Surgery centers are adopting EMR in growing numbers, but it can be difficult to choose a vendor when many systems are tailored for hospitals or physician practices. Here Chad Luttrell, senior vice president of information technology for Meridian Surgical Partners, discusses eight questions every surgery center administrator should ask when considering EMR adoption.
1. Are you single-specialty or multi-specialty? Surgery centers may have different EMR needs depending on number of specialties. "Some EMRs are tailored for a single specialty, so they've wrapped the features and functionality around a single specialty," Mr. Luttrell says. "The information needs within a multi-specialty center can vary from a single specialty center. An EMR system needs to have the flexibility to meet those different needs. "
It is also important for an EMR in a single or multi-specialty center to be efficient enough to handle the higher patient volume and turn over present in the ASC space. "There are some EMR systems that will only allow one person to be in the chart at a time," Mr. Luttrell says. "You need a system that really allows multiple people to access a chart to perform their work."
2. How will you host the EMR? Surgery centers have a few options when it comes to hosting EMR:
• EMR hosted in the cloud by the vendor. If the vendor hosts the EMR, implementation is relatively simple. "Turn it on and you can start using it," Mr. Luttrell says. "The time involved to start using it in a production environment can be reduced." However, he says vendor hosting also comes with a fixed monthly expense, and it's important to understand what you're getting for that expense.
For example, the vendor will charge a monthly fee for hosting and access to the EMR. You need to understand if that monthly fee includes all annual license fees associated with the system. Mr. Luttrell says another challenge of vendor-hosted EMR is the question of who owns the data. If you need to change EMR vendors, you may find that your vendor has retained access to your data and will not relinquish it without an ongoing access fee. “You need to incorporate that into the agreement up front,” Mr. Luttrell says.
In addition, a hosted solution may impact the performance of the software. Due to the dependency on your internet connection, make sure you have enough bandwidth to meet the requirements of the EMR system. You may also need to consider a backup internet connection.
• Install the EMR on your own servers. If you decide to install it on your own servers, which may be local or hosted remotely you may have a greater capital expenditure upfront for the installation and hardware. The EMR installed on your own servers provides much easier access to historical records if you decide to change EMR vendors. Some vendors don’t have an option to install the software on other servers.
3. What's the total cost of ownership for the various options? Determining total cost of ownership is essential to choosing an EMR — and TCO will likely vary tremendously depending on what you choose. Evaluating your TCO over 3-5 years makes it easier to compare the different solutions and how they could be implemented. The TCO model also helps identify annual or recurring costs in the future.
Vendors will also differ in their pricing models. For example, one vendor might charge an initial fee with an annual maintenance fee along with additional license fees for add-on products, while another vendor might charge a lower initial fee with a flat rate per case going forward. Talk to your vendor about their pricing model and determine whether a cost is associated with various potential situations. For example, if your surgery center grows, it is important to understand if there is an increase for adding a new physician or specialty. "It's important for you to take responsibility and identify those costs and ask those questions," Mr. Luttrell says. "You should work closely with the vendor to identify all related costs”.
"There's no fixed dollar amount or range you should be expecting to find", Mr. Luttrell says. "What’s most important is that you work closely with each vendor to negotiate a price that meets your budget requirements and project objectives. When you apply the different pricing models to a TCO over three to five years, it helps identify the most cost effective solution."
4. How will your staff access the EMR? Make sure you understand how the EMR will be delivered to your staff. Some EMR applications run within the browser, some run as a thin application and some only operate on a Citrix or Terminal Server that may have additional associated licenses and fees. If possible, choose an EMR that works on a tablet device so that staff members can move around freely while entering information.
5. How will new EMR software work with your current billing vendor? You don't necessarily have to use one system to meet your billing and EMR needs, Mr. Luttrell says. If you already have billing software that works well, consider a "best of breeds" solution and choose an EMR that will meet the needs of the center. Mr. Luttrell recommends speaking with your billing vendor, as they will probably make a recommendation about a system they prefer.
"There are obviously some symbiotic relationships there because of the interaction between those companies," he says. "Definitely talk to them and discuss it with your peers. Get feedback on the technology." He recommends exploring two to three EMR options, to make sure you understand what's available.
6. How will current or new staff support your software after implementation? You may need to contract additional technical support if the software is installed on your servers. Think about how you will respond if the software stops working — do you have an "on call" representative at your EMR vendor, or can you assign someone at the surgery center to fix the problem? Either way, make sure you have a system in place for the inevitable bugs that could occur during the first few months.
7. What are your needs in terms of unit and stress testing? When the vendor sets up the EMR, you will have to conduct "unit testing." This process tests the general functionality of the application in a controlled environment. "That's great, and you need to do that, but don't forget to also perform a stress test with the application as well," Mr. Luttrell says.
He says many surgery centers complete "unit testing" and forget to see how the software performs in a "real life" situation. "Put the EMR in the hands of your staff, and simulate four or five people using it," he says. "It will help you identify whether you have a problem with your wireless or internet bandwidth." He recommends unit testing for two to three weeks, then stress testing for one week. Once you've successfully tested the EMR, start a month-long transition from paper to complete EMR use.
8. How will you track your progress with the EMR? Make sure you have a single point of contact at your vendor for the first few months, and update them regularly on how the software is performing. You should also think about how you will measure the system's efficacy.
Before you implement the EMR, Mr. Luttrell recommends establishing benchmarks under your current processes — such as documenting the time and resources it takes to complete high-volume cases compared with more complex cases. "When you're using the EMR, do the same benchmarks again and see how they compare," he says. "This should give you a true bottom line comparison." There should be noticeable gains in staff access to the patient record. Instead of looking up a patient’s chart to then review the information, they will direct access to it from the computer. The EMR should also reduce the time required to meet the center's reporting needs.
Learn more about Meridian Surgical Partners.
Related Articles on Business Office, Accounting and HR:
Using a Part-Time Administrator to Oversee an ASC: 5 Thoughts From MedHQ's Tom Jacobs
Best Practices for ASC Business Offices: 2 Executives Weigh In
Pinnacle III Improves Operations and Revenue Management at Orland Park Surgical Center
1. Are you single-specialty or multi-specialty? Surgery centers may have different EMR needs depending on number of specialties. "Some EMRs are tailored for a single specialty, so they've wrapped the features and functionality around a single specialty," Mr. Luttrell says. "The information needs within a multi-specialty center can vary from a single specialty center. An EMR system needs to have the flexibility to meet those different needs. "
It is also important for an EMR in a single or multi-specialty center to be efficient enough to handle the higher patient volume and turn over present in the ASC space. "There are some EMR systems that will only allow one person to be in the chart at a time," Mr. Luttrell says. "You need a system that really allows multiple people to access a chart to perform their work."
2. How will you host the EMR? Surgery centers have a few options when it comes to hosting EMR:
• EMR hosted in the cloud by the vendor. If the vendor hosts the EMR, implementation is relatively simple. "Turn it on and you can start using it," Mr. Luttrell says. "The time involved to start using it in a production environment can be reduced." However, he says vendor hosting also comes with a fixed monthly expense, and it's important to understand what you're getting for that expense.
For example, the vendor will charge a monthly fee for hosting and access to the EMR. You need to understand if that monthly fee includes all annual license fees associated with the system. Mr. Luttrell says another challenge of vendor-hosted EMR is the question of who owns the data. If you need to change EMR vendors, you may find that your vendor has retained access to your data and will not relinquish it without an ongoing access fee. “You need to incorporate that into the agreement up front,” Mr. Luttrell says.
In addition, a hosted solution may impact the performance of the software. Due to the dependency on your internet connection, make sure you have enough bandwidth to meet the requirements of the EMR system. You may also need to consider a backup internet connection.
• Install the EMR on your own servers. If you decide to install it on your own servers, which may be local or hosted remotely you may have a greater capital expenditure upfront for the installation and hardware. The EMR installed on your own servers provides much easier access to historical records if you decide to change EMR vendors. Some vendors don’t have an option to install the software on other servers.
3. What's the total cost of ownership for the various options? Determining total cost of ownership is essential to choosing an EMR — and TCO will likely vary tremendously depending on what you choose. Evaluating your TCO over 3-5 years makes it easier to compare the different solutions and how they could be implemented. The TCO model also helps identify annual or recurring costs in the future.
Vendors will also differ in their pricing models. For example, one vendor might charge an initial fee with an annual maintenance fee along with additional license fees for add-on products, while another vendor might charge a lower initial fee with a flat rate per case going forward. Talk to your vendor about their pricing model and determine whether a cost is associated with various potential situations. For example, if your surgery center grows, it is important to understand if there is an increase for adding a new physician or specialty. "It's important for you to take responsibility and identify those costs and ask those questions," Mr. Luttrell says. "You should work closely with the vendor to identify all related costs”.
"There's no fixed dollar amount or range you should be expecting to find", Mr. Luttrell says. "What’s most important is that you work closely with each vendor to negotiate a price that meets your budget requirements and project objectives. When you apply the different pricing models to a TCO over three to five years, it helps identify the most cost effective solution."
4. How will your staff access the EMR? Make sure you understand how the EMR will be delivered to your staff. Some EMR applications run within the browser, some run as a thin application and some only operate on a Citrix or Terminal Server that may have additional associated licenses and fees. If possible, choose an EMR that works on a tablet device so that staff members can move around freely while entering information.
5. How will new EMR software work with your current billing vendor? You don't necessarily have to use one system to meet your billing and EMR needs, Mr. Luttrell says. If you already have billing software that works well, consider a "best of breeds" solution and choose an EMR that will meet the needs of the center. Mr. Luttrell recommends speaking with your billing vendor, as they will probably make a recommendation about a system they prefer.
"There are obviously some symbiotic relationships there because of the interaction between those companies," he says. "Definitely talk to them and discuss it with your peers. Get feedback on the technology." He recommends exploring two to three EMR options, to make sure you understand what's available.
6. How will current or new staff support your software after implementation? You may need to contract additional technical support if the software is installed on your servers. Think about how you will respond if the software stops working — do you have an "on call" representative at your EMR vendor, or can you assign someone at the surgery center to fix the problem? Either way, make sure you have a system in place for the inevitable bugs that could occur during the first few months.
7. What are your needs in terms of unit and stress testing? When the vendor sets up the EMR, you will have to conduct "unit testing." This process tests the general functionality of the application in a controlled environment. "That's great, and you need to do that, but don't forget to also perform a stress test with the application as well," Mr. Luttrell says.
He says many surgery centers complete "unit testing" and forget to see how the software performs in a "real life" situation. "Put the EMR in the hands of your staff, and simulate four or five people using it," he says. "It will help you identify whether you have a problem with your wireless or internet bandwidth." He recommends unit testing for two to three weeks, then stress testing for one week. Once you've successfully tested the EMR, start a month-long transition from paper to complete EMR use.
8. How will you track your progress with the EMR? Make sure you have a single point of contact at your vendor for the first few months, and update them regularly on how the software is performing. You should also think about how you will measure the system's efficacy.
Before you implement the EMR, Mr. Luttrell recommends establishing benchmarks under your current processes — such as documenting the time and resources it takes to complete high-volume cases compared with more complex cases. "When you're using the EMR, do the same benchmarks again and see how they compare," he says. "This should give you a true bottom line comparison." There should be noticeable gains in staff access to the patient record. Instead of looking up a patient’s chart to then review the information, they will direct access to it from the computer. The EMR should also reduce the time required to meet the center's reporting needs.
Learn more about Meridian Surgical Partners.
Related Articles on Business Office, Accounting and HR:
Using a Part-Time Administrator to Oversee an ASC: 5 Thoughts From MedHQ's Tom Jacobs
Best Practices for ASC Business Offices: 2 Executives Weigh In
Pinnacle III Improves Operations and Revenue Management at Orland Park Surgical Center