Coders

dvitalone1

I wanted to throw this out there for couriosity sake. Are any of your coders remote? If they are remote, how often are they required to come in for education, meetings, etc? Are any of your remote coders part of the CDI team? Thanks! Dawn

ggoodman@virginiahospitalcenter.com

Our coder work from home. They are not considered part of the CDI team - though I do think it would be beneficial to have one of them act as a coding/cdi liaison, to help us with our coding questions. They do not come in very often for meetings/education, maybe quarterly...

dbutler

A number of our inpatient and outpatient coders are remote. Requirements are first broad band access (in rural Eastern NC that is not always available) and then having met and maintained certain quality, accuracy & productivity standards.

They come in periodically, probably less than monthly. Some of the meeting/educaiton (such as sharing the quarterly PWC results) are conducted via phone conference for the remote staff.

Even though we are moving more and more to all EMR, the value of the face to face interaction for me is too important to the CDI role, so none of our CDS folks are remote. There are programs that have successfully figured out ways for part time remote.

There was an on-line poll that asked "Do your CDI reviewers work from home (i.e., performing data entry, reviewing charts electronically, etc.)?" 50% reported working from home an average of 1x/ week. See full poll here:
http://www.hcpro.com/acdis/view_readerpoll_results.cfm?quiz_id=2183

Don

kmckaig

All of our coders are remote. However, one is inhouse every week for the whole week. They rotate. The inpt coders are part of the CDI process in that they all work with the CDS to ensure proper coding. Also, they also query physicians for Present on Admit or cc/mcc's as needed. We also have a Task Force 2x/month that they come inhouse for along with their monthly staff meetings which are done back to back with the Task Force meetings. The Task Force is CDS/Coder meetings on coding clinics, special case review, physician issues, education planning for physicians etc.

dallend@einstein.edu

All of our coders work from home. They come in once a month for their coding meeting. They call in for educational sessions. We do not have coders on our CDI team - there are 3 of us - all nurses.
However, we do work closely with our coding staff.

bea.smith

Dawn,
Our ER coders are remote and they have to come in anytime we are having
a dept meeting. None of our inpatient coders are remote, mainly because
our records are not 100% electronic thus far. I wouldn't be surprised if
remote inpatient coding is an option once we have a total EHR. I'm not
sure our facility will ever let the CDI team work remotely, mainly
because they want to keep the face to face contact with the physicians
each day.

Bea Smith, RHIT
Clinical Documentation Specialist
Cullman Regional Medical Center
ph: 256-737-2926

God grant me the serenity to accept the things I cannot change; courage
to change the things I can; and the wisdom to know the difference.

mark.dominesey

All of our coders are remote and employed by us with the exception of a
Supervisor, Lead, and a part-time person.

The biggest stumbling block to remote coding is bandwidth. Satellite
Internet just won't cut it - there is approximately a second delay and
the two systems don't always sync at the same time, this term is called
latency. I am responsible for the network/computer/hardware/application
support for my HIM department (13 yrs IT experience before becoming a
nurse) and I have set some of our remote coders and transcriptionists
up. I found that a 3G phone/Internet connection is adequate
(~1.2mb/sec), DSL is good, Cable is better, FIOS is blazing, just like
you were in the same building. Our 3M apps require a minimum of
780kb/sec, so any transfer rate must include some overhead above
780kb/sec for discrete calls to the EHR.

We have a hybrid EHR - it is electronic, but progress notes, EKGs and
other documents are still paper. We have a scanning solution with
Cerner called CPDI where all paper documents are scanned at discharge
and added to the electronic medical record. This way all
records/documents are available through the electronic medical record,
and thus are available to remote coders.

Hope this helps,

Mark

Mark Dominesey, RN/BSN, MBA
Clinical Documentation Improvement Specialist
Health Information Management Services
Martha Jefferson Hospital
459 Locust Ave
Charlottesville, VA 22902

lspryszak

How wonderful that you were able to develop this working relationship with your coding team! Would you be willing to share how you enacted this collaborative process? I know many people are struggling with how to build a strong, interactive HIM-CDS team.

kmckaig

I will be more than willing to share. I want to get some feedback from their perspective as well in order to offer insight into both sides and then I will write back. At this point, I will tell you that we constantly work on communication and it often involves debates and disagreements and hours of discussion but we have developed a process that allows for this and also provides a specific avenue for conflict resolution.
Thank you for asking and I will be able to share more in a day or two.
Karen

dvitalone1

We are a new program (since Aug) we have tried many different arrangements with coders. At this time we have 2 CDI specialists and now 2 coders designated to CDI. So far it is working well. For productivity reasons once the CDI coder has completed the CDI charts they go back to their regular cue. The CDI coders have access to our CDI EHR which is MIDAS and can see when we have place a query on a record and what notes we have on the patient. This is very helpful because we are all human and 2 sets of eyes are better than one.


Dawn

dvitalone1

dvitalone@comhs.org
219-513-2611


Dawn

dvitalone1

M-F 8-430 central


Dawn