Bsn, Rn, Ccds - Acdis
Remote CDI: A Panel DiscussionLara Faustino, BSN, RN, CCDS, Remote CDSBoston Medical Center, Boston, MARebecca Willcutt, BSN, RN, CCS, CCDS, CDIP DirectorKara Masucci, MSN, RN, CCDS, Remote CDI NurseCooper University Hospital, Camden, NJ1Lara Faustino, BSN, RN, CCDSBoston Medical Center, Boston, MA2Learning Objectives At the completion of this educational activity, thelearner will be able to:– Identify key components necessary for a successful remoteCDI program during development and implementation– Describe some common misconceptions surroundingremote CDI work– Identify the top benefits achieved as well as barriers andresolutions– Identify collaborative efforts that support the success of aremote CDI program32017 Copyright, HCPro, an H3.Group division of Simplify Compliance LLC. All rights reserved.These materials may not be copied without written permission.1
“Raise Your Hands” Question1. How many have CDSs who work partially remotenow?2. How many have CDSs who work 100% remote now?3. How many would like to experience working 100%remote after this conference?4Oliver!HelloACDIS!5Exceptional Care Without Exception BMC is a private, not‐for‐profit, 496‐bed academic medical center The primary teaching affiliate for Boston University School of Medicine BMC is the busiest level I trauma center in New England– More than 24,801 admissions and 1,080,766 patient visits in the last year 59% are from under‐served populations and rely on government payers 31% of patients do not speak English as a primary language62017 Copyright, HCPro, an H3.Group division of Simplify Compliance LLC. All rights reserved.These materials may not be copied without written permission.2
CDI Remote Transition Timeline Program began Oct 2010—floors and laptops—0 battery,limited space– Met resistance with physicians early on—concern for programinterruptions/daily workflow May 2011: Team moved to office setting within the hospital In 2014, Boston Medical Center embarked on an ambitious,four‐year campus redesign– Hospital merger to become one site by 2018 2014: CDI team is moved to the finance building oncampus/away from medical floors Transition: 2 days remote April 2014 Transition: 4 days remote January 2015 (sold) Transition: 5 remote workweek with bimonthly staff meetingsby Spring 20157Check the Box 100% electronic EMRHigh‐speed internet accessQuality CDI softwareInternal hospital messagingAgreed/approved policyProductivity expectationsRemote office settingMotivated CDI team CONFIDENCE8Clinical Scenario Physician statement:“Email me –sometimes I don’twrite my notesuntil midnight ”92017 Copyright, HCPro, an H3.Group division of Simplify Compliance LLC. All rights reserved.These materials may not be copied without written permission.3
Query Response Today in Real Life “Sent from my iPhone”10A Visibly Invisible CDI TeamHow does an invisible CDI team remain visible?Our unique “pop‐up” query process within the EMR ensures visibility across the wholecare team in each individual record, thus promoting visibility of an active CDI team. Daily communication via the following applications:–––––Query process in EMREmailText pagingInternal hospital instant messaging systemWork extensions are forwarded to preferred remote lines Promotes privacy of personal home/cell lines Physician education:– On‐site as needed per preference of physicians’ platform 1:1 meetings, small or large educational speaking engagements11December 2014 EPIC Go‐Live! Implementation of our unique electronic queryprocess Created with physician leadership approval Allows customizable physician query response Real‐time documentation Activated/deactivated by CDI team– Based on query response/policy122017 Copyright, HCPro, an H3.Group division of Simplify Compliance LLC. All rights reserved.These materials may not be copied without written permission.4
Query “Pop‐Up”13Query “Pop‐Up” Instructions14Growing Pains Problems Token sign‐on IT upgrades Teleconferencing Software upgrades Hospital “downtime” Power loss Prevention of unauthorizedhospital/patient information Friday active queriesSolutions Aruba boxes Savvy IT remote login Coaching/practice Management collaboration Downtime review policy Hospital policy for loss ofpower/internet connection BMC telecommuter policy Friday disclosure notice152017 Copyright, HCPro, an H3.Group division of Simplify Compliance LLC. All rights reserved.These materials may not be copied without written permission.5
Clinical Documentation Specialist (CDS) Telecommuter PolicyHealth Information Management DepartmentBoston Medical CenterAgreement By signing below I certify that I have read, understand and voluntarily agree to the terms andconditions of the CDS Telecommuting Program as outlined in the telecommuter document dated. I will adhere to the duties, obligations, responsibilities and conditions for telecommuters asdescribed in this agreement as well as hospital policies and procedures, as they may be amendedfrom time to time. I agree that I will maintain my remote workspace in a safe manner, employing appropriatetelecommuting security measures to protect information and systems. I will take all the necessaryprecautions as outlined in the departmental policies regarding confidentiality and necessaryprecautions to secure proprietary information at my home workspace to prevent unauthorizedaccess to any hospital and/or patient information. I understand that telecommuting to provide services to the hospital is a voluntary program and aprivilege. I may stop telecommuting by providing notice to my supervisor. I also understand that thehospital may, at any time, change any or all of the conditions for which I am permitted or notpermitted to telecommute.Employee Signature:Date:16Clinical DocumentationPlease be aware that any active queries without a response noted in EPICby 2 p.m. on Fridays will remain open in EPIC andre-addressed Monday morning.Thank you and we apologize for the inconvenience!17Achievements Creative communication streamlines:– CDIS productivity/quality review– Most often real‐time physician query resolution Queries “pop‐up”/documentation is clarified or deactivated (hours) Optimized collaborative efforts/physician engagement Vested in query response even when off service (if query escalated) Documentation best practice physician education:– Optimally timed for the physician– Applied documentation best practice to all records182017 Copyright, HCPro, an H3.Group division of Simplify Compliance LLC. All rights reserved.These materials may not be copied without written permission.6
Common Misconceptions vs. Reality Online shoppingCookingCleaningChild/senior careCoffee shopUnder the radar Time nal IM systemExceed productivity19Tips for Successful Remote Days! RoutineGym/yogaShowerDay clothes (not pajamas!)Connect with colleaguesSelf‐education if any downtime– ACDIS website Take a walk Take a trip after work– Even if it’s just to the grocery store!20#GOALSCurrent state Physician education MS/APR‐DRG reviews Variety service linereviews Quality collaborationFuture state Physician champion CDI ladder/team lead Grow/expand CDI team Variable shifts Outpatient CDI NICU/obstetrics/GYN Per diem CDI212017 Copyright, HCPro, an H3.Group division of Simplify Compliance LLC. All rights reserved.These materials may not be copied without written permission.7
The Bottom Line This program positively impacts the organization on both a departmental andindividual level, while supporting Boston Medical Center’s vision of a positivework/life balance for its employees.A full‐time remote CDI program CAN be successful after a well‐established CDIprogram is proven within an organization.The remote office setting has proven to impact overall health and well‐being, asevidenced by employee satisfaction, respected physician relationships, and meetingmetric goals.The organization benefits with staff retention—all employees hired into thedepartment are still with the department!Organization saves on real estate, resources, and utilities.Employees do not occupy parking spaces, making more available forpatients/families.Attractive role for quality CDI candidates(autonomy/critical thinking).If you have tried before and failed try again!How can our model help your organization?22Rebecca Willcutt, BSN, RN, CCS, CCDSKara Masucci, MSN, RN, CCDSCooper University Hospital, Camden, NJ23zz242017 Copyright, HCPro, an H3.Group division of Simplify Compliance LLC. All rights reserved.These materials may not be copied without written permission.8
Identify key attributes for new hires andsuccessful onboarding of remote CDI staff Discuss successful strategies to implement ahybrid program and build a cohesive teamATTRIBUTES &ONBOARDINGTEAM BUILDING Explain barriers affecting the efficiencyand effectiveness of a hybrid program Define best practices and list metrics ofa hybrid programBARRIERSBEST PRACTICE ANDMETRICS Predict the benefits to the hospital, staff,and practitionersBENEFITSCooper University Health Carein Camden, NJ, operates anacademic, tertiary (specialist)care hospital; a leading cancercenter; a children’s hospital;three urgent care centers; andmore than 100 outpatientoffices throughout South Jerseyand Pennsylvania.Daily censusAdmissionsHospital beds41629,47363526zz272017 Copyright, HCPro, an H3.Group division of Simplify Compliance LLC. All rights reserved.These materials may not be copied without written permission.9
Clinical Documentation ImprovementProgram (CDIP) Team Falls under quality & operational excellence department Institute (service line) model– CDS team on‐site– CDS remote 100% PSI and HAC review pre‐bill– Remote CDS & director Hybrid staff–––––3 on‐site CDS RNs8 remote CDS RNs1 remote CDS director1 on‐site lead CDS RN1 on‐site medical director (trauma surgeon)28KaraMasucciRN, RN,BSN,CCDSRemoteCDS RN, BSN, CCDSSarahLaSourceWhippany,New gham,AlabamaMount Holly,New JerseyRemote CDS Requirements RN with Certified Clinical DocumentationSpecialist (CCDS) or Certified DocumentationImprovement Practitioner (CDIP) credential Certified Coding Specialist (CCS) or Certified RiskAdjustment Coder (CRC) credential requiredwithin 1 year Proficiency with vendor software and hospitalEMR Knowledge of regulatory environment Spirit of excellence Problem solving and deductive reasoning skills Behavioral‐based review and solid references Self‐owned office equipment and computer302017 Copyright, HCPro, an H3.Group division of Simplify Compliance LLC. All rights reserved.These materials may not be copied without written permission.10
Successful Remote Onboarding Ensure access to necessary hospital computer applications––––Citrix installed prior to startRemote connect via VPNComputer with fast and secure internetOften the biggest hurdle to onboarding First week––––––IT setup day and mandatory online compliance classesPreceptor assignedFull‐staff group WebEx meeting for introductionCDIP policies, process flow maps, and query formatComplete a few patient reviews with preceptorNo queries posted until okayed Communicate expectations–––––New patient reviews per dayFollow‐up reviews time frame per PFMQuery follow‐up per PFMReconciliation of casesFlexibility is a must; not everyone has the same query opportunity31Benefits of Hybrid CDI Team Immediate return on investmentOn‐site CDSs are the face of the programLess disruptive to the physician’s workflowLess physically intrusive in the unitsFrees up valuable real estate100% electronic clarification processPhysicians have full access to the CDSs during business hoursand contact via phone or email Less distraction and interruption for the CDSs greaterproductivity Less distraction and interruption for the physicians happierphysicians Flexibility of not having to commute happier employees32Barriers Affecting the Efficiency andEffectiveness of a Remote CDI Program Rely only on the EMR– EMR is cumbersome– EMR contains duplicate information– Difficult to collaborate with bedside RN IT issues, including internet and Citrix downtime Increased difficulty in establishing relationship withphysicians Loss of “ad hoc” education for physicians andcontinued education for CDSs CDSs may feel unsupported in their role332017 Copyright, HCPro, an H3.Group division of Simplify Compliance LLC. All rights reserved.These materials may not be copied without written permission.11
Growing and Nurturing a Hybrid TeamPlant Trust“Be a good leader, treat people well, motivatethem well, and don’t try to second‐guesseverything they do.” ‐Richard BransonPlant Loyalty“Train people well enough so they can leave.Treat them well enough so they don’t want to.” ‐Richard BransonPlant Joy“Happiness inspires productivity.” ‐ShawnAnchor96% Employee Satisfaction/Engagement Score34Open Virtual Door & Relationships Maintain open lines of communication–––––Daily group instant messaging is keyOut of sight is NOT out of mindOver‐communicationGroup emailsEmojis and GIFs Attitude, attitude, attitude Humor and laughter Get to know each other on a personallevel to mitigate feelings of isolation Ask for and give help Encourage small talk and IM chitchat Bring entire team together annually35Servant LeadershipServant Mindset Your team is your #1 customer—don’t pull rankBelieve the best about each team member; give benefit of doubtWork should bring happiness, satisfaction, and psychological safetyLead by examplePlease & thank you, smiles, honesty, transparency, admitting mistakes, and the Golden RuleGet to Know Them Know birthdays, names of spouses, children, and petsEncourage high, strong emotional engagementFriendly rapport builds morale, productivity, and job satisfactionFamily comes firstBuild Confidence Turn weakness into strengthGive affirmation, appreciation, and kudosEmpowerment is contagious—spread itTalk each other upLoyalty Trust, trust, trustEmpathy: Never humiliate or devalueBelieve in the power of autonomy and a long leashGive credit when credit is dueHave their backs362017 Copyright, HCPro, an H3.Group division of Simplify Compliance LLC. All rights reserved.These materials may not be copied without written permission.12
zz37Clarification Process CDS enters clarification as a “short note” inelectronic medical record CDS tags the physician and it travels to his/her inbox CDS follows the escalation process Physician responds to the clarification and signs thenote Once signed by the physician, it becomes part of thepermanent record38ClarificationResponseRate 100%2017 Copyright, HCPro, an H3.Group division of Simplify Compliance LLC. All rights reserved.These materials may not be copied without written permission.13
Sample ClarificationEscalation for Unanswered Clarifications72 Hours After Clarification WrittenEscalation #1Contact physician48 Hours After Escalation #1Escalation #2Contact physician and CDIP MD director48 Hours After Escalation #2Escalation #3Contact physician, CDIP MD director, anddepartment head41CDIP Team Metrics CDS individual–––––Initial reviews per CDSSubsequent reviewsImpact clarification rateNon‐impact clarification rate (i.e., severity, HCC, PSI, etc.)Audit of clarification compliance CDIP team––––––––100% PSI review completed100% HAC review completed100% Medicare and Managed Medicare review completedCMIExpected mortalityPhysician response ratePhysician congruent rateFlexibility is a must; not everyone has the same query opportunity422017 Copyright, HCPro, an H3.Group division of Simplify Compliance LLC. All rights reserved.These materials may not be copied without written permission.14
Thank you. CooperHealth.eduMasucci‐Kara@CooperHealth.eduIn order to receive your continuing education certificate(s) for this program,you must complete the online evaluation. The link can be found in thecontinuing education section at the front of the program guide.432017 Copyright, HCPro, an H3.Group division of Simplify Compliance LLC. All rights reserved.These materials may not be copied without written permission.15
- 1 on‐site lead CDS RN - 1 on‐site medical director (trauma surgeon) Beth GsellRemote RN,BSN, CCDS Onsite CDS MountHolly, New Jersey Kara Masucci RN, MSN, CCDS Remote CDS Whippany, New Jersey Matthew Durfee RN, CCDS, CCS CDS Boston,Massachusetts Sarah LaSource RN, BSN, CCDS Remote CDS Birmingham, Alabama 30
BSN Curriculum BSN Coursework BSN 302 Concepts of Professional Nursing Practice (3) BSN 306 Cultural Diversity and Healthcare (3) BSN 346 Human Pathophysiology (3) BSN 382 Health Assessment (2) BSN 381 Health Assessment Skills Seminar (1) BSN 422 Community-Based Nursing (3) BSN 423 Community-Based Nursing Role Performance (2)
This monthly video will be the first Monday of the month. Sponsors would select a client (ideally) or SME to be interviewed by an ACDIS Editor for approximately 15 minutes. Sponsor would work with ACDIS on topic and questions. This is an informal and informational video discussion. This is aired on the ACDIS Facebook page, and then lives on acdis.
Arizona ACDIS Newsletter 4TH Quarter 2022 Page 2 Arizona ACDIS Chapter Newsletter. Arizona ACDIS Newsletter . "There must be a cause-and-effect relationship between the care . provider engagement can be a challenge, however. In collaboration with 3M Health Information Systems, ACDIS issued a survey in January 2022
diploma, ADN, and BSN. An RN-to-BSN completion graduate is a nurse whose basic level of nursing education was something less than a BSN, i.e., LPN, ADN, or diploma, who had returned to school for a BSN. A generic BSN graduate is a nurse whose basic level of nursing education was a BSN. Critical nursing activities are those
Amy Peters, MBA, BSN, RN, is the Chief Nursing Officer at Truman Medical Centers. Gina Rosser, BSN, RN, is our Emergency Department Director. Nursing Education Coordinators: Hannah Olson MBA, MSN, RN Christina Fenwick BSN, RN Current Clinical Team Managers: Jennifer Wilson BSN, RN Lisa Smith BSN, RN Megan Carrol BSN, RN Blake Samskey, BSN, RN
Pre-Licensure BSN & RN to BSN Options Student Handbook 2022 - 2023 (Updated March 2022) Table of Contents . Page . 1. Welcome . (UNM-CON) BSN program or the RN-to-BSN program! As a double graduate of the UNM-CON (BSN 1976; PhD 2013) I can assure you that you have made an excellent choice for achieving
Cottey College: Accelerated BSN Drury University: Dual Degree BSN/BA in Biology Evangel University: Dual Degree BSN/BS in Health Care Missouri State University: ACEND Preselect Option for Dietetics Internships North Arkansas College: RN-to-BSN; BSDI Ozarks Technical Community College: BSN; RN-to-BSN .
An Introduction to Description Logic IV Relations to rst order logic Marco Cerami Palack y University in Olomouc Department of Computer Science Olomouc, Czech Republic Olomouc, November 6th 2014 Marco Cerami (UP) Description Logic IV 6.11.2014 1 / 25. Preliminaries Preliminaries: First order logic Marco Cerami (UP) Description Logic IV 6.11.2014 2 / 25. Preliminaries Syntax Syntax: signature .