Hospitals and physician offices have been implementing electronic health record systems over the past few years at high rates, and now more ambulatory surgery centers are thinking about making the switch. "Many people think that it isn't mandatory and it's very expensive, so they don't want to make the investment until they have to," says Ann Geier, Vice President of Clinical Informatics — Surgery at SourceMedical Solutions. "The government helped hospitals and physician practices, but didn't provide ASCs with extra support. But now major management companies are seriously looking at EHRs and I don't think ASCs will be able to avoid it."
Ms. Geier answers key questions about electronic health records at ambulatory surgery centers and where she sees the collection of healthcare data headed in the future.
Question: What do ASC leaders need in an EHR? How is that different from what hospitals and physician practices need in an EHR?
Ann Geier: There are specific reporting requirements for ASCs and the EHR should be able to generate those reports. Depending on state requirements, the software company can build an EHR system tailored for you that includes both state and CMS-specific reporting.
You want a system that is on top of reporting G codes for the center and allows you to solve reporting problems before sending out claims. We don't know how complicated those codes will be after ICD-10 implementation, but you want to have a system with that information available.
Within the system, drop down menus are easy to use and you want to make sure the pages are easy to read. You don't want to have to log into different tabs; instead you should be able to move through the system seamlessly. Another important factor is the ability to type information in one area and have it populate other areas on the medical record that require the same information.
ASCs should also look for systems that will integrate with physician offices so the physician can complete the ASC requirements, such as the physician order, H & P or informed consent, at the office and then send it over to the ASC. This eliminates duplicating information or filling out forms twice.
Q: Can ASCs just use physician office software? Would that make the integration easier?
AG: You can't use the same software as the physician's office because it won't give the ASC historical data or case costing; office systems don't have built-in inventory functions. That's a big deal. If you have ASCs with old systems that weren't designed for them all of the current reporting requirements, it's time to start over.
Q: What problems with EHR integration arise when ASCs merge with hospitals?
AG: If a hospital already has a robust EHR system that meets their needs, they will likely want the ASC to implement their system. However, a hospital system doesn't always comply with the needs of an ASC. To ensure the specific reporting needs of the surgery center are met, work with the hospital administration to maintain an ASC-specific EHR that will interface with the hospital system. You want your ASC system to integrate with the hospital's system, not convert to the hospital system.
If you are using a software system geared toward ASCs and the hospital system doesn't talk its language, that could be an issue. You need to have a discussion about electronic records as part of the transaction prior to the final sale or merger; let the hospital administrators know why it's important to keep ASC software as it is.
Q: HIPAA requirements have recently changed as a result of electronic records. What do ASCs need to know to stay compliant?
AG: HIPAA compliance now means having patient information under an encrypted code. In the past, physician offices would fax everything over to the ASC. With new HIPAA requirements, that's not good enough because you can't encrypt that information. Physicians need to be able to scan and email information in a HIPAA-compliant way.
Q: How can ASCs make sure they are selecting a great EHR?
AG: I would want a system that is highly recommended from users on the system. Those who have used it for a long time will tell you the truth. There is no perfect system. Check your references with administrators the company doesn't provide for you. You might find these people through state associations or other ASC networks. Inquire with them about what system they are using.
Q: After purchasing a system, what is involved in implementation? How should ASC leaders prepare?
AG: Once you chose your system, ask about the training and how intense it will be. Some companies offer offsite support — sometimes it costs extra — and figure out the lead time you have before changing systems. There will be a timeline you have to follow from the software company and both entities are responsible for following that timeline.
Pay attention to the deadline; if you slow the timeline down, that will be an issue. Give the software company any information they need ahead of time. Training is critical, even if you are switching from an old system to a new system within the same company. Centers that are converting are also working and busy doing cases, so understand there will be hiccups along the way.
Q: Where do you see EHR investment headed in the future?
AG: I think the CMS rules and regulations are only going to get more onerous for the surgery centers. There is more reporting with ASC quality and collaborations and software companies need to stay on top of that.
More Articles on Surgery Centers:
How to Best Merge ASC Billing Operations After a Transaction: 3 Experts Weigh In
How Has the ASC Acquisitions Market Changed?
Beyond the Numbers: Benchmarking ASCs to Operational & Financial Success