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covenant surgicalKathy Allison, MHA, BSN, is vice president of Covenant Community Pain Solutions for ambulatory surgery center owner and operator Covenant Surgical Partners. Covenant has partnered with AmkaiSolutions since 2009.

Q: Covenant uses the AmkaiSolutions family of services, including the AmkaiCharts EMR system and AmkaiOffice management and clinical software solution, throughout its clinical ventures. You've been with Covenant for about a year. What has been your experience with AmkaiSolutions?

Kathy Allison: Every place we go, Covenant may have a surgery center that does plastics and orthopedics cases; another one that does only GI cases; another one that does GI and pain; and maybe one that does just ophthalmology. Our business is not a cookie cutter-type of business, and that's not a problem for AmkaiSolutions as its services have flexibility so we're not using a cookie cutter format.

We've been able to customize all of the clinical elements — the pre-procedure, post-procedure and intra-procedure documents — to whatever the specialty is, whether its pain-specific, GI-specific, orthopedics-specific, etc. When you can build documentation unique and specific to a specialty, when you have that kind of flexibility, it provides a strong platform to work with.

The staff members working these cases don't have to do workarounds. For example, if they're working on an ophthalmology, plastic surgery or pain case, there's no need to work within a format designed for GI. AmkaiSolutions has offered us that flexibility to be clinically specific in whatever the specialty is, and that makes a big difference for the clinical team.

Q: How else is this flexibility you note valuable, particularly for pain management?

KA: That makes a big difference for the clinical folks especially in situations such as pain and an established pain center like we have in Bethesda (Md.) and Paramus (N.J.) where they have expert interventional pain specialists and a crackerjack staff. They are accustomed to providing great clinical care but they move fast. Time is money. They don't want their patients waiting; they want to get through their work day as efficiently and expeditiously as possible. There's not a lot of time in between cases or even during a case to sit there and say, "How can I work around this very poor template that is not designed for pain?"

Not only do we have the opportunity to build specialty- and procedure-specific templates, we can also do what are essentially physician-specific templates. For example, if you have a physician who likes to start all procedure notes with "The patient was placed in the prone position" and another physician who starts all procedure notes with "After examining the patient and discussing the risk and benefits of the procedure," you can design every procedure note associated with the physician to start with that verbiage. There are key elements that have to be in every clinical note in order for it to be a viable record, and we can capture these while customizing the record to each physician's unique expectations.

With AmkaiSolutions, if staff members of the center are operationalized appropriately and able to get a majority of their pre-procedural phone calls made, then they're able to receive a lot of the information on the front end before the day of the procedure. That really supports efficient, smooth processing through the day of the procedure. That's part and parcel of running a good ship.

This is also a satisfier for the patient and a satisfier for the staff. Anything you can do to streamline the processes and still meet the demands of the payor — to ensure you capture all of the elements of an accurate and complete medical record — is tremendously valuable. For us, with AmkaiSolutions, we're able to capture the elements unique to a specific patient for a particular procedure and avoid wasting time gathering information we do not need. If a patient is having a pain procedure, we don't necessarily need to know they were pregnant 25 years ago or they had gall bladder surgery 30 years ago. What we need to know and identify is how their pain is currently, what medications they are on and have they followed the physician's instructions, as opposed to if you were doing a plastics case you would probably want to know other elements that would be unique to plastic surgery rather than pain management.

With AmkaiSolutions, we have the flexibility to provide that pain-specific template to the staff; this makes their workday more productive and effective, and the trickle-down effect impacts efficiency, patient and staff satisfaction and the ability of the ASC to driving good financial outcomes through high quality clinical outcomes. 

Q: Earlier this year, Covenant Community Pain Solutions opened its first program in partnership with Wayne County Medical Center in Waynesboro, Tenn. This program — Wayne Community Pain Solutions — went live in May. You witnessed a facility receiving its first EMR — AmkaiCharts — at this time. What was the experience like?

KA: Some of the folks at Wayne Medical Center had no experience with an EMR. We brought in AmkaiSolutions, and it was initially a challenge for the team involved with program due to their minimal exposure to EMRs. We negotiated with the CEO to make sure they had time to practice before we went live with the program. They spent a good amount of time with AmkaiCharts and they learned the system.

Now they're very adept six months down the road. Interestingly enough, over the summer, the hospital started its in-house systems implementation using a hospital vendor. The staff has shared with me how much easier AmkaiSolutions is from the clinical side than the other vendor. They say that it's much more user-friendly and intuitive, and they're able to navigate through things in much more efficient manner. That's been shared with me by more than one of the staff members; in fact, I've heard that from most of the staff members. The physicians find the program easy to use and are proponents of an EMR.

Q: How else is Covenant Community Pain Solutions working with AmkaiSolutions?

KA: For the community pain program specifically, AmkaiSolutions is in the middle of building for us a Brief Pain Inventory, or BPI. It's an internationally known validated instrument to ascertain folks who are experiencing chronic pain and their level of pain. You can look at these patients over time and be able to assess true outcomes data with a robust, validated tool. You can answer questions, including "Are we making a difference with this particular person at this particular center?" With the BPI, you can conduct comparison benchmarking from one center to another; you can do a best practice analysis and compare outcomes and approaches of one physician to another.

I'm very excited about that. For community pain, we'll be using that BPI tool as soon as it's rolled out, likely in early 2013. We'll be able do some quality benchmarking. At some point, I expect payors to say, "Show me where you've made the difference," and I want Covenant to be ahead of the curve when we hear that question. If for no other reason, I want to have the ability to benchmark and help those centers or folks who are not moving the program through effectively and have the outcomes they are looking to achieve.

If you do not have data, you just have anecdotes. When you have hard, internationally recognized, robust, validated instruments that you're using, then the arguments are easier to make that your data is accurate and correct. I feel as though we're going to have to prove that we have efficacy in what we do, and I wanted to make sure we were as prepared as we possibly could for whatever we may face. Through the BPI built by AmkaiSolutions, we will be able to do that.