Article

Record Time

Transforming your OASC with an EMR system

In today’s healthcare world of ICD-10 and other paper-intensive regulations, there’s no need to look hard or far for good reasons to implement an electronic medical record (EMR) system in your ophthalmic ambulatory surgical center (OASC).

Just ask Gina Biagi.

“With today’s present and future [data] requirements, all OASCs should be using an EMR,” says Biagi, administrator of Eye Associates and SurgiCenter of Vineland, an OASC in Vineland, NJ. “The amount of paperwork and time required to keep up-to-date data, let alone drawing statistics from that information, is cumbersome compared with just running a report and immediately analyzing the data you need. It is time-consuming and costly to use paper charts.”

Plus, especially with respect to OASCs attached to a clinical practice, there’s the need to log information twice for patients who require cataract and other types of surgery.

“Is that worth the time, money, and effort of making up the charts, handling, and storing them, not to mention, without an EMR, you’re writing in all the information by hand on multiple pages?” Biagi asks rhetorically.

Biagi isn’t the only OASC administrator who’s singing the praises of EMRs. Profitability and efficiency both increase when an OASC implements an electronic medical record system, says Jacqueline M. Burk, BS, RN, director of nursing at The Surgery Center of Central PA, in Allenwood, PA.

“If you complete routine cases with minimal change in the operative record, some systems can generate the operative record at the end of the case, sending it electronically to the surgeon’s box for review and signing,” Burk says, noting that the coding and billing also can be completed the day of surgery.

In addition, she says, transcription is decreased, and often not even needed. Data recall is simpler and quicker, eliminating the need to search through paper files and giving the staff immediate access to the charts, so they can assist patients calling in with questions about their cases.

Proponents of EMRs also tout the reduced chances of protected health information being lost, as well as the reduced need for filing cabinets and closet space.

“Space in an OASC is limited and costly,” Biagi says. “Why waste it with charts and a filing system?”

And then there’s the matter of market competition.

“I feel that patients look for a facility that is state-of-the-art,” Biagi says. “If you’re still using paper, patients won’t see you as organized, efficient, or as up to date as your competitors that do have an EMR.”

Finding the Right EMR for Your OASC

Joining the growing ranks of OASCs that are leveraging the benefits of EMRs isn’t difficult, but it shouldn’t be taken lightly. The first step is to thoroughly evaluate your wants and needs in light of your OASC’s budget, staffing, and infrastructure capabilities. Acquiring an EMR system takes a significant investment of time and money, and it’s crucial to get it right the first time.

“In high-volume centers, staffing needs increase with the use of EMRs,” says Burk. “While one member inputs data, another member is caring for the patient. Conversely, a decrease in staffing sometimes occurs in areas of transcription and billing.”

Tips for Successful EMR Implementation

  • Mandate software training and hold refresher sessions for staff heading into the go-live date.
  • Ensure all backend functions and data tables are complete and accurate before going live.
  • Ensure all preferences are in place to eliminate potential bottlenecks when you go live.
  • Ensure the EMR can adjust to your OASC workflow, not the other way around.
  • Beware of fees for future upgrades and additional features the software may require.
  • Consider using a cloud-based system; maintaining a server may not be as efficient or cost-effective in the long run, especially if you have multiple locations.
  • Develop downtime EMR policies and procedures; have downtime paper chart packets ready and keep them updated quarterly.

It’s also vital to ensure that your OASC’s computer network infrastructure can support the application, especially if it will involve satellite offices, says Kenneth Otto, MD, clinical medical director for Shoreline Vision Ambulatory Surgical Center in Muskegon, MI.

From the outset, most surgery centers will want to consider an EMR system designed specifically for ophthalmology and its related specialties, Biagi says.

“The chore of having someone enter all of the standard ophthalmic data into the EMR settings and design the needed forms for your OASC is completely eliminated when you choose a system that works with other facilities like yours every day,” Biagi says. “When the software company knows ophthalmology inside and out, they’re able to determine the best way for you to log information, while providing quality patient care.”

Considering ongoing compliance with CMS regulations such as ICD-10 and other federal and state laws is also important. As these change over time, the system should be able to accommodate changes quickly and efficiently. If you’re considering adding subspecialties to your OASC in the future, look for an EMR that can easily support those specialties. Another issue to consider is whether your OASC is attached to a clinic.

“If you operate a practice alongside your OASC, it is beneficial to have a system that can easily communicate with the practice EMR,” Biagi says. “At SurgiCenter of Vineland, we never need to re-enter any information for a patient, because all of the medical data and testing results are shared seamlessly between the two systems.”

Burk agrees. “Having the same system enables us to view the clinic chart electronically from the ASC, negating the need to transport or fax paper charts between facilities,” she says. “Also, less protected health information is circulating in office spaces, improving our HIPAA compliance.”

Beyond these major considerations, choosing what additional features to include in an EMR system generally comes down to the preferences of those in your ASC who will be using the system most often.

“Look for an EMR that will go with the flow of a day at your specific OASC,” Biagi says. “Charting needs to be easy with drop-down selections that can be easily changed, depending on your specific OASC or surgeon’s preferences. Simple is better when you look at your screens. Some EMRs have too much information up on the screen at one time. This can be confusing for the user and looks cluttered with information that can be easily stored on a tab if you want to review it.”

For Burk’s part, “must-have” EMR features include areas for listing patient allergies, body mass index, height, weight, medical history, diagnosis, medication, vital signs, and discharge instructions, as well as safety checklists, PACU records, pre-op checklists, orders, anesthesia, progress, phone calls, and consents. She also recommends EMRs that enable users to sign consents when the chart is open and provide a pre-admission testing area.

For the Record: What’s Out There

Three companies offer EMR systems specifically for OASCs. The following is a summary of the systems and their features:

Compulink

Compulink’s Ophthalmology Advantage EHR, practice management and ambulatory surgical center solution includes the OneTab EHR system. OneTab allows OASCs to document an entire procedure from a single screen to streamline workflow and increase efficiency, offers tools to automate MACRA reporting and monitoring of quality scores, and is customizable to meet the needs of the practice and ASCs. The all-in-one system also includes tools for practice management, optical, patient engagement, data analytics, telehealth, and revenue cycle management service. For more information, visit www.compulinkadvantage.com/ophthalmology/overview/ .

iMedicWare

The official ASC EMR of OOSS, iMedicWare’s iASC system allows users to customize consent forms, patient questionnaires, physician profiles, and pre- and post-operative orders. Surgeons can sign off on a patient’s chart with a single click and conduct real-time chart audits to ensure the chart meets all state and federal guidelines. Detailed productivity and case-cost analysis reports eliminate inefficiencies and streamline clinical workflow while increasing profitability. Electronic booking sheets for surgery can be provided to outside practices through the iASCLink feature, even if those practices are using a different EMR system or are still using paper. For more information, visit www.imedicware.com/iASC.html .

Medflow

The Medflow ASC EMR system can run as a stand-alone program or connect with an enterprise practice management system. Users can establish preference cards, surgical procedures, standing orders, RN checklists, CRNA checklists, intra-operative checklists by specialty, by procedure, operative notes by procedure, by surgeon, inventory, and more. For more information, visit www.medflow.com/ophthalmology-ambulatory-ehr.html .

EDITOR’S NOTE: EyeMD EMR is in the process of developing an EMR system specifically for OASCs, according to Jessica LaRue, a company representative.

Shopping for an EMR: Do Your Due Diligence

Once you’ve defined your wants and needs, it’s time to go shopping. Dr. Otto recommends thoroughly researching companies and their products.

Three companies — Compulink, Medflow, and iMedicWare — offer EMR systems specifically for OASCs, while a fourth, EyeMD EMR, has one in development.

“Formulate score cards for each vendor and narrow down your finalists” to invite in to demonstrate their products, Dr. Otto says.

However, “don’t depend on the vendor demos alone,” he advises. “Don’t fall for all the bells and whistles of the demo. If the vendor claims the system performs a certain function, make sure they can show you in a live scenario.”

Biagi agrees, noting that site visits are a vital and critical step for prospective buyers.

“References are very important and should be part of your due diligence,” she says. “If you visit another OASC, you can observe the patient flow, employees’ actions, patients’ actions, and how easy the EMR is to use. Before making our decision, we observed a busy OASC … to verify that the program could handle a center of our volume. It looked easy and quick, and seemed to follow the flow from check-in to discharge.”

As part of these evaluations, you should ask how the vendor performs with respect to client training and service after the sale and installation.

EMR Implementation: Time and Effort Required

By now you have surmised that acquiring an EMR system is nothing like downloading the latest version of Microsoft Office and clicking “install.” Indeed, implementing an EMR can — and likely will — take a good deal of time and effort. Obtaining the proper training on the system ahead of time is vital, says Dr. Otto.

“Invest a large portion of time on training many months prior and up to the go-live date,” he says. “Set follow-up on-site visits and ensure they are part of the implementation agreement. Expect a huge learning curve from both the client and the vendor. The vendor has to learn the idiosyncrasies of the practice, since each practice follows their own workflow.”

Dr. Otto adds that training costs should be included in implementation costs — including the costs of travel on the part of the vendor’s representatives. Biagi echoed Dr. Otto’s thoughts.

“The more [our staff] knew prior to the first day, the better for all. In doing this, you produce a prepared, stress-free environment for those involved. On our first day using iMedicWare, support was available onsite to assist our staff and keep the patient flow moving at a timely pace.”

As for that all-important “first day” of actual implementation, both Biagi and Dr. Otto advise reducing the OASC’s surgical workload.

“When we started with iMedicWare, I decreased the load of patients and spaced them out a bit so the employees had more time to get used to the new system,” Biagi says.

“Expect the system to work perfectly out of the box on the first day,” adds Dr. Otto.

Beyond the first day, continuing client support that’s readily available from the vendor remains vital.

“Ensure the contract references support availability, acknowledges response time, and, most importantly, resolution response time,” Dr. Otto says, whose facility also leverages the iMedicWare EMR system.

“I can tell you there is nothing worse than a company who doesn’t respond to issues you may be having with their software,” Biagi agrees. “You need to consider the client support you will be receiving after the EMR system has been implemented.” She adds that her staff and doctors also make use of such continuing education options as webinars, phone conferences, seminars, and tutorials.

“Always train a successor to use the system,” says Burk, whose facility utilizes the Medflow ASC EMR system. She notes that training multiple employees as “super users” is also a good idea to avoid putting the OASC in a difficult position should staff with extensive knowledge of the system leave the organization.

A Worthy Commitment

Asked about the key ingredient of a successful EMR system implementation, Biagi without hesitation declared it to be commitment of the OASC’s owners, management, and key staff.

“They must be on board and excited about the new system in order to have a smooth transition,” she says. “If employees see that the owners and management are happy and committed, then they will be as well.”

Burk agrees, acknowledging all the time and work that goes into transitioning from a paper-based system to an electronically based system.

“It takes time to implement an EMR system in an ASC, but the commitment is worth it,” she says. ■