Vol. 15 •Issue 24 • Page 18
A New Day Dawning for Remote Coding
Here’s a look back at the past 5 years of remote coding and a fast forward to the new frontier.
It seems like only yesterday I was writing my first article to tell you about a whole new concept for coding–clinical coders working from home. It was the spring of 2000 and only a few, innovative hospitals were sending their coders home to work as a way to fill vacancies and alleviate shortages. During the American Health Information Management Association’s (AHIMA) component state association meetings that spring, I remember the speculation:
“I’ll never send my coders home, I’d lose control!”
“How will I know what they’re doing?”
“I’m afraid they’ll eat bon-bons all day!”
“The technology is not secure!”
Thanks to secure technology, a few innovative HIM directors and thousands of coders who demanded to work from home, remote coding is now mainstream. Most outsourcing agencies offer a remote option and many systems can be used to send your coders home. Remote coding is a commonly accepted method to recruit qualified coders, increase productivity and decrease backlogs–not to mention improve the lives of coders everywhere.
Statistically speaking, the national mean vacancy rate for coders and billers fell from 18 percent before the introduction of remote coding to 8.5 percent just a few years later.1 While many other factors may have played into this decrease, it is apparent that the ability for coders to work from home has helped organizations fill empty positions and reduce their vacancy rates.
Secondly, home coders enjoy a freedom and flexibility of lifestyle never before imagined. Just a quick visit to AHIMA’s Community of Practice for Home Coding2 reflects the enthusiasm and happiness coders experience when working from home.
So what’s next? This article takes a look at the progress we’ve made in the past 5 years with remote coding. Also, it introduces you É once again É to new concepts for coding and how they will take coder productivity and the coding profession into the next frontier.
Five Years and 5,000 Coders
In 2000, Jennifer Shearer, RHIA, then director of HIM at Inova Fairfax Hospital, received AHIMA’s “Best Practices Award” for her implementation of a remote coding system.3 Since that time, Inova Fairfax has sent more than 30 coders home and after 5 years, still enjoys a full compliment of coders and a coder waiting list. During the same 5 years, several Inova coders have moved out-of-state; yet continue to work for the health system via remote coding technology. And Inova Fairfax is not alone.
In 2001, remote coding was named the “top trend” in HIM and in 2002, a survey by HCPro’s Just Coding.com Web site mentioned that 90 percent of HIM director respondents wanted to send coders home to code.4
During 2005, AHIMA is conducting a “Technology in Coding” survey. By the end of this year, the survey will be taken by hundreds of coders and coding managers. One of the survey’s goals is to quantify the number of coders who currently work from home.
In lieu of the official survey results, this author modestly predicts that at least 20 percent of the nation’s hospitals have sent their coders home to work. If each of these hospitals sends five coders home, that’s more than 5,000 coders now working from home, and the number continues to rise. Finally, the number of remote coders isn’t the only statistic on a growth curve. HIM vendors who offer remote coding solutions have increased as well.
What to Look for Today
With only a few options in 2000, many vendors now provide remote coding solutions. As remote coding has matured, new and different features are being added to help coders achieve maximum productivity while maintaining consistent, high coding quality. Some of the new features include advanced coding workflows, computer-assisted coding (CAC), E&M calculators, remote coding management and integration with other systems like document imaging, transcription and encoders. Today most of the systems are Web-based and offer the ability to receive information electronically or via scanning (See Table 1).
Beyond technology features, most vendors today offer both technology and coding services. This combination has given many hospitals the ability to test the software using agency coders before they actually send their own coders home. It also gives hospitals easy, online access to backup coders during vacations, extended leaves and census spikes.
Denise Hunt, MS, RHIA, manager of medical information management at Sierra Nevada Memorial Hospital in Grass Valley, CA, relied upon the expertise of MedQuist’s remote coders to test-drive CodeRunner™, the company’s computer-assisted, remote coding system. “By using MedQuist’s coders first, we were able to implement quickly, thoroughly test the system and verify our processes,” explained Hunt in a recent case study. With a proven solution, Hunt plans to work next with her information technology department to get admission/discharge/transfer, billing and transcription interfaces established and send her coders home using CodeRunner.
But for Sierra Nevada and other hospitals who have sent their coders home, finding ways to increase productivity while maintaining the highest in coding quality doesn’t stop at the coder’s front door.
The U.S. Department of Labor and Statistics predicts a 49 percent increase in the need for HIM workers, including clinical coders.5 AHIMA predicts that 6,000 new HIM workers will be needed every year.6 Over the next 5 years, we will continue to see increases in the demand for coding services and the need for qualified coders. As an industry, we need new wagon trains to help us cross the next frontier. The answer, again, lies in the use of technology. This time, it’s CAC.
In their 2004 Practice Brief, AHIMA defines CAC as the “use of computer software that automatically generates a set of medical codes for review, validation and use based upon clinical documentation provided by health care practitioners.”7
Currently, there are two technology options for CAC. The first is natural language processing (NLP) and the second is structured input. Both options are considered CAC models. The computer-assisted model relies on human intervention to review, validate and approve (or edit) codes generated by the computer system.
In contrast, automated coding systems send computer-generated codes directly to billing with little or any human intervention at all. While a completely automated coding process may be part of our future, the technology used today relies on the expertise of a qualified clinical coder.
Just like with remote coding technology, early systems have met with mixed reviews and skepticism. CAC technology has taken longer than remote coding to be proven and yield consistent, remarkable results. But the tide is turning on CAC and home coders are reaping the rewards.
The Best of Both Worlds
The combination of CAC with remote coding gives coders the best of both worlds. Not only do they transition from data researchers to data analysts, but they also gain the freedom and flexibility of a home office.
Currently available for emergency department (ED) and other outpatient record types, computer-assisted remote coding is making its mark. At South Shore Hospital in South Weymouth, MA, all ED records are now coded using CAC technology and eight of South Shore’s coders work from home. According to a recent case study, ED coding staff are now 60 percent more productive and have taken on the additional workload of professional (physician) fee coding for each ED visit.8
In 2004, two coding productivity studies were performed using remote, CAC technology. CodeRunner was used by MedQuist’s own coding staff to assess the impact that CAC would have on coder productivity for ED records.
The study found that coders increased their productivity ratios (both charts per hour and codes per hour) when CAC was used. Records per hour increased 96 percent with the use of CAC and the average code per hour ratio increased by 85 percent. From a quality perspective, all records had to comply with both MedQuist’s internal 95 percent accuracy rate and the specific hospital’s guidelines for coding and billing (See Table 2).
Several coders who already use computer-assisted, remote coding technology were interviewed for this article. Here are their comments:
• “It makes my job more interesting.”
• “I didn’t realize how far along these systems are.”
• “I was trained over the Internet and within a week, was up to speed.”
• “The system continues to improve and gets more accurate over time.”
• “It will never be 100 percent accurate, but with 80 percent to 85 percent of the codes correct, it’s a huge help.”
• “I can start from a list of suggested codes instead of working from scratch.”
• “It’s just another tool for coders, another avenue for our professional growth.”
Everything Remote for HIM
In conclusion, coding isn’t the only HIM function to go remote. Before coding, it was transcription. Home-based transcription was introduced in the 1990s and now represents the majority of the industry. Today other HIM functions are able to be performed from home, moving many departments closer and closer to a truly virtual environment.
Below is a short list of HIM functions that can be performed from remote locations, including home-based offices. In these scenarios, a few key staff members work within the hospital walls, and the remainder from a remote, centralized HIM department or home offices.
• Coding Management
• Chart Deficiency Analysis and Completion
• Release of Information
• Audits and Chart Reviews
• Tumor Registry
Over the course of my HIM career, I’ve seen many things change—like floppy discs, patient index cards and code books. But many things have stayed the same—stacks of charts waiting for review, incomplete chart rooms and photocopy machines. We’ve crossed many new frontiers, but have many more to go.
As the old saying goes, life’s a journey—not a destination. Having served as a coder when DRGs were introduced in the 1980s and during the early 2000s as an integral part of remote coding, I’m excited about the opportunities CAC holds for coders everywhere. I’m already looking forward to introducing you to coding’s next, great innovation–5 years from now in 2010.
1. American Hospital Association Special Work-force Survey. Available at: www.aha.org.
2. AHIMA Community of Practice: Home Coding. Available to members at www.ahimanet.org/COP/HomeCoding.
3. Shearer, J. “Remote Coding at Home: Tips for Success.” Journal of AHIMA 72, no.2 (2001): 62-65.
4. HCPro. “e-Coding News.” JustCoding.com, Volume 89 (2002).
5. Bureau of Labor Statistics, U.S. Department of Labor, Occupational Outlook Handbook, 2004-05 Edition, Medical Records and Health Informa-tion Technicians, on the Internet at www.bls.gov/oco/ocos103.htm.
6. AHIMA. Workforce Study Project. 2002, on the Internet at www.ahima.org/fore/practice/workforce.cfm.
7. AHIMA e-HIM™ Work Group on Computer-Assisted Coding. “Delving into Computer-assisted Coding” (AHIMA Practice Brief). Journal of AHIMA 75, no.10 (Nov-Dec 2004): 48A-H (with Web extras).
8. MedQuist. “MedQuist’s CodeRunner solves workflow issues, increases productivity by 60%.” Available online at www.medquist.com/pdf/coding/CodeRunner%20South%20Shore%20Case%20Study.pdf.
9. MedQuist. “The Impact of Computer-Assisted Coding.” Available online at www.medquist.com/pdf/coding/Coding%20Productivity%20Whitepaper.pdf.
Beth Friedman is president of The Friedman Marketing Group, Gainesville, GA. She began her HIM career as a coder, coding supervisor and quality assurance director for a three-hospital system in Pennsylvania. In the early 1990s, she began working for health care technology vendors with a focus in document management, electronic records and most recently, remote coding.