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6 Crucial Steps for ASCs Adopting an EMR

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Here are six aspects of electronic medical record implementation for ambulatory surgery centers to consider and plan prior to adoption.

1. Perform facility-wide assessments. After getting your leadership on board, you will work with your EMR vendor to assess the current workflow of your ASC's operations and different departments, said Joe Macies, CEO of AmkaiSolutions. The information gathered during these assessments will help ensure your EMR is properly configured for your ASC. These assessments will include your clinical departments, business office and equipment.

The clinical assessment will provide you with the material needed to update your administrative policies. It looks at paper documentation such as consents, questionnaires, formularies and physician orders. This information is needed to not only configure the software but also train your staff on how to perform these same clinical documentation tasks electronically.

The business office assessment looks at facility fees, insurance carriers, contracts, inventory, preference cards and more. This information provides the framework for the database build to properly meet your facility's needs. The equipment assessment allows your EMR vendor to understand what equipment (computers, laptops, workstations, etc.) is already used by your ASC. "This information helps your vendor visualize how staff members perform documentation, identify hardware needs and determine an efficient deployment and maintenance model for the system," he said.

2. Find software that meets your facility's needs. One of the biggest mistakes ASC leaders make in implementing an EMR is choosing a system that doesn't work for the center, said Sarah Sterling, business administrator at Post Street Surgery Center in San Francisco. "People tend to make the mistake of not doing their research and getting software that doesn't meet the needs of their facility," she said. "The research is important, so what I had done was look at different products from different vendors, demoed their products, created a spreadsheet that listed each products' best features according to their vendors and talked to vendors' clients about those products."

Since more EMR systems are designed for hospitals than for health systems, this research is very important for finding a system that works for your staff and physicians, she said. There may be no way of knowing how a system will function once it goes live without substantial research into the experience of other ASC customers.

3. Do not ignoring infrastructure constraints. EMR implementations often do not take into account infrastructure limitations. Administrators must consider whether they have enough space and bandwidth to support their system and understand whether the EMR will be able to interact with local hospitals and health systems, said Marshall Busko, senior director of executive solutions at Amerinet.  

"Everything is going mobile, so make sure you have a wireless infrastructure that will bring more applications online," Mr. Busko said. "Have a solid backbone to connect with others in the community. You need the bandwidth to do that, so make sure it's there before system implementation."

Many times surgery centers will decide to use old or inexpensive equipment, but an upgrade usually doesn't cost that much more and can make a big difference in how well the system works.

"Ask other surgery center administrators about their mistakes and figure out what worked and what didn't for their infrastructure," he said. "Invest in portable devices and larger monitors. Infrastructure is critical because without that, nothing else works."

4. Research self-hosting vs. service models. ASCs must choose whether to self-host EMR hardware or to rely on a service model. "You really have the same dynamic [as with software]," said Patrick Doyle, executive vice president of sales and marketing for SourceMedical. "You can host the hardware yourself and purchase the server, workstations, tablets, scanners and set up a wireless network, or you can rely on a service model, where you really only need a broadband internet connection." The major benefit with a service model for hardware is the ASC will not need to hire maintenance to keep the server in working order.

The choice to self-host or use a service model depends on the type of ASC, Mr. Doyle said. "For a small center, it might make more sense to use a service model; you're talking about a relatively light footprint in terms of your monthly cost for the hardware," he said. "But when it starts to scale itself out for larger facilities, then you're talking about a lot of connected devices, and [using a service model] may exceed what the cost of your server and maintenance would be internally."

5. Incorporate performance guarantees in contracts. One of the most important points to include in the vendor contract for EMRs is performance guarantees. Vendors must provide the level of service they promise and surgery centers should faithfully implement the system to optimize results.

"Because so many EMRs are being implemented right now, suppliers are stretched thin, and they bring in new people who may not be familiar with the devices," Mr. Busko said. "These new people may not have the expertise they should and the process takes longer. If you have performance guarantees in there, you are covering yourself so the vendor makes good if they don't hit the guarantees."

Run the contract by an attorney to safeguard their interests and make sure all parties will incur penalties if they don't hold up their end of the bargain. The vendor should provide annual support for product use, and if they don't the performance guarantees can defray some of the expenses associated with slow or no implementation.

6. Be patient for the pay off. Investing in an EMR for an ASC can be intimidating, but the investment should pay off after 18 months, assuming a license/self-hosting model, where the ASC owns the software and hardware and pays a higher upfront fee on both. ASCs should plan for the "hard costs" of software and hardware as well as "soft costs," including the cost of labor for three months to implement the software and some case disruption while the staff adjusts to using the EMR, Mr. Doyle said.

The savings associated with EMR include the money spent on chart materials, such as dividers and tabs, chart folders and covers and pre-printed forms, and money spent on document security, including shredding and storage. EMR can also save ASCs money in hours per day spent preparing a paper chart by business office personnel, including chart pack assembly, collating, document and chart retrieval, and copying and faxing. These hard and soft costs can add up to over $120,000 per year and should make the EMR a profitable investment after 18 months.

More Articles on Coding, Billing and Collections:
12 Recommendations From the National Commission on Physician Payment Reform
Connecticut Association of Ambulatory Surgery Centers President: Include ASCs in Health Insurance Exchange
The 2% Medicare Reimbursement Reduction: Q&A on How it Impacts ASCs


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