Are you considering an electronic medical records (EMR) system for your ASC? If so, there’s a lot to ponder. Although the transition won’t be a walk in the park, the end result — access to data in a seamless, paperless patient chart — will be well worth any temporary discomfort.

To help you plan for the conversion, we talked to a busy surgeon and practice administrator who have seen both sides of the EMR transition, as well as a consultant who guides clients though the process.

Gauging Adoption of ASC EMRs

Although many ophthalmology practices have transitioned to EMRs in the past decade, ASCs have been slow to follow suit. Why? Put simply: They don’t have to. There is no regulatory push for ASCs to comply with the same requirements as practices or hospitals, so many owners opt to avoid the added cost and time that implementing an EMR system requires.

“When the federal requirement for EMRs came out, ASCs were treated as an extension of the practice. Regulators didn’t want to burden physicians with essentially implementing these systems twice, so they skipped the requirement for ASCs,” says Debra Stinchcomb, MBA, BSN, RN, CASC, senior consultant at Progressive Surgical Solutions, a division of BSM Consulting focused on ASC compliance, development, and management. “Occasionally, we hear that a requirement is coming, but I don’t think it will happen soon.”

Just as the push hasn’t happened, neither has the pull. There are only a few EMR options designed specifically for the ASC. Without widespread adoption, ASCs aren’t pressured to keep up with their peers. Stinchcomb sees the use of EMRs in the ASC growing in the coming years, influenced by a few important factors.

“In the ASC, EMRs already offer digital access to all patient data, which is a huge advantage. And, as more ASCs adopt EMRs that work with systems used in their practices, those systems will inevitably become faster and offer features that appeal to ophthalmologists,” she says. “At the same time, staff always embrace a smoother process for data management and record storage across locations. In my documentation workshops, I now teach young nurses who only learned to document electronically in school. They’ve never used paper! At some point, that shift may help push ASCs toward electronic record-keeping systems.”

Embracing EMRs on the Practice Side

EMR adoption in ophthalmology practices wasn’t met with open arms. Staff saw a process they could perform in their sleep replaced with new, often awkward and time-consuming steps. Fast forward a few years, and many have warmed to the technology — particularly the busiest people of all.

For example, Blake K. Williamson, MD, MPh, MS, a cataract and refractive surgeon at the high-volume Williamson Eye Center in Baton Rouge, LA, sometimes sees 60 patients per day. While he talks face-to-face with his patients, a scribe uses a tablet to record data in the EMR system. He and his patients get the quality interaction they want without distraction or wasted time. And when Dr. Williamson wants to access his patient information, the EMR system makes it very fast and easy.

“In a cataract consult, I love the ability to access all of the preoperative data — such as OCT, topography, and clinical notes — very quickly in one place, rather than looking at data stored on various devices,” he says. “The whole process takes a minute. It has been indispensable for us.”

Physicians at Williamson Eye can access information all four practice locations at any time, including weekends and after hours — for example, when a patient calls with a concern. What’s more, the system’s electronic prescriptions save time and potentially reduce errors. Administrators use the system’s compliance functions and patient management capabilities, and the system is also tied to billing.

Clearly, the EMR system helps this practice in many ways. However, because it’s engineered to meet all the requirements placed on healthcare practitioners today, nurses have to check a lot of boxes — a process that’s much quicker on paper.

“The one frustration with any EMR system is that it’s more time-consuming than paper. Switching between screens takes longer than using printed sheets, and every physician signoff means handing him a tablet so he can sign in with an electronic signature code,” explains Julie A. Tanoury, RN, BSN, director of nursing and surgical services at Williamson Eye. “Those minuses come with big pluses as well, including clinical support for our surgeons and less re-entry of data and record management across the board.”

Linking a Paper ASC to the Practice’s EMR

When paper ruled, patient files went to the ASC on surgery day. ASC documentation was added to the files, and then they were returned to the right practice locations in time for the first postoperative appointment. Today, when the surgery center has no EMR system, surgeons generally can access the practice’s EMR data remotely from the ASC. After surgery, staff need to merge any paper ASC records into the practice’s EMR system — again, in time for the patient’s next-day appointment.

Williamson Eye used to have an EMR system in the ASC, but when it got a new system for the practice that didn’t have an ASC component, the surgery center went back to paper records. The practice’s EMR provider has an ASC system in the works, but until it’s available, the surgery center’s scanner will be getting lots of use.

“We need access to patient data just 12 to 16 hours after surgery at the first follow-up visit, so our staff scans all the ASC documentation into our EMR system at the end of each surgery day,” Tanoury says. “The paper forms, which follow patients from admission through pre-op, surgery, post-op, and discharge and then record their medications, go into the image and attachment section of the electronic chart.”

“I can access the data I need on a computer or tablet in the ASC and print out the biometry if I might need it — for example, the preoperative topography for a toric lens procedure,” Dr. Williamson explain. “It will be great when the surgery center can talk to the clinic through the EMR system, so we no longer need to scan thousands of pieces of paper. Once we have the ASC component, we’ll also be able to search surgical data, instead of reading through scanned images.”

Customizing ASC Data Capture

Having helped develop her ASC’s previous EMR system, Tanoury emphasizes the importance of tailoring its forms not only to compliance demands, but also to the needs of the specific ASC and each of its surgeons.

“The surgery center side is tricky because we have different standing orders tailored to our providers. Although EMR systems are generalized to fit everyone, they usually have customizable templates that ensure a smooth workflow while we capture all the data we need,” she says. “Optimally, a nurse will click on Dr. Williamson’s template for cataract surgery and see how he wants the patient positioned, as well as which medications, instruments, settings, and supplies he prefers. The more we can customize our forms along those lines, the less time the EMR system will add to our process.”

Although Tanoury can draw on years of experience for customizing a surgery center’s EMR system, Stinchcomb cautions that ASC leadership who are new to the process should set aside significant time for the task.

“Practice and ASC EMRs are like night and day. In the ASC, nursing documentation has much more extensive requirements for compliance. The software needs to support those requirements without taking the EMR system to hospital-level complexity,” she advises. “When shopping for an EMR for the ASC, I recommend that clients choose a system with templates to tweak — not one that must be customized from scratch, which can take many months.”

Stinchcomb and her colleagues have helped many ASCs implement EMR systems. Her compliance expertise gives clients confidence that their choices and customization remain within regulatory parameters.

“We routinely review a surgery center’s paper documentation for compliance and quality programs, and the EMR needs to work the same way,” she explains. “We ask clients to walk us through their processes, so we can ensure they’re reflected in the EMR system.”

Evaluating and Comparing EMRs

ASC leaders who want to use an EMR system have several choices that are designed specifically for their environment. According to Stinchcomb, everyone should weigh each system’s pros and cons based on their individual needs and preferences. She has one very specific recommendation to help clients clearly envision their options and make the best choice.

“A demo is very important, because it allows users to follow the entire process — from admission to pre-op to the OR to recovery to discharge — to see how it fits their center’s existing processes and documentation needs,” she says. “I recommend that the ASC’s clinical director watch online demos back to back. Don’t wait a week to evaluate a second or third system; watch them in sequence, write down the pros and cons, and you’ll see the differences quite clearly. That will help you judge which one is the best fit for your surgery center.”

Stinchcomb also recommends clients see EMR systems in action in other surgery centers. “We offer the chance to talk to our clients who are using various EMR systems. In highly populated areas, there is always an ASC nearby that uses the EMR that interests them.” ■