The ASC industry is in a transitional period as healthcare moves increasingly into digital formats for managing health records and data — but some ASCs are still catching up to this trend.
According to the Ambulatory Surgery Center Association’s July 2025 survey, 76% of ASCs now use an EHR, up from 55% in 2021. The shift reflects growing consolidation, partnerships with health systems and payer pressure to provide better data.
Yet nearly 1 in 4 ASCs still rely on paper, and two-thirds of those plan to remain paper-based until regulations force a change. Cost is the top barrier to EHR adoption, with 49% citing expense as the reason for staying analog.
Jeanine Watson, MSN, senior manager of the ambulatory surgery division of the Association of periOperative Registered Nurses, told Becker’s that the technology divide among ASCs will create compounding issues for facilities in the years ahead.
“I think the biggest challenge for ASC moving forward is that most are still on paper and charting,” she said. “Now, they might scan it in and store it somewhere, and call that a hybrid electronic method, so you can go back in and see the scanned paperwork that has been done,” but their systems nonetheless remain largely unintegrated.
When CMS instituted its outpatient and ambulatory surgery consumer assessment of health providers and systems survey in 2025, many ASCs brought in IT vendors to help support the roll-out of patient satisfaction surveys, Ms. Watson added. But many ASCs found that “their IT platform was not structured to support it, and so it wasn’t just an implementation of a new program,” she said. “They had to start at the basic level of their IT program structure and build it from there.”
“I believe that’s going to be similar with electronic health records. ASCs are buying new equipment. They’re bringing in robots.They’re bringing in very advanced technology, navigation systems and integration systems. And those all integrate with each other, and usually they all connect with the electronic health record,” Ms. Watson said. “If you don’t have an electronic health record, you’ve got a stoppage to where that information can flow, and then you don’t have advantages of the data collection for the quality measures; all those tasks are still going to have to be done manually. And technology doesn’t like working with things that aren’t technologically capable.”
This transition will likely force ASCs to reevaluate many aspects of their organization’s digital hygiene and IT systems overall, she added.
“Cyber security is a major consideration for healthcare organizations of all sizes,” Ms. Watson said. “We’ve seen small orthopedic practices and orthodontic practices being hit with large ransom demands, and their systems are locked down, and their information is held for ransom.”
While cost is a significant barrier to EHR implementation, Ms. Watson said that investing in an EHR is also an investment in safety and quality for ASCs.
“An electronic health record is more than just storage,” she said. “You can implement safety alerts. If there are medication contraindications or medication allergies, your EHR is going to tell you that before you’ve ever given the medication. Whereas, if you don’t have it, that’s a manual process for your professional staff to monitor.”
Additionally, EHRs can help ASC leaders track metrics and data that become essential when negotiating contracts with payers or meeting mandatory reporting requirements.
“You’ll be able to pull data accurately and efficiently,” she said. “If you’re trying to pull data manually, you’re never going to keep up with it. It just evolves too quickly. Manual data collection is prone to errors, and this data is often used to determine the quality-reporting outcome measures for CMS.”
