Administrators at paper-based ambulatory surgery centers face a unique set of challenges when it comes to benchmarking, quality improvement, accreditation and other data-based tasks. Here, two administrators speak to the process of gathering, compiling and using data using paper-based systems.
Note: Answers have been edited for length and clarity.
Question: How does your ASC go about ensuring consistent data collection and compilation?
Dianne Appleby, RN, MBA, Executive Director at Menomonee Falls (Wisc.) Ambulatory Surgery Center: In our facility, we use paper primarily for clinical documentation in our admitting area and recovery rooms, as well as in the operating and procedure rooms. Each point of data entry has been built into the patient workflow: Some is entered concurrently, while other data may be entered at the end of the day.
Data definitions are clearly outlined in policy and procedure to assure consistency. Staff are well trained on those definitions, and we are able to track procedure data entry error and omission rates though database reports that have been created for this purpose.
One obstacle with paper records is that periodic paper chart audits need to be performed to verify that all data points have been collected, whereas a completely electronic system can be set up to prevent moving forward unless all fields have been completed. Another obstacle: Physicians dictate [operative notes] into a transcription system, which delivered electronically to the facility by 6:00 a.m. the day following the procedure. Coding is begun as soon as the operative notes are received. Conceivably coding could be done sooner in a system where the physician dictates and electronically signs the op note directly in the EHR.
Shirley Hines, RN, CASC, LRM, Administrator at Atlantic Surgery Center (Daytona Beach, Fla.): Some of our data collection can be done through various reports within our accounting system; however, the data must be transferred to worksheets and compiled manually. Most often with clinical data, we collect it manually and try to benchmark with local or national organizations.
Q: How does your ASC organize workflow for processes requiring benchmarking?
DA: Much of the benchmarking data required by CMS and accrediting bodies is clinical in nature, some of which may be entered intraprocedurally, while other pieces of information are entered following the procedure. IV infusion times are an example of the former, while complications codes are an example of the latter. Other quality indicators, such as GI measures and infection rates are gathered from the physician's office on paper forms and data is entered at a later date.
SH: We often use data that is being collected, such as infection control data, quality measures, financial or administrative data and use this in our benchmarking projects. An example would be using specific physician infection rates in the re-credentialing process and benchmarking with national guidelines.
The greatest obstacle is collection of data. We can use multiple reports or medical record reviews to collect data, but it ends up being a manual process at some point.
Q: Briefly outline the benchmarking process at your ASC, from data collection to taking action on that data, for a benchmark/metric of your choice.
DA: We benchmark both internally and externally. Internal benchmarking data is typically drawn off of our software system. Other benchmarks, such as wound infections, emergency room visits within 24 hours and patient satisfaction rates come from other sources, including paper, and are entered into our Quality Profile spreadsheet.
This quality profile is reviewed by our quality committee, physician advisory board and our governing body. Following review, any of these groups may recommend that further data collected and/or a quality study be initiated. Depending on the type of study, more data may be collected either from software reports that already exist, or staff may be involved in manually collecting data from the paper record. Depending on the outcome of the study, changes may be made to processes or workflows and/or new or revised policies, procedures or documentation forms may be initiated to address areas in need of improvement.
Q: Are there any special/additional policies or practices your ASC has for benchmarking that an ASC on an EHR might not have? If so, what?
DA: We benchmark externally with other organizations such as the Ambulatory Surgery Center Association, [Medical Group Management Association], etc. Typically data is entered electronically into these organizations’ electronic surveys from data that has already been collected within our facility. Comparative data results are entered into our quality profile for review and comparison as well.
SH: We don’t have special or additional policies for benchmarking that a facility with EHR would have; however, we do have limitations in data collection and man hours needed to collect data. Really good systems can give you most of the data necessary to do everything from case costing to inventory control management.
Q: What is your best piece of advice for paper-based ASCs struggling to benchmark successfully?
DA: For those who are struggling with benchmarking, I would suggest they begin by identifying which benchmark data is important for them to analyze. Whenever possible, draw whatever data is available from the existing software system. If necessary, consult with their software vendor to see if they could create customized reports that might help them collect and collate data more efficiently and cost-effectively than gathering the data manually from paper records.
SH: Getting involved with large benchmarking programs such as "outcome monitoring" through ASCA and others with AAAHC, CDC, VMG can give facilities working manually opportunities to collect meaningful data and use it to the best advantages.
More articles on accreditation:
Trickiest accreditation challenges: 5 most-frequent errors
'First do no harm,' requires significant personal, professional investments
Converting data to results in ASC benchmarking: Q&A with Marcy Sasso
Note: Answers have been edited for length and clarity.
Question: How does your ASC go about ensuring consistent data collection and compilation?
Dianne Appleby, RN, MBA, Executive Director at Menomonee Falls (Wisc.) Ambulatory Surgery Center: In our facility, we use paper primarily for clinical documentation in our admitting area and recovery rooms, as well as in the operating and procedure rooms. Each point of data entry has been built into the patient workflow: Some is entered concurrently, while other data may be entered at the end of the day.
Data definitions are clearly outlined in policy and procedure to assure consistency. Staff are well trained on those definitions, and we are able to track procedure data entry error and omission rates though database reports that have been created for this purpose.
One obstacle with paper records is that periodic paper chart audits need to be performed to verify that all data points have been collected, whereas a completely electronic system can be set up to prevent moving forward unless all fields have been completed. Another obstacle: Physicians dictate [operative notes] into a transcription system, which delivered electronically to the facility by 6:00 a.m. the day following the procedure. Coding is begun as soon as the operative notes are received. Conceivably coding could be done sooner in a system where the physician dictates and electronically signs the op note directly in the EHR.
Shirley Hines, RN, CASC, LRM, Administrator at Atlantic Surgery Center (Daytona Beach, Fla.): Some of our data collection can be done through various reports within our accounting system; however, the data must be transferred to worksheets and compiled manually. Most often with clinical data, we collect it manually and try to benchmark with local or national organizations.
Q: How does your ASC organize workflow for processes requiring benchmarking?
DA: Much of the benchmarking data required by CMS and accrediting bodies is clinical in nature, some of which may be entered intraprocedurally, while other pieces of information are entered following the procedure. IV infusion times are an example of the former, while complications codes are an example of the latter. Other quality indicators, such as GI measures and infection rates are gathered from the physician's office on paper forms and data is entered at a later date.
SH: We often use data that is being collected, such as infection control data, quality measures, financial or administrative data and use this in our benchmarking projects. An example would be using specific physician infection rates in the re-credentialing process and benchmarking with national guidelines.
The greatest obstacle is collection of data. We can use multiple reports or medical record reviews to collect data, but it ends up being a manual process at some point.
Q: Briefly outline the benchmarking process at your ASC, from data collection to taking action on that data, for a benchmark/metric of your choice.
DA: We benchmark both internally and externally. Internal benchmarking data is typically drawn off of our software system. Other benchmarks, such as wound infections, emergency room visits within 24 hours and patient satisfaction rates come from other sources, including paper, and are entered into our Quality Profile spreadsheet.
This quality profile is reviewed by our quality committee, physician advisory board and our governing body. Following review, any of these groups may recommend that further data collected and/or a quality study be initiated. Depending on the type of study, more data may be collected either from software reports that already exist, or staff may be involved in manually collecting data from the paper record. Depending on the outcome of the study, changes may be made to processes or workflows and/or new or revised policies, procedures or documentation forms may be initiated to address areas in need of improvement.
Q: Are there any special/additional policies or practices your ASC has for benchmarking that an ASC on an EHR might not have? If so, what?
DA: We benchmark externally with other organizations such as the Ambulatory Surgery Center Association, [Medical Group Management Association], etc. Typically data is entered electronically into these organizations’ electronic surveys from data that has already been collected within our facility. Comparative data results are entered into our quality profile for review and comparison as well.
SH: We don’t have special or additional policies for benchmarking that a facility with EHR would have; however, we do have limitations in data collection and man hours needed to collect data. Really good systems can give you most of the data necessary to do everything from case costing to inventory control management.
Q: What is your best piece of advice for paper-based ASCs struggling to benchmark successfully?
DA: For those who are struggling with benchmarking, I would suggest they begin by identifying which benchmark data is important for them to analyze. Whenever possible, draw whatever data is available from the existing software system. If necessary, consult with their software vendor to see if they could create customized reports that might help them collect and collate data more efficiently and cost-effectively than gathering the data manually from paper records.
SH: Getting involved with large benchmarking programs such as "outcome monitoring" through ASCA and others with AAAHC, CDC, VMG can give facilities working manually opportunities to collect meaningful data and use it to the best advantages.
More articles on accreditation:
Trickiest accreditation challenges: 5 most-frequent errors
'First do no harm,' requires significant personal, professional investments
Converting data to results in ASC benchmarking: Q&A with Marcy Sasso