Remote CDI: A Remote Possibility?

EDITOR’S NOTE:

During a recent edition of Talk Ten Tuesdays, Dr. Erica Remer responded to a listener’s question about clinical documentation integrity specialist (CDIS) working remotely. Here is Dr. Remer’s response.

As I tell residents, historically, charting and chart review was done on the floor, because that’s where the chart was. Clinical documentation integrity specialists (CDISs) and providers, consultants, and attendings could comingle and communicate. The workflow certainly changed with the implementation of the electronic medical record.

So the question becomes, if the provider doesn’t have to physically be at bedside to document, does the CDIS have to be in-house? I liken it to the dilemma of “do you have to import every lab and radiology report into every progress note?” Spoiler alert, I think the answer to that one is a resounding “no,” too.

The technology certainly can sustain remote CDI. Chart review; querying and documentation; tracking of outstanding queries, responses, and productivity metrics; and data analysis can all be done electronically. You can reach a provider by pager, Spectralink phone, or cell phone. Heck, you could do a quote-unquote face-to-face with a provider by Facetime or Skype.

The pros of remote CDI are the following:

1. Some CDI professionals would like the flexibility and ability to work at home, and a happy employee is a more productive employee. I can relate; sometimes I even do Talk-Ten-Tuesdays in my workout clothes, without makeup on!
2. Eliminating a commute can increase productivity. It is easier to work an extra 20 minutes to finish up a task when you know you are already at your end destination, and you can actually work with a cold.
3. Literature supports an increase in productivity of around 30 percent.
4. There is also a reported decrease in overhead costs.
5. Finally, retention is at least as important as recruitment. If the facility down the road allows for remote CDI, your employee may jump ship.

Cons include the following:

1. There is potential degradation of the relationship with providers. It can be an uphill battle to have CDI be accepted when we are right in their faces, let alone out of sight, out of mind.
2. Administrative concerns about productivity could be allayed by accountability safeguards and metrics.
3. There are legitimate privacy and security concerns.
4. There can be difficulty setting personal and professional boundaries. You have to be clear where your work day ends and your private life begins.
5. There is the threat of loneliness and isolation. Don’t underestimate the value of the camaraderie, and the liberal exchange of ideas and knowledge is quite beneficial.

My opinion is that remote working is not for every employee, but that it is very doable for a system. There should always be some on-site presence interacting with providers and performing verbal concurrent queries, multidisciplinary rounding, and education. There should be at least monthly CDI meetings to keep everyone up to speed and engaged. Only experienced CDISs should be given off-site privileges.

However, I think the ideal is always going to be a combination of remote and onsite presence. How many hours a day, or days a week, how many CDISs at a time will vary by facility and culture, but personally, I think remote CDI is becoming normative.