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For three years, Inova Fairfax Hospital in Falls Church, VA, struggled with a 25% vacancy rate in coding positions. Then the facility began using application service provider (ASP) technology that allowed coders to work from home and receive their records over the Internet. An advertisement boasted of these conveniences and a miracle occurred: Inova Fairfax was fully staffed within three weeks.
"You get inundated with coders by adding that one little line — work from home,’" says Jennifer Shearer, RHIA, director of Inova Fairfax’s medical record department.
Inova Fairfax is using eWebCoding, an ASP based in Atlanta and a division of Intertech Information Management. "They provide the scanning hardware and the software and the storage of the chart. All the hospital and the coder need is an Internet connection," Shearer says.
Preliminary results show that with the new system, Inova Fairfax has gained one hour of productivity per coder, per day for outpatient charts. One of the inpatient coders who had met productivity requirements of 20 charts coded and abstracted per day has now exceeded 27 charts per day for six months. The quality of the coding has not decreased. Shearer attributes the increase to the coders having better concentration and fewer disruptions while working at home.
The installation process of the ASP model was minimal and took only a few weeks, Shearer explains. The main computer system is located and maintained at a remote site, and only workstation hardware was installed at the hospital and coders’ homes. The users downloaded software from the Internet.
Inova Fairfax, which pays a per-chart fee, began its program by scanning and coding emergency room records first. The hospital has a scanner who is responsible for submitting records to each coder in a queue. The coders are then able to download the information from the Internet. Once they complete the record, they submit it back to the server.
For security reasons, the records undergo three levels of encryption. They are encrypted as soon as they are scanned and go across the Internet to the server. They are encrypted again when they go from the server to the coder’s house, and once more when the coder opens the files.
Once the technology was implemented, all but one of Inova Fairfax’s 18 coders wanted to work out of their homes, Shearer says. Inova Fairfax is located in a congested area, and the commute for clinical coder Cheryl Shackleford, CCS, can take 30 minutes to 2½ hours.
The hospital decided to only allow coders to work from home who were experienced and had been employed a minimum of six months. The coders remained hospital employees and were initially required to come into the office every other day to ensure that there were no glitches in the remote abstracting and bill dropping process. New coders remain on-site for three months until they establish their productivity and quality baselines.
The coders like the control they now have over their hours, Shearer says. "They regain so much time in the lives by not having to commute."
Each coder still comes into the office, usually two days a week, to code large bills or multi- volume admissions. The hospital decided not to scan large volume (more than three-volume) records because of the fatigue factor. The coders don’t complain, though, because a rotating schedule allows them flexibility in these days, too.
"We rotate so everyone has the opportunity to be home certain days," Shackleford says. She began working from home last July. The rotation also means that one coder is not responsible for coding the complicated bills all the time. The work arrangement takes off the edge of having to work overtime, too, especially during the holidays. "We don’t mind doing extra to help the backlog since we are working from home," she says.
Morale among the coders is great, Shackleford adds. "It is absolutely wonderful to be able to work from home."
eWebCoding offers services for individual coders too. Coders, for example, can fill out a mini-resume, and that information is shared with the company’s customers, says Beth Friedman, RHIT, director of marketing. "We have a coding pool."
The company is also introducing a free site with about 30 sample records for coders to use. "This site is for students in university programs or coding programs who are learning to code," she explains. "They can practice coding on an electronic image versus a paper chart."
(Editor’s note: A white-paper discussion of Inova Fairfax’s switch to an ASP model for coding is available on the Web at www.ewebcoding.com.)