Trend to Watch: Is EHR Adoption Critical for ASCs?

What’s driving the current shift to electronic health records — and what OR leaders need to understand to make the switch.

Most new ASCs are opening their doors with an electronic health record (EHR) system in place, and estimates suggest somewhere between 20% to 50% of existing freestanding surgery centers have made the switch.

Why? Because standardized electronic data can improve patient care, save clinician time, and help meet regulatory and accreditation requirements — all factors that ASCs should optimize, stresses clinical informatics expert Janice Kelly, MS, RN-BC. She’s president of AORN Syntegrity, a perioperative solution for electronic charting. Ultimately, data stored electronically means patient information can be shared to help guide safer, more coordinated and more cost-effective care, notes Ms. Kelly. “Consider the value of reducing redundant labs or radiology exams, reducing the risk of prescribing the wrong treatment or medication, and increasing the opportunity to flag potential drug interactions,” she says.

From a business perspective, Ms. Kelly says access to standardized electronic data offers ASCs data comparisons and analytics for focused performance improvement. “Having electronic data also makes it much easier to report quality measures,” she says.

Doing more with less (staff)

With staffing shortages becoming the norm, no ASC can afford time-consuming work in any area of its practice, making an EHR system a desirable time-saving solution. The fear is that the switch from paper documentation to EHR is trading one time-consuming practice for another.

Not so, says Bill Willis, director at Vance Thompson Vision, a multi-state outpatient surgery organization based in Sioux Falls, S.D. He and his team made the EHR switch in 2021. Circulating RNs now spend less time documenting than they did with the paper system. “Less cost and time spent on updating, printing, storing and scanning paper charts has been beneficial as well,” he says.

Surgeon time is saved with electronic signature functionality through the EHR, which has eliminated the need for surgeons to sign paper orders, the H&P attestation and operative notes. The anesthesia team has also seen a paperwork burden reduction. However, Mr. Willis says the decision to implement EHR is the easy part — the hard work happens prior to your launch, when ASC teams must collaborate to determine what needs to be documented against what is currently being documented. “You risk making documentation more burdensome if you are not intentional in this assessment,” he says.

VENDOR QUESTIONS

Finding the Right EHR Fit

ASK ME ANYTHING The trial period is the best opportunity to ask potential EHR vendors everything you need to know about the technology.  |  HST Pathways

Don’t be afraid to ask a potential EHR vendor for information that will help you select the software that is the best fit for your facility or system. Here are important questions Ms. Cash and Ms. Kelly suggest asking:

• What are the overall costs and benefits? EHR vendors should have ROI calculations on their product, so ask for upfront costs as well as short- and long-term returns because this information will help your team with decision-making. Also look for comparison costs between paper versus electronic charting — info vendors should have — to help make your case with your team.

• How easy is it to use? Setting up a system correctly is essential and time-consuming, which makes its overall ease of use most important for smooth implementation. Being able to show that the software is designed to be as simple to use as possible and that it can provide reports and analytics with just a few clicks will go a long way toward convincing your team that it is a great choice for them.

• Will it improve patient interactions? Some EHR systems offer enhanced patient experience and communication. Ask about automated text messages to patients such as appointment reminders, electronic educational materials and discharge instructions accessed via a patient portal.
—Carina Stanton

What’s driving EHR adoption

While ASCs aren’t federally mandated to implement EHR systems, there are three key drivers currently pushing ASC leaders to make the switch anyway, according to Maura Cash, RN, BSN, CASC, vice president of clinical strategies for HST Pathways, which provides EHR software for ASCs.

• Staffing recruitment appeal. With staff shortages playing a factor for the foreseeable future, ASC leaders are looking to optimize staffing in a way that is also fulfilling for the teams. The right EHR can increase patient care time for nurses and decrease time spent on duplicate chart information, which can improve job satisfaction. “Given the tight recruitment pool of candidates today, relieving ASC nurses and physicians of cumbersome paper processes with modern charting tools in an ASC-tailored EHR is a huge recruitment tool,” says Ms. Cash.

• Data-driven tools for growing needs. Whether you need the data for submission to CMS and registries or for in-house analytics to make better decisions, Ms. Cash says managing big data is only achievable through EHRs. She describes EHRs as a gold mine of information to achieve better outcomes for patients while improving finances for a facility. “More cases and more challenging patients will flow to the ASC space, which means data-driven care for these patients and data-driven decisions to maintain profitability are paramount,” she says.

• Cost savings in resources and staff time. Paper and storage prices continue to rise, and these costs are compounded by increasing salary costs of staff who manage paper records. Such factors help make the return on investment for electronic charting desirable. “ASC leaders will clearly see the only way to meet the needs of their facilities is to adopt technologies to prepare them for the future,” says Ms. Cash.

Overcome these hurdles to prevent delays

Setbacks can derail the best-laid plans for EHR adoption at any stage of the process. From vendor consideration to implementation to sustaining use long-term, the best way to steer clear of common hurdles is to be prepared. Here are some common obstacles facilities come up against:

• Interoperability. From the beginning of entertaining the idea of switching to an EHR, teams should think about how their electronic data could be shared. “The ability to quickly move information across all care participants is the only way to meet the challenges of the future of medicine,” says Ms. Cash. She suggests ASC leaders look for a forward-looking software solution from a vendor that can address important needs such as security, as well as data sharing via API (application programming interface) or FHIR (Fast Healthcare Interoperability Resources). Overall, she says “you want to make sure the EHR software you purchase meets the maximum standards, not just the minimum.”

• Infrastructure readiness. Get your ducks in a row before implementation, Ms. Cash advises. You’ll want to ensure your Wi-Fi can handle the load, and you don’t have any dead zones where charting occurs. From a team standpoint, she suggests putting people in place to lead EHR implementation, ideally through a committee that will review all software options and your move-forward plan. This team can secure early buy-in by asking staff and providers for EHR elements and functionalities important to them.

• Pushback during implementation. Securing buy-in from the whole team is a key challenge for EHR adoption, according to Mr. Willis. “We know it only takes one or two people rallying against any change to make implementation painful,” he says. To jumpstart an engaged EHR transition, the Vance Thompson team created mock patient charts within a sample EHR to demonstrate how the team would use it throughout a patient’s course of care. “After these mock charts were worked through, we asked for team feedback and worked with our vendor to make adjustments in areas they felt could be improved,” explains Mr. Willis. Throughout this process, leaders should keep in mind that clinicians may have different perspectives on how much documentation to keep.

“Leaders play an important role in guiding the team toward a focus on essential charting,” he says.

For successful coordination with the surgeon team, Mr. Willis says to be clear that there will be disruptions to normal workflow, and it will take time at launch — this sets expectations to reduce frustration. To circumvent discontent with delays, Vance Thompson reduced its schedule by 30% on the first day, 20% on the second day and 10% on the third day. “On the fourth day, we returned to full capacity effortlessly,” says Mr. Willis, If you can make it work, he suggests providing surgeons with a scribe or designee to assist them with their EHR responsibilities. “If this isn’t an option, create the most efficient process possible for them,” he says. “Include them in your planning as they offer a different perspective and ask good questions.” OSM