“If physicians and ASCs aren’t automated on the front end, reporting can’t be automated on the back end,” says Marion Jenkins, PhD, CEO of QSE Technologies. “It’s that simple.”
Interestingly, those physicians who are automated are happy with it.
“Physicians who use [EHRs] believe such systems improve the quality of care and are generally satisfied with the systems,” write the authors of the study. “[They] reported positive effects of these systems on several dimensions of quality care and high levels of satisfaction.”
“Electronic Health Records in Ambulatory Care ? A National Survey of Physicians” assessed physicians’ adoption of outpatient EHRs, their satisfaction with such systems, the perceived effect of the systems on the quality of care and the perceived barriers to adoption. Just 13 percent of the 2,758 physicians surveyed reported having a basic system; primary care physicians and those practicing in large groups, in hospitals or medical centers, and in the western United States were more likely to use EHRs.
Dr. Jenkins says that, in order to be ideally suited for the challenges posed by quality reporting, ASCs would be equipped with hardware and software for the following tasks.
1. Getting the data in. Tablet PCs, scanners and cart-based workstations that let staff enter data to the health record at the point of care would ease data collection most, because this method avoids the data’s being non-digital in the first place.
“You have to have technology close to where the person, event and, therefore, data are,” says Dr. Jenkins. “Otherwise they are writing things down at the point of care, then entering the information later. This increases the chance of misinterpretation and error, not to mention it’s time-consuming. Duplication of effort and transcription errors are leading causes of inefficiency and higher healthcare costs.”
Further, there should be templates for entering information from the procedures themselves.
“Doctor 1 can’t be dictating free-form prose in his style while Doctor 2 is dictating in his style,” says Dr. Jenkins. “But templates exist for orthopedics, ophthalmology and other specialties, and you can customize them for your facility. If you take the time on the front end, and the result is clear operative notes that you can come back later, query and get usable information, it’s well worth it.”
Digestive Health Specialists has a system that requires entry by both physicians and nurses at the time of each patient encounter. This lets the center track GI best-practice data such as arrival to patient in room; patient in room to time- out; time-out to scope in; scope in to scope-out; scope-out to recovery start; recovery start to discharge; and polypectomy rate.
“It’s all done basically in real time,” says Susie Ross, the center’s director of information systems. “So before each patient leaves, the data is captured and the operative and data reports are essentially complete.”
2. Preserving the data. While electronic records can free up space in your facility, you still need a secure physical location for servers to store and back up data. Generally, there is too much data to store it or back it up online. You also need to ensure that all data are HIPAA secure, meaning it is protected against loss or breaches (see the Jan./Feb. issue of Becker’s ASC Review for more on HIPAA security).
3. Delivering data back over the network. For the data to be any good, it needs to be accessible by business and clinical staff who need it, and easily searchable. This is where those templates come in, making it easy to find data. In addition, high-speed and wireless networks (complete with encrypted security, of course) are a must.
4. Mining the data. There is software that makes this process nearly instant ? you can analyze data for billing and collections, internal quality benchmarking and improvement initiatives, supply and case costs, and outside reporting. The only catch is, “if you don’t do steps one through three, four is impossible,” says Dr. Jenkins. “And because a lot of people aren’t properly accounting for one through three, four becomes so hard that you don’t get around to doing it, or when you do, it becomes a monumental exercise in playing catch-up.”
Whatever hesitation there may have once been at Digestive Health Specialists regarding switching from manual to computerized tracking and to EMR, it’s a thing of the past.
“The nurses love it,” says Chalene Wilson, RN, the center’s director of nursing. “Now, if you want to research something on a patient, it’s immediately available to you. For peer review, physicians review physicians’ records and we do nursing reviews on documentation. We used to pull stacks of charts and distribute them. Now, we just enter a list of names into the program, and it’s done. Electronic records are very helpful to ensure we’re meeting our own criteria.”
Various EHR systems are available on the market to provide you with these capabilities, either in full or by working in conjunction with add-on software.
So what’s holding ASCs back?
Aside from a general technophobia, says Dr. Jenkins, “some centers don’t believe in the dollars-and-cents payoff.” The NEJM study concurs: “Financial barriers were viewed as having the greatest effect on decisions about the adoption of electronic health records.”
“To be profitable, you need a high ratio of billable to non-billable staff; in healthcare, you usually have three support staff to one billable staff (the physician),” says Dr. Jenkins. “If healthcare followed the lead of other industries like retail, hospitality and transportation and spent the money to get itself automated, there would be fewer non-billable people, which would be a huge long-term savings. At first, it seems much more palatable to hire another person for $4,000 a month than to spend $250,000 for a full EHR system. But if you hired someone last year, another this year, and have to hire someone next year, you’re going to end up spending more; the only difference is that hiring more staff is a slow death.”
While ASC advocates are working to ensure that CMS’s quality reporting requirements don’t impose an undue burden, it will still result in some extra work for facilities.
“A lot of ASCs have been tracking data because they have to, but at survey time, it’s been the medical version of April 15,” he says. Now, as unannounced surveys are becoming the norm and the federal government is demanding more transparency, “it’s time to embrace the quality, cost and efficiency that EHRs offer.”
Ms. Ross agrees: “Especially in the new transparency environment, there’s more information to collect. Down the road, who knows how that will change workflow and make us even better?”
