By Lisa A. Eramo, MA for For the Record
When COVID-19 hit, Joe Naretto, MHA, RHIA, senior director of HIM at Novant Health in Charlotte, North Carolina, was faced with the task of transitioning 80 full-time employees anchored onsite at various corporate locations across the state to remote work arrangements.
“Our direction from leadership was: ‘Stay-at-home orders or not, we’ve got to get as many people home as quickly as possible,’” Naretto says. “In a week, it went from ‘let’s think about it’ to ‘we’ve got to make this happen.’”
In a matter of days, deficiency analysts, scanning specialists, and release of information (ROI) specialists shifted to at-home work arrangements. Transitioning ROI staff home was the most challenging because Naretto didn’t want them to print patient information from home or receive ROI requests at their home address.
The solution? Staff worked out a rotating schedule to ensure someone would always be onsite to process paper requests in a timely manner. “A lot of our requesters are also working remotely, so output methods have transitioned to more digital methods of releasing information as well, which is good,” Naretto says. “Several scanners also work onsite to scan paper documents and process mail requests.”
Naretto says the rapid shift to remote work arrangements would have been impossible without the help of robust analytics. “All of the hard work we’ve done in terms of getting our analytics capabilities up and running was what allowed us to monitor performance as we’ve transitioned to remote work so quickly,” he says. “Up until the end of 2019, we did not have the level of reporting and analytics capabilities necessary to track departmental metrics, team member performance, and workload analysis in a robust enough manner.”
So far, HIM operations continue to run smoothly, though Naretto admits he’s pleasantly surprised. “If you had told me at the end of 2019 that everyone would be remote, I would have probably laughed and said, ‘I don’t think so.’ But it’s funny how quickly you innovate when you’re trying to keep people safe. Our success through this transition is a testament to how resilient our HIM leaders and team members are under pressure,” he says.
Health care isn’t any different from any other industry grappling with COVID-19, Naretto says. “We didn’t realize how capable we were of making this transition. I’m sure a lot of organizations—whether they’re in health care or not—find themselves in this same scenario,” he says.
Privacy and Security Concerns
Rebecca Harmon, MPM, RHIA, CCA, HIM director at a large medical center in Pennsylvania, had already been planning to move most of her 50-member HIM team prior to COVID-19. “I was already talking to my supervisors and saying that I’d really like to shift our practice to one where people could work from home at least two days a week,” she says.
Coders already worked remotely, but Harmon wanted to transition record reviewers, HIM specialists, scanners, and ROI staff home as well. Working from home would be a perk that could help with retention, especially for staff on the verge of retirement. “I wanted to retain their expertise and the knowledge they had,” Harmon says. “I can’t give someone more money, but I can provide other perks like working from home.”
Then the pandemic hit. Harmon’s staff each signed a remote/telework agreement and completed web-based training modules that covered basic information about privacy, security, and remote access. Some staff use employer-provided laptops while others use personal laptops with a smart card reader provided by the health system. Employees navigate to a URL that facilitates access to the hospital’s system. They enter log-in credentials, insert the smart card, enter a passcode, and then access the system.
Normally, the health system issues laptops to all remote employees. However, enabling staff to use their own laptops in a private and secure way expedited the transition because HIM staff didn’t need to put their name on a waiting list, Harmon says.
Now, most HIM staff work from home. Staff have a rotating schedule to ensure someone is onsite daily to scan paper EKG strips and respond to paper-based ROI requests.
“It’s working, and it’s working well,” Harmon says. “HIM operations are proceeding as they did before. I’ve been really proud of my team for being willing to do things differently.”
Capitalizing on Existing Infrastructure
At Sanford Health headquartered in Sioux Falls, South Dakota, working from home had been the norm for more than one-half of the health system’s 450-member HIM staff. Spread out over more than 20 states, the work-at-home staff includes coders, transcriptionists, cancer registrars, HIM analysts, data integrity analysts, speech recognition support team members, several document imaging staff, several ROI staff, and a bunch of other leaders. An additional 20% of staff went remote in the first few weeks of the pandemic.
Senior director of HIM and Coding Carol Person, MS, RHIA, and her leadership team worked with each staff member to determine who preferred to work from home and whether their job responsibilities were suitable for an at-home arrangement. Several document imaging specialists processing paper documents as well as ROI staff processing paper requests remained onsite. A handful of employees also remained onsite by choice.
“I think our long-term experience really worked to our advantage in terms of our ability to make a smooth transition,” Person says. “We already had work-from-home agreements, policies, and procedures in place.”
Managers and supervisors monitored workloads daily—particularly in light of decreased patient volumes due to fewer elective procedures. “We did adjust hours as needed in relation to workload volumes,” Person says. “They either took paid time off or they may have reduced their hours without pay.”
Person says the transition has gone well so far. “It takes work and creativity. You learn to adapt, but I believe you can be very successful,” she says.
Tips for Managing Remote Staff
Prior to COVID-19, HIM managers may have gained experience managing remote staff—particularly coders. However, few had experience with managing an entire team remotely. As a result, experts say the pandemic required a pivot in leadership style.
“You can’t transition to remote work and lead the same way you did when everyone was in the building,” Naretto says.
To manage remote staff effectively, consider the following tips:
Be patient. Working from home isn’t always an easy transition, particularly for parents who suddenly find themselves thrust into a work-from-home arrangement while also trying to home-school their children.
HIM professional Makema J. Massey, RHIT, CCS, knows this challenge all too well. Although she was laid off during the pandemic, she continues to apply for contract coding positions and is currently studying for a clinical documentation improvement credential—all while taking care of her four children ranging in age from 8 to 17.
“This is my workspace, and now they’re all in it,” Massey says.
Massey has organized her days in a way that promotes productivity. In particular, she provides each of her children with a daily productivity schedule that includes lunch, recess, and breaks as well as a copy of her own schedule so her kids can see when she is and isn’t available. Massey works normal business hours in her dedicated office space and, for the most part, takes only a half hour break to eat lunch with her children.
Even if parents don’t have an office, Massey says they can work at the kitchen table and hang up a sign that indicates if and when interruptions are allowed. “You need to keep your boundaries because, as all parents know, children will swallow you whole, and you’ll get nothing done,” she says.
Open the lines of communication. “We’re trying to maintain the same meeting cadence—just virtual,” Naretto says. “Now that we’ve got the team settled into working from home, we need to really start focusing on scaling up some additional activities and virtual team building.”
Even when there isn’t a scheduled meeting on the calendar, Person and her leaders frequently video chat with employees. “Treat your employees as if they’re onsite,” she says. “I encourage my leaders to drop in on employees just as though you would walk by their workstation and see how their day is going.”
Arm staff with resources. This is especially true during COVID-19 when there are so many changes related to coding and billing for testing, telehealth, and more, says Betty Schulte, MBA, RHIA, CCS, CCS-P, senior director of audit services at himagine solutions, who oversees approximately 100 internal and external auditors, all of whom work remotely.
Schulte says himagine provides a monthly webinar for customers as well as internal remote staff. “We make sure everyone is hearing the same message,” she says. This is in addition to quarterly town hall meetings, weekly meetings between directors and leadership, biweekly one-on-one meetings between directors and managers, and biweekly meetings between managers and production staff.
Naretto is on board with this approach. “Having up-to-date training materials, job aids, and reference guides is critical. This is true for onsite staff, and it’s even more important when the team is decentralized at home,” he says.
Spell out expectations clearly. This includes work hours, lunch breaks, and productivity standards, Schulte says. “You can assume that someone knows what you expect from them, but unless you speak it to them, they don’t. Communication is key,” she notes.
Try not to micromanage. “I think the older generation is used to that 40 hours, minute-to-minute workday,” says Jacqueline Thelian, CPC, CPC-I, CHCA, president of Medco Consultants, who oversees a remote team. “It’s not about the 40 hours. It’s not about the time. I’d rather have better productivity and more relaxed staff than the extra 20 minutes that might have been missing,” she says.
Harmon agrees. “I believe that my team is talented and capable—and that they’re good people who show up every day to do a good job,” she says. “People will rise to the expectations that you have for them. Have faith that you’ve got a good team. Believe in their inherent goodness and inherent commitment.”
Now that HIM departments have been largely remote for several months, will they remain that way indefinitely?
“I’m not hearing an end date to all of this because there’s so much uncertainty about the virus,” Harmon says. “I’m really planning on this being the new normal for HIM mostly because it works. We are able to do what we need to do and my team is so willing, flexible, and giving of their intellect and hard work. They’re doing such a remarkable job that I don’t see a need to change it.”
Naretto echoes that sentiment. “If we can continue to operate successfully in this model, then I think it’s going to forever change how we work,” he says. “We’ll be a more predominantly remote workforce. There’s no reason to unwind all of the things we’ve put in place as long as they continue to work.”
However, maintaining momentum will be a priority, Naretto says. “As the pandemic fades, we will need to phase in and refocus on a more balanced approach with departmental metric performance indicators, individual team member performance, workplace flexibility, and overall team engagement,” he says. “We’ll also need the ability to maintain a functional, high-performing, and engaged team in a remote environment. This will be of particular importance as workload scales back up toward prepandemic levels.”
Person will continue to monitor productivity and quality over time before making any decisions. “If an employee is struggling with their productivity a bit, we may ask them to come onsite for a while to help them and coach them,” she says. “I think there will be some employees who will return to the worksite because they would prefer to work onsite. We will support them with that. But I think there will also be some who prefer to remain working at home. Our approach is that we will address each employee individually.”
Thelian plans for a hybrid approach in which consultants continue to work remotely but come onsite only for certain projects or when they need the help of an administrative assistant. “I think most businesses will come back, but not the same way,” she says. “They’re going to reimagine how they use their workforce. Our remote arrangement seems to be working well. Employees seem to like it because they can manage their time and spend more time around their family. I also find that the productivity is better.”
Thus far, COVID-19 has taught many HIM managers that their teams are capable of maintaining smooth operations in the face of significant challenges. “What else do we think is impossible that we’re probably able to do? Sometimes you just need to take the plunge and figure it out on the fly,” Naretto says.