10 Key considerations to evaluate remote CDI readiness
“Will I ever have an opportunity to work from home?” It’s a question often asked by Clinical Documentation Specialists (CDS). As a CDI leader, you’ve likely heard it, most likely by some of your most experienced, productive employees and those most respected by physicians. Perhaps your initial response might be to answer “no,” based on the culture within the business or internal constituents. You probably have many concerns and the questions about whether a remote CDI model would be effective. The most common we hear from our clients are:
- Would the program be able to sustain collaborative physician relations?
- Would allowing one or two CDS’s to work remotely open the opportunity for others to do the same?
- How can work be monitored for consistency and productivity?
The UASI team works with a number of clients that have successfully transitioned employees from an onsite CDI model to an effective remote CDI model. If you’re considering a full or partial remote CDI program, we recommend you keep in mind the following key considerations to determine your organization’s readiness:
1. Electronic health record systems and CDI tools
A remote CDI model requires a fully functioning electronic health record (EHR) system and CDI tool. Without these in place, it can be challenging to operate an manage a remote CDI program. If your business is in the process of switching EHRs or implementing a new CDI tool, then your staff would benefit from onsite training, working through issues together and developing a standard process prior to the remote transition. However, if your program has an established EHR and CDI tool with a stable and functioning process in place, you can check this off your list.
2. Necessary tools, technology and support
Before an employee works remotely consider what tools, equipment and support will be needed to ensure success. Consider these important questions:
- Who provides the computers?
- Does the system require the use of a specific computer model or manufacturer?
- Are dual monitors needed?
- If a phone is required, what will the number be and who will pay for it?
- Is high-speed internet access available? Will remote worker be reimbursed for?
It is important to engage IT support in advance and identify an IT contact who is familiar with your remote working program. This person should be available when the CDS needs to troubleshoot IT issues when working from home.
3. Staff expectations
Because you want your employees to be successful, managers should clearly define expectations and review policies on an ongoing basis. Consider including specific information in your policies to cover the following:
- Are there set business hours or can the CDS start and stop their work day at their discretion?
- Does the CDS need to notify management if leaving for an appointment?
- Is there an established response time for email communications?
- In the event of a computer issue or internet connection, will you require the CDS to be onsite or take PTO?
- Will the employee need a designated, private office space to maintain confidentiality?
4. Monitoring of metrics
Data is a driver. Establish expectations and metrics upfront that clearly define what is required of remote employees. Make sure your remote CDI guidelines are up-to-date and outline the expectations for the minimum number of initial reviews completed each day, continued stay reviews and query rate.
When setting these expectations, consider the number of years of experience, the number of systems required to access and the areas being covered (e.g., orthopedics vs. intensive care unit). We also recommended that managers monitor physician response rate. Establish how often performance is evaluated and whether the employee would need to come back onsite if performance goals are not met.
5. Quality review process
A quality review process is vital for both onsite and remote CDI programs. However, we strongly recommend that you conduct regular internal or external audits of employees to verify their queries are compliant and there are no missing opportunities in the health record. This also gives leadership insight to where education or additional training is warranted.
6. Experience of the CDI team
Learning how to perform quality CDI reviews is time-consuming and often take comes from a lot of collaboration with multiple healthcare disciplines. Therefore, we typically recommend that a CDS has a minimum of six months experience onsite before he or she is eligible for remote working. That way, you can be sure that there is an established comfort level with other disciplines and physicians. The workflow is best for more experienced CDS’s, too. Can employees collaborate over the phone? Yes, but remote working is likely not an ideal way to learn CDI.
7. Administrative and physician support
Gaining such support is critical for remote CDI programs. Be prepared to show your administration a detailed remote CDI plan. Be prepared to discuss the benefits of moving to a remote model, which can include increased employee satisfaction, productivity enhancement and lower overhead costs.
The change to EHRs has also changed the physician’s work habits. Physicians can now review labs and test results from their office or home. Remote communication can be just as effective, but developing a relationship with the CDI program is still a very important piece. Have a discussion with your physician advisor and set up a communication and escalation process – whether the team is onsite or remote. Some remote programs keep managers, supervisors or a lead CDS onsite to maintain relationships with providers. This can be helpful if their issues ever arise with a query or a physician has a question they have one consistent point of contact. Having a contact person onsite is also important for continued education and collaboration amongst other department leaders.
8. Collaboration with key departments
Collaboration with other departments is critical to the ongoing success of a CDI program. Establish up-front how you want to manage team meetings. Consider these questions as you define the policies and leadership philosophy for your CDI program:
- Will you require your CDI staff to come onsite for meetings?
- Do you have conference call number capabilities for your team to call in?
- Do you have Skype capabilities?
- Will you establish a monthly in-person touch-base meeting?
- Will you require your staff to be onsite to work through difficult cases or other special circumstances?
- Will your staff be required to attend onsite training or education?
- Will your staff be required to meet with other departments, such as coding or quality?
We have worked with clients who have managed these issues in multiple ways and achieved great success.
9. Enhancing staff satisfaction
It can be a challenge to recruit experienced CDS staff. Once you have hired such workers, you invest a great deal to ensure their success. It’s important to keep staff engaged and satisfied and many CDS’s find working remotely one or two days per week to be satisfying. There are many benefits to working remotely, including less travel time, less parking hassle and less bad weather to deal with. Some CDI pros many say it helps with productivity and focus.
As a leader, you understand the value of an effective CDI program. So when the department is not functioning at required staffing levels, you know that the records are not getting reviewed and most likely the complete picture of the patient is not being captured in the documentation. With a remote model, you can utilize interim staffing agencies to help with maternity leaves, FMLA or while looking for the right staff to hire permanently.
10. Utilizing staff strengths
Working from home is not for everyone. Utilize the strengths of your employees when evaluating who would succeed when working remotely. Employees with performance issues or who aren’t disciplined with their time may not be successful remotely. Some CDS’s perform better in an office environment, where there is daily face-to-face communication. But that doesn’t mean you cannot have a mixed model where some employees work onsite and others work from home.
Assess your employees’ strengths and weaknesses – some employees do produce a quality review and meet quantity requirements, but struggle with physician interaction – in identifying the right people to work from home. You may also have a valued CDS who enjoys meeting with and providing support to providers. This employee might miss that interaction if they worked remotely. Perhaps the physician CDS liaison position would be a better fit. In other words, an effective remote CDI program is not a one-size-fits-all proposition.
UASI consultants are experts in implementing effective remote or hybrid inpatient CDI staffing models. If you are considering remote CDI staffing, UASI can partner with you to find the right solution for your organization’s needs and objectives. Contact us by calling (800) 526-0594 or email at firstname.lastname@example.org.
Staci Josten, BSN, RN, CCDS
Senior Manager, CDI & UR Staffing Services, UASI
Rebecca A. “Ali” Williams, MSN, RN, CCDS
Manager, CDI & UR Staffing Services, UASI