AI Clinical Documentation Integrity Market Map
This is part of Elion’s weekly market map series where we break down critical vendor categories and the key players in them. For more, become a member and sign up for our email here.
Good clinical documentation isn’t just paperwork; it’s the backbone of quality care and accurate billing. That’s where AI Clinical Documentation Integrity (AI CDI) steps in.
Historically, CDI was a manual slog, with dedicated CDI specialists, nurses, and physicians painstakingly reviewing patient charts to ensure documentation supported the care delivered.
Today, AI is reshaping this landscape.
3 Flavors of AI in CDI
While it’s still early days, we’re seeing three primary approaches to applying AI when it comes to CDI:
CDI + ambient scribing—an AI ambient scribe and AI CDI assistant operate simultaneously, generating comprehensive notes and surfacing codes for physicians to review at the point of care. (Example: Ambience Health)
CDI via real-time diagnosis support—diagnoses are suggested at the point of care based on the ingestion and evaluation of clinical data in the EHR, with auto-generated documentation and audit trails. (Example: Regard)
CDI via an AI-driven post-coding / pre-billing review—the entire patient record is ingested and analyzed against what is coded, surfacing suggestions for revenue and quality opportunities. (Example: SmarterDx)
ROI? Quality + Revenue + Admin Burden
There’s a compelling ROI case for these solutions:
Quality: enhanced patient care and improved quality analytics
Revenue: more complete billing, reduced denials, and more accurate patient severity and care complexity (i.e., CC/MCC capture)
Admin Burden: less manual work required across several stages of the revenue cycle—documentation, CDI, medical coding, and denial management
Progressing from admin to clinical use cases
To date, AI in healthcare has focused on administrative use cases. With AI CDI solutions, we’re taking a step closer to clinical workflows.
As clinicians get used to AI-suggested diagnoses in the CDI context, it will be interesting to see if this increases their comfort with AI playing a role in clinical care.