Podcast recap: Adapting to remote work during the COVID-19 pandemic

April 2, 2020

CDI Strategies - Volume 14, Issue 14

By Wednesday, March 18, 2020, COVID-19 had begun to rage full force in the United States. Westchester County, New York, where Kerry Seerkircher, RN, BSN, CCDS, CDIP, serves as CDI director at Northern Westchester Hospital in Mount Kisco, New York, was considered an epicenter for the disease spread.

In Salt Lake City, Utah, a rare 5.7-rictor scale earthquake struck an obscure fault line. At the time, Michelle Knuckles, RHIT, manager of inpatient coding and CDI at the University of Utah Health in Salt Lake City, knew there were 41 confirmed COVID cases in the state but her organization had already begun to shift query focus in light of the expected burden on providers.

In New Orleans, Julie Foley, MSN, RN, CDIP, CCDS, director of documentation excellence at Ochsner Health System was self-quarantined.

Nevertheless, these CDI professionals joined with ACDIS Director Brian Murphy, ACDIS’ CDI Education Director Laurie Prescott, RN, MSN, CCDS, CCDS-O, CDIP, CRC, and sponsor Julie Salomon, BSN, RN, 360e chief product owner at 3M Consulting Services for a special edition of an ACDIS Podcast: Talking CDI.

As people across the globe self-distance, keeping at least six feet away from one another, and most non-essential personnel stay home or work remotely, CDI programs have needed to shift quickly to transition their staff.

Foley’s team moved to majority remote work approximately five years ago with a few staff members defined as leads remaining on site within each facility to conduct rounding with physicians, education, and engagement priorities. So, when the Ochsner administration asked all revenue cycle staff to work 100% remote, the transition was relatively smooth.

Seekircher’s program employed a hybrid model, with staff working one to two days from home. One day it was business as usual and the next her team was asked to be 100% offsite. Knuckles’ team, too, had been 100% remote for a couple of years.

Only 17% of CDI staff were still working onsite, according to roughly 250 respondents of an ACDIS poll, as of March 30. Nearly 80% say COVID-19 has “significantly” or “somewhat” affected their daily work activities, according to more than 700 respondents to a poll taken during the March 18 podcast.

Even those with pre-existing remote options for workers find themselves constrained with additional challenges such as children and spouses who’ve also been confined to the home as schools and daycare centers close.

“We have to be flexible,” said Foley, who added that policies stating that work-from-home opportunities aren’t a replacement for childcare and flex scheduling needed to be updated so that individuals needing to split childcare duties can work into the evening if needed.

Seekircher encouraged both CDI staff and managers alike to take a minute or two, or even a day or two to settle into a new routine. “The key here is to be flexible and not to be critical when we hear a dog barking in the background or a child interrupt because we all have to work together to get through this.”

She’s keeping her Westchester team together with daily checkpoint calls to touch base and stay on top of both work and personal concerns via Microsoft Teams instant messaging and communications platform.

People love instant messaging, agreed Foley, who pointed out the technological blessings of the wide variety of tools available to use at this difficult time.

Knuckles sends out daily communications to her staff and staying in touch via telephone, Skype, and instant messaging. They also use Yammer an internal, social media site allowing staff to stay connected on a more personal level.

“As leaders right now, it is so important to stay connected with our teams and to offer up support. It’s the little things,” Seekircher said, “like saying good morning or saying good night like you would do if you were working alongside someone in the office,” that can help maintain a sense of normalcy.

It can also be a challenge to simply not be in the room with your colleagues, Knuckles said. Body language and facial cues can go so far in helping managers identify those who maybe need additional assistance with a core concept or help the staff feel connected. Keeping a regular check-in on schedule particularly in trying times can help keep the team engaged, even if it is virtual.

As of the airing of the podcast, Foley and Seerkircher hadn’t changed their query process but Knuckles’ team was asked to temporarily pause sending any queries and to hold off on any query escalation, following up on any pending queries and on education, etc. Knuckles did have her team go ahead and review the records and create any queries but are holding them in a queue and only sending the most critical ones.

University of Utah Health also held any COVID related cases from billing for a period of time in order to assign the appropriate code which was set to be released on April 1 as well as to identify any state or federal funding sources devoted to the outbreak.

Executive and leadership staff at Ochsner were asked to help with screening for employees and CDI staff were asked to volunteer to help with order entry. “Essentially, we’re looking at being able to provide any backup support that we can to help those working on the front lines,” Foley said.

Seerkirchers’ CDI specialists were asked to help man their facility’s COVID-19 information line. “It’s been a nice way to partner with our healthcare teams and actually a nice way to be supportive of our whole community.” With the surge of the outbreak, patients were seeking help on telephone hotlines and not getting any answers or follow-up. “People were just so appreciative of hearing a kind phone on the other side of the line to alleviate fears.”

Whether speaking internally with administration, CDI staff, or nursing teams or whether is speaking with the larger CDI community or geographical communities the message needs to be consistent, she said. “We need to stay connected and we need to send that message over and over and over again; We’re in this together and we will get through this.”

Editor’s note: ACDIS has a number of pre-existing tools to help CDI professionals with remote efforts including the following:

A case study from the ACDIS Advisory Board’s Physician Engagement series profiling the innovative ways CDI programs at NYU Langone and Orlando Health, engaging their organization's physicians within a hybrid onsite/remote staffing models.
“10 essential tips for managing a remote CDI workforce,” CDI Leadership Insider (CLI), August 2019.
“Technology for a hybrid remote CDI network,” CDI Journal, vol. 13, issue 2, March/April 2019.
“Guest Column: Can remote CDI really work for you? Really? Really!,” CDI Journal, vol.12, issue 3, May 1, 2018.

“The pros and cons of remote CDI: Evaluate before you implement,” ACDIS White Paper, April 25, 2018.
“Establishing effective remote CDI takes planning,” CDI Journal, vol. 11, issue 3, May 1, 2017.
“Resolutions for making remote CDI efforts effective” CDI Journal, vol. 11, issue 1, January 1, 2017.
“Ask yourself: Could your CDI program work from home?” CDI Journal, vol. 9, issue 3, May 1, 2015.
“Telecommuting: CDI Policy” from Lee Ann Landon, BSN, CCMC, CCDS, CDI manager at Honor-Health in Scottsdale, Arizona.
“Telecommuting: Policy and Work Agreement” from Bonnie Epps-Long, MSN, RN, the director of CDI at Emory Healthcare in Atlanta, Georgia.

Additionally, as organizations across the globe embrace remote efforts a number of online platforms are being leveraged to assist and lots of advice on how to leverage best practices for a remote workforce including: