IT Systems Drive Today’s ASCs

IT Systems Drive Today’s ASCs

By Michelle Beaver 

Electronic systems are irritating when they break, but even the most lofty luddite must admit that technology plays a vital role in today’s ambulatory surgery center (ASC) environment.

INFORMATICS — which is the design and application of information technology — is a mighty tool for many ASCs. The academic definition of informatics (according to the Donald Bren School for Information and Computer Sciences at the University of California, Irvine) is that informatics “studies the structure, behavior, and interactions of natural and artificial systems that store, process and communicate information. It also develops its own conceptual and theoretical foundations.”

The skinny of this definition is that in proper working order informatics saves time and acts as a whole team of secretaries.

Products can include appointment scheduling, paperless faxing, order tracking, organization of procedure reports, lab results, coding, etc.

When various systems in one ASC work in conjunction, the benefits can be incredible, says Scott Riemenschneider, president of Schedule- Surgery.com, LLC.

“Informatics truly has the potential to empower and improve efficiency and decision- making on the clinical and business side of the ASC,” Riemenschneider says.

“Considering how you can capitalize on the benefits that a particular informatics system can deliver should be a regular exercise,” he says. “Along with how technology can impact your clinical, operational or financial decision-making capabilities, or how process automation provided in the same areas can improve your efficiency and productivity, it behooves just about any size ASC to consider its current environment and at least put some level of ROI (return on investment) analysis into potential informatics investment.”

The Real World

Informatics programs are helpful but kinks can arise, says David Redmiles, chair of the Department of Informatics at UC Irvine, who learned this lesson early in his career.

 “When I visited the end users of my software system, I learned how far apart software developers’ intentions could be from end users’ understanding of their work and how both could be different from the system’s requirements articulated by domain experts,” Redmiles says. “It was a jolting lesson in human collaborative activity.” Redmiles built on what he learned and still strives to alleviate problems that stem from poor communication.

“In my post-doctoral work my colleagues and I studied how developers and end-users collaborate, especially focusing on the problem of mismatched expectations,” he says.

The consequences of an end-user misunderstanding a program can be terrible, says Susan Hollander, BSN, MBA, FACHE, vice president of National Surgical Care (NSC).

“Depending on the extent of the use of informatics at the surgery center, a mismatch at the most extreme level may become a causative factor resulting in an adverse event, such as wrong-site surgery,” Hollander says.

“This could be related to programming errors in a newly-designed system or multi-software interfaces under testing,” she adds. “The end-user should always have multiple checks and balances while in the testing phase to assure these incidents do not occur.

More often, the severity is related to billing errors resulting in delay of payments from payor denials.”

Limitations

Technology saves the day on a regular basis, but everyone who’s ever lost important data or had other technical problems knows that computerized systems are far from perfect.

Indeed, they are limited, Redmiles says, but that was a tough point for him to realize.

“When I wrote my first program, I realized that computers were highly constrained environments but it seemed as if they could be programmed to achieve any imaginable objective,” he says.

“I have come to learn that although computers are great enablers for human beings, computers are indeed limited to finite possibilities,” he adds. “Therein lies part of the tension between computers and the real world; it is difficult to craft the finite to function in the infinite — or at least much larger — world of possibilities. Consequently, this tension is the source of challenges to computing and software development and in turn the source of ‘buggy’ behavior in software.”

Faulty Communication

Sometimes frustration with one computerized organization tool can beget a larger distrust of informatics, Riemenschneider says.

“At a high level, healthcare informatics applications and systems which do not meet end-user expectations have the affect of impeding further informatics adoption,” he says. “If a healthcare facility has had a bad experience with an application, they will think twice about their next implementation.

This creates a serious problem for the healthcare industry, because in this age of information, innovative information management tools are what can and will make the business of healthcare more efficient and cost effective for everyone.”

Honest and clear communication is key throughout the entire process.

“There needs to be a symbiotic relationship between program developers — who think they have an idea of what customers’ want — and potential customers who also think they know what they want,” Riemenschneider says. “Developers need to be regularly engaged with customers in confirming that the product they are building, and then providing, is not only what the customer wants, but something the customer can and will actually use.”

The average informatics user probably comes up with plenty of excuses for why systems don’t always function properly, including, “this network is so stupid,” “technology never works,” and “this computer hates me,” but in actuality, common culprits are of course less personal.

Culprits

Sometimes applications are just plain hard to use, a flaw which can stifle even the most innovative product, Riemenschneider says.

Another problem is that applications are occasionally marketed and implemented inaccurately, and poor training and unrealistic expectations can also lead to dissatisfied users, he adds.

These reasons all throw a wrench in the situation. That is unacceptable, Riemenschneider says, for “If an application cannot meet the enduser’s expectations then what is the point?”

Misunderstandings are often at the root of it all, but don’t have to be.

“The development process of any successful application requires a close and iterative relationship with early adopters to help guide the application as it matures from a proof of concept through its alpha, beta, and production release versions,” Riemenschneider says.

Even if a product is pretty much perfect, it does an ASC team little good if it is not used to its full ability. Under use is indeed a problem, according to Hollander.

“I believe (informatics) can be more useful than it currently serves the staff,” she says. “In small ASCs I frequently see centers that do not use their systems to their maximum ability resulting in administrative slow down of processing information requested by its physicians, inaccurate case costing information and underperforming cash management with overstocking of inventory by not using the materials management module.”

Tips

The most important advice Riemenschneider offers to potential purchasers of informatics systems is to do their homework. 

“Before considering any technology or informatics systems, and regardless of a facility’s size, I would suggest identifying where the real bottlenecks exist in your ASC’s performance and then look for technologies which address them,” he says. “Don’t just buy technology because it seems like the thing to do; buy it because you have identified a problem or area of under performance which needs to be addressed.”

Riemenschneider further suggests that purchasers consider a system’s interoperability.

“How easily can a system integrate and securely exchange information with other informatics systems?” he asks. “As in any other business, there are always going to be new innovations which can improve the efficiency and efficacy of the ASC. You want to consider how much an information system limits your ability to adopt new technological innovations. Because in this era of falling reimbursement and ever-tightening margins, you need to constantly be finding new ways to improve your business operations.”

In basic terms, all healthcare information systems are just vessels that hold data, but the stakes are still high.

“The ease by which that data can (or cannot) be accessed can adversely or positively affect your ability to bring bottom-line innovation to your ASC,” Riemenschneider says.

“So when you are considering various healthcare informatics systems, don’t think of them as residing in their own segregated silos. The information flow within the ASC is truly a stream which flows through and permeates all elements of the business — be it clinical or financial — outcomes.”

He suggests that shoppers consider the willingness and capability of their vendor to work with other vendors. He also suggests that shoppers think about HL7 compatibility.

According to the staff of EMR Edge (which develops electronic medical record products) HL7 stands for “Health Level 7” and is the standard for information interchange between systems in the healthcare industry.

Riemenschneider also suggests that shoppers “test drive” applications.

“You won’t know how an application can really fit in your environment unless you can try it out beyond a simple demonstration,” he says.

Product Pantry

When considering products it is wise to think about how long an installation process will take, how much technical support will be available down the line and how helpful that support will be, Hollander says.

“One important pitfall to avoid is to underestimate the time it will take to build the databases,” she says. “Find a vendor who is willing and able to upload your materials, dictionaries of CPT codes, fee schedules and other large, time-consuming bits of data.”

Only a handful of products work for NSC, Hollander says.

The Vision training program can be accessed any time and includes simulations, tests, videos and study guides.

According to Mednet Technologies, every ASC that wants to get ahead in the industry must consider Web-based ASC management software.

“Computers today provide us with capabilities that were unthinkable a short time ago,” company literature states.

“Software enhancements and upgrades are announced daily keeping us on top of the latest technology. At the same time this industry is years behind in the current information technology.”

Another company, gMed, was founded on the idea of providing products that are superior to a paper medical chart.

“Physicians are in a rapidly changing environment and the pressure of adapting to a paperless system to remain competitive can be daunting without the right products and guidance,” gMed literature states.

The company includes installation, training, customization, support and maintenance for several services including:

• Digital storage of messages, appointments, lists, results, faxes, prescription refills, etc.
• An “office note” program that quickly calculates billing codes and manages medical orders 
• Documentation of pre, intra and perioperative procedure information

Glimpse into the Crystal Ball

There are some changes coming down the pipes in how informatics will serve the ASC industry, Riemenschneider believes.

“(Foremost is) the growing adoption of business intelligence and analytics tools and services (which are) currently used more for financial analysis, but will become even more valuable as they are further integrated into outcomes monitoring and strategies.”

“Web-based portals for case scheduling, patient registration and broader information exchange are replacing traditional phone and fax-based communication between physician offices and ASCs,” he says. “These portals provide facilities with improved operational efficiency, as well as marketing and customer service capabilities.

“The degree to which different systems and different entities can efficiently and effectively exchange information will be integral to how much information technology will be able to help ASCs in the future,” he adds.

Overall, ASC staffs are not rapidly changing the way they use informatics, according to Hollander.

“Not on a day-to-day basis in your typical, average ambulatory surgery center,” she says. “There are always exceptions to this statement, but in working in the ASC industry for the past 20 years as both an AAAHC (Accreditation Association for Ambulatory Health Care) surveyor who experiences other surgery centers and as a vice president in a national company participating in evaluating the operations of other surgery centers, there has not been a leap in application of the ASC software packages available for purchase on the market today.”

The most significant change, Hollander says, is the ability of the end user to train on the Web (a practice that cuts down on travel time and expenses).

Another significant change, according to Hollander, “will be the ability of the ASC to interface the physician’s electronic medical record information with the ASC’s program to avoid errors and duplicity in patient demographic and clinical information.

A recent development is the access of the ACSs scheduling program with the physician’s office in order to allow the physician to manage his own operating room schedule.”

Hollander hopes that in the future each software system will be “programmed so that interfacing with other software systems is not tedious, expensive and under prioritized by the informatics companies.”

In the meantime she will strive to use current products as efficiently as possible, and will continue to base purchase choices on, “the reliability of performance, minimal rebooting, speed of the system, integrity of data and the ability to recover data in case of major disaster and data availability.”

And if that fails, one can always resort to the question that popped up circa 1990, “Why does this computer hate me?”