Effect of concurrent computerized documentation of comorbid conditions on the risk of mortality index

• Objective: To evaluate the effect of adding concurrent computerized documentation of comorbid conditions to standard medical record review on the severity of illness index and risk of mortality index. • Design: Cross-sectional study. • Setting and participants: 377 surgical patients at 2 academic centers undergoing inpatient surgery from September 2004 to January 2005. Standard medical record review was performed by the hospital's professional medical records coders. Concurrent computerized coding was performed by an anesthesiologist doing preoperative assessment using a software tool. • Measurements: Severity of illness index, risk of mortality index, and number of comorbid conditions. • Results: Concurrent coding averaged 5.3 additional comordid conditions that were not identified by medical record review. 9 of 13 comorbid conditions increased with concurrent coding. Mean severity of illness index and risk of mortality index scores were 1.92 and 1.44 with medical record review and 2.23 and 1.68 for concurrent coding. Concurrent coding increased severity of illness by 16% and risk of mortality by 17%; severity of illness and risk of mortality increased by 1 category in 27% and 23% of patients, respectively. • Conclusion: Concurrent coding significantly increased the severity of illness index and risk of mortality index, which can have important implications for health outcomes research, perceived quality of care, and financial reimbursement.