mobile work station

cnolan@swgeneral.com

Our administration feels it is necessary to be more visible/available to the physicians; we presently work from our office.
The nursing units have very little space for the CDIS.
Our director is interested in purchasing a "mobile work station."
Any ideas? Is anyone presently using such a system? We are thinking something similar to the "WOW" systems the nurses use on the floor; however with an attached seat??
Please advise! Thank you.

Colleen M. Nolan R.N.
CDI Specialist
Quality Management
Phone: 440-816-6398
cnolan@swgeneral.com


Southwest General - HEALTH is our passion, QUALITY is our focus, COMPASSION is our way
18697 Bagley Road | Middleburg Heights, Ohio | 44130-3497 | Tel: 440-816-8000 | www.swgeneral.com

wchenney

We use laptops and take them to the floor to work on so as to not take up a floor computer. We are then on the nursing divisions to be more visible to the docs and others.
Wendy

cnolan@swgeneral.com

Yes we have laptops; however there is no space available still!

lsipos@monument.health

Colleen

Are you in only one unit per CDI? I cannot imagine doing that, and can honestly say that I don't think providers would utilize us just because we were there. For us, I think it would cut down on the number of patients we review- because we would feel that the noise, interruptions etc detracted from our focus. Our office is a quiet environment that allows us to focus. We generally see all Medicare patients on every floor so I cannot imagine having to truck around a WOW/COW to the units and 10 floors that we go to. I think that would even further cut down on the accts reviewed! Good luck though! We do have lap tops, and even finding a spot for those is some days isn't reasonable. I think you have to find the fine line of being visible for your providers, but not necessarily IN the way!

We do round daily as we are still hybrid; we ask providers we see if they need anything, and make a special trip to the provider lounges. We send out weekly "information pearls" through our CMO to all providers. We hang posters with our photos and numbers EVERYRWHERE-provider lounges, dictation areas etc. We attend HOSP meetings and pretty much accost them at every opportunity. I would wonder, what your director thinks moving to the floors is going to do? Unless you are "elbow" educating every provider I would wonder the value? I would like to know once you start if your review numbers go down!!?? Good Luck!

Juli

Unknown

I used an AV cart which I pushed around with my laptop. I could take reference material or whatever with me.
I have since been given office space and spend much less time on the units. In my experience, being more visible on the floor equates to less records reviewed.




Charlene Thiry RN, BSN, CPC, CCDS
Clinical Documentation Specialist
Quality Resources
Menorah Medical Center

rmhosler1

For 6 years we have used a mobile work station. It has a laptop inside it and we utilize a computer keyboard on a pulltray under a desk. We also have a printer. Several of our team is complaining of neck and back problems from leaning over the keyboard to see the screen. We have 17 inch laptop screens. We run two programs side by side our JATA software and our EMR.

The pros: you can make a desk anywhere. You can catch the doctors when they round. You can take the laptop out but their is a risk there. We were recently told we could no longer do that, due to HIPPA, in case it were stolen etc. We have a concurrent process, no retrospective.

The cons: hard to see the screen, one more thing in the hallway and you are frequently in the way. After awhile they do get used to you if you stay in the same spot. The printer is a mobile printer so you frequently go through them as well as cartridges. I would way we go through a printer a year as an average. This is multiplied x 5r people, so 5 printers a year. We try to print from the floor printer, but we use colored paper for Queries which have to be recopied onto pink paper, etc. I would definitely try to get your own printers.

As far as the screen, I would not use a laptop inside a mobile station. The font is very small. I would get the biggest screen your cart can handle.

Funny, we are talking about becoming more office based as we go fully EMR.


Mary A Hosler MSN, RN
Clinical Documentation Specialist
Alumnus CCRN
McLaren Bay Region
1900 Columbus Ave.
Bay City, Michigan 48708
(989) 891-8072
mary.hosler@mclaren.org

cnolan@swgeneral.com

Agree with you 100%.
We have three CDI's and each cover multiple units!

angelisa.romanello

I agree very strongly with the visibility on the units. We have hybrid charts, partially electronic and partially handwritten therefore we take our laptops to the units. Each of the CDIs have six units and we have worked hard to find a little space on the units. Since we are not present all day it is not usually a problem.
I believe it helps tremendously to be in front of the physicians and available if they have questions or concerns.

It works for us and we have a 95% response rate on our queries.

Lisa


Lisa Romanello,RN,BSN,FNS,CCDS
Manager, Clinical Documentation Improvement Specialist
CJW Medical Center
Quality and Compliance
804-228-6527

katysuegood@gmail.com

We currently work from offices (with me from home). We have considered being on the units but opted against. We do attempt to be visible but we are completely electronic and honestly, the MD's are not on the units much either. If they are on the units, it's to see patients or communicate with the RNs and they do not want to be bothered. They dictate their notes or do them in the EMR and that is not done on the units.
We recently changed departments and there was a big push for 'communication' with the providers. They wanted more verbal queries and 'at-the-elbow' discussions. After a month or two the feedback they got from the providers wa that they prefer written queries and not to be bothered when they are on the unit unless it is urgent. We do go to rounds and try to get any questions answered then.
I have seen some good mobile options but I definitely think that you will see a decrease in productivity. I would want to make sure that everyone was aware of that prior to making the switch.

Good luck!

Katy Good, RN, BSN, CCDS, CCS
Clinical Documentation Program Coordinator
AHIMA Approved ICD-10CM/PCS Trainer
Flagstaff Medical Center
Kathryn.Good@nahealth.com
Cell: 928.814.9404

evanspx@sutterhealth.org

To those of you working remotely, how do you view concurrently the record while at the same time code the chart? Do you employ one large screen and 'split' the view, or do you use dual-screens?

I know that everyone does not use an encoder while performing CDI work, but If this is your method, I am curious as to how you view all of the information concurrently. Our team has access to the coding software which provides us with MS-DRG and APR-DRG information.

Thanks,

Paul Evans, RHIA, CCS, CCS-P, CCDS

Manager, Regional Clinical Documentation & Coding Integrity
Sutter West Bay
633 Folsom St., 7th Floor, Office 7-044
San Francisco, CA 94107
Cell: 415.637.9002
Fax: 415.600.1325
Ofc: 415.600.3739
evanspx@sutterhealth.org

katysuegood@gmail.com

Paul,
We do not concurrently code each record, but we do use the encoder for some charts depending on the situation. However, we do use a web-based program to track reviews so we always have at least that and the EMR open at the same time. We all have duel screens. When I do not have access to my duel screens, I see a SIGNIFICANT drop in my productivity.

Katy Good, RN, BSN, CCDS, CCS
Clinical Documentation Program Coordinator
AHIMA Approved ICD-10CM/PCS Trainer
Flagstaff Medical Center
Kathryn.Good@nahealth.com
Cell: 928.814.9404

sharon.cole

We actually have 3 programs we use - Allscripts for documentation and queries, Epic is the medical record, and Quantim for encoder. The coders actually were given 2 screens - one for Epic and one for Quantim. The CDI staff uses laptops since we cover more than one unit and just have to flip back and forth between screens/programs. We also have to keep email open since this is the preferred method of communication with director and department. Problem here is that everything (except email) times out after a few minutes. So we are constantly having to log in. We've argued that our laptops are assigned to one user and can be locked if we are up looking at charts or speaking with providers, but still no extending the length of time between time outs.

On some units we review records in the doctor's dictation rooms, on others, there is a work room for ancillary staff - us, case management, OT/PT/ST, dietary, etc. I would love the opportunity to work remotely!

Sharon Cole, RN, CCDS
CDI Specialist
254.751.4256
Sharon.cole@phn-waco.org

evanspx@sutterhealth.org

Katy: Thanks - does productivity decline because you must 'toggle' views? We convert to EPIC very soon, and we are considering how to configure our revised work flow with the electronic record. (Dual screens or split screens seem advisable)?

Paul Evans, RHIA, CCS, CCS-P, CCDS

Manager, Regional Clinical Documentation & Coding Integrity
Sutter West Bay
633 Folsom St., 7th Floor, Office 7-044
San Francisco, CA 94107
Cell: 415.637.9002
Fax: 415.600.1325
Ofc: 415.600.3739
evanspx@sutterhealth.org

katysuegood@gmail.com

Yes, I personally think that it breaks my train of thought. And I find that I am 'toggling' constantly whereas I would just be glancing over to my review worksheet otherwise (for ex: to see if I have already listed a documented dx).

Katy Good, RN, BSN, CCDS, CCS
Clinical Documentation Program Coordinator
AHIMA Approved ICD-10CM/PCS Trainer
Flagstaff Medical Center
Kathryn.Good@nahealth.com
Cell: 928.814.9404

fishdl@shands.ufl.edu

We are still located in the hospital, but work from a central office. We also have access to the coding software which provides MS- & APR-DRG information. We have dual monitors to enable us to view our EHR and access the coding software simultaneously.
To echo Katy, since going completely electronic (including our queries), the providers spend very little time on the floors - except to see their patients. Their chart completion is done from workrooms / offices. Sadly, it seems like the good old days of interacting with the providers on the floors/units is over.

cynthia.a.goewey

I split my screen; I have a 24" monitor. I have my Epic medical record opened on one side and my worksheet on the other. Works well for me. When I have to work off my laptop I would say it takes me a bit longer when I have to move from screen to screen.
Cindy

Cindy Goewey RN, BSN, CCDS
Clinical Documentation Specialist
Dartmouth-Hitchcock Medical Center
1 Medical Center Dr
Lebanon, NH 03756
Phone 603-653-6814
Pager 4741

rmhosler1

I also have access to the encoder. I have a split 17 inch screen on the laptop and toggle to the encoder, as the EMR and our JATA software utilize the split screen.


Mary A Hosler MSN, RN
Clinical Documentation Specialist
Alumnus CCRN
McLaren Bay Region
1900 Columbus Ave.
Bay City, Michigan 48708
(989) 891-8072
mary.hosler@mclaren.org

evanspx@sutterhealth.org

Mary: Thank you. I trust you find it useful and practical to split the screen? Or , would it be more efficient to use dual-screens? I am struggling with this choice and have no practical experience with either configuration. (Currently, we review paper records and we toggle on one screen - it is not efficient. When we go 'live' with EPIC, this process must change for our team.

Paul Evans, RHIA, CCS, CCS-P, CCDS

Manager, Regional Clinical Documentation & Coding Integrity
Sutter West Bay
633 Folsom St., 7th Floor, Office 7-044
San Francisco, CA 94107
Cell: 415.637.9002
Fax: 415.600.1325
Ofc: 415.600.3739
evanspx@sutterhealth.org

angelisa.romanello

We have access to the encoder and I split my screen also.

Lisa Romanello, RN,BSN,FNS,CCDS
Manager, Clinical Documentation Improvement Specialist
Quality Department
CJW Chippenham Campus
Angelisa.Romanello@hcahealthcare.com
804-228-6527

lindenbm@bellsouth.net

We have dual screens and work in one central location in the hospital. Our coders have 3. I love the dual screen.

I appreciate all the talk about whether or not to be on the floors. We have been debating whether or not to be on the floors and the information provided is helpful.

Mary Lindenboom, RN, BSN, CCDS
Clinical Documentation Manager
Flagler Hospital
400 Health Park Blvd.
St. Augustine, FL 32086
(904) 819-4254

angelisa.romanello

Paul,
I will tell you we have dual computer screens on our desks. IT is a true blessing. You can review the electronic chart on one screen with all of your labs and then input the information into your documentation system ( currently we use 3M CDIS). It is also helpful to have the dual screens when creating your queries. Our queries are electronic now so we have the actual query form on one screen and the medical information on the other.

It is such a time saver to have dual monitors ! Our laptops that we use on the units are capable of a split screen however when we return to our offices the dual screens are fabulous.

Good Luck with your conversion to EPIC !

Lisa Romanello, RN,BSN,FNS,CCDS
Manager, Clinical Documentation Improvement Specialist
Quality Department
CJW Chippenham Campus
Angelisa.Romanello@hcahealthcare.com
804-228-6527

evanspx@sutterhealth.org

I appreciate all of the helpful responses...thank you, all.

Paul Evans, RHIA, CCS, CCS-P, CCDS

Manager, Regional Clinical Documentation & Coding Integrity
Sutter West Bay
633 Folsom St., 7th Floor, Office 7-044
San Francisco, CA 94107
Cell: 415.637.9002
Fax: 415.600.1325
Ofc: 415.600.3739
evanspx@sutterhealth.org

debra.stewart@halifaxregional.com

This is a topic that interests me also and just looking at all the responses is very helpful. I am trying my first response here on CDI talk—so want to make sure I come through appropriately-so let me know Guys.
Deb

sharon.cole

Even though we are around the nursing stations, we rarely see the MDs anymore. The Hospitalists generally round and then disappear to their office to document as do the residents. Of the other groups who are electronic - we only see the critical care Intensivists. Everyone else rounds and disappears.

Sharon Cole, RN, CCDS
CDI Specialist
254.751.4256
Sharon.cole@phn-waco.org

katysuegood@gmail.com

Yes, this is our experience. The MD's are on the floors to see patients. They do not write their notes there. So, they generally see their patients and then go to a dictation room, lounge, or office. They are easily accessible to staff via text if patients need attending to but they are not just hanging out on the units. This is especially true of specialists (not hospitalists and intensivists). If they were hard to run down before, it is much more difficult now. Our orthopods (for example) round early and are basically only seen otherwise to deal with urgent patient issues.

Because of this, we have found that rounds is the best time to 'see' the providers. Otherwise, even if we are on the units, they likely won't be....

Katy Good, RN, BSN, CCDS, CCS
Clinical Documentation Program Coordinator
AHIMA Approved ICD-10CM/PCS Trainer
Flagstaff Medical Center
Kathryn.Good@nahealth.com
Cell: 928.814.9404

CLINDOCSPECLIST

We have electronic records for almost everything and there are only a few doctors who still write out their progress notes. We originally started with iPads which allowed us to be mobile, but we found this was VERY inefficient because we have at least 3 programs we have to toggle between. We finally have been able to secure space out on the floor, but I have to echo the feelings of others that since the record is mostly electronic, we rarely see our doctors. We each have our own PC on the floor and we have a "mobile" network that allows me to log in on one PC and then if I need to go to another floor to track down a doctor I can quickly log out and log back in on the other floor and all of my work is still right there open and ready for me to finish. We don't work on duel screens, which I wish we had, but I have also found that if you use the notepad feature on your PC or laptop and have that open you can quickly cut and paste the information from the progress notes or labs that you need and that paste that into our review software. Toggling that way doesn't see to slow me down much.

Being out on the floor has its pros and cons, but I would definitely prefer a quiet office. Our boss really wants us to stay visible, but I think those days of being there for the physicians really is over. They just don't stay on the floor like they used to!

Rebekah Foster RN CCDS
Kaweah Delta Medical Center
400 W. Mineral King
Visalia, CA 93291
(559) 624-5085
rfoster@kdhcd.org

jschoonhoven

My dept. still works with a hybrid record-- won't be full HER until 2015. The CDS's have offices on the floor they cover, and use dual screens. Additionally they have 'remote access' to their PC from any computer out on the floor so they can use their programs when at the physical chart as well. We do a great deal of personal discussion/ interaction with the docs in both our hospitals here.

Do those who follow a less in-person process see this changing at all with I-10 prep and implementation? I believe the docs will need significantly more guidance through this period and in-person would be effective.
Thoughts?

Janice

Janice Schoonhoven RN, MSN, CCDS
Clinical Documentation Integrity
Manager- PeaceHealth Oregon West Network

katysuegood@gmail.com

Our I-10 education is happening mainly in the same way we currently educate. We are amending queries, going to department meetings, tip sheets, we have designed a monthly newsletter specific to I-10, planned a twitter campaign, online education sessions for MD's, etc. We of course may find that we need to change this as we transition and we have greatly increased staffing in the last 9mo with this in mind (we went from 2.5 FTE's to 8) so we should be able to adjust if needed. But at this point, our MD's are not available on the unit so we have to find other ways to reach them.

Katy Good, RN, BSN, CCDS, CCS
Clinical Documentation Program Coordinator
AHIMA Approved ICD-10CM/PCS Trainer
Flagstaff Medical Center
Kathryn.Good@nahealth.com
Cell: 928.814.9404

paxneros

I agree! We have been given the ball for I10 and will definitely be running interference for I10 documentation!

Howvever I am interested in what you wrote here:

"Additionally they have 'remote access' to their PC from any computer out on the floor so they can use their programs when at the physical chart as well".

What application do you use to do this? Do you have access to encoder software this way? We have been talking about the capability to log onto any PC and work. It would give us more mobility.

Thanks,

Norma T. Brunson, BS, RHIA,CDIP,CCS,CCDS

CLINDOCSPECLIST

The program that we use for "remote access" is called MyKD. It is a program that was specifically built for us by a company called Citrix and it is accessed thru the Citrix web-based interface. It is a pretty handy function. My desktop is accessible no matter where I am in the hospital (my virtual desktop) and I can run the encoder, and all other programs that I need thru that. Whatever chart I am working on, I can leave all my programs open, disconnect from the virtual desktop and then reconnect on a different floor and all of my work is sitting there just as I left it. Very handy when I have 2 units to cover!

Rebekah Foster RN CCDS
Kaweah Delta Medical Center
400 West Mineral King
Visalia, CA 93291
559-624-5085
rfoster@kdhcd.org

katysuegood@gmail.com

We use Citrix too and we have a MyDesktop program o access your desktop from any computer too

Katy Good, RN, BSN, CCDS, CCS
Clinical Documentation Program Coordinator
AHIMA Approved ICD-10CM/PCS Trainer
Flagstaff Medical Center
Kathryn.Good@nahealth.com
Cell: 928.814.9404

CLINDOCSPECLIST

I bet they would. Our ISS dept is the one who handles that so I am sure if you approach your IT guys and talk to them about it you could have them do the same for you. The great thing is I can also pull this up on my iPad if I really am in a pinch and access my virtual desktop thru the Citrix app they have as well. VERY handy! Good luck!

Rebekah Foster RN CCDS

vdavis2

We have dual screens, moving to triple... and work in a centralized location in the hospital. We attend physician rounds on units that have this type of rounds. In my opinion, mobile workstations are not worth the money! There are too many distractions on the units and standing all day is not optimal! (We also have an issue with space on the units.) Fortunately, our physicians are also creatures of habit and generally round at the same times daily. J

Vicki S. Davis, RN CDS
Clinical Documentation Improvement Manager
Health Information Management Department
Cone Health at Alamance Regional
Office (336) 586-3765
Ascom Mobile (336) 586-4191
Fax (336) 538-7428
vdavis2@armc.com

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