Scott Palmer, president and COO of SourceMedical's surgery division, discusses the effect of information technology on ambulatory surgery centers.
Q: Where does the ASC industry stand in terms of IT utilization currently?
Scott Palmer: I think a problem in our industry is that people are somewhat technology-adverse. We're not on par with other industries or even with other sectors within healthcare in terms of technology utilization. I think this is for a couple of reasons. First of all, there is a lack of IT resources internally. A typical ASC has a nurse administrator and a physician board, and they're not thinking about the latest [developments] in technology and applying new technologies to their business. They're focused on patient care. That's also true in of the case of some small management companies; they're focused on day-to-day operations.
There is an opportunity for IT in the ASC industry, especially in these times where there are going to be top-line revenue challenges and pressures on cost. Surgery centers may be able to maintain or even improve margins with expanded IT utilization.
Q: What would you say to surgery center leaders who believe the upfront capital expense of IT outweighs the possibility of long-term cost savings?
SP: Let me give you some short-term and long-term recommendations. First of all, a number of vendors in the market today have incremental products that improve efficiency. An example is online patient follow-up surveys. There's no reason that anybody today should be surveying patients on paper. Not only is an online survey less expensive, but electronic surveying can provide immediate alerts to patient care problems and improved insight and benchmarking. The same is true with patient intake — why do we ask people to come in a day before surgery and fill out paperwork? That can be done online with tools that exist from any number of vendors. There are many more examples of short-term recommendations for incremental ways to improve efficiency and reduce cost.
Long-term, the number one technological development is cloud computing. The simplest way to explain cloud computing is to say that you're taking your server out of your facility and putting it in a professionally-managed data center. You're doing that to achieve some well-defined benefits today: anywhere, anytime access, reduced risks, access to improved web-enabled applications, improved interoperability and significantly lower total cost of ownership over time.
Q: How does cloud computing reduce the cost of ownership over time?
SP: Software as a service, or SaaS, should not typically involve a significant upfront cost. However, your vendor will ask you for an extended commitment of 3-5 years to recover their investment. The vendor will also allocate cost using a metering approach — a per-case, per-user or per-OR cost, for example. This is an appropriate way to allocate cost as well as to provide a graduated pricing scale for small surgery centers.
Total cost of ownership will also include labor and other soft costs. Vendors guarantee almost 100 percent uptime, as well as managing all the patches, upgrades and backups. Security risks are better managed as well.
Q: Are there other benefits to cloud computing in terms of access?
SP: Surgery centers and management companies also have access to more applications. In a license model, vendors tend to charge for each module. In an SaaS module, you get access to all the applications for the [per-case, per-user or per-OR] fee. We're seeing a big shift. We like selling our modules, but we want our clients to use our software, so that's not happening today. For example, we have a surgeon scheduling portal that, in a traditional model, we would sell as an optional module. In our Vision OnDemand package, it's included and you can have your doctors scheduling appointments remotely. This goes back to driving efficiency and increasing utilization of the facility.
Q: In your experience, how many ASC companies and centers are already taking advantage of cloud computing?
SP: Utilization of cloud computing, as currently defined in the market, is very low. However, management companies and large accounts have typically traditionally hosted applications on behalf of their centers, so they've started moving them into a data center somewhere. I would estimate that 20 percent of the market has a server managed by a third party.
Another point on cloud computing is the move to an enterprise solution. Right now, large national accounts with 50-plus centers have the opportunity to combine all their facilities into one database. Whereas previously you actually maintained separate facility databases, in a true cloud environment, it's an enterprise database. Large companies have longed for that kind of solution. It makes on-boarding a facility really easy because you have a standardized [database] across your company, and all you have to do is add some locally relevant data, such as doctors and employees. You can be up and running very quickly.
Enterprise solutions also provide enterprise reporting, which combines data from all centers and makes it available at the push of a button.
Q: How is the movement toward electronic health records impacting surgery centers?
SP: Clinical automation is shifting from a paper-based record to an EHR [in surgery centers]. Today, about 18 percent of the ASC market uses an EHR, and a lot of those aren't true EHRs. They're just scanning systems. The centers are taking a paper chart, scanning it and referring to it as an electronic chart. We're seeing [EHR implementation] as a growing trend, driven by the need for efficiency, doctors expecting an electronic medical record in any facility they participate in, and, of course, the government's current and future mandates.
Q: Why do you think surgery centers have lagged behind hospitals in terms of EHR implementation?
SP: I think it's comfort with a paper chart, first of all. Also, vendors in the traditional model were expecting a significant upfront investment. I think that will shift. In some cases, the EHR software wasn't that advanced, and facilities were waiting for the software to improve. Also, physicians and hospitals were provided with stimulus funds to shift to an EHR, and that has dramatically increased utilization, whereas we are just starting to see the rollout of those rules that will impact ASCs.
Q: With many vendors competing for a surgery center's EHR business, where should ASC leaders start looking? How do they know what they need in terms of functionality?
SP: We see three general categories of software vendors in the ASC market today: vendors serving the ASC market specifically, vendors specializing in physician practice management software claiming to have an ASC solution and acute care vendors. I would suggest to any ASC that you look to the vendors serving and supporting the ASC industry. [These vendors should] provide guarantees to support any current and future government requirements specific to ASCs. The vendor should fully understand the nuances of the ASC market, and the software should follow the workflow of an ASC.
Also, keep in mind that EHR applications are very complex, require lots of product development resources and take years to develop and integrate properly, so potential buyers will want to carefully consider their options.
Q: Meaningful use criteria have not yet been developed for ASCs, and surgery centers also are ineligible for stimulus funding to implement EHRs. Do you predict that the government will involve ASCs in meaningful use and available funding in the future?
SP: Indications are that ASCs are included in the Stage 2 Meaningful Use requirements that will be available later this year. Overall, the government cannot achieve its objectives for leveraging [EHR without involving ASCs].
Q: How do you predict social media will affect surgery centers specifically?
SP: "Word of mouth" is shifting to the web, and 23 percent of social media users have noted that they use their online contacts to discuss their healthcare experience and seek advice. Along these lines, 74 percent of all adults now use the Internet, and 61 percent report having used the internet to research medical information and treatment options. These numbers will continue to grow, and users will embrace social media as a means to share experiences and be better educated consumers. It's a great opportunity for ASCs to speak to [their] advantages in providing top quality care in a safe and comfortable environment.
Q: How should surgery centers use social media to market most effectively?
SP: How social media users and patients interact is not something a facility or industry can control. However, you can facilitate providing positive information and making your facility visible to social media users. Also, having a strong online presence will assist you in promoting your local business and helping educated legislators to the value of our industry.
First, track your quality metrics and consider posting them to your web site periodically. For example, [you could post], "Over 98 percent of our patients report that they would recommend our facility to their friends and family" and consider adding some patient quotes to your facility — de-identified, of course. Your website is the first contact that most patients will have with your facility, and you will want to make a favorable and lasting impression.
Secondly, open Facebook and Twitter accounts for your facility, and add this as a connection within your website to help users connect and provide positive feedback. With 750 million users on Facebook, you are getting an inexpensive second website for users to access. You should be prepared for some negative feedback since unhappy consumers are more vocal than satisfied users, but the overall benefits should prevail in the long run.
Third, use metadata in your web pages to help search engines list your facility for key services you provide. Your webmaster can assist you with these simple and inexpensive tasks.
Q: What else can we expect for future trends?
SP: Interoperability is a hot topic in healthcare, but unless your facility is part of an IDN it probably hasn't impacted yet. Moving forward, be prepared to be connected to a health information exchange, accountable care organization and other parties. Be sure your vendor and applications have a well-defined strategy for supporting interoperability to meet internal and external requirements.
Related Articles on Information Technology:
Few Customers Believe Technology Has Improved Health Insurance, Customer Service
CMS to Adopt Predictive Fraud-Fighting Technology July 1
Information Technology for Surgery Centers: Achieving Positive Outcomes and Avoiding Complications
Q: Where does the ASC industry stand in terms of IT utilization currently?
Scott Palmer: I think a problem in our industry is that people are somewhat technology-adverse. We're not on par with other industries or even with other sectors within healthcare in terms of technology utilization. I think this is for a couple of reasons. First of all, there is a lack of IT resources internally. A typical ASC has a nurse administrator and a physician board, and they're not thinking about the latest [developments] in technology and applying new technologies to their business. They're focused on patient care. That's also true in of the case of some small management companies; they're focused on day-to-day operations.
There is an opportunity for IT in the ASC industry, especially in these times where there are going to be top-line revenue challenges and pressures on cost. Surgery centers may be able to maintain or even improve margins with expanded IT utilization.
Q: What would you say to surgery center leaders who believe the upfront capital expense of IT outweighs the possibility of long-term cost savings?
SP: Let me give you some short-term and long-term recommendations. First of all, a number of vendors in the market today have incremental products that improve efficiency. An example is online patient follow-up surveys. There's no reason that anybody today should be surveying patients on paper. Not only is an online survey less expensive, but electronic surveying can provide immediate alerts to patient care problems and improved insight and benchmarking. The same is true with patient intake — why do we ask people to come in a day before surgery and fill out paperwork? That can be done online with tools that exist from any number of vendors. There are many more examples of short-term recommendations for incremental ways to improve efficiency and reduce cost.
Long-term, the number one technological development is cloud computing. The simplest way to explain cloud computing is to say that you're taking your server out of your facility and putting it in a professionally-managed data center. You're doing that to achieve some well-defined benefits today: anywhere, anytime access, reduced risks, access to improved web-enabled applications, improved interoperability and significantly lower total cost of ownership over time.
Q: How does cloud computing reduce the cost of ownership over time?
SP: Software as a service, or SaaS, should not typically involve a significant upfront cost. However, your vendor will ask you for an extended commitment of 3-5 years to recover their investment. The vendor will also allocate cost using a metering approach — a per-case, per-user or per-OR cost, for example. This is an appropriate way to allocate cost as well as to provide a graduated pricing scale for small surgery centers.
Total cost of ownership will also include labor and other soft costs. Vendors guarantee almost 100 percent uptime, as well as managing all the patches, upgrades and backups. Security risks are better managed as well.
Q: Are there other benefits to cloud computing in terms of access?
SP: Surgery centers and management companies also have access to more applications. In a license model, vendors tend to charge for each module. In an SaaS module, you get access to all the applications for the [per-case, per-user or per-OR] fee. We're seeing a big shift. We like selling our modules, but we want our clients to use our software, so that's not happening today. For example, we have a surgeon scheduling portal that, in a traditional model, we would sell as an optional module. In our Vision OnDemand package, it's included and you can have your doctors scheduling appointments remotely. This goes back to driving efficiency and increasing utilization of the facility.
Q: In your experience, how many ASC companies and centers are already taking advantage of cloud computing?
SP: Utilization of cloud computing, as currently defined in the market, is very low. However, management companies and large accounts have typically traditionally hosted applications on behalf of their centers, so they've started moving them into a data center somewhere. I would estimate that 20 percent of the market has a server managed by a third party.
Another point on cloud computing is the move to an enterprise solution. Right now, large national accounts with 50-plus centers have the opportunity to combine all their facilities into one database. Whereas previously you actually maintained separate facility databases, in a true cloud environment, it's an enterprise database. Large companies have longed for that kind of solution. It makes on-boarding a facility really easy because you have a standardized [database] across your company, and all you have to do is add some locally relevant data, such as doctors and employees. You can be up and running very quickly.
Enterprise solutions also provide enterprise reporting, which combines data from all centers and makes it available at the push of a button.
Q: How is the movement toward electronic health records impacting surgery centers?
SP: Clinical automation is shifting from a paper-based record to an EHR [in surgery centers]. Today, about 18 percent of the ASC market uses an EHR, and a lot of those aren't true EHRs. They're just scanning systems. The centers are taking a paper chart, scanning it and referring to it as an electronic chart. We're seeing [EHR implementation] as a growing trend, driven by the need for efficiency, doctors expecting an electronic medical record in any facility they participate in, and, of course, the government's current and future mandates.
Q: Why do you think surgery centers have lagged behind hospitals in terms of EHR implementation?
SP: I think it's comfort with a paper chart, first of all. Also, vendors in the traditional model were expecting a significant upfront investment. I think that will shift. In some cases, the EHR software wasn't that advanced, and facilities were waiting for the software to improve. Also, physicians and hospitals were provided with stimulus funds to shift to an EHR, and that has dramatically increased utilization, whereas we are just starting to see the rollout of those rules that will impact ASCs.
Q: With many vendors competing for a surgery center's EHR business, where should ASC leaders start looking? How do they know what they need in terms of functionality?
SP: We see three general categories of software vendors in the ASC market today: vendors serving the ASC market specifically, vendors specializing in physician practice management software claiming to have an ASC solution and acute care vendors. I would suggest to any ASC that you look to the vendors serving and supporting the ASC industry. [These vendors should] provide guarantees to support any current and future government requirements specific to ASCs. The vendor should fully understand the nuances of the ASC market, and the software should follow the workflow of an ASC.
Also, keep in mind that EHR applications are very complex, require lots of product development resources and take years to develop and integrate properly, so potential buyers will want to carefully consider their options.
Q: Meaningful use criteria have not yet been developed for ASCs, and surgery centers also are ineligible for stimulus funding to implement EHRs. Do you predict that the government will involve ASCs in meaningful use and available funding in the future?
SP: Indications are that ASCs are included in the Stage 2 Meaningful Use requirements that will be available later this year. Overall, the government cannot achieve its objectives for leveraging [EHR without involving ASCs].
Q: How do you predict social media will affect surgery centers specifically?
SP: "Word of mouth" is shifting to the web, and 23 percent of social media users have noted that they use their online contacts to discuss their healthcare experience and seek advice. Along these lines, 74 percent of all adults now use the Internet, and 61 percent report having used the internet to research medical information and treatment options. These numbers will continue to grow, and users will embrace social media as a means to share experiences and be better educated consumers. It's a great opportunity for ASCs to speak to [their] advantages in providing top quality care in a safe and comfortable environment.
Q: How should surgery centers use social media to market most effectively?
SP: How social media users and patients interact is not something a facility or industry can control. However, you can facilitate providing positive information and making your facility visible to social media users. Also, having a strong online presence will assist you in promoting your local business and helping educated legislators to the value of our industry.
First, track your quality metrics and consider posting them to your web site periodically. For example, [you could post], "Over 98 percent of our patients report that they would recommend our facility to their friends and family" and consider adding some patient quotes to your facility — de-identified, of course. Your website is the first contact that most patients will have with your facility, and you will want to make a favorable and lasting impression.
Secondly, open Facebook and Twitter accounts for your facility, and add this as a connection within your website to help users connect and provide positive feedback. With 750 million users on Facebook, you are getting an inexpensive second website for users to access. You should be prepared for some negative feedback since unhappy consumers are more vocal than satisfied users, but the overall benefits should prevail in the long run.
Third, use metadata in your web pages to help search engines list your facility for key services you provide. Your webmaster can assist you with these simple and inexpensive tasks.
Q: What else can we expect for future trends?
SP: Interoperability is a hot topic in healthcare, but unless your facility is part of an IDN it probably hasn't impacted yet. Moving forward, be prepared to be connected to a health information exchange, accountable care organization and other parties. Be sure your vendor and applications have a well-defined strategy for supporting interoperability to meet internal and external requirements.
Related Articles on Information Technology:
Few Customers Believe Technology Has Improved Health Insurance, Customer Service
CMS to Adopt Predictive Fraud-Fighting Technology July 1
Information Technology for Surgery Centers: Achieving Positive Outcomes and Avoiding Complications