• 3 Steps to Control Labor Costs

    At the 11th Annual Spine, Orthopedic & Pain Management-Driven ASC Conference on June 15, Thomas Jacobs, president and CEO of Westchester, Ill.-based MedHQ, shared three strategies for controlling surgery center labor costs.  By Jim McLaughlin -
  • Improving Documentation and Coding Compliance in Advance of ICD-10

    In a session at the 11th Annual Spine, Orthopedic and Pain Management-Driven ASC Conference in Chicago on June 14, Tim Meakem, MD, medical director at ProVation Medical, discussed the increased importance of proper documentation and coding by physicians and what it means for the practices and ambulatory surgery centers where they treat patients. By Lindsey Dunn -
  • Are Your Vendors Violating HIPAA? Why Internal HIPAA Compliance May Not Be Enough

    We have recently assisted several healthcare provider clients that have discovered that their business associates had allowed protected health information of the provider's patients to be improperly disclosed in violation of the Health Insurance Portability and Accountability Act of 1996. Specifically, the providers entrusted their patients' PHI to a business associate, and the business associate did not appropriately protect it. In at least one case, the provider was forced to conclude that a PHI breach had occurred and was required to report the breach to affected individuals and HHS.  By Holly Carnell, JD, and Meggan Bushee, JD, McGuire Woods -
  • Johnson & Johnson Will No Longer Produce Metal-on-Metal Hip Implants

    Johnson & Johnson has decided to stop production of its DePuy all-metal hip replacements after Aug. 31, though executives say the decision is not related to safety or effectiveness, according to The Legal Examiner.  By Heather Linder -
  • Pyramid Healthcare Solutions Names Michelle White Coding Director

    Clearwater, Fla.-based Pyramid Healthcare Solutions named Michelle White, RHIA, as its director of coding services. By Heather Linder -
  • 30% of Physicians Don’t Notice Test Results in EHR System

    A survey, the results of which were published in a Journal of the American Medical Association Internal Medicine research article, found that 30 percent of physicians in the Department of Veterans Affairs health system, participating in the survey, failed to notice important test results sent via the VA's electronic health records system, according to a Medpage Today report.  By Anuja Vaidya -
  • East Coast Hospitals & Surgery Centers Select Professional Data Systems

    Professional Data Systems, a medical IT solutions company, announced that it has been selected by a number of hospitals and surgery centers for information technology support services.  By Anuja Vaidya -
  • 8 Ways to Expand Practices Without Hiring New Staff

    Physician practices can expand without adding new staff members to save during tough economic times, according to a recent Medscape article by Elizabeth Woodcock.  By Laura Dyrda -
  • 20 Statistics on Patient Visits for Key ASC Specialties

    Here are 20 statistics on patient visits to physician offices for key ambulatory surgery center specialties, based on the Medscape Physician Compensation Report 2012. By Laura Dyrda -
  • 5 Ways Positive ASC Employee Culture Translates to Profitability

    Here are five ways a positive employee culture can translate into increased profitability for ambulatory surgery centers. By Laura Dyrda -
  • Outpatient Caregivers in Short Supply, Says Saint Louis University Physician

    Frederich Scheuning, MD, recently said that the St. Louis area is suffering from a paucity of outpatient providers, following the opening of Saint Louis University's new outpatient bone marrow transplant center, according to a St. Louis Beacon report.  By Rachel Fields -
  • How Much Does Your ASC Spend on Employee Salary & Wages? 16 Statistics

    Here are 16 statistics on employee salary and wages in ambulatory surgery centers, according to the VMG Health Multi-Specialty ASC Intellimarker 2011. Note: All numbers are averages.  By Rachel Fields -
  • Indiana's Shoreline Surgery Center Receives Community Improvement Award From City

    Shoreline Surgery Center, part of Porter Health in Portage, Ind., recently received a "community improvement award" from the Greater Portage Chamber of Commerce, according to a LaPorte County Life report.  By Rachel Fields -
  • Private Equity Firm Invests in SRS

    Electronic health record technology and services company SRS has received a substantial investment from Thoma Bravo, a private equity investment firm focusing on information technology.  By Laura Dyrda -
  • 5 Big Challenges ASCs Can Solve With Healthcare Information Technology

    Dan Short, Vice President, Sales for Medical Web Technologies, outlines five major challenges ambulatory surgery centers face and how health information technology platforms can provide an efficient and cost effective solution.  By Laura Dyrda -
  • 8 Steps to Implement a Successful Surgery Center Bonus Program

    A bonus program can incentivize good behavior and reward employees for meeting targets critical to a surgery center's profitability. Here are eight tips from MedHQ's John Merski Jr. on how to implement a successful bonus program that improves employee performance without breaking your budget.  By Rachel Fields -
  • Dr. Christine Cassel Appointed President, CEO of National Quality Forum

    Christine K. Cassel, MD, has been appointed president and CEO of the National Quality Forum, effective mid-summer 2013.  By Sabrina Rodak -
  • Timeline for the Transition to an EMR: During Integration (Part 2 of 3)

    This is the second in a three-part series on the different stages an ambulatory surgery center goes through when switching to an electronic medical records system. Part one appeared in the October issue of Becker’s ASC Review and on www.beckersasc.com.More ASCs are making the switch to electronic medical records to take advantage of the myriad benefits an electronic system provides to patients, physicians and staff. But making the switch requires more than just a flip of a switch: it requires buy-in from leadership and staff, careful planning and ongoing collaboration between the ASC and its EMR vendor.There are three stages inherent in the transition to an EMR: before, during and after integration. In this part of the series, we will discuss the second stage, or the series of events that take place from the beginning to the completion of the system’s implementation. There are 10 steps your ASC will need to take during this stage to ensure a smooth implementation that will have your facility immediately reaping the rewards of the EMR system.1. Kick off the project. The beginning of implementation establishes a plan for the entire implementation process. The project kickoff begins with your EMR vendor meeting with the project leaders — those staff members who will work closely with the vendor during implementation. This may include a staff member designated as a project manager, or may include the clinical director, administrator, a few nurses, a physician and a representative from anesthesia. These leaders are not necessarily all of the “super users” discussed in part one of this series, but there may be some overlap.Working with these project leaders, the EMR vendor will review any previously gathered information on your operations for accuracy, and may request additional details. Then the leaders will work with the vendor to target a feasible golive date. This is accomplished by determining your “go-live requirements.”Go-live requirements focus on who you want using the system at go-live, which is typically a combination of nurses, surgeons and/or anesthesiologists. You will also determine what parts of the system your ASC intends to use immediately after the system goes live and those features you plan to use later. An EMR system has many components, and most ASCs choose to use only some of them at the beginning and then slowly incorporate others.You will then choose a go-live target date. There are two types of go-live dates: a “hard date” and a “soft date.” If your ASC is a new facility under development and will open on July 1, for example, it would make sense to set a hard date of July 1 for the EMR’s go-live so the day your doors open, your EMR is operational. If your ASC is already operational, a soft, flexible date is more practical as it allows for adjusting the date. It is better to delay your go-live than rush to meet an unrealistic date.Once this date is chosen, you will work with the vendor to plan the project backwards, identifying significant target dates during implementation, developing realistic expectations for the implementation process and holding an orientation to discuss the different phases of implementation. This orientation will likely touch on many of the steps we will discuss in the rest of the column. It is important to note that these steps — the phases of implementation — are frequently concurrent.Note: In addition to working with your EMR vendor during implementation, you will need to involve the vendor supplying and setting up new computer hardware. The date your hardware is ready will often affect the go-live date, as a number of the steps described below require use of the hardware.2. Install software. Working with your ASC’s IT staff/vendor, the EMR vendor’s technical team will discuss your ASC’s server capabilities and then install its software and databases to your server. This is typically a short process.3. Perform facility assessment. Your EMR vendor will work with your staff to review information on facility workflow and personnel roles. The vendor will discuss how the system and supporting hardware will impact your operations. An EMR will improve your efficiency and reduce the time needed to perform many tasks, so you should use this discussion to start considering changes to make to your ASC’s workflow and staff responsibilities to maximize the system’s benefits.4. Gather and review business and clinical documentation. If the EMR system you choose incorporates your ASC’s documentation into the software’s database, you will need gather all your business and clinical documentation and provide it to your vendor. These documents will likely include your ASC’s consents, pre-op phone call questions, patient instructions, anesthesia records, physician orders, discharge instructions and medication formularies.Before you provide these documents to the vendor, analyze them and determine whether these documents can be improved. If you want to change a document, this is the optimal time to make a revision so the improved document and process becomes the new standard in your EMR system.5. Build database. Once your ASC provides the business and clinical documentation to your vendor, the documents are built into the EMR’s database. The vendor will then take your ASC through the software and show how your documentation is accessed and populated in the system. During this step, your ASC may still have the opportunity to make electronic revisions to the documentation and activate some of the EMR’s features to further improve your documents.Your EMR vendor will also teach you how to add documents to the database so you understand how to maintain your database going forward.6. Undergo training. Once the database build process is far enough along (it doesn’t need to be complete), your EMR vendor will work with a team from your ASC to simulate a real case moving through the system. This team, sometimes referred to as an advisory committee, will involve individuals from throughout your ASC who can complete the documentation during each part of a case.It is during this mock case — and perhaps throughout your training — that a staff member previously assigned to completing a task involving a paper record is no longer the most appropriate person to complete the same task using the electronic record. This is another opportunity to analyze your workflow and staff responsibilities to identify areas for improvement.After the mock case simulation is completed, your EMR vendor will train other staff members on use of the system. This will include simulated experiences based upon the specific responsibilities of staff members and training on different EMR applications. Your vendor will work with your ASC’s administration to schedule the most appropriate times to train different members of your team to limit the impact of taking staff away from other responsibilities.7. Create charting policy. After the database build is complete and you learn more about those EMR applications that you designated for immediate use, you will create a policy that assigns completion of the different components of the patient chart and use of these applications to specific staff. While many responsibilities will not change, you may reassign some tasks to further improve workflow, and you will identify who will use new applications. For example, if you start to use a pre-admission questionnaire included in the EMR, you need to determine who will perform this new task.8. Fix issues. Until you start to test and train on the system, it is not unusual to encounter some issues in areas like hardware, workflow gaps and improper device implementation and placement. Throughout the implementation process, you and your EMR vendor will assess your progress and identify any problems to fix or changes to further improve your operations.Prepare your staff members for the possibility that not everything will go exactly according to plan, but if they maintain a positive attitude and assist with fixing issues that do arise, those obstacles will not hinder the implementation process.9. Go live. The approach ASCs take to their go-live is different for each facility. It will be up to you, discussing options with your vendor, for how to proceed on the first day using your EMR for real cases. For example, you can use your EMR for all of a day’s cases or a single case. You can select individual staff members who are comfortable with the technology to use the system or have all of your staff on the system. If you have multiple operating rooms, you can choose all of them to use the system or have a phased-in approach where just those you identify as having the strongest users go live on the first day.Once these decisions are made and the go-live date arrives, you and your EMR vendor will perform a final onsite walkthrough, and the vendor will shadow users within each department to help ensure a smooth transition to the live system.10. Celebrate! When you make the switch to an EMR, you are investing in a resource that will significantly improve your operations and the experience of your team and patients. Since the preparation for and the implementation of the EMR system requires significant time and energy from all of your staff members, celebrate their effort, and recognize the commitment of those team members who led the way to making your surgery center an even better, safer and more efficient place to work and receive care.Joe Macies is the CEO of AmkaiSolutions, software/services provider to the ASC industry and its affiliated practices and clinics. The company’s AmkaiCharts EMR, together with the AmkaiOffice administrative program, provides a comprehensive, fully integrated solution designed for the specific needs of the ASC. Learn more at www. amkaisolutions.com. By Joe Macies, CEO, AmkaiSolutions -
  • Timeline for the Transition to an EMR: After Integration (Part 3 of 3)

    This is the third in a three-part series on the different stages an ambulatory surgery center goes through when switching to an electronic medical records system. Part one appeared in the October issue of Becker’s ASC Review and on www.beckersasc.com. Part two appears on p. 29.In this final part of a three-part series, we will be focusing on the third stage of an ASC’s transition to an EMR — the period after integration. There are five steps your ASC should take during this stage, when you will continuously work to maximize the benefits of the investment in the EMR and ensure all staff members are using the system properly.1. Reevaluate education and perform follow-up training. Very few ASCs will utilize every feature of an EMR on the day the system goes live. An EMR has numerous tools, and learning about these resources and how to use them effectively during initial training, and retaining this information can be a challenge.Once you are comfortable with using the tools learned during initial training, your EMR vendor will return to your ASC to discuss your staff ’s experience and address any questions or redo training in specific areas. Then you will put your team, primarily the “super users” discussed in parts one and two, through training on the additional EMR features you want to incorporate into your operations.2. Train new employees. When new employees join your team, they will need to receive EMR training. This is where your super users come in. As with any employee training, set aside sufficient time for your super users to train new employees on using the system. They should start slowly, covering the essential components at the beginning, and then gradually educate them on the specific components of the EMR that will become their responsibility.If your ASC experiences significant staff turnover and your super users are challenged to educate a large number of new team members, ask your EMR vendor to send a few representatives to your ASC to conduct on-site training.3. Workflow remediation. When you switch to an EMR, your ASC will assign staff members to new tasks and will likely reassign some responsibilities in an effort to improve workflow. If any of these assignments do not improve your operations, work with your team to reassign responsibilities to better optimize workflow.4. Undergo upgrades. Like most software, your EMR will undergo periodic upgrades. When your vendor informs you about a planned upgrade, learn about the improvements and new features prior to the upgrade. Request educational materials from your vendor on the changes; these materials may include documentation, pre-recorded videos, and live webinars providing a walkthrough of what will change with the upgrade.When it’s time for the upgrade, work with your EMR vendor to schedule it during off-hours. After the upgrade is completed, explore the new features as soon as possible so the education you received on the changes is fresh in your mind.5. Expand your use of the system. As we mentioned earlier, it is worthwhile to examine the ancillary features of the EMR that are not being utilized by your ASC and determine whether these resources should become a part of your operations. This philosophy is also true for new features introduced during upgrades.Remember not to rush incorporating new features. Ensure your staff members are comfortable using the current features first. If you introduce a new resource at the right time, your team will be ready to embrace the change and the tool will contribute to the improvement of your ASC’s workflow.Making the switchMaking the switch to an EMR is a gradual process, and one that requires an ASC-wide commitment, teamwork and patience. But once the switch is made and integration completed, ASCs will find their effort and the investment in the system pays immediate, significant dividends as an EMR allows them to work smarter, more efficiently, reduce costs and provide better care to their patients.Joe Macies is the CEO of AmkaiSolutions, software/services provider to the ASC industry and its affiliated practices and clinics. The company’s AmkaiCharts EMR, together with the AmkaiOffice administrative program, provides a comprehensive, fully integrated solution designed for the specific needs of the ASC. Learn more at www. amkaisolutions.com. By Joe Macies, CEO, AmkaiSolutions -
  • U.S. Rep Introduces Legislation to Help ASC Physicians With EHR Requiremets

    U.S. Representative Diane Black (R-Tenn.) introduced the Electronic Health Records Improvement Act this week, which would provide a temporary solution to ASC physicians facing penalties under CMS' EHR incentive program, according to an ASCA report.  By Rachel Fields -

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