Implementing an electronic health record can be a daunting task for an ambulatory surgery center, considering the capital needed to purchase hardware and software, train employees and account for productivity loss during implementation. Robert Lamont, CEO of The Eye Center of Central PA and The Surgery Center of Central PA, discusses how his ASC successfully implemented an EHR.
1. Take "soft costs" into account before implementation. Mr. Lamont says while the "hard costs" of implementation — such as the cost of software and hardware — are relatively easy to predict, some ASC administrators may forget to plan for training and staffing costs. "You have an idea how much training is involved, but you're never really sure until you're doing it," he says.
Mr. Lamont says "soft costs" involving staff are broken down into two categories: the extra hourly wages paid to staff while they go through training prior to go-live and the cost of scheduling more staff members at the ASC while the center is running two systems. He says while staffing costs will vary for every center, the most important thing is to plan for greater expenses than you expect.
2. Involve the staff in choosing an EHR. Mr. Lamont says his ASC held a staff meeting where the physicians and administrators explained the plan for implementing an EHR to the staff. "We said, 'Here's what we're going to do. We're required to do this, and we're all going to work together and get on the same page and accomplish this task,'" he says.
From day one, he knew it was essential to have the staff on board if the ASC wanted the EHR to be useful. He says while physicians should head the decision to buy a certain microscope or laser, the staff needed to be involved in EHR selection because they would be using the system every day.
Mr. Lamont says the ASC did its due diligence when selecting a vendor by finding a system that suited the ASC as well as the physician practice. "There are some vendors that only want to deal with large hospital systems, so you have to find the right vendor who will engage in your practice as well as ASC side," he says.
The management team picked a certain number of vendors and then whittled the group down to three or four. Once those had been selected, the management team scheduled some on-site previews of the different systems and asked staff members for their feedback. "When we got it down to two, we had the two final vendors come back and give presentations to the doctors and staff, and then we chose," he says.
3. Expect to transition from paper to EHR gradually. Mr. Lamont says some ASC leaders expect that once they implement an EHR, the center will go paperless immediately. He says in reality, the transition between paper and electronic charting is much more gradual. "One day we were all paper, and then the next day we were 90 percent paper and 10 percent EHR, and we kept working in that direction until we're now almost 100 percent EHR," he says.
He says this transition must be gradual because it takes time for staff members to become comfortable with the new system. If you ban paper charts and force staff members to use only the new system, they may feel patient care is jeopardized.
He says ASC leadership made the transition easier by using the system with only a few patients at first. "I would advise [ASCs to test the system on] a few patients here and there and see what works and what doesn't," Mr. Lamont says. "That way, you can fix the problems before they go full-blown live." This will also help nervous employees feel more comfortable with the system before they are expected to use it for every case.
4. Assign someone to take responsibility for the system. "I think the perception is that once you're on EHR, there won't be many issues and it will run smoothly, but that is not the case. Things in EHR need tweaking, and they don't work right all the time," Mr. Lamont says. He says because of these necessary tweaks, it's important to assign someone from the surgery center to oversee maintenance, upgrades and troubleshooting. Mr. Lamont is fortunate to have a full-time IT director at his clinic and surgery center, but he recognizes that many surgery centers may not have the resources for a full-time IT staffer.
Instead, he recommends assigning a staff member as a go-to person or outsourcing an IT consultant who can dedicate a few hours every week to fixing any problems. "If you go into it without these types of people, you're setting yourself up to fail," he says.
He says it's also important to build a good relationship with your vendor so they can assist you when you run into problems. It will be easier to get help if you've established a rapport with the IT representative from your vendor.
5. Bring staff in on weekends to learn and customize the system. Mr. Lamont initially trained some ASC staff members as "super users" who could help to customize the system by building order sets and tailoring op notes to fit the center's needs. Those super users then held weekend sessions to train other staff members on the system. Keep in mind that you will probably need to pay employees overtime to come in and learn the system. Mr. Lamont says this process turned into a good team-building session for employees. "We ordered breakfast and lunch and tried to make it special for everyone," he says.
Learn more about The Surgery Center of Central PA.
Related Articles on Surgery Center EHR:
Electronic Health Records: Ready, Set, Go Live
5 Reasons Surgery Centers Are Not Likely to Receive EMR Incentives Under HITECH Act
Dr. Flora Lum on Ophthalmology EHRs: Interoperability is Key
1. Take "soft costs" into account before implementation. Mr. Lamont says while the "hard costs" of implementation — such as the cost of software and hardware — are relatively easy to predict, some ASC administrators may forget to plan for training and staffing costs. "You have an idea how much training is involved, but you're never really sure until you're doing it," he says.
Mr. Lamont says "soft costs" involving staff are broken down into two categories: the extra hourly wages paid to staff while they go through training prior to go-live and the cost of scheduling more staff members at the ASC while the center is running two systems. He says while staffing costs will vary for every center, the most important thing is to plan for greater expenses than you expect.
2. Involve the staff in choosing an EHR. Mr. Lamont says his ASC held a staff meeting where the physicians and administrators explained the plan for implementing an EHR to the staff. "We said, 'Here's what we're going to do. We're required to do this, and we're all going to work together and get on the same page and accomplish this task,'" he says.
From day one, he knew it was essential to have the staff on board if the ASC wanted the EHR to be useful. He says while physicians should head the decision to buy a certain microscope or laser, the staff needed to be involved in EHR selection because they would be using the system every day.
Mr. Lamont says the ASC did its due diligence when selecting a vendor by finding a system that suited the ASC as well as the physician practice. "There are some vendors that only want to deal with large hospital systems, so you have to find the right vendor who will engage in your practice as well as ASC side," he says.
The management team picked a certain number of vendors and then whittled the group down to three or four. Once those had been selected, the management team scheduled some on-site previews of the different systems and asked staff members for their feedback. "When we got it down to two, we had the two final vendors come back and give presentations to the doctors and staff, and then we chose," he says.
3. Expect to transition from paper to EHR gradually. Mr. Lamont says some ASC leaders expect that once they implement an EHR, the center will go paperless immediately. He says in reality, the transition between paper and electronic charting is much more gradual. "One day we were all paper, and then the next day we were 90 percent paper and 10 percent EHR, and we kept working in that direction until we're now almost 100 percent EHR," he says.
He says this transition must be gradual because it takes time for staff members to become comfortable with the new system. If you ban paper charts and force staff members to use only the new system, they may feel patient care is jeopardized.
He says ASC leadership made the transition easier by using the system with only a few patients at first. "I would advise [ASCs to test the system on] a few patients here and there and see what works and what doesn't," Mr. Lamont says. "That way, you can fix the problems before they go full-blown live." This will also help nervous employees feel more comfortable with the system before they are expected to use it for every case.
4. Assign someone to take responsibility for the system. "I think the perception is that once you're on EHR, there won't be many issues and it will run smoothly, but that is not the case. Things in EHR need tweaking, and they don't work right all the time," Mr. Lamont says. He says because of these necessary tweaks, it's important to assign someone from the surgery center to oversee maintenance, upgrades and troubleshooting. Mr. Lamont is fortunate to have a full-time IT director at his clinic and surgery center, but he recognizes that many surgery centers may not have the resources for a full-time IT staffer.
Instead, he recommends assigning a staff member as a go-to person or outsourcing an IT consultant who can dedicate a few hours every week to fixing any problems. "If you go into it without these types of people, you're setting yourself up to fail," he says.
He says it's also important to build a good relationship with your vendor so they can assist you when you run into problems. It will be easier to get help if you've established a rapport with the IT representative from your vendor.
5. Bring staff in on weekends to learn and customize the system. Mr. Lamont initially trained some ASC staff members as "super users" who could help to customize the system by building order sets and tailoring op notes to fit the center's needs. Those super users then held weekend sessions to train other staff members on the system. Keep in mind that you will probably need to pay employees overtime to come in and learn the system. Mr. Lamont says this process turned into a good team-building session for employees. "We ordered breakfast and lunch and tried to make it special for everyone," he says.
Learn more about The Surgery Center of Central PA.
Related Articles on Surgery Center EHR:
Electronic Health Records: Ready, Set, Go Live
5 Reasons Surgery Centers Are Not Likely to Receive EMR Incentives Under HITECH Act
Dr. Flora Lum on Ophthalmology EHRs: Interoperability is Key