Philip Bernard, MD, usually waits until Tuesday to open his inbox. For Dr. Bernard, a pediatric intensivist who also serves as senior vice president and chief medical information officer of Dallas-based Children’s Health, that means an inbox full of clinical documentation integrity requests — some about patients he cared for five days earlier.
“You have the angry doctors who are like, ‘I don’t know and I don’t care.’ And then you have the super conscientious ones who are burned out. And then you have people like me: if I remember, I answer it. If I don’t, the answer is almost always, ‘I don’t remember, I don’t know,'” Dr. Bernard said. “This is the state of the current CDI.”
That lag — between the moment care happens and the moment a physician is asked to clarify it — was in sharp focus during a panel hosted by Abridge at Becker’s Health IT + RCM Conference Sept. 14. The session brought together Dr. Bernard; Brian Wilson, chief commercial officer of Abridge; Nadim Ilbawi, MD, vice president of clinical success and strategy at Abridge; and Lisa Lohmueller, who leads solution strategy for revenue cycle management at the company.
Their shared message: Too much of CDI happens after the fact, and it doesn’t have to.
Paid for what is documented
Mr. Wilson framed the stakes with a line Abridge founder and CEO Shiv Rao, MD, has used since the company’s early days: “Health systems aren’t reimbursed for care delivered — they’re reimbursed for care they document they delivered.”
The gap between those two things widens with every encounter, Mr. Wilson said. Clinicians and care teams face a growing volume of information each hour, and in the inpatient setting the problem compounds. Procedures, imaging, labs and shift changes accumulate, with multiple team members touching the record.
“The clinical reality of the care that’s being delivered starts to drift, really from day one,” Mr. Wilson said.
The answer is not more alerts or more complexity. Instead, Abridge is pushing the clinical context captured in the patient conversation into adjacent business processes. In June, the company introduced new clinical decision support capabilities. Since the panel, it has expanded that offering into Abridge Assistant, which combines patient-chart context with clinical evidence and can draft referrals and handoffs for clinician review.
On Sept. 14, it announced a pre-bill review capability for inpatient CDI and coding teams. Concurrent CDI surfaces documentation gaps while clinicians are writing notes during the hospital stay; pre-bill review compares coded diagnoses and DRGs with supporting documentation before claims are submitted. Authorized CDI and coding reviewers retain control; the system does not independently change documentation, codes or claim status.
The tool runs on the same platform clinicians use at the point of care, which Abridge expects to support more than 100 million patient-clinician conversations across more than 300 U.S. health systems this year.
Dr. Bernard, who has worked in CDI for about 15 years, does not blame the tools that came before. As Dr. Ilbawi summarized from an earlier conversation with him, healthcare is full of great technology paired with bad workflows.
A coach, not a judge
Dr. Bernard recalls the predecessors: the click box that asks one specific question, the full-note submission that sends questions back later and the pop-up that interrupts whatever you happen to be doing.
The click box, he said, checked a requirement without adding much: “We didn’t really improve the story, but we did click the little box.” The pop-up was worse. “You’re in the middle of doing something and you’re like, well, I forgot what I was doing, but now I have a pop-up,” he said. None of it helped, and all of it broke his focus while he was trying to care for a patient.
What he wants instead is a system that coaches in the moment rather than judges after the fact. He made the case through golf.
“I’m the worst golfer,” he said. “I don’t need anyone to judge me. I don’t keep score. It’s that bad. I really need a coach, someone there actively evaluating my swing, telling me which club to use.”
In Dr. Bernard’s broader vision of clinical coaching, a coach works in the stream of care and without judgment: Have you considered adding a beta-blocker? This patient will likely need a biologic that requires prior authorization — why not answer those questions now so office staff don’t have to later?
“You would be a better clinician, but more importantly, your patients would get much better care,” Dr. Bernard said. “And I don’t think that’s a hope for the future. I think that’s today.”
Dr. Ilbawi, an outpatient physician, said that kind of coaching sticks. A nudge during one visit becomes muscle memory for the next. “It’s almost like having an attending physician who’s putting his hand on your shoulder and saying, this is something you will remember next time,” he said.
The panel also took on a common concern: that AI could deskill clinicians. Dr. Bernard said his experience has run the other way.
Time savings from ambient documentation have proven more modest than many expected, he said — and he has come to see that as beside the point. Before, admitting a patient from the emergency department meant rushing the history so he could enter orders, write the history and physical and coordinate referrals. Now the ambient technology drafts the H&P, and anything he says with the family goes into the note.
“Now I get to have this incredibly robust conversation with the family,” Dr. Bernard said. “All the things that I’ve wanted to say are now in the note. The copy-paste drudgery that we deal with where we can’t figure out what actually happened with the patient goes away. And paradoxically, I spend more time with the patients now than I ever have.”
That logic extended to trainees. Dr. Bernard, affiliated with UT Southwestern Medical Center in Dallas, said the academic medical center went through a lengthy debate over whether residents should have access to these tools. The conclusion? They had to, because the tools made the residents better physicians.
Showing the work
Coaching only works if clinicians trust the coach. Ms. Lohmueller explained what that takes.
Traditional CDI engines run on rigid rules that have to be updated every time ICD-10 codes or coding guidance change. Abridge’s approach instead reasons across past notes, medications, labs and imaging to spot diagnoses that could be more specific, uses clinical evidence and applicable AHIMA/ACDIS guidance to support compliant clarification queries, and shows clinicians why it’s asking. A question only reaches a physician if the system is confident it’s worth their time.
“We take each query that we present as something that needs to be extremely high trust to have the attention of a provider to respond to it,” Ms. Lohmueller said.
In a live demo, she showed how those documentation cues, updates and formal clarification queries show up right inside the note. Some are just a heads-up, like a new lab result or stale, copied-forward data. Others suggest ways to round out the clinical story. The most formal are CDI queries tied to a billing code, with the evidence and answer choices right there to click. Clinicians review the evidence and determine the appropriate response. CDI teams, meanwhile, get an audit trail of what the system found, what it asked and how the clinician responded.
The early response time surprised the team. In early use, clinicians were answering queries within minutes, while the clinical context was still fresh.
Dr. Ilbawi, who has served as a physician advisor, said the conversation about what makes a good note touches on something CDI programs have long struggled to convey to clinicians: The note is not paperwork. It is how the next colleague, and the author on a return visit, understands what the physician was thinking.
“When the note is better, the care is better,” Dr. Ilbawi said.
Mr. Wilson closed the session by pointing to transparency as the thread linking Abridge’s original Linked Evidence feature to its CDI work. Good technology, he said, should sit in the background. He then asked attendees to weigh three questions during roundtable discussions: How can this technology be valuable to your organization? How can it be trusted? And how can it scale? For revenue cycle and clinical leaders, those questions reframe CDI less as a back-office correction step and more as a matter of timing. The documentation gap does not close by asking physicians to remember better on Tuesday. It closes by asking the right question, with the right evidence, while the physician still knows the answer.
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