Vol. 12 •Issue 21 • Page 10
Designing a Remote Coding Program: Seven Steps to Success, Part I
Leslie: During the past two years we have devoted many of our columns in ADVANCE to discussing aspects of remote coding, but I don’t think we have talked about the whole process of designing a remote coding program.
Patty: You are right Leslie. However, in working with our clients these past few years we have identified Seven Steps to Success that cover the whole process from beginning to end. Perhaps the time has come to share that process with our readers.
Leslie: The process that has emerged from our work is a dynamic and flexible approach that can be molded to the needs of most organizations. However, let’s not underestimate the creativity that each health information management (HIM) director and project manager will bring to their own remote coding projects. Remote coding is a new way of working for most HIM departments and should allow for innovation and breakthrough ideas. Our process simply guides the way through this important change project.
Patty: Our Seven Steps to Success remote coding program begins with the HIM director or coding manager obtaining executive sponsorship. If you are struggling with maintaining a full complement of coders, or you are left reeling from periodic backlogs, or you manage multiple contract coding firms to keep the coding function current, you have probably been considering remote coding as an option for getting your coding function under control. To design a remote coding solution, your first step to success will be to get a solid backer. A good executive sponsor will understand the urgency of problems caused by coding staffing issues in your organization, will have the right connections that can elevate your project to a priority status, and will champion your project all the way up to the Board of Directors.
Leslie: Do you really mean all the way to the Board Patty?
Patty: Yes. Remote coding is a giant step toward conducting HIM in an electronic practice environment or as the American Health Information Management Association (AHIMA) now calls it, e-HIM. As paper records transition to electronic records, it is essential that an organization realizes the full benefit of e-HIM, and remote coding is one of those benefits. It is also a significant departure from the “way we have always done it” and it will need powerful backers. It may be the first time that a hospital’s employees are working from home with patient information and accessing hospital information systems through remote access technology. Accountability for assuring maximum security and privacy of patient information is a critical feature of a remote coding program.
Leslie: That’s a good point Patty. With fiscal responsibility and corporate integrity being such high profile issues in today’s business environment, accountability right up to the board is justifiable. Also, as a bonus, when the Hospital’s Board is aware of important new initiatives, they monitor their progress through the CEO. The success of a project like remote coding, which has very tangible benefits to the organization, can be a feather in the cap of the CEO.
Patty: Once the director has recruited an executive sponsor to help create a sense of urgency for the project, the director needs to create a remote coding project team. Designing a successful program should be neither a one-man show nor should it include a cast of thousands. It should really be more like a repertory company. Key individuals for this project team would include representatives from the information systems department, the human resources department, finance or business office, as well as the HIM operations manager, coding manager or supervisor and representative coders. Many of these same people may be involved in future e-HIM projects, thus, consider a remote coding project as an opportunity to create a model for successful change projects.
Leslie: Step three is creating and communicating a vision for the project. This step is perhaps the most critical one in the whole process for assuring success. However, it is the one step that we find is often forgotten and skipped entirely. In their enthusiasm to get the project accomplished quickly, project teams leap to discussing tactics. They are excited to talk about the latest and the greatest in software or telecommunications, and their discussions immediately focus on the technology and its implementation.
Patty: That’s right Leslie. I don’t know how many times we have had to say, before we talk tactics, we really need to understand your vision, only to learn that there is no vision, or that the vision is only in the HIM director’s head and has not been communicated to coders, HIM customers or hospital leadership. People are off and running, but no one is really clear about the destination.
Leslie: Our readers might be thinking that surely the HIM director that is looking at remote coding solutions has a vision. I would say that they know they have a problem and that they want that problem to go away. But that is a far cry from being able to describe to others how the HIM department and the whole organization will be different after implementation of remote coding. It won’t capture what people are saying about the department after implementation. It probably doesn’t include the relevant metrics that will change and how much they will change. These are the elements of a clear vision.
Patty: Let me help here with an example of a remote coding vision in a seven-hospital system. It might sound something like this:
“One year after implementation of remote coding our hospital system will exceed DNFB expectations, spend less money maintaining the coding function, have more satisfied coders, less turnover and happier HIM customers. In one year all of our ED and outpatient coding and abstracting is done by at least 12 hospital coders working from their homes and 12 working from centralized coding offices in three of the hospital system’s seven hospitals. Coders are directly accessing ED and outpatient patient clinical information via the electronic medical record (EMR). Coders remotely access the EMR, encoding and clinical abstracting systems. Inpatient records are scanned and transmitted to a remote coding application hosted by an ASP. Longer stay records continue to be coded at the hospital site. By 2005, when our total EMR system is fully deployed, inpatient clinical data will be directly accessed using secure remote technologies.
Within the first year, space has been reallocated for other HIM department functions in the four hospitals using the remote coding program from offsite locations. The Chief Financial Officer (CFO) is ecstatic over the steady cash flow created because recurrent backlogs have been eliminated. Further, coder turnover rates have diminished, reducing the need by 75 percent for contract coders to fill gaps and catch up backlogs. Within two years the impact is considered budget neutral.”
Leslie: Nice vision Patty. But, why does creating the vision come as a third step? It seems intuitive that a vision comes first before you start lobbying for support and putting a group together.
Patty: In successful change projects, one enthusiastic or strategic individual starts a vision. However, a vision isn’t worth much if it isn’t communicated. Good communication is reciprocal. A dialogue begins between the initiator of the project and the newly appointed project team. Getting suggestions from the team and letting the team revise, mold or elaborate on the original vision is a first step in gaining buy-in from key individuals who must then carry the message far and wide.
Leslie: Communication is definitely a critical factor in making the vision a reality. Everyone needs to know the vision. The vision needs to be communicated to all the departments and individuals whose cooperation or support is needed to bring about a successful implementation. Without a clear understanding of how things will be different, essential departments may appear to put up roadblocks. They do this not because they are obstructionist by nature, but because their departments are affected more dramatically than we might imagine.
Patty: That’s right. For example, a human resources director needs to understand how the project will play out from a staffing perspective because a remote coding program will change recruiting processes for coders, telecommuting policies will have to be created or revised, contracts with temporary agencies may need to be renegotiated, the compensation program may need revision, etc. Without the vision, the human resources director and her staff are not likely to make their pieces of the project a priority, thus appearing as obstacles to the timeline.
Leslie: Well, Patty, we are only through three steps and we are out of space for this month. To do our subject justice, we will continue this discussion next month.
Patty: I agree. But, let’s not leave our readers in suspense. The next four steps are to determine the technology needs of the project, perform a readiness assessment to determine process re-engineering needs, develop a work plan, and implement the work plan. Next month, in Part II, we may have to devote the whole column to the technology step because the variety of technology solutions is expanding. We want our readers to be able to make good choices for today and for tomorrow.
Leslie: OK. Steps five, six and seven will be Part III of this series for our final column of the year. Sounds like a plan!
Leslie Ann Fox is president and chief executive officer and Patty Thierry is vice president of operations and chief information officer, Care Communications Inc., Chicago. They invite readers to send their thoughts and opinions on this column to [email protected] and [email protected].