The Birth Of An Integrated PM/EMR Application Specifically Made for Bariatric ASCs

As you may know, the launch of an ambulatory surgery center (ASC) requires a task list a mile long. There are hundreds of tasks required to open just a single center. Developing business plans, construction plans, architects and accreditation is just the tip of the iceberg. Meeting federal, state and county requirements is a monumental task in and of itself. Typically, one of the last items on the list is researching and deploying the clinical applications that will enable the organization to operate the center on a daily basis. The common misconception is that ASCs don’t need to utilize practice management (PM) and electronic medical record (EMR) applications until it’s time to open the doors. The reality is that truly successful centers almost always begin the software procurement and deployment process months in advance of the first surgery.

Due to the long pre-op process with bariatric surgery, the PM/EMR application should be operational within the ASC at least several months prior to opening. It was critical that our surgery centers have tight integration between the medical records system and their practice management (billing/collections/reporting) application. Obtaining insurance authorizations for bariatric surgery is a lengthy process that requires a substantial amount of supporting data. Tracking and documenting the patient and ASC staff member’s workflow steps, pre-op and post-op, is critical in meeting Centers of Excellence (COE) requirements, which was one of our primary goals for the NewHope system.

Ideally, our bariatric ASCs would utilize an all-in-one software application that manages all operations and compliance requirements from intake to discharge. As the chief information officer of NewHope Bariatrics, I spent almost four months discovering that there was no such software product available on the market. I was unable to locate a product that met slightly more than half of what I was looking for in a system. I was beginning to think that we would have to attempt to build an interface between two separate software products, and from years of experience, I knew that integration projects between PM and EMR systems rarely work out as planned — and if they do, they require an enormous commitment to staffing an IS department. Based on NewHope’s business plan and the fact that the company was a start up operation, my IS manager, Wendy Gramer, and I would have to implement a product that met both the operational needs and the clinical needs of the business within a reasonable budget. Some of the other system requirements we had set as a company included the need for the application to be easily deployed across multiple states in dozens of locations with minimal IT staff to support the application.

After researching dozens of PM and EMR software companies, it became apparent that we would have to hire a programming staff or contract programmers to build an application from scratch, as there appeared to be no viable option available on the market. Finally, in October of 2006, I found a company that specialized in rapidly configuring EMR tools on top of their PM tool set to address the needs of niche healthcare industries such as bariatrics. The company was Raintree Systems, Inc. from Temecula, Calif., and after a series of demonstrations, my team and I decided to partner with Raintree to build the industry’s first completely integrated software application.

Our team completed a series of system design meetings with Raintree’s enterprise product manager, Stacey Goodwin. During these meetings, we worked jointly to collect data requirements, document system rules, forms and report configurations to meet COE requirements. We designed the Raintree application to track and document each pre-op and post-op process for the nursing staff, anesthesiologists, and surgeons through an easy-to-follow clinical pathway.

The project leads designed and configured the tables and electronic data interchange tools to meet the needs of NewHope’s back office operations. The project team concurrently worked with MDNetSolutions to build an interface between Raintree and LeadTracker™, which NewHope utilizes for marketing purposes. The full implementation involved four major projects that entailed several hundred tasks. All of this was completed in parallel with NewHope opening its first ASC in Los Angeles.

The PM/EMR implementation project planning and specifications gathering process began in mid January 2007. The product was completely configured, tested and deployed in time for the center’s open date in August of that same year. In my career, historically software development life cycles typically have lasted between 12 and 24 months, depending on the scope of the project. Completing a project of this scope in less than six months would be impossible with most software tool sets. That our project team was able to complete the implementation while concurrently preparing to open this first ASC, is nothing short of remarkable, and we credit Raintree’s dedication and fast tracking development to NewHope’s ultimate success.

With the successful opening of our second ASC in Overland Park, Kansas, and plans for many more over the next year, NewHope enjoys the additional benefit of the fact that Raintree is a hosted ASP application that requires no servers or additional overhead at each of the centers; thus saving tens of thousands each year in maintenance and overhead, to speak nothing of the fast deployment time. Each computer requires the install of a single client file and is up and running in less than five minutes.

Raintree delivered a product to NewHope that is scalable, and easy to deploy, and support that allows access to our staff and physician partners anywhere an Internet connection is available. It truly meets and exceeds all of our requirements for a PM/EMR system.