MDS Alert

See whether you can complete your ‘second shift’ at home instead of staying late.

Nursing homes are routinely understaffed, a fact that the Centers for Medicare & Medicaid Services (CMS) is trying to address with a multipronged approach of incentivizing and penalizing facilities for their staffing scheduling. But Nurse Assessment Coordinators (NACs) are being hit especially hard as facilities grapple with restructuring for the Patient-Driven Payment System (PDPM) while already facing shortages of team members who have the knowledge or experience to navigate the MDS effectively.

In short, NACs seem few and far between on the ground, even though they’re responsible for coordinating much of resident care, as well as proving that the care the facility is providing deserves reimbursement from payers. With electronic health records (EHR), electronic medical records (EMR), and the computer-based input and submission of the MDS, you may be wondering how and whether you can take some of that work home.

Working out of the office depends on a facility’s or an organization’s information technology (IT) department, says Linda Elizaitis, RN, BS, RAC-CT, CDS, president of CMS Compliance Group in Melville, New York.

Prioritize Electronic Security

The Health Information Portability and Accountability Act (HIPAA) set specific restrictions and conditions on what health information healthcare professionals may access and from where. NACs obviously need full access to do their jobs correctly, which is why some facilities may pause before allowing off-site work, as the they may be concerned about liability or leaks and resulting litigation.

However, the technology exists to make appropriate access to EHR and EMR safe. Virtual Private Networks (VPNs) are one strategy that makes accessing information more secure. The VPN connection is encrypted, and users must provide authentication to enable them to reach the facility’s or organization’s servers and information.

“If the organization believes that it has the proper security on a company-owned device to allow an employee to take it home or can provide secure remote access to the network or remote-access to an EMR, then there isn’t really a reason why an MDS coordinator couldn’t continue to work from home,” Elizaitis says.

Plus, facilities have access to tools to hold you to your word.

“The organization’s IT department can monitor and audit connections and employee activity to ensure that company policies are being followed, allowing the employee to get in those few extra hours of work,” Elizaitis says.

Boost Specialized Education

If you aren’t currently offered this option but your facility has already implemented the technology, emphasize your interest by educating yourself on the basics and showing your respect for the rules by requesting specialized training on how you can securely access the EHR you need to do your job off-site. (See sidebar, page 76, for information about HIPAA risk analysis.)

“Employees who do this work should receive additional training about privacy and securing their devices, as well as the proper disposal of items such as paperwork that cannot just be thrown in a regular trash can,” Elizaitis says.

Volunteer to complete annual trainings for HIPAA, especially on the specifics of the Security Rule to keep on top of avoiding a breach. If your superior (or other higher-ups) doesn’t understand how hard it is for you to complete your work while at work — because of the sheer volume, the distractions, the timelines required for simultaneous assessments and care plans, etc. —  explain how hard it is to focus when you need to stay beyond your standard shift.