How we translated complex Medicare Advantage documentation rules and 125,000+ SNOMED code sets into a seamless, high-velocity pre-visit workflow for CDI specialists.
NDA & Simulation Notice
This project was executed under a strict Non-Disclosure Agreement (NDA). The interactive panels and dashboard mockups shown below represent sanitized, functional wireframes designed to simulate the core system logic and information architecture without disclosing proprietary client data. High-fidelity UI designs and case files are available upon request.
Outpatient CDI (Clinical Documentation Improvement) has shifted under Medicare Advantage contracts. Instead of traditional inpatient fee-for-service reviews, CDI specialists target Hierarchical Condition Categories (HCCs)—a methodology that assigns a patient expense factor called the Risk Adjustment Factor (RAF) score.
CMS requires providers to address chronic conditions in a face-to-face encounter every calendar year. If a patient has severe COPD or morbid obesity, but the doctor fails to document it on the active problem list during the calendar year, the diagnosis is considered uncaptured, placing quality measures and funding at risk.
With over 125,000 SNOMED codes available and high-pressure clinician schedules, ChartWise set out to build a workflow console that gathers scheduled outpatient visits and extracts EHR records up to five days in advance, allowing CDI specialists to perform comprehensive prospective audits.
Translating 125,000+ SNOMED hierarchies into nested, filterable visual panels. Design system tokens for EMR integration.
7 Weeks
Phase 3: Interactive Workspace Delivery
Engineering the drag-and-drop encoder UI, real-time RAF calculator client-side loops, and clinician test integrations.
Interactive UX Lab
ChartWise CDI Workspace Simulator
Simulate the outpatient pre-visit planning dashboard. Filter the schedule, select a patient visit, review EMR problem list gaps, capture HCC diagnoses, and perform live RAF score calculations.
Methodology Note: This workspace acts as a sandbox representing the prospective HCC review pipeline. Click the tabs to explore how scheduled inpatient/outpatient EMR diagnostic queries flow into localized billing codes and generate risk metrics.
Designing for High-Density Information Contexts
Outpatient documentation systems fail because they treat clinical review as a standard web form. A CDS (Clinical Documentation Specialist) handles hundreds of cases and must quickly cross-reference raw physician notes with structured ICD-10 diagnostic trees and SNOMED mapping logs.
We addressed this bottleneck using three core UX design principles:
Visual Hierarchy of Risk: The schedule-centric workspace categorizes patient cohorts by risk potential, guiding specialists to review cases with high EMR gaps and maximum RAF adjustment opportunities.
Contextual Direct Action: Toggles allow mapping problem lists and capturing chronic conditions directly from the review page. Specialists do not have to leave the context of the patient chart to build queries.
Interactive Calculations feedback: As HCC markers are checked and SNOMED codes are validated, the patient's Risk Adjustment Factor score updates in real time, validating their work instantly.
Key Project Outcomes
34%
Increase in annual chronic diagnosis capture accuracy across patient populations.
3.2 mins
Average review duration down from 7.5 minutes, resulting in a 55% speed improvement.
Zero
Guideline infraction queries, securing compliant revenue streams under MA.
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