When researching electronic health record (EHR) systems, ASCs will find that they seem to have a lot of options. On the surface, this would appear to be advantageous. After all, more choices should mean more opportunities to identify the ambulatory software system that will best meet an ASC's needs.
But dig a little deeper and something will become apparent: Many of the EHR options available to ASCs are not systems designed for surgery centers. Rather, they are hospital- or practice-focused systems that have either undergone modification or received add-on functionality intended to permit the use of these systems in ASCs.
Unfortunately, attempting to implement such software in an ASC can lead to significant problems. Here are six of the most noteworthy issues — three associated with hospital-focused software and three associated with practice-focused software.
Shortcomings of Hospital-Focused Ambulatory Software
1. Complexity and workflow
Hospital systems and their EHRs are designed to support an extensive variety of complex surgical procedures, resource needs, and billing/coding rules in an inpatient setting. This provides multiple internal departments (e.g., imaging, pharmacy) with the ability to write into the same patient chart.
In contrast, ASCs specialize in high volumes of specific types of procedures performed exclusively in an outpatient setting. Reimbursement is typically provided by multiple programs and organizations (e.g., Medicare, private payers) that often follow different contract rules and requirements.
Hospital EHRs are not well-suited to support these ASC-specific needs. Deploying cumbersome hospital software in an ASC setting can overwhelm staff who will probably use only a fraction of the capabilities and features a hospital would require.
Further complicating matters, staff may need to find manual and time-consuming workarounds outside of the hospital software to meet the specific scheduling, resource, supply, and billing requirements of a busy ASC. Ultimately, a hospital system can slow down staff and negatively affect an ASC's efficiency.
2. Regulatory requirements
ASCs are highly regulated by federal and state entities. Centers for Medicare & Medicaid Services (CMS) regulations, state-specific audit reporting, and benchmarking and accreditation typically require different data from an ASC than what hospitals are required to monitor and disclose. Those who are considering implementing a hospital-focused system in an ASC must consider the potential extra cost to configure the software to efficiently and accurately capture and share the detailed data needed to comply with various ASC reporting requirements.
Alternatively, ASC software is designed and consistently updated to capture the specific data points needed to ensure compliance with ongoing reporting, auditing, benchmarking, and certification requirements.
Hospitals must be prepared for an array of procedures across a wide array of specialties. The complex systems required to support such needs are not inexpensive. It is commonplace to read that a hospital spent hundreds of thousands or sometimes millions of dollars on management systems.
Since most ASCs specialize in high volumes of procedures from one specialty or just a few specialties, they require only a fraction of the capabilities a hospital system would need to perform. ASC software is built for surgery center workflows, is intuitive, and contains all the features/functionalities a center needs to run efficiently "out of the box." Since there is a significantly reduced need for configuration and training, ASC technology is much more affordable and provides a much faster return on investment.
Shortcomings of Practice-Focused Ambulatory Software
Practices need software that supports the scheduling of appointments. ASCs need software that supports the scheduling of surgeries. While scheduling surgery requires some of the same information captured for practice appointments, such as insurance details and patient demographics, the similarities end there.
When scheduling a procedure, ASCs must capture details that will or may include procedure name, laterality and position, anesthesia type, authorizations, CPT and ICD-10 codes, allergies, preoperative testing, supply/equipment requests, and preoperative antibiotic and medication orders. Once this information is entered into the software, it must be accessible by other ASC team members so they can complete their clinical and financial responsibilities.
Expanding practice software scheduling capability to account for the additional information that must be captured and then integrated into ASC workflows will require cumbersome workarounds that can reduce staff efficiency and increase the likelihood of data entry errors.
5. Surgical documentation
Practice software includes the documentation required to account for the needs of patients during typical visits. Since surgery is not a component of such visits, the software will lack much of the management and clinical documentation required for ASCs. Such documentation covers areas including patient assessment, operative notes, preoperative questionnaire, anesthesia, medications, surgical time-out, supplies, risk assessment — the list goes on.
Manually adding all of these documents is an expensive, laborious proposition. Furthermore, such an undertaking can prove risky if documentation is omitted. If an ASC proceeds with scheduling and performing procedures without the required documentation, this can increase compliance risk.
6. Patient throughput
The experience of a patient at a practice and ASC is starkly different. In a practice, a patient will check in, sit in the waiting room, perhaps have vitals checked by a staff member, and then meet with the physician. Discharge may involve scheduling a future appointment or no activity at all. Little can go wrong during a practice visit. At worst, patients might have their appointments canceled or experience a long wait.
The surgical process is much more complex, and there are inherent risks associated with any surgery — even the elective procedures performed in ASCs. These potential risks increase patient anxiety. Stress levels can be elevated further leading up to their procedure. Patients must often prepare for their surgery by following specific dietary instructions. On the day of the procedure, patients undergo preoperative assessments and may receive anesthesia. Handoffs keep patients moving through the perioperative process all the way through discharge. In the meantime, family members or friends often sit in the waiting area, looking forward to updates.
Practice software tends to lack components designed to help improve a patient's experience since there are very few ways to affect the experience. On the other hand, well-designed ASC technology will include functions that can help provide patient comfort and reduce stress leading up to and during the day of surgery.
Such components include preoperative questionnaires and surgical instructions sent via email or text message for ease of completion around a patient's schedule; tracking boards that help move patients efficiently through the surgical process, reducing wait times at each stage; waiting room boards that show family and friends the patient's progress; and electronic insurance verification and patient responsibility estimation that inform patients of their upfront costs, reducing anxiety about surprise medical bills. These and other software features can improve the overall patient experience, which may be reflected on patient satisfaction surveys.
The Solution: ASC-Focused Software
Trying to scale down a hospital EHR or scale up a practice EHR to meet the needs of an ASC often requires significant configuration (cost) to implement. Rather, partner with an ASC information technology vendor that supports the unique clinical, operational, reporting, and patient requirements of the ASC.