By Laurie M. Johnson, MS, RHIA, FAHIMA, and Lynn A. Wall, MBA, RHIT, CCS, CDIP
If you are reading this article, chances are that connectivity and infrastructure is something you have taken for granted throughout your career. Every day, you went to an office, used technology to perform your duties, and communicated with colleagues with relative ease.
At the beginning of 2020, this comfortable routine was entirely upended by COVID-19. The social distancing protocols necessary to suppress spread of the virus made simple tasks difficult and difficult tasks seem insurmountable.
The one harrowing certainty we shared was that the runway for successful remote transitions was extremely short.
The United States Marine Corps has a perfect motto for what the world was facing: “Improvise, adapt, and overcome.”
To survive—and thrive—in this new normal, organizations around the world needed to utilize a deep well of creativity and oftentimes limited resources to lead their teams through the pandemic and the economic turbulence that follows in its wake.
Perspective—CDI Department
Adjustment and adaptation were the primary challenges faced by the clinical documentation department at St. Luke’s University Health Network in Bethlehem, PA.
Our team needed to scale not only remote operations, but navigate a leadership transition, a software implementation, and the addition of a new facility. This article described how we faced those challenges and explores the lessons learned.
The excitement of working remote led, in part, to the success of the transition from on-site to remote operations.
“Our clinical documentation integrity (CDI) program is a very mature program, and as a result it made the transition from on-site to remote easier than anticipated,” says Karen Larkin, network manager of CDI and DRG denials at St. Luke’s. “Additionally, we saw an increase in productivity due to no travel.”
However, Larkin notes, the hardest part about going remote was adapting quickly to technology, and there were several areas that needed to be addressed.
The first was the clinical documentation specialists’ (CDS) technology skillset. Not all CDS possessed the same technology skillset. To be successful, it was necessary to ensure all team members could function remotely with minimal interruptions.
“We opted to take an individual approach, meeting with each CDS one on one to assess and train based on their personal skillset and overall technology knowledge,” Larkin says. “Use of tip sheets, screen shots, and screen sharing capabilities within Microsoft Teams afforded us the ability to train our team members. We even successfully trained two new CDS remotely using Teams.”
Technology equipment was the second area of focus. While some staff took their work laptops and docking stations home, others used their personal laptops and secured additional monitors for their home office to mirror their work setting.
It was important to ensure that each CDS could work from home as seamlessly as they would in the office, which meant optimal connectivity and minimal downtime.
The third area of focus was collaboration, not just among the CDS but also with the inpatient coding team and the medical staff. In the office, it was easy to discuss cases—to pick someone’s brain or play devil’s advocate regarding documentation, supporting clinical evidence, and coding guidelines.
Remote work took away the benefits of in-person collaboration, so the team improvised with Microsoft Teams to collaborate on cases, Larkin says. The CDS teams also used TigerConnect, a healthcare communications tool to facilitate physician communications.
“It was a game changer for us,” she says. “The CDS team member texts the physician with their request and the physician has the ability to immediately address, or if unavailable to address later. The tool includes a ‘do not disturb’ functionality, which puts the app on silent and holds the text messages for the physician until they are available. Once available, text messages automatically populate, and the physician is able to see what is needed and respond.”
Perspective—HIM Consulting
Another operational area that was required to improvise, adapt, and overcome was on health information management (HIM) consulting.
Depending on the client, consultants typically work both on site and remote. HIM consultants had to adapt to not being on site during the pandemic. Most hospitals were shut down to visitors, so consultants could not be there. If the consulting organization was doing an assessment, a new method of obtaining key performance indicators (KPIs) and other data was used.
In addition to facing the usual challenges of fully remote operations, such as wonky conference software and connectivity issues, HIM consultants needed to rethink how to safeguard privacy in atypical work environments.
Consultants worked remotely so the maintenance of privacy was a high priority. According to the American Hospital Association, ransomware attacks on hospitals increased during the pandemic. The need to use email encryption or secure drop boxes to send information became imperative. The number of people accessing the hospital data was reduced as well.
Lessons Learned
“Our team’s ability to be flexible and open to the change allowed us to be successful,” Larkin says.
Looking back, Larkin says she would have sent the teams home with their office equipment immediately, rather than a dual set-up. “It would have made the transition a little bit easier,” she says.
Larkin cites the following as important and fundamental takeaways for continued success during the public health emergency:

Assess your team’s technology skillset and invest in the necessary training to be successful
Always create—and have available—training tools for every application your team needs, and review periodically to ensure consistency with application usage
Set up remote access upon hire and test routinely to ensure ease of transition, if and when it’s needed
Always think outside the box
Prepare for the unexpected

The Future of CDI
The landscape of CDI has changed for the indefinite future, but these teams can learn to be innovative and adaptable. While something indelible is lost when moving to remote operations, such as personal connectivity, proven processes can be put into place to ensure that each team member is working to the best of their ability for the benefit of the organization as a whole.
Karen Larkin is the network manager for CDI and DRG denials at St. Luke’s University Health Network, with a staff of 18 CDI professionals and 3.5 DRG denials specialists. St. Luke’s University Health Network is comprised of 11 facilities in Pennsylvania and New Jersey, with its main facility located in Bethlehem, PA.
Laurie M. Johnson ( is senior consultant of Revenue Cycle Solutions, LLC and an AHIMA-approved ICD-10-CM/PCS trainer.
Lynn A. Wall( is inpatient coding and CDMP manager at Duke Lifepoint Healthcare—Conemaugh Health System and an AHIMA-approved ICD-10-CM/PCS Trainer.

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