today's surgicenter Roundtable: Information Technology

Information technology (IT) is a vital part of any successful ambulatory surgery center. With the rise in going paperless via electronic records and the need to provide a fast, convenient experience for the patient, the right IT system can make for a seamless trip for both physician and patient, while maintaining the highest amount of security possible.

today’s surgicenter spoke with four experts to give their insight into the importance of information technology in ASCs: Donald Fallati, senior vice president of marketing at Amkai, LLC; Ron Pelletier, vice president of market strategy at SourceMedical; Raj Tuli, CEO and managing director at Mednet, LLC; and Jeff Blankinship, president and CEO at Surgical Notes.

With the push by the federal government to have all medical centers and ambulatory surgery centers use electronic medical records (EMR), how is your company helping to make the transition go more smoothly for your clients?

FALLATI Surveys of EMR adoption consistently find that the leading barriers are cost and perceived difficulty of implementation. We attempt to address these concerns in several ways. First and foremost, we put ASCs in touch with our many EMR users, who provide peer-to-peer advice not only on the benefits that an EMR brings, but also on tips and tactics that promote smooth implementation and adoption. There is no better way to convince people that EMR technology is beneficial and practical today, then showing them successful implementations.

Second, we address the investment concerns both by working with the client to detail expected ROI, and by offering flexible pricing programs that allow the ASC to acquire the technology affordably and comfortably.

Third, having done many EMR installations, we have built a set of best practices on how to prepare for, implement and train users and organizations to achieve their EMR goals smoothly. ASCs adopting today are thus the beneficiaries of the knowledge gained from many previous implementations.

Finally, Amkai has been developing the EMR for many years and continues to enhance its software to address the very specific needs of outpatient surgery, while keeping current with changing regulations and requirements in the industry. We believe this factor is crucial in adoption. Too many ASCs have been turned off to the idea of an electronic record because they have seen “generic” software attempt to be force-fit into the ASC environment with poor results.

PELLETIER Several important initiatives and strategies have been put into place within our organization to facilitate the implementation process and ensure our clients’ needs are met. First, we have built a state-of-the-art learning center – which includes a mock ASC. We believe that focused classroom training for key individuals is a critical key to success.

From an operational standpoint, we believe having the right team in place to support our clients through each stage of the project is of the utmost importance. To this end, we have designed a process and built a dedicated team where skills are carefully matched to each stage of delivery. This includes adding staff members with proven track records and extensive experience implementing clinical systems or working as care providers in ambulatory surgery centers.

While having the right people is critical, we have also employed the latest technology and design strategies into our Electronic Health Records (EHR) products. Perhaps the most important example of this is the fashion in which the EHR is integrated with the other systems in use within a facility. Our solutions are completely integrated, resulting in improved ease of use, reduced infrastructure costs and the elimination of duplicate data entry and the headaches often associated with running disparate systems.

Lastly, our exclusive focus on the ASC market allows us to concentrate our efforts, leading to a product that is a perfect fit for a surgery center, and not a modified platform that never quite meets expectations.

BLANKINSHIP Surgical Notes has introduced VMR Express. This exciting new software application allows ASCs to ease into the EMR requirements. VMR Express is a Forms Generator and Document Imaging Solution. The product allows ASCs to print forms and create chart packs that include patient demographic data without the use of sticky labels. We have a strategic partnership with SourceMedical and other vendors that allows us to pull patient data directly from the practice management systems (Advantx, Vision, SIS). And once the chart pack makes it through the surgery process all forms are simply scanned back into the VMR Express system for easy storage and retrieval. We have been able to save facilities thousands of dollars and increase reimbursement by eliminating errors from data transposition.

TULI We have document management, patient records including the financial and clinical records already built into the application as part of EMR.  Additional features of EMRs are currently being built and will be deployed by the end of the year.

Patient privacy appears to be a big issue when it comes to EMRs. What is your company doing to keep patients’ records secure and private?

PELLETIER We employ a comprehensive range of techniques and strategies to this end. For example, our systems have very granular and thorough security access checkpoints, which ensure that only those users that have a need to access information can do so. In addition to preventing inappropriate access we have implemented other crucial security protocols, including failed-attempt locking, mandatory password changes and support for industry-leading data encryption. Finally, having comprehensive auditing capabilities available to round out the package.

FALLATI It is a common misconception that electronic charts are not as secure or safe as paper charts — nothing could be further from the truth. Health care organizations in New Orleans lost hundreds of thousands of paper charts during Katrina; but no electronic medical records were lost. In fact, there was a specific program to increase the adoption rate of EMRs in Louisiana after the hurricane. Everyone has seen charts stacked on desks, on carts and other unguarded areas where anyone can look at them. A well-designed EMR restricts access and even keeps track of anyone who looks at a chart.

In addition to having core security functionality such as robust password protection and encryption technology, we have developed an internal messaging system that permits the communication flow that exists between the departments of an ASC while protecting patient health information. The messaging module does not rely on a standard email client as many such systems do, so there is no danger posed by exposure to the public Internet. In addition we have a comprehensive audit trail that tracks all interactions with the system, recording even just an attempt to view a record.

TULI Our application is built on a secure Microsoft .Net platform. Our hosted servers are SSL 128 bit encryption. In addition, we have features built into the application that maintain the security of patient information. Features include IP authentication, screen lock and user rights and alerts.

BLANKINSHIP Surgical Notes takes privacy concerns very seriously and strictly adheres to the rules governing the Health Insurance Portability and Accountability Act (HIPAA). All of our systems are fully HIPAA compliant. We are constantly retraining our staff to ensure full compliance with the HIPAA guidelines.

What new innovations in IT will be a factor for ambulatory surgery centers?

BLANKINSHIP The price of digital storage space has come way down over the years. This price reduction allows facilities to large amounts of data much more affordably. By storing digitally these centers can more easily access their records and now for less cost. I really think with the new EMR mandates that digital records storage is becoming the standard.

PELLETIER Surgery centers will continue to expand upon their use of the Internet to drive operational efficiency and improve service to their patients and physicians. Web-based tools that connect providers, patients, payers, and all stakeholders will become absolute necessities. We are already seeing how facilities are benefiting from the use of WebSuite, our new Web-based scheduling tool, SourcePlus Passport, our online patient portal for pre-assessment interviews, and EdgeSurvey, which provides electronic satisfaction surveys at a fraction of the cost of paper surveys with improved response and benchmarking. By leveraging the Web, we have many similar innovations launching in the coming months.

TULI “Business Process Applications,” providing features to better manage and streamline your day-to-day processes, creating cost efficiency and reimbursement maximization, helping to increase profit margins.

FALLATI Looking ahead, we see these areas, among others, achieving significant usage and benefits:

• Barcoding and RFID. There are many uses for these technologies, most notably in inventory management and in medication management. The ability to track key items electronically and in fully integrated fashion with the electronic health record system creates tremendous opportunities for cost savings and efficiency. Perhaps even more important, these technologies promote patient safety because they are highly accurate and consistent.
• Direct Patient Information Capture. Whether through a waiting room kiosk or a secure Web portal, ASCs will increasingly use technologies that permit patients to complete questionnaires and convey necessary information to caregivers. Such technology also helps to automate today’s manual process of calling patients, saving valuable staff time. Advocates believe that patients are more thorough, accurate and honest when allowed to provide personal information in this fashion. Moreover, patient satisfaction tends to be high when healthcare institutions allow this type of interaction. Kiosks are also beginning to use technology that allows credit cards to be swiped in order to check automatically with the patient’s insurance carrier and even pay the co-pay or other balance. These technologies are also ideal for post-op and patient satisfaction surveys.
• Data Mining. The real long-term promise of discrete data electronic health records stems from the fact that, unlike traditional narrative or forms-based information, they create structured data. As a result, the data can be accessed easily, combined with other data and mined to uncover patterns and draw conclusions. There are many benefits to such analytics, ranging from improving ASC profitability by being able to spot trends and inefficiencies, to creating management dashboards and contributing to the goal of better care through evidence-based medicine. Creating rich, structured electronic data will also ease the burden of meeting the rapidly growing government and third party reporting requirements.

How do you see the IT market developing in the future for the medical industry?

BLANKINSHIP Surgical Notes has been working on a few new medical industry ideas. One that I am very excited about is not quite ready for market yet, but will revolutionize the way patients manage their medical records data. Our new Web based system, My Doctor’s Notes, is a personal health portal for the general public. It allows the user to store their private medical records on a server for easy access. The records can be downloaded to a new physician or just stored for safe keeping. There are many ideas that will come from this single application, but that is all I want to say about it for now. It’s still a work in progress.

FALLATI Healthcare IT will continue to drive greater automation of the many manual processes that still dominate in facilities today. This automation will increasingly move beyond just the administrative side of the organization to include more of the clinical functions as the demand for increased care quality and patient safety grows. A major development in pursuit of this automation will be using the advanced Web tools and functionality coming into strong usage across many industries and applications. These tools will enable healthcare to achieve “anytime, anywhere” access to rich information in affordable, easy-to-use ways.

We also feel that healthcare will continue to move toward and require a comprehensive view of information management. Systems will need to ensure that information capture gaps are not permitted, and that information does not remain in inaccessible silos.

PELLETIER True peri-operative EMRs dedicated to the ASC space will take front and center stage. With data collection around quality measures and outcomes monitoring becoming increasingly important in the ASC, the current myriad of non-specialized EMRs designed for practices or other markets, and which struggle to fit within an ASC, will diminish. Facility operators will demand an EMR that is designed and optimized exclusively for an ASC and will desire an EHR that is developed and supported by a single vendor.

In addition, as consolidation in the market increases, true enterprise-based solutions, which we define as a single server and database supporting multiple facilities, including an inherent ability to roll-up and standardize data, will be a requirement of management companies with 10 or more facilities.

TULI The medical industry in this country is about 10 years behind in information technology. With new awareness, more and more providers are going to move to newer technologies that will provide them with hands-on tools to improve efficiency and provide better patient care.

Tell us about any new products, technology, etc. that your business is introducing or developing that will help the IT market?

TULI Medical Inventory Reporting Application (MIRA) is a medical supply chain management application, and Online Ambulatory Surgical Information Systems (OASIS) is a full ASC management application. Both MIRA and OASIS are fully Web-based applications, with minimum IT infrastructure requirements.

MIRA is a complete supply chain management application like no other in the industry.  The application manages perpetual, just-in-time and periodical inventory system with checks and balances in place to better manage your supply chain management requirements. The application includes features such as barcodes to manage various inventory functions; an Electronic Data Interchange (EDI) to submit PO’s and receive confirmation, an accounts payable interface to work with an accounting application, and many others.

OASIS is a full ASC management application with many detail features never available before. OASIS is built by users, for users.  Some of the more detailed features include insurance contract management tools, document management, reimbursement maximization tools, and a full supply chain management tool. 

PELLETIER As mentioned earlier, our technology platforms are enabling us to move in exciting new directions by fully utilizing the web and more easily integrating and sharing information across the enterprise. We are launching products that will simplify and streamline the manner in which patients, providers, payers, and facilities communicate and share information.

By encompassing what have historically been many disconnected systems and processes into centralized and synchronized systems, the efficiencies that will be realized will be unprecedented. For example, by automating and allowing clinical documentation and transcription to flow electronically into a patient chart, a facility can eliminate the labor intensive process of chasing paper, faxing, and phone tag. Simply put, computers are tools and we have the experience and technology to put them to work for our customers.

FALLATI Consistent with our view that a single-vendor comprehensive information management solution is what is needed, we have just recently introduced AmkaiEnterprise 2.0 which provides a modular approach consisting of a next-generation administrative management system to replace legacy software widely in use today and an EMR with many new features and that fully integrates with the management system. We think this product portfolio finally gives the industry tools that resolve the many deficiencies of existing systems.

BLANKINSHIP We are mostly in the business of using technology to help the ASC industry. Our focus in purely ASC driven.