Posted July 28, 2008

Coders began working from home less than a decade ago. And as more and more provider organizations have deployed electronic medical records (EMRs), nearly one out of every four coders has gone home, at least part of the time. [i] Today's ever-widening ring of telecommuters and remote workers has grown to encircle cancer registrars. This article applies a few of the lessons learned from remote coding and provides practical steps to get you started on the road to home!

Convince Your HIM Director
Of all the various tasks performed by registrars, abstracting is the easiest to do from home. To get started registrars need to take three important steps: educate your employer, get the right technology in place and cover your bases back at the office. The first step, convincing your employer, starts with a face-to-face meeting to explain what you do and then a brief conversation about the similarities between cancer registry and clinical coding. While not necessary in large cancer registries, it is a "must do" for registrars working in small, rural or community hospitals. 

Start by explaining what you do and how the business issues of clinical coding and cancer registry are similarly aligned to your HIM director. HIM professionals are rarely trained on cancer registry. While they are often responsible for the function, they have limited knowledge of what you do. Walk your HIM director through your daily workflow. Explain case findings, abstracting, state reporting and how the national boards and registries work. From there, explain the similarities between cancer registry and clinical coding business issues with a focus on how:  

• Work force shortages make recruitment difficult.

• Importance of high quality data drives need for certification.

• Working from home can reduce costs.

Your HIM director knows there is a national shortage of qualified coders, and how home-coding helps organizations recruit and retain coders. At least 800 new registrars will be needed within the next 15 years and the pending retirement of older registrars is driving demand for replacement workers.[ii] Perhaps this is why data from ADVANCE's Salary Calculator found registrars in Texas earn 23 percent more on average than coders in the same state. Recruiting experienced cancer registrars can be as difficult as finding coders!

HIM directors also understand that high levels of coding quality and accuracy are the foundation for right reimbursement and drive the need for experienced, certified professionals. The same industry pressures for quality data exist in cancer registry.

• Accurate cancer data directly impacts an organization's ability to improve cancer patient care.

• Local registry data is combined with national outcomes to help society prevent, detect and develop a future cure for cancer.

• Registry rules are constantly changing, which makes certification and continuing education essential.

The federal government, state governments and the Commission on Cancer (CoC) have recognized the direct correlation between high quality data and certification. Certified tumor registrars (CTRs) are now required to oversee data collection and reporting to state registries as mandated in the Cancer Registries Amendment Act of 1992.

Finally, by sending registrars home, HIM directors can reduce costs in space savings, higher productivity and improved registrar retention. It's common sense these days that a work-from-home option improves morale, boosts job satisfaction and reduces turnover. With your employer convinced, now it's time to set up your home office!

Your Home Office: Technology and Tools
Remote abstractors need two important technologies in order to work from home: access to the organization's EMR (some form of electronic or digitized record) and an online registry software application. The good news is that 44 percent of hospitals report having an EMR according to the 2008 HIMSS Leadership Survey and most registry tools are now available via the Internet.  

If your organization does not have an EMR, perhaps your HIM department's outsourced release-of-information (ROI) or coding vendor can help. Many of these vendors use their own Web-based document scanning technology to provide their service. The same staff and technology application can be used to scan medical record documents for cancer registry.

Integris Baptist Regional Health Center in Miami, Oklahoma, uses this approach. The organization outsources ROI and cancer registry. Their vendor provides on-site staff and a Web-based document image capture technology. While on-site performing ROI, the vendor's employee also scans records needed for cancer registry. With only 100 cases per year, an outsourced solution is more affordable and efficient than trying to recruit and retain a full-time registrar.  

Other at-home tools include the standard workstation of a personal computer (PC), printer, shredder and more. You'll need a safe, secure office space and high-speed Internet connection for maximum efficiency. Finally, make sure you have a copy of all resource materials you currently have in the office, or have them available online.

Wind Beneath Your Wings
To be successful abstracting at home, you'll need a little wind beneath your wings--in other words, someone back at the office to help. This can be a clerical person within HIM, a newly hired coder or registrar, or perhaps a manager. Whatever the title, this person should help with:

• Registry management

• Case identification

• Finding and pulling paper medical records

• Information system support (GEEK Squad also works well)

• Communication with physicians, committees and more

Alternatively, many registrars have set up a combination of at-home and in-office days whereby they perform all office tasks themselves while on-site at the hospital and focus on abstracting (typically 30 percent of the workload) from home.

All Roads Lead Home
During your journey, the road to a home office may seem endless. Don't worry, there is an end and when you arrive there, your hard work and perseverance will be worth the wait. Home based coders report higher levels of job satisfaction, increased ability to attend family functions, and an overall improvement in their work-life balance. The hardest part may be your tendency to work too much. Separating work life and family life can be a challenge for home-based registrars. Maybe coders can give us a few tips there too!

Donna Kraybill serves as a coding, compliance and cancer registry consultant for HealthPort. Prior to joining HealthPort, Donna served as director of HIM at several hospital and ambulatory care centers in Oklahoma including Cushing Regional Hospital, American Transitional Hospital and the Continuous Care Center of Tulsa.