How to Migrate EHR to Your ASC

Leave paper charting behind to unlock a wide range of clinical and operational efficiencies.

The status quo can be comforting and reassuring, but it also can choke innovation, progress and growth. In the ASC world, perhaps its most seductive example is paper charting. Yes, the thinking goes, using paper might be shockingly old-school and occasionally a hassle … but if ain’t broke, why fix it?

Making the transition

The fear of the unknown that comes with transitioning from paper to electronic health records (EHR) — cost, potential disruption to time-honored clinical and operational workflows, the learning curve for personnel, pushback from long-time staff — makes it easy to kick this can down the road year after year. As each year goes by, however, an ever-growing number of ASCs — perhaps your own direct competition — are embracing EHR not only to make charting easier, but also to use the evidence-based information these digital systems produce to make clinical and operational changes that improve workflow and throughput, boost profitability, enhance patient safety and much more.

If your center evaluated EHR systems in the not-so-recent past, the technology has advanced. The major drawback of needing to install and maintain computer servers and related IT equipment on-site — consuming precious square footage in the process — is no longer necessary, as many EHR systems reside entirely (but securely) in the cloud. That means, for those with proper login credentials, many EHRs are now accessible from any device, such as a desktop PC, laptop, tablet or smartphone. The authorized user doesn’t even need to be physically present at the ASC; they can check in from a remote location virtually anywhere.

In addition, your physician partners’ offices as well as your patients can directly — and again, securely — view or feed data directly into many systems. It’s also easier than ever to expand EHR far beyond charting by integrating scheduling, billing, supply management, patient education and other functionality into one cohesive platform. It sounds intimidating, especially for those uncomfortable with technology. But by engaging a vendor partner or consultancy that will dig in with you to understand exactly what digital functionality your business needs and that your budget can accommodate, you can build a system that makes so much of what you and your staff do every day more collaborative, more efficient and just plain easier.

Or you can stick with paper charts and watch the world eventually pass your practice by. That’s your right, of course. But as surgery becomes more data-driven, and larger data-aware health systems and other moneyed entities continue to move into the ASC space, paper-based “mom and pop” ASCs are in danger of falling significantly behind their competition. We recently spoke with two ASCs that successfully converted from paper to EHR and have subsequently reaped additional benefits they likely never imagined originally.

Collaborative effort

Specialty Orthopaedics Surgery Center (SOSC) in Gainesville, Ga., began performing total joint replacements reimbursed by private payors in 2016, and its practice grew further after CMS began reimbursing ASCs for total knees in 2020. As these major cases began to dominate its operations, the center planned to expand from two ORs to four — and the limitations of its time-honored paper charting system were thrown into much sharper focus.

SOSC was dealing with so much paper, in fact, that it contracted an off-site facility to store it all; only records from the past year were kept on-site due to space limitations. When an older chart needed to be pulled — common with repeat patients — SOSC paid a courier service to bring it from the storage site to its facility, with requests requiring 24 hours’ advance notice. The paper-based system frustrated patients, surgeons and staff alike to the point that the ASC created a labor-intensive workaround. “In the three years before we went to the EHR, we started scanning charts as opposed to sending them to storage,” recalls Elizabeth Rushton-Conto, the ASC’s business office manager.

SOSC also wanted to reduce the potential for documentation errors and duplication of efforts. “With paper charts, you’d have a patient on the schedule, make the chart, and they might move five times before they actually have that surgery,” says SOSC Director of Nursing Michelle Sloan, BSN, RN, CNOR. “Keeping up with that process was very time consuming.” Only one nurse at a time could access a paper chart, which was assembled on a clipboard once the case was scheduled and passed around throughout each patient’s episode of care.

To address these inefficiencies, SOSC’s forward-thinking CEO encouraged a switch from paper to digital, which would allow multiple people to access the same chart in real time with no clipboards involved. The center already used ASC management software and engaged its vendor about integrating it with its cloud-based EHR product.

Ms. Sloan says staff buy-in was facilitated by involving them in the project from the get-go, particularly staff “super-users” who championed the conversion as well as less tech-savvy, more reluctant users. “It helped having them as a large part of the build,” she says. “We kept them up to date on what we were doing and managed to do the build and keep the ship floating at the same time, which was a little tricky. Staff could see the benefits of eliminating the duplication that happens with paper charting, how many times we were writing the same thing. In the digital world, things carry over from one place to another.”

“Get staff members involved in the project as early as possible so they have extra time to digest it and learn it, and they’ll be more likely to be okay with it by the time you’re ready to go live,” recommends Ms. Rushton-Conto.

Ms. Sloan says SOSC’s small staff benefitted from the project going live during a slower week. “We would have regular huddles to make sure we were capturing all the data points that were on paper into the digital format,” she says. SOSC also held weekly calls with its vendor during the implementation process. “They kind of gave us assignments every week to make sure we accomplished what we needed to meet our original goals for implementation,” says Ms. Sloan.

To ensure the conversion’s accuracy, the implementation team developed a chart audit sheet on which staff could note if anything was missing or not working properly in the electronic system. The day before the system went live, they did a dry run. All told, the conversion took less than two months. “We were still doing our daily roles,” says Ms. Sloan. “Some days you might carve out an hour, a couple hours on the build. Some weeks were more labor intensive. Others involved making sure it looked like what we wanted and that everybody was happy with how it was going.”

Because the EHR was just one component of the cloud-based platform SOSC implemented, the ASC kept expanding its digital capabilities. “The more we used it, the more we saw other ways we could improve,” says Ms. Sloan. For example, the platform is now used for case coordination with vendor reps. “We can notify reps in real-time on cases and time changes, and communicate with them about implants and instrument trays we need,” she says. Ms. Rushton-Conto says schedulers at physicians’ offices can see and even request cases during their block times on SOSC’s schedule, and surgeons can pull up patient charts, all in real time, even when the facility is closed. This helps SOSC maximize its OR utilization.

Among other things the platform has enabled: Patients can review instructions and submit information from home that goes directly into their charts; patient tracking boards keep families aware of their loved one’s status through their perioperative journey, with staff better aware of the status of each day’s flow; and Ms. Rushton-Conto can manage and track the progress of billing and coding through the entire revenue cycle.

“It’s given us the one-up on the business,” she says. “As patients go to other facilities, especially the hospital, they expect real-time information and updates. As managers, we can pull up the schedule on our phone; we don’t have to be in front of our computer. We can work from anywhere. We all like that it’s fully customizable. Now, if a physician changes an order or there is a change in discharge instructions, instead of changing it on paper and distributing that everywhere, we can go in there and change it in seconds. That’s a time-saver. You almost forget what it was like beforehand.”

“Set your goals, set your guidelines,” says Ms. Sloan. “Don’t get overwhelmed by the process, don’t talk yourself out of it. Visit a center that has gone through it, and you’ll see how it’s changed everything for them.”

Embrace the new normal

GROUP EFFORT With EHR, every provider in the perioperative chain can access and modify a patient’s record simultaneously in real time.

Gramercy Surgery Center, which operates multispecialty ASCs in Manhattan and Queens, N.Y., rapidly moved from paper to digital shortly after it opened for business in the 2000s. “It was a hard transfer for the first two weeks, but because we were busy and it was such a repetitive action, the nurses got into the chart relatively quickly,” says Jeffrey Flynn, CASC, administrator and chief operating officer.

Over the last 15-plus years, Gramercy’s EHR system has evolved, from clinicians and managers tweaking it to embracing a cloud-based platform that eliminated on-site computer servers while bringing additional functionality beyond simply charting — ASC management, communications with patients and physicians, mobile access and more that has made workflows more efficient. One big benefit, says Mr. Flynn, is the ability for nursing leaders to monitor charting and rapidly discuss corrections with specific staff who are weak in certain areas of documentation.

Gramercy’s data-aware and highly customizable technological foundation — including specialty-specific documentation templates that can be easily built — has improved interdepartmental and interdisciplinary communication and given the independent ASC operator a competitive advantage in a constantly evolving and competitive market.

Mr. Flynn, who also serves as vice president of the New York State Association of Ambulatory Surgery Centers, says time is running out for the estimated 45% of ASCs in his state that still use paper charting. For example, the trend is moving toward patients having centralized electronic access in real-time to their medical records. “In the surgery center business, for us to be considered part of the solution and be taken seriously as one of the alternatives, we need to show we are following the same rules that everyone else is,” he says.

He believes ASCs must overcome their reluctance about the cost of EHR in a world where data is crucial to prove the efficacy of services ASCs provide to payors, regulators and patients. “Health care is going our way,” says Mr. Flynn of ASCs. “I really do believe this is our time, and that we will make a significant difference in the cost of delivering care in the country, but we need to be up to all of these standards, and you can’t do that on paper. As we go to value-based payments and performance-based payments, there’s no way to prove it without data, and these people are going to be left behind.”

Worth the short-term pain

Mr. Flynn believes paper-based ASCs would be best served by going all in on digital, beyond EHR. “It may be hell for a little while, but you’ll know you’re going to be better off in the long run at the end of it,” he says. “I’m not the most computer savvy by any means, but I also know that the information that our system gets for me has allowed me to find ways we can use this tool to our advantage.” One powerful example of the kind of business intelligence these systems can generate: a quick determination of the profitability of adding a new program to the surgical mix. “So many people start a new program and, a year later, find out they were losing money on each case,” says Mr. Flynn. “With our system, I pretty much can know within a four- or five-week period whether we’re losing money on the cases or not, and we can switch to something else.”

If you’re fixated on ROI when it comes to EHR and other digital tools, Mr. Flynn gives what he calls the bluntest answer for why you should embrace them: “You’re going to be able to keep your license and keep your center open. We’re moving more highly complex procedures into surgery centers that we haven’t done before just because technology is changing. If we’re antiquated and can’t prove anything, we can’t move forward. People are just going to find themselves just out of luck.” OSM