When a patient who has been hospitalize for more than two stays is dischaged from the hospital, the billing department assigns a bunch of codes which relate to what services the patient received.
After patient discharge, those codes are "held" in a "pre-bill" state before being sent to the insurance company.
SmarterDx wants to look at them to make sure they are not losing out on any money.
For every 10,000 discharges, SmarterDx is able to help find $2,000,000 in lost revenue by identifying a better primary diagnosis.
SmarterDx takes a direct HL7 feed from the hospital, reviews the coded diagnosis and recommends if the primary diagnosis should be replaced with a different diagnosis because it has a higher reimbursement rate. The hospital CDI team can accept or deny the recommendation.
As a human in the loop CDS user, I want to be able to quickly view the a list of rules based recommended primary diagnosis and their financial impact and determine if the clinical evidence is justifiable to change the primary diagnosis.
Historically, CDS users are unable to see all relevant clinical evidence that supports a primary diagnosis in one view.
A single view that allows a CDS user to validate if the primary diagnosis reccomendation is valid or not.
As a human in the loop CDS user, I want to be able to make internal comments and view any clients comments.
Internal CDS users were unable to view comments related directly to the ICD-10 code resulting in confusion and lack of context when discussing complex cases
Created a thread to append all internal CDS comments as well as being able to view all client comments.
G9341 Metabolic encephalopathy is one of the top 4 primary diagnosis that is rejected by insurance companies.
As a human in the loop CDS user, I want to be able to quickly navigate to the clinical evidence based on MEAT (Monitor, Evaluate, Assess, Treat) which is required for clinically query as well as quickly navigate to the clincial evidence.
Metabolic encephalopathy charts are largely note based as it is based on observation creating long charts that need to be scrolled.
Appending the clinical notes to MEAT for easy query by client and allow the user to anchor link to the clinical evidence for quick navigation.
Ensuring to clients that cases won't fall through the cracks is incredible important and we needed an advanced sorting and filtering system to make that happen.
As a human in the loop CDS user, I want to be able to quickly view all my cases as well as have flexible to view other cases so that no case falls through the cracks.
Internal CDS users were using a google sheet to navigate to specific hospitals URLs to complete cases on a manual basis based on manager assignement.
A simple yet flexible filter and sorting by drop down panel that allows for optimal view results for all internal CDS users.
Given 30 plus internal CDS members would be together at an onsite, I need to make sure I was able to get their feedback and get them engaged in the product.
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GenAi healthcare product designer
