Remote Clinical Documentation Improvement Coding
There’s no doubt that remote work has its perks for employers—increased productivity, lower overhead costs, and a better pool of candidates from which to choose. We explored the benefits of remote work options in a recent blog topic here. However, in a virtual world, the nuances of good old fashioned face-to-face communication are often lost. This can be problematic in professions that rely almost entirely on open lines of communication, including clinical documentation improvement (CDI). Many CDI specialists work remotely and may not have ever met some of the coders and physicians with whom they dialogue via email, phone, or internal notes within the electronic health record (EHR). Some CDI specialists may even work in entirely different time zones from the one in which the hospital is located.
Given CDI’s reliance on communication, is this trend toward remote work okay, or should organizations be worried that information will be lost in translation?
The good news is that many organizations have found remote CDI programs to be extremely beneficial. In these cases, organizations typically go above and beyond email and phone to ensure that coders and CDI specialists have other options for communication. For example, the Journal of AHIMA recently reported that Baystate Health in Springfield, Mass., which has a remote CDI program, incorporates software as well as a system-wide instant messaging system to allow coders and CDI specialists to communicate.
For The Record Magazine reported a similar experience with Kaiser Permanente’s remote CDI program that includes 28 full-time CDI senior consultants, each of whom works remotely. CDI staff members meet onsite at a regional office for monthly gatherings, and they also use instant messenger for communication. In addition, CDI staff members attend monthly face-to-face physician meetings and frequently communicate with an onsite physician champion.
The Human Element In CDI
The human connection is critical in CDI, and it’s often the missing link in remote programs that aren’t ultimately effective. The human connection fosters relationship building, and it also builds trust. There is no substitution for face-to-face conversation or communication. Consider the following strategies to add a human element to any remote CDI program:
1. Begin the CDI program onsite before launching a remote initiative. This allows coders, CDI specialists, and physicians to get to know one another, put faces to names, and establish relationships.
2. Consider hiring an onsite CDI specialist who can be the ‘eyes and ears’ for those working offsite. This individual can help escalate queries to which physicians don’t respond. He or she can also view patients personally and provide clinical insight for those working remotely.
3. Schedule team meetings using videoconferencing technology rather than the phone only.
4. Provide a variety of communication options for coders and CDI specialists, including text messaging, instant messaging, phone, and email.
5. Require onsite attendance, if possible, for regular monthly meetings between coders and CDI specialists.
Why Open Communication Is Critical In Any CDI Program
Open lines of communication are an essential ingredient for any CDI program regardless of whether it’s onsite or remote. As the HIM department continues to become more virtual, it’s important for HIM directors to understand the role of communication and how it affects coding and CDI quality. Technology is a tool that makes communication more efficient; however, a quick response is not always the best response. By making quality communication a priority, remote CDI programs will ultimately be more successful.
What has been your experience with CDI? I would love to hear your thoughts about remote versus onsite arrangements.