hands on help: technology applications
Home-Based or Bust: Developing A Telecommuting Program
Patty Thierry, MBA, RHIA, CCS
Your coding position has been vacant for six months with no relief in site. Your transcription manager wants to telecommute two days a week and one of your coders just resigned to work out of her home for a local coding staffing company. You reach for the aspirin and begin to do research on your organization’s telecommuting policy. You learn that there isn’t one. You contact the human resources (HR) director who agrees to work with you on the development of telecommuting policies. Determined to retain your transcription manager and create an attractive, flexible work structure for coders, you set your sights on developing a telecommuting program for the health information management (HIM) department.
Whether you are gearing up for telecommuting for your own staff or for working with an HIM staffing/outsourcing vendor, you need to know about the technology resources that are available.
Three Prerequisites for Developing
A Telecommuting Program
1. Building a business case.
The critical first step in developing a telecommuting program is to understand your business needs and HR issues. Start by identifying your business drivers such as shortage of coders, turnover, competition, lack of space, etc. Identify the benefits of having staff work out of their home (see telecommuting benefits sidebar) and/or in utilizing the remote services of coding, transcription and information systems (IS) vendors. A telecommuting policy will need to be developed outlining the performance expectations and other HR issues between the organization and remote employee. (See Learning/Action plan section below for available resources on telecommuting policy content and development)
2. Assessing your telecommuting requirements.
Next, ask yourself the following questions regarding processes and remote access:
* What are the most common tasks to be performed?
* Will remote users need access to e-mail, Internet and file transfers?
* Will remote users need 24x7x365 access? Or just certain times a day?
* Will remote users need access to network applications? If so which ones? (e.g., encoder, abstracting system, imaging system, dictation system, etc.)
* Will administrative and clinical documentation required for coding and abstracting be accessible? If not, how can this information be securely transferred? (i.e., scanning technology, high-speed fax machines, encrypted data transfers?)
3. Understanding your organization’s existing network infrastructure for handling remote traffic.
Once you have built a business case and have defined your telecommuting requirements, you will need to understand how your organization’s existing network infrastructure handles remote traffic and the technical components that enable telecommuting. Most likely, your organization has a remote access infrastructure, but it may or may not support telecommuting. Your goal is to learn the capabilities of your organization’s existing remote access infrastructure and to assess how the current structure (and future remote access strategies) meet your business needs.
Telecommuting Technology Building Blocks
There are several technology building blocks essential to telecommuting such as network services, telecommuter’s equipment and network security. Knowing to what extent these building blocks are in place will determine your organization’s readiness to implement telecommuting. IS departments are building more complex remote access services to support telemedicine, teleradiology and physicians who need remote access to patient data. If your organization’s current remote access infrastructure is minimal, be patient. Work within IS resources to accomplish your business needs. It’s only a matter of time before remote access grows exponentially to meet the needs of the changing workplace.
Network services include three critical pieces of technology to be employed. They are: a communications wiring scheme, a compatible method of connecting each end of this wiring to achieve a link, and software that can efficiently operate across this path. First is a telecommunications conduit for communications (phone lines). This is what the home office or remote location access lines use to connect through the telephone Central Office (CO) and/or Internet to your organization. The types of remote access lines include analog (just like your telephone line), ISDN (Integrated Services Digital Network) and DSL (Digital Subscriber Service). Your IS department will let you know which remote office line(s) they support.
In cases where any significant distance is involved, remote access is more economical using the Internet as a bridge from the remote user’s local telephone CO to the CO closest to your organization. Direct dial-up connection from home modem to office modem or modem pool (most common) is also an option, but long-distance charges are generally more costly. Establishing a toll-free “800” number can decrease these costs and centralize billing at the same time.
Understanding the existing network services environment will help you determine the speed with which remote access will occur and what kind of bandwidth is in place. The IS department may have installed ISDN, fractional T1, or T1 lines to handle incoming remote traffic. Each of these lines vary in size (size = speed) and cost. Slow bandwidth will inhibit efficiency of software applications and slow access to data.
The bottom line is to make sure that the remote users response time is not substantially slower than what staff currently experiences while working in the HIM department. In the HIM department, you expect system response times to enable productive work. The same goes for bandwidth. Smaller bandwidth can result in poor response times and decreased productivity. In addition, it will be important to know the volume of remote users accessing the network at the same time and its effect on speed/response time.
The methods of linking a remote PC to your central office can vary greatly. Your IS department may have already implemented remote node or remote control technology. Remote node technology allows a remote PC to directly connect to the LAN as if they were physically present. Remote control technology allows a user to connect to a PC (usually a designated desktop or server) and control the PC from a remote location. Popular examples of remote control solutions include Symantec’s PCAnywhere and WinFrame from Citrix Systems. An example of remote node technology is Microsoft’s remote access service (RAS). Each method has its strengths and weaknesses and will be deployed based on your organization’s current resources.
Finally, the applications to be operated across the remote link are a critical part of the success of this solution. Be certain that you discuss the best method to install software and deploy the associated databases (e.g., abstracting system). For example, some applications require a remote version (known as “remote client”) rather than the application version used in the office (workgroup client). The important issue here is to understand the software requirements needed to access applications remotely.
Telecommuter’s equipment is another important building block. The optimal telecommuting design will allow home-based staff to perform their function the same way they do in the office. This means setting up an office that duplicates most of the functionality of their current work environment.
Most telecommuters will need a computer; monitor (consider larger sized monitors for coders, especially if accessing imaging systems remotely); modem or high bandwidth (broadband) router; printer; fax capabilities (stand-alone fax machine or fax software); telephone; and voice mail.
Work with your IS department to define your software and hardware requirements and the best way to connect all of this equipment to minimize multiple phone lines.
Finally, network security is one of the most important components of the telecommuting plan.
The key technologies of a telecommuting security program are: identification and authorization; access control; encryption (if transmitting data); auditing; alarms and event reporting; and physical safeguards.
You will need to understand what kind of identification and authorization will be required to access your facility’s information systems, as well as the kinds of access controls and auditing mechanisms in use.
Armed with your business case and an awareness of technology capabilities, you are ready to develop your program and associated policies. Below are suggested resources and activities.
1. Read AHIMA’s detailed practice brief issued in February 1999 titled “Telecommuting.” This will be an excellent resource for your planning process. It includes checklists and sample policies. It’s a great step-by-step guide and can be found on AHIMA’s Web site at www.ahima.org.
2. Visit the Telecommuting Knowledge Center at www .telecommuting.org for telecommuting articles, case studies and other resources. You will have to register, but it’s free.
3. Ask your IS department to draw you a picture of how remote access equipment is connected so you can understand your organization’s current remote access topology. Ask for a demonstration so you can see for yourself how to remotely access your network and the speed with which applications are accessed.
4. Develop your telecommuting plan and pilot it with the assistance of the HR and IS departments. Pick a function like coding or transcription and work with coders and transcriptionists and/or your HIM coding/transcription vendor to implement your plan. *
Patty Thierry is director of information management at Care Communications Inc., Chicago. She can be contacted via e-mail at firstname.lastname@example.org.
* Improved quality of life–reduction in commuting stress and more time with family
* Decreased absenteeism–minor colds typically won’t keep the telecommuter from working
* Reduced office space requirements
* Increased productivity–The GartnerGroup has reported that productivity of home-based employees increased by two hours more per day
* Aids in recruitment and employee retention
* Flexible work schedules
* Eliminates travel costs associated with using HIM temporary or outsourced services.