Understanding the Intersection of Treatment Use Case and Clinical Documentation

In the world of healthcare, there's often a clear separation drawn between treatment use case and administrative tasks. However, dismissing clinical documentation as merely an administrative act overlooks its critical role in patient care.

At Reveleer, we believe comprehensive clinical documentation, when conducted by providers, is intrinsically linked to the treatment of patients. Here’s why.

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Clinical Documentation: More Than Just Administrative Work

Clinical documentation is a process mandated by the Centers for Medicare and Medicaid Services (CMS) where providers document all chronic conditions of a patient. According to CMS, “Risk adjustment ensures that health plans have adequate funding to provide services to high-cost patients who are sicker and require more intensive medical care.” This comprehensive documentation ensures patients receive the appropriate level of care and healthcare providers are reimbursed fairly. While health plans might use clinical data retrospectively to assess costs and set premiums, for providers, it's a proactive, treatment-centric activity.

Why Clinical Documentation is a Treatment Use Case

According to the latest Trusted Exchange Framework and Common Agreement™ (TEFCA) definition, treatment encompasses a range of activities involving the provision, coordination, or management of healthcare and related services by licensed healthcare providers. Here’s how clinical documentation fits into this definition.

TEFCA Required Treatment includes the following:

• Covered entities that electronically transmit health information in connection with the Department of Health and Human Services (HHS)-adopted standards, including a variety of healthcare providers such as hospitals, skilled nursing facilities, clinics, and individual licensed providers.
• Government healthcare entities like the Veterans Health Administration, Department of Defense, and Indian Health Service.
• Delegates of Qualified Health Information Networks (QHIN), Participants, and Subparticipants, excluding health plans for initiating queries.

The TEFCA Required Treatment XP Code can be used if the query informs healthcare services provided or intended to be provided to a patient through interaction with a licensed individual provider. This includes querying for records to support care management, medication reconciliation, and identification of care gaps for individual patients. As TEFCA states, these queries are “intended to support health care services for individual patients.”

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How Reveleer Aligns with Treatment Use Case

Provision of Health Care

• Identifying Diagnosis Gaps: By identifying potential diagnosis gaps, providers can provide more accurate and comprehensive care. This ensures that no chronic condition is overlooked, leading to better patient outcomes.
• Surface Pertinent Clinical Records: Our platform helps providers access and review the most relevant clinical records, enabling informed decision-making.

Coordination or Management of Health Care

• Comprehensive Patient Data: Clinical documentation requires a detailed understanding of a patient’s health status. This comprehensive data collection supports the coordination and management of patient care, ensuring that all aspects of a patient's health are considered. The CMS emphasizes the importance of this data, noting that “accurate risk adjustment promotes fair payments to health plans that enroll individuals with significant health care needs.”
• Integration with Epic Network: Our connections with the Epic network enhance the utility of clinical records, providing a seamless flow of information between different healthcare providers.

Consultation Between Health Care Providers

• Supporting Consultations: Our platform facilitates consultations among healthcare providers by highlighting areas that need attention, ensuring that all providers involved in a patient's care are on the same page.
• Enabling Referrals: By documenting and understanding chronic conditions, providers can make more informed referrals to specialists, ensuring that patients receive the targeted care they need.

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Capabilities That Enhance Patient Care

At Reveleer, our solutions are designed to support these critical aspects of treatment:

• Advanced Clinical Data Integration: We leverage advanced clinical data integration to access pertinent information on behalf of the covered entities. This ensures their providers have the necessary data to make informed decisions, enhancing the overall care process.
• Proactive Diagnosis Identification: Our platform uses advanced algorithms to identify potential diagnosis gaps, helping providers catch conditions that might otherwise be missed.
• Real-time Data Access: We ensure that providers have access to up-to-date clinical information, facilitating timely and accurate decision-making.
• Seamless Communication: Our Epic network connections and interoperability solutions ensure smooth communication and data exchange between healthcare providers.

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Consortium of Vendors

It is important to note Reveleer operates within a consortium of vendors that provide access to this critical clinical information. We facilitate this access on behalf of the covered entities, ensuring that we do not misrepresent ourselves as the direct providers of access. This collaborative approach ensures compliance and maintains the integrity of our partnerships.

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Conclusion

Comprehensive clinical documentation is far from being a mere administrative task. When conducted by providers, it is a critical component of patient care that aligns perfectly with the definition of a treatment use case. By providing, coordinating, and consulting on healthcare, providers ensure all chronic conditions are managed effectively, leading to better health outcomes.

At Reveleer, we are committed to supporting healthcare providers in this essential work. Our platform is designed to enhance the provision, coordination, and consultation of healthcare, ensuring that clinical documentation serves its true purpose: improving patient care.

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Sources

CMS. (n.d.). Risk Adjustment. Retrieved from CMS.gov

TEFCA. (n.d.). Trusted Exchange Framework and Common Agreement. Retrieved from HealthIT.gov

HHS. (n.d.). Health Information Privacy. Retrieved from HHS.gov