CDI From Home?
How to Implement and Maintain a
Successful, Productive
Telecommuting Arrangement
Michelle Callahan, RN, BSN, CCDS, CRCR
Regional Manager, Clinical Documentation Integrity
Kaiser Permanente NCAL Revenue Cycle, Oakland, CA
Jillian Fore, RN, MPH, ACM
Clinical Documentation Integrity Senior Consultant; Former Interim Director,
Clinical Documentation Integrity
Kaiser Permanente NCAL Revenue Cycle, Oakland, CA
CDI From Home?
How to Implement and Maintain a Successful,
Productive Telecommuting Arrangement
Electronic Health Records
CDI work-at-home options
Economic Pressures
The presentation will detail:
• Policies
• Procedures
• Productivity expectations
• How to manage relationships among the team and
with providers
• Successful management of telecommuting staff
About Kaiser Permanente
Northern California
• Founded in Oakland, CA, in 1945, Kaiser Permanente serves a diverse
population in Northern California
• Nationally, we currently serve 8.9 million members in nine states and the
District of Columbia
– Northern CA serves more than 3.3 million members in 21 hospitals and 233
medical office buildings
– We have 7,129 physicians and 74,985 employees, of whom roughly 65% are
represented by a labor union
• We have the largest civilian electronic health record in the world
• Kaiser Permanente’s approach to the CDI program supports two important
organizational goals:
– Our support for work-at-home programs is in keeping with our long history of
energy conservation and environmental stewardship
– KP is dedicated to being the best place to work, offering employees multiple
options for fulfilling their responsibilities
CDI: Growing a New Program
In the Beginning
• Regional program
with regional
• Individual medical
• Place regional CDI
staff in multiple
local facilities
• Space challenges
• Staffing issues
• Interacting with
local staff and
• Day-to-day
Ask ourselves:
What was the
TRUE benefit of
having CDI staff
located on-site?
Back to the Drawing Board
Who will do
the job?
Where will the
telecommuting as an option
work be done?
Why should the
work be done this
How will you
support this model?
• Leadership approval
• Technological requirements
• Staff satisfaction
• Go green!
Telecommuting as a Win-Win
• Creating a recipe for success
– Intensive new hire training program
– Clear requirements around quality and
– Practical tools and a safe work environment
– Detailed policies and procedures
– Regular connections and follow-up
• When possible, hire self-driven people with success
working independently
Position “work from home” as an earned benefit, not a
guaranteed benefit.
You Can Establish a Virtual CDI
Function in Any Organization
Getting Started
Lay the
Establish the
for High
Set Ongoing
Expectations and
• Telecommuting
policies and
• Performance
expectations and
• Ensure high performance
before offering
telecommuting as an option
• Equipment
• Signed telecommuting
• Support staff who require
additional assistance
• Performance
improvement processes
• Monitor performance trends
• Home office
• Support staff performance
with honest and timely
Lay the Foundation
• Telecommuting policies/procedures
– Check with your human resources department to determine
whether there are existing telecommuting policies/procedures
– Revise current HIM/coding telecommuting
• Equipment
– Determine which supplies/equipment your organization is willing
to supply
– Identify a specific plan for IT issues
– Document accountability for damages to equipment supplied by
• Home office assessments
– Ergonomic evaluation
– Environmental safety assessment
– Adequate space/accommodations
Establish Framework for High
• Clear department policies and desk-level
– Recommended accompanying procedures
• Absence notification
• Communication expectations
• Productivity and quality expectations
• Performance management/improvement process
• Telecommuting agreement
• Telecommuting procedure (including all requirements
w/check-off list)
• Competency validation
• Provider query procedure/query compliance procedure
• Chart review completion
Set Ongoing Performance
Expectations and Guidelines
• Productivity and quality
– Ensure high level of individual staff
performance prior to allowing telecommuting
• Identifying performance opportunities
– Management monitoring of performance
– Ongoing discussion regarding comfort level
and employee self-assessment of needs and
areas of opportunity
• Supporting staff performance
– Give honest and timely feedback
Staying on Course
Building and Maintaining the Team
Control the Things You Can
Foster What You Can’t Control
• Training
– Initial CDI training
– Continuing education
• Work flow and workload
• Relationships
– With providers and facility
– Begin with specific work
– Allow personalization as
staff become more
– Identify opportunities to
assign work based on
areas of program focus
– Build opportunities for
– Develop incentives for
• More relationships!
– With other team members
– Institute daily connections
and opportunities for team
Staying on Course
Managing Across Distances
Management Adjustments
• Adjust management-to-staff ratio
• Clear, realistic performance
• Make the extra effort to connect
with individual staff members
Performance and Data Sharing
• Work hours
• Identified performance metrics
• Performance data
Staff Adjustments
Retention Strategies
• Career paths
• Recognition programs
• Incremental work-at-home
• Peer-to-peer kudos cards
• Manager-designated awards
• Goals include clear action plan for
• Take responsibility for education, as
• Remain connected to the home site
• Identify process improvement
Management Adjustments
• Staffing and responsibilities of management
– Will take more time and energy than
traditional staffing; adjust management-to-staff
ratio accordingly
– Establish and document clear, realistic
performance expectations
– Make an extra effort to connect with each staff
member regularly
Performance and Data Sharing
• Performance monitoring and communication
– Monthly review of work hours (through
electronic systems)
– Weekly or monthly review of designated
performance metrics
– Facility- or service-level performance data
(response rate drilled down to provider level)
– Consider blind performance data sharing
Retention Strategies
• Consider promotional level within
organizational/departmental structure
• Increased accountability and additional
responsibilities/special projects
• Employee recognition program
• Incremental work-at-home increases
Staff Adjustments
• Increased staff accountability
– Clear action plan for performance under goals
• Education
• Returning to home site
– Staff responsibility to identify process
improvement ideas
Potential Pain Points
The Right People
• Self-driven with high
levels of personal
• Professional
• The right experience
• The right temperament
• Skilled communicators
The Right Sponsorship
• From regional leaders
• From local leaders
The Right Systems & Support
• Downtime procedures
• IT escalation plan
The Right Performance
Management System
• Performance feedback
• Ongoing communication
• Data sharing
• Remote education and
• Implement staff ideas for
The Right Places
• Proximity to home facility
The Right People
High level of personal accountability
Chart review experience
Experience and success with high-volume/high-stress
work environments
Ideally not straight from inpatient floor nursing
Expertise at public speaking, education, presentations
Previous experience within the facility
Previous experience with electronic heath record and
high level of comfort with basic computer programs
– Consider new employee testing in this area
The Right Sponsorship
• Gaining approval and acceptance
– Leadership
• Thorough and thoughtful plans prior to presentation
• Utilize current organizational goals and initiatives to
support this work model
• Consider a trial
• Regular performance feedback
Michelle Callahan, RN, BSN, CCDS, CRCR
Regional Manager, Clinical Documentation Integrity
Revenue Cycle
Kaiser Permanente, Northern California Region
[email protected]
Jillian Fore, RN, MPH, ACM
Senior Consultant, Clinical Documentation Integrity
Former Interim Director, Clinical Documentation Integrity
Revenue Cycle
Kaiser Permanente, Northern California Region
[email protected]
In order to receive your continuing education certificate for
this program, you must complete the online evaluation which
can be found in the continuing education section at the front
of the workbook.

Performance and Data Sharing