EHR in ASCs Big Trends Emerging Sponsored By April 2015
2 Introduction EHR in ASCs: Big Trends Emerging Featuring: LoAnn Vande Leest RN, CEO Northwest Michigan Surgery Center Cindy Klein VP, CMIO United Surgical Partners International R. Michael Boyer DO, FAOCA, Physician Consultant Joint Commission International Electronic health records are revolutionizing health care delivery at hospitals and physician offices. Now ambulatory surgery centers are seeing the benefits of EHR technology and are searching for the appropriate technology for their site. In order to truly be agile, efficient and cost-effective, we are focusing on standardization of data and processes, says Cindy Klein, Vice President and Chief Medical Information Officer for United Surgical Partners International. We need accurate quality, comparative data to meet business goals, share information with partners and continually focus on improvement. This won t be an easy road for ASCs as the federal government offers financial incentives to hospitals and physician offices for meeting Meaningful Use criteria through the use of EHR technology, but not to ASCs. However, surgery centers still need to report quality measures to Medicare, and an EHR can make this process more efficient. The regulatory environment definitely influences our strategic plans for health care technology in a big way, says LoAnn Vande Leest, RN, CEO of Northwest Michigan Surgery Center in Traverse City. When we have to prove quality, its much easier to do so with information from discrete fields that can be reported on easily by running reports versus going through every chart and using the stubby pencil method. However, most EHR systems are designed for large hospitals with a cumbersome user interface. ASCs need the ability to streamline their EHR and design an efficient user interface for the outpatient setting. The best approach for ASC, EHR success is to collaboratively work with the vendors in order to improve applications, says R. Michael Boyer, DO, FAOCA, Physician Consultant, Joint Commission International (former Medical Director of Olson Ambulatory Surgery Center, Northwestern Memorial Hospital, Chicago, Ill.). Cindy Klein, Vice President and Chief Medical Information Officer at United Surgical Partners International, has extensive experience implementing Cerner EHR at USPI surgical hospitals and working with key stake- In order to truly be agile, efficient and cost-effective, we are focusing on standardization of data and processes.
3 holders to develop the appropriate technology. Interoperability is key for ASCs to communicate with physician offices as well as potential hospital partners. We will never get to where we globally need to be without interoperability, says Dr. Boyer. Lack of full interoperability is bad for patients, for institutions and for the health care system. As providers move closer toward providing high quality, seamless care, the health care market will demand systems speak with one another. If you look at the interoperability requirements CMS is working on now, the goal of our government is to have all care providers contribute to the continuum of care and to do that you have to be interoperable with the EHR as a foundation, says Ms. Klein. I think that s an important driver of what will happen in the future. The difficulty is the government has not given us the guidelines for our EHR structures or standards for vendors to follow to invest in the products with the workflow and interoperable needs of the ASC. HIT Strategy Physician offices and ASCs are working together to provide the best care possible for patients. EHR implementation can be part of a larger health care information technology transition including benchmarking, data gathering and patient tracking. Ms. Klein describes her HIT strategy in a few key steps: 1. Work with health care industry and government leaders on these initiatives: We use the lessons learned in the surgical hospitals to develop a system that meets the needs of an ASC and uses the knowledge and experience gained in the Meaningful Use program to help create a certification for ASCs that {includes measures that matter. Developing a voluntary EHR certification so ASCs can participate in interoperability Guidance to vendors on developing a quality and cost-effective EHR Advise on what makes EHR sustainable in the ASC Advocate for the physicians to work in ASCs without Meaningful Use penalties 2. Work with vendors to develop a patient-focused, multi-tenant, interoperable technology platform that is cost-effective, process-driven and integrates the ASC s workflow, which includes: Revenue cycle Supply chain Clinical documentation 3. Implement technology that supports the overall goals. For USPI, the overall goal is to participate in data sharing and population health. { The lack of inclusion in Meaningful Use has driven a strategy that focused technology implementation in surgical hospitals first, says Ms. Klein. We use the lessons learned in the surgical hospitals to develop a system that meets the needs of an ASC and uses the knowledge and experienced gained in the Meaningful Use program to help
4 create a certification for ASCs that includes measures that matter. Some centers that were early adapters can see long-term benefits from employing an EHR in their HIT strategy. EHR technology was invested in by our last CEO, as he was a very forward-thinking individual and he wanted NMSC to be cutting-edge in technology and the assumption that it would soon be required, says Ms. Vande Leest. Over the years, the popularity of that decision has waxed and waned, but overall when the system is working out well, it is more of a benefit than a hindrance....the popularity of that decision has waxed and waned, but overall when the system is working out well, it is more of a benefit than a hindrance. Choosing an EHR USPI has Cerner EHR in 12 surgical hospitals. The company chose Cerner because of their platform s interoperability. efficiency. The hospital EHRs are acute care and emergency department based, and include technology for ancillary services not appropriate for an ASC. The same quality measures don t make sense in outpatient ASCs. For us, because we have the modeled partnership between physicians and hospital systems, we felt strongly about having a foundation system around interoperability, says Ms. Klein. Since we implemented the EHR in our surgical hospitals, we met Meaningful Use and we re now working on MU2. There are a lot of similarities between hospital and ASC needs from an EHR, with the stark difference being quality measure reporting, and an overall emphasis on ASC and physician office staff spend a lot of time searching for information, lab results, radiology results and medication history, says Ms. Klein. In an ASC environment there is care integration between the physician office and the facility. There is a need to exchange H&P, OP notes and discharge summaries. Today this is costly and time consuming. The ability to exchange this information electronically will improve access to information in a timely and more cost-effective manner. Because we have the modeled partnership between physicians and hospital systems, we felt strongly about having a foundation system around interoperability.
5 EHR Benefits The EHR system allows all staff in the ASC to access the patient s chart at the same time and see where the patient is within the episode of care. The nurses are able to eliminate duplicate questions because information can flow from one form in the EHR to another. The EHR allows us to access cumulative information quicker and easier, says Ms. Vande Leest. This helps in a myriad of ways, from infection control research to staffing as well as internal and external benchmarking. It also enables us to share information more easily with the patient population as well as the medical community. But the positive impact on providers isn t immediate; it takes time to truly incorporate EHR technology to deliver the desired result. The return on investment comes in several forms, says Ms. Vande Leest. There are savings in not having to print and assemble charts, along with the staff time involved. Also, when looking for reports, the discrete fields help us to mine data faster than doing it by hand. There are cost reductions in these areas: Staff time putting charges together Chart storage reduction Paper reduction Transcription Accurate data is necessary for best clinical decision making and for developing best financial efficiencies. data gathering is feasible. This will enhance compliance/safety/quality and ASC financial performance. There are also improvements in medication administration safety. The EHR includes a closedloop medication administration which allows nurses to confirm the dosage, dosage time and whether the patient has already received the dose. It enhances the clinician s ability to make decisions and think through areas where they might make a mistake, says Ms. Klein. Finally, data gathering becomes easier with EHR technology. Implementing an EHR makes the center data-rich, but figuring out how to use the data appropriately can be challenging. With an EHR you have to change how you report, says Ms. Klein. You have to understand the data and the parameters to make sure you have a return on information that is appropriate for the outcome of the report. Have a good report-specification tool and expect to spend a lot of time developing reports. Accurate data is necessary for best clinical decision making and for developing best financial efficiencies, says Dr. Boyer. If your EHR vendor or health care organization proactively builds excellent provider guidance and data gathering tools, (to utilize within provider documentation workflow) best-practice care pathways and best Knowing what information you want to pull out ahead of time makes the process more efficient. Keep the EHR simple and inclusive to foster the best results, especially during training. At USPI surgical hospitals, the surgical hospital staff trains new staff on the EHR process while vendors train on the technical aspects.
6 Future Possibilities In the future, EHR technology will also play a role in patient engagement and decision-making. Care pathways are very important in the ASC, says Ms. Klein. We can tell the total knee replacement patients where they should be in each step of the { process, from preoperative to surgery and then recovery. We can show them where they should be and communicate electronically about their process. We can send direct emails back and forth to improve patient engagement. In the end, the ultimate goal is to provide best-practice patient care, quality and safety. EHRs can also improve an ASC s ability to communicate with payers. If certain payers require certain information to pay for a patient s care, you can build exactly what the payer requires within clinical and non-clinical provider documentation tools to utilize within their workflow, says Dr. Boyer. Then payers have accurate/timely information that they need for proper coverage determination. Health care providers can also share successes more quickly. If one ASC develops more efficient tools within the EHR, { the vendor can make those upgrades for other ASCs to incorporate at their centers relatively quickly. ASCs can also more accurately measure whether their processes are actually best practices against others. ASCs and EHR vendor collaboration, communication and cooperation allows for timely changes in health care delivery and financial management, says Dr. Boyer. In the end the ultimate goal is to efficiently provide best-practice patient care, quality and safety. About Cerner At Cerner, we re continuously building on our foundation of intelligent solutions for the health care industry. Our technologies connect people and systems at more than 18,000 facilities worldwide, and our wide range of services support the clinical, financial and operational needs of organizations of every size. Together with our clients, we are creating a future where the health care system works to improve the well-being of individuals and communities. By designing leading-edge health information technology, we offer strategies that empower organizations to know, manage and engage their populations. Our applications are developed with physicians in mind so they can focus on people, not technology. And providers can manage their day-to-day revenue functions with our integrated clinical and financial systems. These helpful tools are designed to work for today and think for tomorrow. From the beginning, we have innovated at the intersection of health care and information technology. Our mission remains to contribute to the improvement of health care delivery and the health of communities. Sponsored By