OASC | TECHNOLOGY

Would an EHR System Benefit Your ASC?

Many clinical practices have made the switch, but there are special considerations for ambulatory surgery centers.

By James Knaub, Contributing Editor

Today, though a majority of clinical practices have adopted an EHR system, many ASCs are still on the fence. EHRs offer ASCs many benefits; however, there are drawbacks, too. If your ASC is contemplating making the switch from paper to electronic record keeping, here are some key factors to consider.

Key Benefits

Perhaps you’re wondering if an EHR system is a smart investment Here are four benefits of implementing EHRs in your ASC.

1. CMS compliance and quality assurance requirements. Documentation required by the CMS ASC Quality Reporting program can be built into an ASC EHR system. The documentation automatically becomes part of the operative report that goes back to the practice and is readily available for billing purposes.

In addition, though current meaningful use (MU) requirements specifically exclude ASCs, that probably won’t always be the case. And by the time they are included, today’s incentive payments will likely have become penalties for failure to meet MU requirements. Eligible providers can still qualify for MU incentives by using a certified electronic health record technology (CEHRT) in ASCs, according to the Ambulatory Surgery Center Association (ASCA) website. Looking ahead, it makes sense to make the transition to a certified EHR.

2. Commercial payer requirements. In addition to CMS reporting requirements, commercial payers are increasingly demanding that their providers use an EHR system.

In fact, Glenn deBrueys, CEO of American SurgiSite, says pressure from Blue Cross/Blue Shield in Pennsylvania in 2008 prompted his company to develop iSurgiSite in a partnership with iMedicWare.

3. Quality and safety. An ASC EHR that is well integrated with the practice’s EHR can improve accuracy because the electronic data exchange reduces the need for duplicate data entry, which in turn decreases the likelihood of data entry errors. Also, procedure templates, audit trails, and system alerts help catch mistakes.

4. Efficiency and profitability. When it comes to EHRs in an ophthalmic ASC, it’s not all about the surgeon — well, not entirely. In the ambulatory surgery setting, nurses and CRNAs enter the bulk of the data and tend to be the primary EHR users. As such, the system’s data input and workflow need to help the surgical staff efficiently produce accurate, complete documentation.

In addition to pulling together all the information from the nurses and CRNAs for the surgeon’s review, a well-integrated system reduces duplicate data entry, which improves efficiency. It’s also a great benefit if multiple users can access the same chart. Most systems support this in some fashion, but it’s a must-have feature for peak efficiency.

Other potential efficiencies to note:

• Procedure templates can automatically create lists of standard supplies needed for a specific procedure, helping to standardize and speed the preoperative nurse’s preparation.

• Automated audit trails save time compared with manually time-stamping paper charts.

• Inventory management modules can pull information from documents to track supply and device use and streamline inventory management.

Considerations

If the benefits have convinced you to seek an EHR for your ASC, EHR for your ASC, the next step is researching and deciding which system is right for your center. Here are a few helpful tips.

1. Start with your current vendor. If you use an EHR system in your practice and operate your own ASC, your current vendor is the logical place to start, as you can expect better integration between your ASC and practice systems if they were developed by the same vendor. Compulink, NextGen, MedFlow, Management Plus, and iMedicWare are among the commonly used clinic systems that offer an ASC product. Another company, Modernizing Medicine, is working on the development of an ophthalmic ASC component.

2. Inquire about compliance. A key benefit of EHR systems is that they help to maintain medical compliance. Ask potential EHR vendors how their systems handle documentation such as patient burns, falls, and prophylactic IV antibiotic timing when evaluating vendors. Also ask about the future requirements. For example, flu vaccination status among healthcare staff is a quality reporting requirement that comes on line in 2016, according to the ASCA website.

3. Evaluate efficiency. Not surprisingly, a decline in productivity is the top complaint about EHR adoption, cited by 65% of practices responding to a survey by the American Society of Ophthalmic Administrators this year. While the survey wasn’t specifically aimed at EHR systems for ASCs, the concern is valid. Therefore, it’s important to choose the system that best serves your staff and maximizes efficiency.

The nurses at The Eye Center of Central PA, which operates its own ASC, had concerns that using EHRs would distract them from patient care duties. “But after about a week, they were convinced the system actually added time for patient care,” says Scott Peterson, CIO of The Eye Center of Central PA. Though it’s important for the system to efficiently serve ASC staff on the front end, it’s crucial that it allow the surgeon to review and complete the operative report without disrupting his workflow.

“Our doctors are doing the same thing they’ve always done,” says Peterson. “It doesn’t really change the surgeon’s routine, except that the doctor isn’t chasing documentation from several people’s desks. When the patient walks out the center’s door, the documentation is done and just needs to be reviewed and electronically signed by the physician. Then everyone within the organization has access to it.”

Including its Allenwood ASC, The Eye Center of Central PA operates 16 offices staffed by four ophthalmologists, 13 optometrists, and four physician assistants, plus technicians and support staff. Those offices are spread across nine counties in Pennsylvania. In a single surgery session, 30 to 40 patients can move through the center’s two operating rooms.The key operational value of EHRs is that the system efficiently brings together the required documentation work of the entire team for the surgeon to review and sign. The Eye Center of Central PA uses Medflow’s ASC EHR, as well as its 8.1 office EHR.

“After each person has entered his portion of the data, the system validates that the required documentation fields are filled, and the physician reviews the record and electronically signs off,” Peterson says. “All the information is compiled almost instantaneously and the operative report is generated, based on the proper rules and regulations associated with documentation. The surgeon’s signature completes the process and generates the report that we electronically fax in PDF format to the referring doctor’s practice.”

4. Choose your preferred integration. These systems are available in two varieties, preferred partner or fully integrated systems, and both come with their share of pros and cons.

“A fully integrated system allows the direct exchange of [structured] data from clinic to ASC,” says Heather Bush, COT, a product manager with Compulink. However, this would require replacing your system and taking on the cost — and too often, the hassle — of a data migration to put both clinic and ASC systems on the same platform. Bush says that in her experience, about 20% of practices choose migrating to a new system.

A more popular option is a preferred partner system. “Most clinical ophthalmology EHR systems have a preferred partner,” says Bush. “Generally, this requires an HL7 interface to pass data between the two systems.”

Using a different vendor for your ASC and clinic systems can limit the data exchange, often leading to sending electronic documents between facilities rather than electronic data exchange.

“In an HL7 [health level 7] environment, it’s a little more difficult to pass the data between the two. With tight integration, the clinic info can be transferred to the surgery center by creating a companion record. That means there’s less information for the surgery center staff to print and enter into their system. Tight integration also improves accuracy,” says Bush.

Data passing from clinic to ASC or vice versa must be verified by staff, but doesn’t require manual data entry unless changes are required. After surgery, key information (i.e., details about the IOL and the operative note) can be transmitted back to the clinic’s EHR system.

Preferred partner EHR systems developed by the same vendor will have a compatible database design, allowing the direct exchange of more structured data between the ASC and the clinic. Though helpful, Peterson says it’s not the panacea it might seem. For example, he notes that even if a patient’s medication information is transmitted to the ASC system, the pre-op nurses must perform their own assessment to make sure the information is current. The expectation that a preferred partner EHR system eliminates duplicate data entry with automated data exchange is unrealistic. Many practices have EHR and practice management systems with unstructured textual data that’s difficult to convert to structured data and exchange electronically. In those cases, as well as for many ophthalmologists who have privileges in an ASC but no ownership, an effective system for sending electronic documents is the practical objective.

“For standalone ophthalmology practices that don’t own an ASC and want to work in a surgery center, there is better technology available to electronically fax PDF files back to the clinic and reconcile with the charts,” says Jim Messier, vice president of product development with Medflow.

If an ophthalmology practice owns and operates a multispecialty ASC, an ophthalmology-centric EHR may not be the right choice either. An ophthalmologist who asked to remain anonymous and whose practice owns a multispecialty ASC, said his group decided not to use an EHR in their ASC because their surgeons’ needs were so different that no single EHR system seemed to serve them all. In their case, sticking with paper made more sense.

If your practice still uses paper charts and is contemplating the move to electronic records, the same logic about better integration would apply.

“The key in our EHR selection process was that we wanted a system specifically focused on ophthalmology and optometry,” Peterson says.

An eye care-centric system should require less customization for procedure templates, nurse documentation, anesthesia documentation, intraoperative documentation, operative reports, drug formulary, timeout documentation, electronic consent, and discharge instructions. Every document that’s part of your paper process should be evaluated to see how it is managed in each vendor’s EHR environment.

5. Cloud versus LAN. Like much of the computer world, there is a migration toward browser-based cloud computing and away from local area network (LAN) systems. Some vendors offer both cloud- and LAN-based options, others are still developing their cloud-based platforms. If your practice EHR is LAN-based, ask vendors about the details of possibly switching to a cloud-based system. LAN systems certainly work, but the information technology field is embracing the easier system maintenance and cost-saving benefits offered by cloud computing.

The shift also supports the software payment model, in which a monthly fee replaces many hardware and software purchases. Cloud-based systems can eliminate much of the up-front cost and change the acquisition from a capital purchase to an ongoing operational expense.

Some EHR systems are available in both LAN- and cloud-based configurations. Your financial analysis should compare the ongoing monthly subscription fee to the purchase cost, upgrade costs, and licensing fees of an LAN system. American SurgiSite’s deBruey says its software as service monthly subscription makes using iSurgiSite cost efficient at about 1,000 procedures per year.

Making the Right Choice

Choosing an EHR system for your ASC is a significant and complex undertaking. The tips provided here can help you to choose the system that best supports what should be your two primary goals: (1) not disrupting the surgeon’s workflow and productivity and (2) efficiently producing and sharing strong documentation, both of which will help increase patient safety in the center. ■