St. Alexius Medical Center Implements Remote Coding and Realizes Significant Productivity Improvement
Posted on 10/4/2004
3M Customer Profile: St. Alexius Medical Center, Bismarck, ND
Winter winds blow cold and the snow gets deep in Bismarck, North Dakota.But thanks to a remote coding program, St. Alexius Medical Center’s home-based coders can stay warm in their homes without missing a day of work. In a rural area where many employees live long distances from the hospital, the program has allowed St. Alexius to not only retain and effectively recruit experienced coders, but also achieve significant increases in coder productivity.
St. Alexius was the first community hospital in North Dakota, founded by Benedictine sisters in the nineteenth century with just 15 beds. Today St. Alexius is a 264-bed medical center and the major healthcare provider for the region around Bismarck, serving central and western North Dakota, Northern South Dakota, and eastern Montana. The hospital averages 925 inpatient monthly discharges, and 5,220 outpatient monthly visits. Like many hospitals, St. Alexius has a high percentage of Medicare and Blue Cross enrolled patients, so the organization operates on a predominantly fixed-payment system.
GOING REMOTE-SETTING UP THE INFRASTRUCTURE
Before allowing coders to work from home, St. Alexius provided remote computer access to other areas of the organization, such as the finance department and transcriptionists. Both the IT infrastructure and experience were already in place to extend remote access to HIM department personnel.
In addition, the HIM department itself was well-prepared for the change. “We started building our electronic medical record in October 1992,” says Tamara Darling, Health Information Management Director for St. Alexius. The hospital uses an optical imaging system to scan and combine patient data into one electronic medical record that can be accessed by authorized users, including coders.
Within 48 hours of a patient’s discharge, the patient’s record is available in the optical imaging system, and from that point onward, the medical record is wholly electronic. St. Alexius uses the 3M™ Health Record Management (HRM) software alongside of the optical imaging system to complete the record abstracting process.
For coding, the organization uses the 3M™ Coding and Reimbursement System, along with the optional 3M™ Coding Reference Software and 3M™ Coding Reference Plus Software modules, which provide coders with online access to the latest versions of industry-standard references. The 3M coding system incorporates expert logic to guide coders through a series of relevant decisions for each diagnosis and procedure. It draws upon the cumulative wisdom and experience of 3M’s coding experts and clinicians to ask the right questions as codes are entered, so it helps improve coding completeness and accuracy right from the start. To connect the coders to the hospital’s application server, St. Alexius uses a single Microsoft® Terminal Server connected to a Virtual Private Network (VPN) device with a firewall. The optical imaging system, the 3M™ Health Record Management Software, and the 3M™ Coding and Reimbursement System all
run on the terminal server. Remote coders tie in via a high-speed connection and attach to a Terminal Server network.
EASY IMPLEMENTATION
Joy Krush, RHIT, CCS, CCS-P, St. Alexius’ Reimbursement and Coding Supervisor, claims, “The writing of policies and procedures took the majority of the time for implementation. The important item to understand is that we already had an electronic record in place and had been coding from scanned and interfaced medical records using this workflow for two years.”
Darling says little help was required from 3M to set up the remote coders. After installation, most problems were solved in less than a day. “There were some little things, like connections getting broken, and some other questions, but nothing that took long to resolve,” she says. “The systems work like the in-house versions, and there was no special training required.” Darling adds that the people at home use the systems “as if they’re right here.”
GOING REMOTE-BENEFITS ALL AROUND
St. Alexius has six coders, and three of them are now working remotely. Darling says the extensive electronic coding arrangement and familiar workflow made it easy to convert to remote coding. “Our coders were already used to electronic coding, so sending them home was the natural next step.”
Remote coders do travel into the hospital for monthly meetings and any other time they are needed for face-to-face interactions. They are responsible for their own internet connections and monthly fees. The hospital provides the PCs and IT-department support and diagnostics for the remote coders’ computers.
Setting up the remote coders has improved St. Alexius’ retention rate, an important consideration in a small labor market. For example, one of St. Alexius’ remote coders is a new mother. Faced with returning to the road as ccommuter, she could have oopted to leave the work force altogether. “Remote coding has helped us retain her and other coders,” says Darling.
Two of the experienced coders live 45 miles away in Tuttle, North Dakota. Unable to get high speed Internet connections at their homes, the two coders were so motivated to participate in the program that they share the cost of rented office space in Tuttle, where DSL service is available.
Improved morale has been yet another major benefit. Krush and Darling both receive e-mails during the depth of winter from staff who appreciate being able to do their jobs without coming into the office. “During ‘Bosses Week’last October, the home coders even sent us flowers,” comments Darling.
IMPROVED CODER PRODUCTIVITY HELPS THE ORGANIZATION
“It takes discipline to work from home,” says Darling, noting that she and Krush monitor the coders’ productivity very closely. Some coders have chosen to continue coming into the office. “It’s not ideal for everyone,” Darling says. Remote coding has had some impact on staff FTEs, with one employee going from 40 to 66 hours per week. In the outpatient area, the HIM department has been able to absorb additional job functions without adding head count.
Both Darling and Krush cite the primary benefit of the remote coding program as a significant improvement in productivity. Darling notes, “Anytime you have a productivity improvement, it improves turnaround.” Krush also credits the 3M™ Coding Reference Software and 3M™ Coding Reference Plus Software with being key to the improved productivity in her department. These software packages give coders online access to the industry-standard references they are most likely to need during a coding session.
Clicking on a highlighted term allows coders to jump to the appropriate reference to help ensure that coding is accurate, complete, and compliant.
Remote coder productivity has been and continues to be measured. “We were looking for about a 10 to 13 percent increase in production with going home, combined with the 7 to 10 percent increase with concurrent coding from an electronic record, for a total of a 20 percent increase,” Krush says. Having achieved the 20 percent overall improvement goal-with 10 percent directly attributed to the remote coding effort-St. Alexius’HIM department and its coders have clearly found a better way to weather those North Dakota winters.