EHR and Surgical Centers: Key Points to Consider

By Linney Patton, COE

Choosing the right electronic health record (EHR) system for an ASC is different than choosing one for a clinic or office. While surgical centers are an increasingly popular way for surgeons to perform outpatient procedures and increase their business profile, government rules and regulations governing them are quite different from those of a regular clinic, and the pace and tasks that take place in surgical centers are distinct as well. Customization and automation are keys to an effective EHR system in any surgical center.

Rudimentary Requirements of ASC Systems

One of the most basic requirements of ASCs is they must have completely separate patient records and billing systems — even if the clinic and surgical center are owned by the same doctor and occupy the same space. However, replicating patient data into two systems is not an efficient use of staff time, and patients are often unhappy if asked to complete separate forms for what they consider to be one entity. Thus, it's essential that the EHR system in the clinic has a surgical center module and that the two are fully integrated. This way, patient demographic data and medical history are automatically populated and updated between the two systems.

Surgical centers are different from clinics in a number of ways including:

1. Surgical centers are governed by state health departments

2. They must comply with a variety of state-specific rules that can change at any time

3. They move at a faster pace

4. They must keep logs of activities such as equipment sterilization, generator testing, HVAC room temperatures, machine function tests and ASC terminal cleaning, as well as temperature logs for anything requiring refrigeration

5. Patients must signed informed consent numerous times at different points throughout their stay.

The distinct functions and data recorded mean there must be an appropriate means for capturing this data. It's extremely important that you're able to customize an EHR system to the specific laws of your state and maintain the ability to update your system as laws change. Once the data is logged at the surgery center, it must also be submitted to the state for auditing.

The state of Texas, where our offices are located, passed into law a new system which requires surgical centers to upload additional information including patient demographics such as race, and surgery center financial data, such as how much of a fee insurance covered and how much patients paid out of pocket in an effort to enable patients to make more informed decisions. However, the manual input of that information can be very time-consuming for staff. It's important to have an EHR software provider that is cognizant of those needs and is current on state regulations so they can provide you with automated solutions. Our vendor is creating a way for us to automatically download the required information from our database to the state database, eliminating the need for manual entry. This is will be a huge efficiency improvement for us.

Checks and Balances

In the ASC, we take many preoperative measurements and tests such as length of the eye, shape of the cornea, blood pressure and pulse, and ensure these are part of the permanent record as well as something the physician can review when he enters the OR. Because the required tests are set up previously, if one is missed, the technician is alerted and the patient can't progress until it's completed. This enhances patient care by reducing errors that can happen along the way. Surgical centers also require signatures from patients frequently — for initial consent forms as well as post-surgical confirmation of having received oral and written instructions. For our all-digital office, this required compatibility with numerous signature pads, which are used throughout the surgery center.

Creating a Well-Oiled Machine

In our office, we use Compulink's Ophthalmology Advantage and have customized the system so it's specific to our needs. We started by creating screens that were very similar to our paper forms. We wanted to ensure the staff would be familiar with the forms and not be hesitant to use them. When either medical or administrative personnel feel they're being forced to change to fit a computer system, it discourages them to willingly adapt to the new system. We also made sure our most relevant information was at the forefront. This is particularly important in a surgical setting. When a physician performs surgery, he gets into a rhythm and things tend to move rather quickly. Most doctors have very personalized routines in which they conduct surgery. It becomes frustrating and inefficient if they have to interrupt their routine to click through various screens to find the information they need. Everything should be very user-friendly in a surgical center.

At the end of the day, the surgeon and nurses can review the patient records and make sure everything is correct. This is when good software is really appreciated. We have standard operating procedures that automatically populate for each given surgery, but the physician also has the ability to easily make changes as necessary, so the surgical report is a true record of each unique surgery. In addition, any missing data is flagged and brought to the surgeon's attention so he can make the report complete before closing it for the day. With paper records, little details were often missed and when someone noticed later, it was almost impossible to remember what had occurred. This is a great benefit to our patients, and our auditors have commented on the completeness of our electronic records.

Another efficiency gain is that all of the disposables for the day's procedures can be automatically tabulated and reordered based on the information in the system, and inventories and supplies are always tracked and up-to-date. Shortly, this function will be connected to a modem that will automatically fax over our supply orders, which means one less task staff will have to complete.

We really try to use our system to its fullest, and have almost every function automated. There's a single piece of paper printed out when patients are in the clinic or surgical center that follows them from start to finish, keeping them on track as we move them through the practice; everything else is automated. A tech can check the system to see which patients are present, where they are and where they need to go next. Surgical counselors know exactly when to check in on patients and when to expect them to be ready for their paperwork. If a patient needs to head to the optical shop, their prescription will be ready on the computer for them. Data is entered a single time and tasks are carried out, eliminating most of the possibility for errors in transcription or transposing information. This is great for both the patients and us because it cuts down on remakes.

Another important benefit to overall patient care is the ability to track and analyze outcomes. With a fully integrated surgical center module, a surgeon can cross-reference clinical records with those from the surgical center to evaluate if patients who received a particular implant or procedure, had better postop results than others. It's always better for patients when the surgeon can analyze the surgical data, know which circumstances created the best outcomes, and then alter his actions accordingly.

A surgical center can be an enormous boost to a clinic's business profile and many patients prefer them to hospitals for outpatient procedures. However, it's important to consider your specific needs when selecting an EHR system. My top three requirements in selecting an EHR system are:

• A system that can be customized to the laws of the specific state in which the ASC is located
• Screens that can be adapted to mirror a surgeon's preferred surgical routine
• A responsive vendor that is dedicated to adapt to your ever-changing needs.

With the right software, an EHR system is an asset to a clinic or surgical center. Not only are we more efficient and meeting government regulations, we're also providing better care for our patients. ■