Evolving Healthcare IT

By Kris Ellis and Jennifer Schraag

The evolving door of healthcare information technology (IT) is forever leaving new and exciting ways to ease the daily operations of an ambulatory surgery center (ASC). From implementation to security issues, all the way to the descent into electronic health records, IT is playing a vital role in keeping ASCs not only compliant to regulatory changes, but also state-of-the-art.

When looking to implement any IT system, Travis Maham, chief technology officer with Dallas-based Surgical Notes advises careful, calculated thought throughout the process. “They need to have a vision and they need to have a clear-cut plan on where they want to be and how they want to get there,” he advises.

“For a new center, they need to be sure they thoroughly research who they are going to choose as their vendor. They don’t want to paint themselves into a corner by maybe choosing outdated software, choosing something that may be cheaper the day that they purchase it, but 18 months from now they’re going to be in a corner as far as what they can do with that software. In a nutshell, one of the biggest pitfalls is not having a clearly defined vision and goal of how you want to use IT for your center. IT should be part of increasing your profits, not a loss for your center, and the way to do that is by investing in the right technology.”

Ron Pelletier, professional service director of Prescient Healthcare Systems, affirms that clinical and business management systems that are tailored to meet the specific needs of an outpatient surgical center can play a vital role in the operational success of a facility.

“Outpatient surgical centers have unique needs, processes, and policies that vary greatly from those of hospitals and medical practices,” he says. “To expedite any implementation and ensure a seamless transition, any system must be coupled with exceptional customer service, user training, and a partnership between the entire facility and the application provider.”

Important items Pelletier says to keep in mind as your facility undergoes a system implementation include:

• Ask questions and encourage your staff to do the same. Be certain that your vendor has experience implementing systems for outpatient surgery centers.
• Invest in both initial and ongoing training. The power of any system can only be realized if users possess a thorough understanding of the features and operation of the application.
• Prepare and plan for change, challenge, and disruption. A typical implementation project can span over a period of 8 to 10 weeks, allowing time for installation of equipment, training, and database preparation.
• Learning a comprehensive information management system, and updating your workflow and practices to best match the efficiencies of that new system, requires a substantial investment of time.

“Choose quality,” he says. “Invest in quality hardware and service plans to minimize the expense and disruption of excessive down-time.”

“Have a vision, have a goal, have a plan, and stick to it,” Mahem concludes.

About 2,800 patients who scheduled appointments at Ohio State University Medical Center on April 19, 2004 had their personal information posted on the Internet. The information included the patients’ names, addresses, phone numbers, date of birth, Social Security numbers, and reason for their visit. This is a perfect example of the types of things that can occur without proper security in place. Securing records is vital. IT can make or break a center’s adherence to privacy protection and HIPPA laws as well as disaster recovery protection.

“In an ASC you have a computer network and you should manage it as if it’s a computer network,” says Glen Pridgen, vice president/director of technology at Alliance Surgery, Inc. He notes that a basic network has three vital components – a firewall, virus protection, and data backup.

“It’s amazing how many centers leave virus protection up to the end user. What I mean by that is, if they install McAfee or Symantec anti-virus, that runs out after six months or a year and it becomes the end user’s responsibility to renew it or let somebody know that it needs to be renewed, and oftentimes they don’t do that. So after six months or a year you’re not protected from viruses.” Pridgen also cautions that back-up tapes must be verified as non-functional tapes would be useless in the event of a breakdown or emergency. “Normal network and business rules apply to an ASC – have a network and back it up.”

According to Scott Palmer, chief executive officer of Prescient Healthcare Systems, Prescient offers its customers a service called DataSecure. “On a weekly basis we can retrieve a copy of their database, verify the integrity of the database, and maintain a copy offsite. Prescient Vision database backups are crucial to a facility’s business operations and satisfy HIPPA requirements. Data is vulnerable to loss due to hardware failure, corruption, theft, fi re, and many other causes,” he says.

Mahem points out other areas to consider when looking into security aspects of an IT company.

“We address security from several different aspects – not only software, but physical security. We protect our clients’ data and information with biometric access controls to our facility with only authorized personnel having access to our actual data center.

“Administratively, we have an exhaustive list of policies not only for our internal users, but also our password policies are virtual private network (VPN) policies. Buyer’s protection policies, we have a guideline for everything we work around that our systems have to fi t in to,” he says.

As far as Surgical Notes’ software goes, “We can granularly control access permissions through our application to who can open a report, who can edit a report, who can electronically sign a report, even down to who can even print a report out through the system,” Mahem says. In addition, all data transmissions are encrypted.

Surgical Notes also offers an extensive disaster recovery plan. All of its production systems are backed up daily to a Network Attack Storage (NAS) unit, and then backed up to tape from that disk storage unit. “If we had a total system meltdown, we could be back up and in production within 20 minutes,” Mahem adds.

“There’s a small amount of software that’s specific to the market,” Pridgen notes. He says that he sees many ASCs choose management or billing software that is designed for a physician’s practice or a hospital, as opposed to software that is designed specifically for an ASC. This can be problematic, according to Pridgen, in that an ASC’s practice is often much different than a hospital’s or a doctor’s. “In situations where hospitals are managing a surgery center, normally they’ll take that ASC and they’ll drop them on to their hospital software and try to make it work, but they have almost zero reporting capability and they miss a lot of information that has to do with specifically running that ASC. Practice management software usually doesn’t accommodate preference cards, so they’ll keep their preference cards in a different system, and they’ll keep their inventory in a third system because it usually doesn’t accommodate inventory. So it really becomes a scheduling software and a billing software.”

“I’m also starting to see a lot of just-in-time inventory,” Pridgen says. “That way what would happen is, as the inventory depletes, it automatically generates orders out to McKesson or Broadlane to go ahead and fi ll those orders. Then they just send back a purchase order and the purchasing manager authorizes it. One of the biggest weaknesses in managing an ASC right now is managing the inventory. It’s cumbersome, and there are vendors that see some great opportunity in the ASC marketplace.”

Craig Veach, senior vice president at Amkai, says ASCs that use practice management software are missing out on many useful tools. “For example in scheduling you have the preference card capability; a good system that’s designed for an ASC will automatically bring along how long the surgeon takes to do that procedure, in a practice management system you just don’t get that,” he says. “It’s usually just a two-dimensional scheduling where you have either the room or the physician and the patient. In the system that was designed for an ASC, you’ve got three or more dimensions that are involved in that scheduling – you’ve got the room, the patient, the surgeon, supplies, equipment, and all that gets taken into consideration when you’re scheduling.”

Veach also reiterates the lack of ability to maintain just-in-time or real-time inventory when using an administrative system designed for a practice. “That also eliminates the ability for you to do costing analysis, which is critical in an ASC environment when you consider that reimbursement rates are not going to change for several years, and when you add inflation to it, in effect your reimbursement rate is actually going down,” he notes. “You have to be able to do costing analysis and identify areas where you can improve your bottom line, and ASCs really only have two ways to do that – number one, you can alter your product mix, in other words, do procedures that are more profitable, and the only way to identify that is through cost analysis. Or, you can become more efficient.”

In terms of electronic medical records (EMR), Veach explains that ASCs must be discerning in evaluating the options. “You have people who are just scanning existing paper documents and trying to represent that as electronic medical records and all that does is put your paper and instead of putting in the fi ling cabinet, it puts it on a computer,” he says.

“The other thing is some people are coming out with systems where they’ll tell you, ‘We can take exactly what you’re doing on paper and put it on the computer screen, so you don’t need to do it on paper.’ While initially that sounds somewhat attractive, it doesn’t bring any additional benefits to you such as patient safety or improved information collection, as well as being able to establish your own policies and procedures and adhere to those.”

More advanced EMR products can offer a wealth of other features, according to Veach. “A full EMR can produce what’s called a medication administration record (MAR) that keeps track of every single thing that’s given to a patient and is readily available to the clinical staff so they know exactly where they are on that whole process,” he says. This type of system may also be able to facilitate adherence to an ASC’s policies and procedures. “With a system like AmkaiCharts, you’re able to put within that system what your requirements are with policies and procedures and it prompts people to follow those. Because it has an integrated task list, it will even keep track of the records or the jobs that people have to do that aren’t completed yet, so management has clear access to that. Also, because you’re dealing with actual data, you can do an outcomes analysis of your clinical pathways so that if you want to do a study on a particular procedure that was done a certain way using this type of anesthesia, and a different way using a different type of anesthesia, you’re able to have the system present that data to you in an understandable format that can help you adjust your way of doing things to improve outcomes for the patient.”

It is also possible that making the switch to EMR can result in significant cost savings, according to Veach. “In a four-OR surgery center that we recently did a study on, they are spending in excess of $130,000 just to maintain their records. When they put our system in, including hardware, software, training, and everything else, they have a payback in about 14 months, and after that it only costs them about $19,000 per year to maintain their records. So if you amortize it over, say, a three-year period, every year people immediately begin realizing a 40 percent savings in their records costs.”

Scott Palmer, chief executive officer of Prescient Healthcare Systems, and Travis Maham, chief technology officer with Dallas-based Surgical Notes shares what’s hot in IT for the ASC industry.

Software as a Service (SaaS) – A shift is occurring in the way that software applications are purchased and delivered. Also known as “utility computing,” “application service provider,” and “subscription model,” the SaaS model allows an ASC to subscribe to a service that provides the facility with their application. Overall, the SaaS model offers significant benefits to the end user, including reductions in cost, risk, and the length of time it takes to recognize value from the investment.

Clinical and Business Integration – There is more emphasis on clinical automation. Combining clinical and administrative information in the same database removes duplicate data entry, facilitates timely and accurate reporting, helps manage quality and risk, and improves service to patients and surgeons.

Standardization –- Standardization on platforms between the different ASCs; especially from a development company standpoint. ASCs should move to standardize on the same practice management systems then move toward electronic medical records (EMR).

Paperless – The move to a paperless environment will create efficiencies and reduce costs.

Leveraging the Internet – We are just scratching the service in terms of using the Internet to increase efficiency, improve service, and reduce costs for ASCs, says Palmer. As an example, CTQ Solutions uses email to communicate with patients post-operatively, increasing satisfaction survey participation to an average of 60 percent versus the 30 percent typical of paper surveying – at a lower cost.

“We have a utopian vision of the Internet utilizing Web services to seamlessly, securely, and speedily exchange information between the ASC and its stakeholders,” Palmer says. “While today’s reality is more ordinary, we’re including the Internet in our product development strategies moving forward.”

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