kertes June 14, 2024
Australia's private and public health systems are currently facing immense pressures that threaten their sustainability. These pressures, driven by..

I have a clinical background and want to become a CDS; do I need a coding qualification?

Nour Alatari May 20, 2024
In the intricate world of healthcare, Clinical Documentation Specialists (CDSs) play a vital role in ensuring patient records are accurate and..

CDI Strength: Beat Risks, Boost Sustainability

Mike Kertes March 27, 2024
In the ever-evolving landscape of healthcare, Clinical Documentation Improvement (CDI) stands out as a critical pillar, ensuring the accuracy,..

CDI Queries Work Best if the Recipient is Kept in Mind

Dr Erica Remer March 13, 2024
I had an epiphany the other day while discussing compliant query composition with a very knowledgeable clinical documentation integrity specialist..

A CDI Year-In-Review

Mike Kertes December 7, 2023
Reflecting on the past year in the realm of Clinical Documentation Improvement (CDI), particularly in countries using ICD-10-AM and AR-DRGs, it's..

Reflecting on CDI 2023 - Harnessing Momentum: A Turning Point for Clinical Documentation Improvement (CDI)

Mike Kertes September 19, 2023
As I sat on the plane on my return flight home from the Gold Coast, I couldn't help but feel a sense of pride and elation to be a part of something..

Clinical Documentation Improvement- a nursing role?

Joanna Forteath July 31, 2023
This article was first published in the Australian Nursing & Midwifery Journal (ANMJ) Jul-Sep Volume 28, No. 1 and has reproduced with consent. If I..

'What the Heck is This?' Written Documentation Queries: A Clinician's Perspective

Dr Felicity Sinclair-Ford May 26, 2023
What do we want? Clinicians who document efficiently and thoroughly, specifying diagnoses, linking them to interventions, and including pertinent..