When it comes to procedure documentation, manual transcription and dictation is expensive. Transcription and printing are costly. In addition, paper-based processes contribute to inefficient workflows, unstructured data that's hard to analyze and documentation that is inaccurate, incomplete and potentially non-compliant.
At Becker's ASC 26th Annual Meeting: The Business and Operations of ASCs in Chicago in October, Provation sponsored an executive roundtable which highlighted several best practices for implementing a cloud-based procedure documentation platform. Raymond Hino, MPA, FACHE, discussed the successful deployment of Provation® Apex across three Surgery Partners’ Northern California facilities. Mr. Hino served as the regional director of operations for Surgery Partners San Francisco-based services from Oct. 2017 to Oct. 2019 and is now the vice president of operations – West Coast at Physicians Endoscopy.
The search for a procedure documentation solution
Nashville, Tenn.-based Surgery Partners is a leading operator of surgical facilities and ancillary services, with more than 180 locations nationwide. According to Mr. Hino, three of the company's ASCs in Northern California recognized their manual processes for procedure notes were costly and inefficient.
Once a procedure note was dictated and transcribed, a manual review process began. The note was passed back and forth between the physician, transcriber, billing department and a quality and reporting resource. Not only was the time-consuming process wasteful, it also put the ASCs at greater risk of inaccurate billing. The manual procedure documentation process was also inconsistent across the three facilities.
Mr. Hino explained, "We were looking for a more streamlined process, which would only be possible with the help of software. Our optimal solution would be easy, intuitive, accurate and secure, automated end-to-end, aligned to physician workflow and integrated with our electronic health record system."
The Surgery Partners team began to research means of improving documentation efficiency and accuracy. Physicians at two of the California sites had been using Provation in their hospital practices and were asking to bring the solution into the ASCs. Upon researching Provation’s offerings, Mr. Hino decided Provation® Apex, its cloud-based, software-as-a-service (SaaS) solution, offered the right functionality at an attractive price point for the ASCs.
Implementing Provation® Apex
User adoption of Provation® Apex at the three ASCs went smoothly, especially among those physicians who were accustomed to using Provation in the hospital setting. They found the cloud solution to be intuitive and similar to the on-premise product.
On day one, physicians began customizing their documentation workflows with the system's "favorites" feature. "The favorites functionality gives physicians the opportunity to add their most used selections; with the customs menu, they can create their own menu selections. Physicians can also add clarifying statements with free text," said Mr. Hino. “Better yet, Apex has artificial intelligence to learn each clinician’s most-used selections over time and automatically adds them as favorites.”
The ASCs have been very pleased with Provation® Apex. The biggest fan of the system, beside the physicians, is the medical records specialist. She no longer has to chase down dictated procedure reports and there are few discrepancies. Another supporter is the quality coordinator. She is excited that she can easily access mandatory quality reporting.
The digital physician procedure notes are organized and easily understood by physicians, primary care providers and other staff members. Management can now standardize documentation and processes across sites. This makes it easy to report on the sites and analyze their strengths and weaknesses.
Mr. Hino added, "The savings we experienced by eliminating transcription and printing on expensive photographic paper has almost paid for the Apex system. We anticipated our first-year savings at the Skyway Surgery Center in Chico at about $20,000."
Based on the Provation® Apex implementation experience, Mr. Hino recommends following three best practices when deploying a SaaS procedure documentation platform.
Best practice #1: Identify an internal champion
It is essential to identify at least one knowledgeable, on-site leader who will continuously engage with physicians and staff. The internal champion helps prevent initial dissatisfaction by keeping everyone informed before, during and after the software implementation. He or she also prepares the staff for change and educates them about the importance of standardizing procedure notes.
Skyway Surgery Center's internal champion was a nurse manager who runs the GI service. She was on board with the Provation® Apex implementation from the beginning and had used Provation in a hospital setting prior to working at the ASC. She was immediately enthusiastic and handled all the coordination to set up the physicians and email addresses in the system.
Mr. Hino noted, "Although the SaaS procedure documentation platform is easy to learn and to teach physicians, I recommend having a nurse manager champion when you implement it. It took ours just two hours to complete the software training and to feel knowledgeable enough to help other team members learn."
Best practice #2: Recognize the importance of staff education
Staff education is a critical step to ensure that a system implementation will be successful. Key steps include:
- Preparing users that the look and feel of the procedure documentation platform will be new, but better.
- Notifying them about the launch date.
- Emphasizing the benefits of the new solution and underscoring that the change is for their benefit.
Mr. Hino commented, "There is a learning curve, but once people get used to the software, they accept the change. At our ASCs, there's no lag time anymore between when physicians dictate and the procedure report. Physicians can document immediately following a procedure and in minutes, they receive a fully documented report including photographs."
Best practice #3: Prepare for the future of documentation
When implementing a new documentation solution, consider your organization's future. Many ASCs are now adopting cloud-based software solutions for various functions. In addition to the Provation® Apex system, Skyway Surgery Center has also implemented a cloud-based telephone system.
Cloud-based solutions make clinicians' and staff members' jobs easier. Sites no longer have to worry about buying and maintaining servers or updating software. In addition, users don't need to be tied to a workstation. With Provation® Apex, for example, users can document or access notes on a tablet.
Conclusion
To truly standardize and digitize the procedure documentation process, ASCs need a platform that meets the needs of all physicians across the organization. ASCs also need a scalable solution that can accommodate mergers, acquisitions, physician turnover and new procedures. Any of these events are possible in the dynamic ASC market.
For Surgery Partners' ASCs in Northern California, Provation® Apex met these requirements. Mr. Hino said, "I couldn't be happier. It's turned out great. We had physicians at all three centers asking when we were going to have Provation at the ASC. The cloud-based solution makes it much more affordable for small centers."
For more information on cloud-based Provation® Apex, visit provationmedical.com/apex.