Three Critical Questions for Keeping HIM Onsite During COVID-19

By Elizabeth Delahoussaye, RHIA, CHPS, and AnnE Rice, MS, RHIA

We blinked and everything changed. No warning signs. No ability to prepare. In a matter of days, COVID-19 forced health information management (HIM) professionals to innovate and evolve.

Now that the initial shock has worn off, HIM managers are looking ahead to the future—a future in which the pandemic may continue to persist indefinitely. Some managers who initially sent staff home to comply with social distancing mandates are reconsidering their decision as patient volumes slowly ramp up. Others have maintained a lean onsite presence to respond to in-person requests for copies of medical records. Either way, keeping staff on site has its own challenges. We’ve provided answers to three questions likely keeping managers up at night.

1. How can I truly ensure social distancing?

If your staff work in “cubeland,” it may seem impossible to keep them six feet apart. However, there are ways to make it work. One idea is to extend cubicle walls upward using plexiglass to create more effective barriers.

Another is to create two teams—one that works onsite and one that works remotely. Moving some staff off site creates space on site so everyone can remain physically distant. Both teams rotate on and off site and only have contact with other members of their team. Limiting one’s number of contacts helps slow the spread of the virus. In addition, if a team member tests positive, only the other members of that team must self-quarantine. Members of the opposite team can continue to come onsite. Without teams, the entire department would likely need to go home and self-quarantine on short notice.

Social distancing also extends to other areas. For example, identify a maximum capacity for each conference room based on a six-foot distance between chairs—and post a sign on the conference room door discouraging people to enter once that capacity has been met. Don’t permit staff to congregate in breakrooms. Discourage lines in or near the bathrooms.

2. How can I keep my staff safe?

Let’s face it: Staff look to their managers to protect them, and managers must advocate for their employees’ safety. Here a few examples of ways managers can do this:

  • Partner with your legal department and human resources. Not everyone will be on board with wearing a mask, and managers must work with human resources to establish clear policies as well as consequences for noncompliance. This includes consequences for everyone—including physicians, patients, and all staff. The idea is to create a culture of accountability in which all employees feel comfortable telling their managers when they see someone not wearing a mask or not maintaining social distancing. Other questions to consider: Can—and should—managers require staff to perform self-temperature checks? Can—and should—they require staff to undergo COVID-19 testing at regular intervals? If an employee tests positive, what is a manager’s legal responsibility to inform coworkers?
  • Eliminate or reduce patient contact. According to the Office for Civil Rights (OCR), patients must have easy access to their information. There’s no specific OCR requirement stating providers must give patients the ability to physically come into the department. For example, during COVID-19, providers could require patients to call the HIM department for all requests. Then staff could verify patient identity over the phone (which OCR permits) and produce records via email, paper mail, fax, or the portal. The only caveat is that OCR requires providers to notify patients when sending unencrypted information. Many organizations send an email stating, “We will email your records shortly. Please be aware that this information is not encrypted.” If your electronic health record (EHR) only permits staff to send encrypted messages, the organization may need to educate patients on how to unencrypt a message once they receive it. If your department does permit patients to come into the department, the organization can use plexiglass at the front desk. Another idea is to require security officers at the welcome desk in the lobby to provide patients with release forms. The guards can then deliver completed forms directly to the HIM department for processing.
  • Partner with nursing staff. Inquire whether nurses are willing and able to scan paper documents so HIM staff don’t need to travel to patient care floors to do it. If that’s not possible, consult with your infection control department to determine whether paper records should be brought down to the HIM department in a Ziplock bag or other sealed format and left unopened for a period of time.
  • Identify how you’ll address staff who travel out of state. Now that the weather is nice, staff may be traveling for vacation or to visit family and friends. In some cases, they may even be going to a hot spot for the virus. Upon their return, will you require them to stay at home to monitor symptoms? What can you do to reassure other staff that you have their best interest in mind?
  • Post signs. Then post more signs. It’s easy to get up from your desk to use the restroom, printer, or fax machine without donning your mask. Identify all public and high-traffic areas throughout the department—and make sure a sign is posted nearby.

3. How can I keep all of my staff connected?

It can be challenging to keep staff connected during times of social distancing. However, it’s critical to maintain connections. When a team feels connected, people are more willing to step up and cover for each other when someone is out sick. They may even be more willing to disclose their own health information and look out for one another during the pandemic. For example, staff may be willing to alter their own schedules to accommodate a coworker when they know he or she has asthma and can’t risk being exposed to COVID-19 onsite. Some ideas? Host a coffee hour where everyone is masked and sits six feet apart. If some staff work remotely and some staff are onsite, consider hosting a virtual lunch so everyone can take part. Another idea is a virtual happy hour after work. Be creative, and you’ll probably think of other ways to keep people connected as well.

Remember: Be a role model

Most importantly, managers must remember that their job is to set the tone and be an example. Let employees see you wipe down chairs and tables in your office every time someone leaves the space. If you remain calm and focused on keeping people safe, your staff will follow suit.

Elizabeth Delahoussaye ([email protected]), RHIA, CHPS, is the chief privacy office at Ciox Health, and AnnE Rice, MS, RHIA, is senior director of HIM and privacy officer at the University of Pittsburgh Medical Center.

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