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Mobile_Comms_Graphic-01.pngDuring National Health IT Week, we're kicking off a new blog series on using technology to solve common issues in outpatient facilities. Our first installment focuses on the challenge of communication between surgeons and ASCs.

As I travel each week and talk to SourceMed clients that entrust their Ambulatory Surgery Centers (ASCs) to our solutions, a common theme resonates through my discussions with administrators, business office managers, and surgeons – the importance of establishing a dependable communication method between the center and the surgeon and how challenging this can be. Many surgeons arrive at the ASC just prior to their procedures and then need to return quickly to their practice or hospital to attend to more patients, making it difficult for teams to adequately communicate. Phone and email communication provide basic blocking and tackling, but missed calls and email back-and-forth can be frustrating for the ASC and the surgeon, resulting in wasted time, delays and errors in scheduling and documentation. So what is an ASC to do?  

Three areas are resident in most of my conversations with leaders and physicians when I ask them “what are your top issues in 2016?”

  1. Getting dictated Operation Notes (Op Notes) completed, edited, and signed in a timely manner for coding and billing.

  2. Communicating last minute changes to the surgeon's schedule at the ASC.

  3. Messaging (texting) the surgeon in a HIPAA-compliant manner.


Time and time again, receiving timely and accurate Op Notes from the physicians is mentioned as a big challenge for ASCs. Op Notes generally need to be completed within 24 hours and the longer it takes to get from dictation to review and signing, the greater the delay in the coding and revenue cycle management processes. Many customers tell stories of having the dictation completed and printed out, and then put into the surgeon's 'mailbox' at the ASC. They come back in a week or two, make edits to the Op Note and then send it back to the medical transcription company, only to have it placed back into the surgeon's 'mailbox,' creating a cycle of delays that continues. Depending on how often that surgeon comes to the ASC, this process could take weeks.

Another communication challenge I hear often is ‘tracking down the surgeon.' Many ASC administrators and business office staff utilize the surgeon’s practice to coordinate patient scheduling and documentation needs, but at times they need to speak to the surgeon directly. While texting via mobile devices is an ever growing communication tool used by healthcare professionals, maintaining proper security protocols can be difficult when using basic applications.

It is well known that providing electronic patient health information (ePHI) over an unsecure (not encrypted) connection is a data breach, but many do not realize the steps to achieve proper compliance: All ePHI must be encrypted to NIST standards, reside in a secure network and only be accessible by authorized personnel with designated and secure access control (username and secure password), PLUS have an audit log of the conversation. A standard text on a mobile phone does not meet these requirements, nor do simple encrypted text applications, because the ASC does not maintain control and custody of the user groups, encryption standards used, or have full control of the audit log. (HealthcareIT.gov gives an excellent overview of the do’s and don’ts with mobile devices and it is well worth reviewing your ASC practices around the use of mobile communications.)

The same challenges reside in sending ePHI over email. If the providers are on the same encrypted email system, challenges are reduced if the IT Department or consulting firm have encrypted email communication, but more often than not, ASCs are communicating to other providers and surgeons on disparate and potentially unencrypted email servers. This requires a more intensive structure and IT teams working to setup a secure Transport Layer Security (TLS) that will encrypt ePHI not just over the internet, but also “at rest” on the respective email servers. The “open” email systems like Gmail or Yahoo! can do TLS encryption, but the issue there is that the respective providers do not have “custody” of those emails for future reference or auditing as required by HIPAA, making them not advisable for use. 

Fortunately, technology solutions are available that meet the proper security requirements and are easy to use, many that work with your team's existing mobile devices. When considering an application such as these, look for one that offers more than just secure messaging, but serves as a true communication hub for exchanging information concerning scheduling, documentation, and reporting. Some of these applications can be integrated into Practice Management solutions, providing efficiencies in workflow and eliminating the need for your team to access "one more thing" for communication. 

It's also a good idea to work with your technology providers when selecting a communication application. A good health IT company or consulting firm will understand the security and privacy requirements to ensure HIPAA compliance and can provide guidance in how to integrate the new technology into your current system.

Making sure that your ASC is getting timely, accurate and complete clinical documentation is critical to coding and billing, and securely communicating with the physician and his/her practice is paramount to meet secure ePHI. These are challenges that most ASCs face daily, but ultimately ones that can be solved through technology.


How is your facility using technology to solve communication challenges?