Feeling confused by the electronic medical records options for ASCs? Overwhelmed by the wealth of sometimes-contradictory information and opinions? Based on 20-plus years’ experience in healthcare and information technology, I’m going to share what I’ve learned — and, more to the point, what you need to know — about EMR implementation in ASCs.
1. Hardware might be your biggest challenge.Tablet PCs, integral to the use of EMR, remain too expensive — still more than $1,000 in most cases — for most ASCs to afford as ASCs are, at their heart, small businesses. Regular PCs are a dime a dozen; you can buy them fairly inexpensively and even keep two or three extra lying around in case one breaks — you needn’t be offline very long (unless your file server is the problem, but that’s another story entirely). Tablet PCs are still too expensive, and the technology is still too unreliable for that, not to mention they got dropped a whole lot more than desktop PCs. On top of that, you have the challenge of maintaining passwords and making the transition employeefriendly. To meet all these challenges, you need an expert.
2. But that doesn’t mean you should be the expert. At one Northeastern U.S. ASC that implemented EMR, the person who became the expert was the administrator; as a result, all her other job duties fell apart. She was spending 16 hours a day just keeping the new system up and running. If you are going to do it right, you are, at the beginning, probably going to have to add one FTE, either to be your facility’s super-user, or to replace the super-user. Ideally, this dedicated person is a nurse, and that nurse is probably going to end up training other staff on the system full-time in the early stages.
3. Hire a consultant to help you with the process. Hire a company that’s going to help you through this process. Yes, your software vendor is going to be there to get you set up and to hold training in-services. But I’m talking about someone to manage that pesky hardware and infrastructure — someone who will set up your Internet and wireless access, file server, e-mail, faxing, security, HIPAA compliance, and hardware and software updates. For this job, I prefer to look local, because you’ll need someone who can be there if your system goes down.
And here’s 3a: Your system will go down eventually. And you need to be prepared with a backup plan: Know how you will switch to paper, who will do the data entry and how you will transition back when you system is up and running again. Support services can run about $150 per short visit, but if you want these system outages to be as brief as possible, build the cost into the EMR budget.
The good news is that, in every facility, somebody good at geeky stuff like this usually pops up at some point. And over time, this person may be able to step in to troubleshoot when you have a problem. If you’re really lucky, it’ll be the same person as your super-user. More likely, this will be someone separate who can handle networking and hardware issues on the spot, while your nurse super-user will handle any issues among staff with using the software correctly.
4. EMR won’t replace staff — but it will make your life easier. I’m not sure you’re going to achieve efficiencies with regard to smaller staff, but that’s not my purpose when I implement EMR in a facility. (If you’re going to trim staff, it will probably happen on the medical records side, not the clinical side.) The aim is to have a more accurate, complete medical record and to free clinical staff to do their jobs, rather than be tied up with data entry and paperwork.
Some of the improvements you’ll see:
• If you forget to fill out a box on the paper record, nothing happens. With EMR, the software will notify you and, in the case of critical information, prevent you from doing anything else until that information is entered or box checked.
• You’re going to find yourself significantly reducing the amount of writing you have to do and number of lookups you have to complete. The computer will do these for you.
• Spelling will be correct, and legibility — a huge issue in medical records — becomes a non-issue.
• You never lose the medical record, have to send it off-site or deal with the process (and expense) of having it sent back when a patient returns for a colonoscopy five years later.
• You will have some great capabilities and tools for change on your hands. With all the data elements EMR captures, you can do incredible research studies. Previously, trying to figure out which QI study to do next took three months of reading logs and records to see where there may be an opportunity. Then you had to get everyone to change practice in order to keep logs and records that track what they do on a daily basis; and after that, you had to tabulate the data. With EMR, all that data is there already, and captured as a matter of course. And a key benefit: You don’t get a bump from people who know that a QI study is going on. Under the manual method, if you tell everyone you’re tracking discharge times, for example, you might not get a real snapshot of what discharge times were when people didn’t think they were being watched.
• Perhaps best of all, EMR ends the ongoing fight between nurses, surgeons and anesthesia over who gets the medical record first. And no one can take a piece of the record out and put it back in the wrong place. Four people can each be on a computer, working on the same medical record — and getting it done more quickly. Speaking of speed, correcting and completing records at the end of the day is a snap: The reviewing nurse simply pulls up all the errors (for example, are you missing implants used during the procedure?), and makes corrections before forwarding the op reports on to billing. The turnaround to billing is fast, efficient and accurate, helping ensure you get paid in full in a timely manner.
5. You’ll still need a crack coder who works well off the reports. That being said, if you have a well-utilized EMR system, it’s a real boon to a great coder. Imagine the coder has some questions or doesn’t understand something or something’s missing from the op report — she can use the medical record to supplement what she knows about the procedure. She’s still coding from the op report, but now she’s got a better understanding of, for example, a new procedure.
Plus, coding and billing staff are quite adept with technology, because they’ve been using systems for years — they’re where nurses will be in another five years with EMR. And that’s when we’ll wonder how we ever lived without it.
Mr. Goehle (john@goehle.net) is a senior vice president at Facility Development and Management, which provides consultative, developmental and managerial services for outpatient ambulatory surgical centers throughout the United States.