Standing out from the crowd — How Tom Hui helped HSTeChart rise above the ASC EHR market

When HSTpathways CEO Tom Hui founded his company and set about developing an EHR for the ASC setting, he did it with the unique challenges of surgery centers in mind.

Becker's ASC Review spoke to Mr. Hui about HSTeChart and the journey he took to develop an ASC-specific EHR.

Question: Why did you design HSTeChart?

Tom Hui: The HST team designed a game plan from day one to innovate, meet and stay ahead of our ASC customers'' future needs and run in a league of our own. We wanted to move to where the ball was going. On the playing field, the customers' dialogue about eChart changed from, "Do we have to go electronic?" to, "What products are available and affordable for a surgery center?" Most surgery centers see automating clinical documentation as a necessary and key component for operating safely and efficiently. The current shift in thinking about eChart is analogous to the 1990s, when surgery centers realized that automating their practice management [scheduling and revenue cycle management] was a necessary component of operating efficiently and complying with regulatory mandates.  

Q: What challenges did you have to overcome to design an ASC-specific EHR?

TH: One of the most important external challenges we faced when introducing eChart was the frustration and dissatisfaction around EHRs in the ASC industry. Physicians operate their own practices and had existing negative perceptions. We were deliberate about turning this initial challenge of industry frustration into a core design principle for our team.

Other external challenges involved the technical environment of the ASC customer such as the quality of their network [speed and availability], device integration to automatically feed data and display that data within HSTeChart and mobile devices and the variations in their version of browser support. We concluded that a successful electronic charting system had to be mobile-compatible. Creating user interfaces that displayed the necessary information on a limited screen size demanded a lot of design iterations and revisions.

The internal challenge was one of executive commitment. We had to recruit and build a clinical development team from the ground up. This challenge was ultimately a key element of our success. Our design and implementation team are composed almost exclusively of [registered nurses] and former nurse managers of surgery centers. We actively engaged with surgeons, anesthesiologists and medical directors to get their reaction to our product design and usability. Our technical software engineering team is twice as large as I initially envisioned. Ultimately, our challenges were met by assembling a highly collaborative and experienced team.

Q: What sets you apart from other EHRs?

TH: We didn't want to be part of the crowd. We thought turning a paper system into an electronic record was misguided. Our design team came up with the following mission: eChart had to improve patient safety. HSTpathways is the first company to introduce an ASC-industry-specific EHR that allows concurrent charting at all times, in all areas of the patient care documentation process. This advantage enables clinicians to continue documenting the patient experience in a concurrent manner without having to wait on others to complete their tasks electronically. And [it enables] real-time charting between clinicians as part of patient safety.

HST's eChart had to have strong security and auditing features for improving best practices and compliance with policies and procedures. A trusted cloud helps our customers mature their information risk management programs to prevent avoidable data breaches. eChart had to win the adoption challenge by making the workflow powerful and intuitive. eChart should create a reduction in the surgery center's staffing costs. eChart should identify and automate the many routine tasks that create added costs and frustration; as reported, "Chart completion is a prime example."

HSTeChart is integrated with HSTpathways database, its practice management system. Having an integrated versus an interfaced solution eliminates added costs and complexity [because they're tightly coupled]. Inherent risks associated with interfaced EHR solutions are version compatibility, added cyber security risks, synchronization of data sources and reconciling which data source is the "system of truth". Support, especially for diagnostic and resolution of problems, are typically more prompt with integrated solutions.​

Q: How was the KLAS Category Leader determined? What did it mean to you to win this industry recognition?

TH: Winning the KLAS award meant a great deal, not only to me, but to the entire team at HST. To win No. 1 with KLAS, we had to lead in two products. KLAS interviewed many clients just as they did with our competitors. We are the first winners of this new category, so it is a big deal to HST.

One common attitude we all share is that we "own" the outcome of our customers' satisfaction. Any dissatisfaction reflects on all of us. The high rating we received from KLAS interviewing our customers was an independent confirmation that our culture of ownership and commitment is real. Winning the award was also a validation that we engineered the best product using current technologies and combined that product offering with a number one service organization. If these comments reflect our pride in who we are, it is because we do take pride in accomplishing our mission.

One CIO who was interviewed for the KLAS report said, "We feel that HST understands this market, which is very unique. We feel that HST is developing the product. They have already released their EMR. They are working on analytics and various other enhancements that will make HSTpathways a more useful product for us. We are really happy with our partnership."

KLAS is shining a light for healthcare organizations on the best top performing software provider options, based on interviews with thousands of providers. According to the KLAS ASC report, "The HSTpathways system stands out as a very high performer in a market where many other products are subpar or simply adequate. ASC organizations that use HSTpathways are very happy with the solution."

The Category Leader designation is reserved for vendor solutions that lead select market segments in which at least two products meet a minimum level of KLAS Konfidence. Adam Gale, president of KLAS, said, "Category Leader is more than a ranking. It is recognition of vendors committed to delivering superior solutions. It gives voice to thousands of providers who are demanding better performance, usability and interoperability in healthcare technology."

Q: How has your EHR been received in the market?

TH: We have received validation that our eChart has hit the target. HSTeChart has been implemented in some of the largest ASCs in the country averaging more than 20,000 procedures a year, as well as many smaller, single-specialty centers. Additionally, our largest corporate clients also have implemented eChart.

Many of our eChart customers were waiting for a product that is tailored to the fast-paced, efficient workflow of a surgery center. We have eChart implementations scheduled through the end of this year, with many of our corporate accounts scheduling implementations for 2018 and 2019.

Q: What would you say to an administrator considering HSTeChart?

TH: First and foremost, eChart enables the ability for reporting on all the regulatory requirements and clinical measures. The industry knows staying on paper is going to be difficult going forward. The decision to join the digital chart community is a matter of "when," not "if." So, planning all aspects of electronic charting is the most important responsibility of management. Electronic charting can remove many of the limitations of paper systems, which implies eliminating certain inefficient steps. Change management requires strong leadership, commitment and clear communication to the entire staff, clinical and administrative.

Finally, administrators immediately get the advantage of going with a software that is uniquely designed for the ASC setting.  

More articles on quality:
Where the 67 new ASCs are being built and opened in the 1st half of 2018
Regent RCM: 4 internal auditing tips for ASCs
University Gastroenterology president Thomas Sepe receives clinical professorship at Brown University

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