Brent Ashby. The opening of Audubon ASC at St. Francis in Colorado Springs, Colo., in Sept. 2008 presented Brent Ashby, administrator of the facility, with a challenge. The ASC, a second joint-venture between local physicians and Penrose-St. Francis Health Services, became necessary when Audubon Surgery Center, eight miles away, started reaching capacity. Mr. Ashby, who is also administrator of Audubon Surgery Center, wanted to be able to monitor both facilities regardless of which he was working in, otherwise he would be forced to travel between sites to check on operations.
Mr. Ashby found a vendor that offers ASC clinical and financial software, which was able to link the IT systems in the two facilities, letting him manage both with a software program. The system lets staff at the facilities receive and enter payments for either facility. Staff members can also access patient accounts from either facility, which lets them address any questions from patients without forcing patients to contact the other center.
Here are four other IT-related projects that Mr. Ashby has overseen at the two facilities.
• Physician office access to schedule. A high-volume pain management physician has direct access to Audubon ASC’s scheduling system, letting his staff to schedule the thousands of cases annually when they are booked, rather than doubling the work by having the ASC staff enter them later. It’s an experimental program at the moment, but Mr. Ashby says there is consideration to give other physicians’ offices access as well.
• Web site as a patient tool. The Audubon Surgery Center is using its Web site as a tool to help patients while helping the center at the same time. On the Web site, patients can fill out a pre-op questionnaire for their procedures. Mr. Ashby says the center’s use of the Internet will continue to grow as a tool for patients. He eventually pictures the ASC’s Web site letting patients access their account, view its status and possibly to make payments online.
• Reduction of paper records. To deal with rapidly accumulating paper records, Audubon Surgery Center purchased a scanner. A person comes to the ASC several times each week and scans charts that are about two to three months old (if patients do not have outstanding balances). The charts are scanned and then those medical records are stored on a CD and labeled by patient numbers. The CDs are searchable and the patient records are easily retrievable.
• Development of EMR/paper hybrid. To help less-tech-savvy nurses feel comfortable with the EMR, Mr. Ashby has developed a hybrid method — a cross between an EMR and a paper record. The takes all documents sent to it by physician offices, labs or other locations (which are generally faxed to the facility) and physician operative reports (which are often e-mailed to the center) and, instead of printing these documents, the center stores them in a digital format in a folder linked to the patient. So nurses can create and use paper medical records, but at the end of the day, the center scans the medical record into the system, links it to the patient and the digital folder, then destroys the paper record.
Chuck Brown, MBA, MHA, Stacey Benson and Christa Hall, RN. Multi-specialty Bidwell Surgery Center, a joint-venture between local physicians, Atrium Medical Center and Children’s Hospital of Dayton, just received Medicare certification May 23, but it is fully equipped for electronic documentation of everything that happens in its five ORs and one procedure room.
Bidwell is outfitted with a software package that comprises workflow management, scheduling, registration, A/R control, claims, statement processing, and automated patient collections and insurance follow-up, denial tracking and job scheduling, among other tasks. While the center is not yet ramped up to its full projected case volume, the technology is already making an impact.
“We have minimal staff and are trying to hold off on hiring more FTEs while we get fully ramped up,” says Stacey Benson, the facility’s business office manager. “But this has let us not worry about that — we don’t need to have someone handling the time-consuming job of dealing with forms. I can just push a button and get what I need and handle it myself while we’re in this startup phase.”
In addition, Bidwell chose an ASC-specific electronic medical records system that could also save one FTE by freeing clinical staff from having to sit and do charts, in addition to the various other benefits (see “5 Things You Should Know About EMR in ASCs on p. 47”).
“We wanted something robust yet user-friendly,” says Chuck Brown, MBA, MHA, administrator. “The thing I really like about the company we chose is its willingness to listen to clients and make adjustments in the software updates based on that feedback. Our EMR can do things bigger players can do, but at a lower cost; and others cost less, but their packages were not comprehensive enough for us.”
In order to ensure that the facility was wired for success from the beginning, Bidwell worked with an IT consultant that established infrastructure, hardware and networking components.
“We wanted to hit the ground running on our IT efforts,” says Mr. Brown. But he and his colleagues don’t plan to leave well enough alone. “We’re going to make the most of our capabilities as we move toward accreditation and as we develop and under take QI studies. Those things are very difficult to do, from a paper copy standpoint, and our technology will help us do them thoroughly and efficiently.
“ASCs are geared toward efficiency and keeping costs low — employing HIT certainly fits in with those aims.”
Anthony Coletta, MD, MBA, FACS. Many facilities shy away from EMR implementation because of the price tag. But Anthony Coletta, MD, MBA, FACS, president of The Surgery Center of the Main Line in Bryn Mawr, Pa., encouraged his partners to invest in EMR from the beginning of their de novo project.
“It was obvious to me at the outset that we should institute EMRs from day one,” Dr. Coletta says.
He identifies the following four reasons investing in EMR was the right decision for The Surgery Center of the Main Line.
• “First and foremost was the fact that I saw paper records as archaic and, given that there was no hospital system in our area with an electronic record, this was an opportunity for us to differentiate ourselves in a very tangible way,” he says.
• “The second was the efficiency a good EMR would provide especially if it could be linked to our financial systems,” he says.
• “It seemed to me that, if we ever were in a position to sell the enterprise, a fully integrated EMR along with a knowledgeable staff would clearly increase our market value,” Dr. Coletta says.
• “I knew that we had the 15 busiest surgeons in the region working at the center and if we wanted to keep our records current, the EMR provided the most efficient means to do that,” he says.
While it wasn’t easy to bring all of the surgeons on-board with the idea, the decision has certainly paid off for the organization.
“At first the partners objected to the added expense, but once I convinced them, we made the investment and have never regretted it,” says Dr. Coletta.
Stephanie Diem, RN. For the past six years, Stephanie Diem, RN, has acted as administrator, clinical director, project manager, nurse manager, and all-around go-to-person for PHGI Associates’ Washington Square Endoscopy Center, located in the heart of Philadelphia.
After practicing for years in a suite of procedure rooms rented from the University of Pennsylvania Health System, the PHGI group made plans to build a new, state-of-the art Endoscopy Center on hospital grounds. With this move, the group was intent on starting fresh and refining less-than-efficient documentation workflows and processes. Ms. Diem led the charge to select, implement and drive utilization of the endo center’s scheduling, billing, EMR and procedure documentation systems. She was critical in developing the IT infrastructure for both the endoscopy center and the physician practice, and has led the center’s efforts to maximize the ROI on its IT investments. She is still responsible for maintaining day-to-day information system functionality.
Among the IT projects Ms. Diem has undertaken:
• She spearheaded implementation and use of the facility’s documentation software to shorten reporting and billing cycles, deliver faster, more comprehensive reporting to referring doctors, and meet regulatory standards set forth by organizations like The Joint Commision, AAAHC and the Office of Inspector General (OIG).
• In 2005, Ms. Diem measured results to find that her implementation of her chosen vendor’s software had increased patient throughput from 6,400 cases to 7,400 cases annually, eliminated an average of $3 per procedure in Mavigraph printing, and significantly increased documentation compliance. Measuring against an internal performance scale based on standards of care, CMS requirements, and state licensure requirements and accrediting standards, Ms. Diem found that her efforts to leverage the site’s IT investment had resulted in a 10 percent improvement in physician charting, a 39 percent improvement in anesthesiologist charting, and a 39 percent improvement in nursing and technician charting.
• More recently, Ms. Diem lead a project to build a full forms repository on the Washington Square Endoscopy’s intranet, which has significantly minimized the need for paper storage and increased staff member efficiency across the board. She has been deeply involved in the development of a patient portal, as well as the facility’s external Web site (www.pennsygi.com).
• In addition to and in conjunction with her IT efforts, Ms. Diem is responsible for maintaining Joint Commission accreditation and licensure and patient safety standards, facilitating competency programs for clinical staff, overseeing professional staff credentialing, and performance improvement activities, including monthly monitoring activities, managing performance measurement data and reporting.