In the ongoing shift toward value-based care, ambulatory surgery centers (ASCs) may need to rethink their record-keeping.
While hospitals embraced electronic health records (EHRs) years ago, often propelled by federal mandates, many ASCs continue to rely on paper documentation and manual processes.
But momentum to go digital is building.
With private equity activity, more health system affiliations, and a growing need for cost savings and efficiency, ASC operators are implementing digital record-keeping.
Data keeping is important for the industry, Janet Carslon, who oversees the strategic development, construction and operation of new surgery centers across Kentucky, Indiana and Illinois with Commonwealth Pain & Spine, told Ambulatory Surgery Center News.
If payers are presented with data that recognizes that ASCs can do more with less, that will be a boon for outpatient settings, Carslon said.
“I don’t think folks in legislation at the state and national level really know what an ASC does and understand the value proposition at all, so it’s slow moving,” she said. “We can take care of patients sooner, and our quality outcomes and our patient satisfaction are always very high.”
Kentucky-based Commonwealth Pain & Spine is a medical practice group specializing in spine-related conditions.
Why ASCs lag behind
While hospitals and larger health care systems are mandated to keep digital records, smaller outpatient facilities have largely been exempt from those regulations.
“The majority of ASCs are still paper charting,” Matt Cordio, president of Medserve, a narcotic management technology provider for ASCs, told ASC News.
Yet going digital could allow ASCs to be more effective, and safer, Cordio said.
“Today, we’re replacing key locked cabinets with physical keys, and paper narcotic logs that are in a log book or binder, there’s a huge potential for inaccurate record keeping,” he said. “And you don’t truly know who’s accessing the medication.”
Historically, many ASCs, often operated as small businesses, found themselves without the same regulatory pressures and resources that incentivized hospitals to make the digital leap.
Yet recent trends, particularly health systems establishing joint ventures and private equity backed groups buying and consolidating centers, are accelerating demand for EHRs.
“I think that as the industry consolidates and we see more private equity activity, more health systems who are no stranger to technology in the ASC space, that we’ll see more technology adoption,” Cordio said.
While there is no specific, imminent bill currently moving through Congress or set to take effect that would require ambulatory surgery centers to implement EHRs, a federal mandate is not out of the question.
“We don’t know when, but there’s already legislation that’s being passed around and being talked about that says, ‘Hey, we need to mandate the EHRs across the board for health care, not just physicians offices, not just hospital systems, but also outpatient surgery,’” Grant Luke, a strategic account manager at CapExpert, who previously worked on EHR implementation for several ASC management companies, told ASC News.
Colorado-based CapExpert is a health care supply chain platform.
Another example of how federal regulation shaped EHR-implementation progress is behavioral health care. Similar to ASCs, behavioral health entities weren’t mandated to adopt EHRs.
As a result, just 6% of behavioral health facilities and 29% of substance use disorder treatment centers use electronic health records, according to industry research.
Hospital systems don’t always fit
ASCs handle fewer services and smaller patient volumes than hospitals, so many large, hospital-focused EHR solutions don’t always align with the needs of outpatient environments, Luke said.
Hospital EHR vendors often remove certain hospital-oriented modules and repackage their platforms as “ASC-friendly,” but the fit can still be cumbersome, Luke said.
“When I was at Surgical Care Affiliates and United Surgical Partners International, we compared all the different practice management and EHR solutions that included folks like Epic,” Luke said. “And the biggest thing that we saw was, for our purposes, folks like Epic, it’s like they bring a nuclear warhead to a water gun fight.”
Epic Systems is a common EHR system, along with others, like Surgical Notes and Cerner.
“When we were evaluating [EHR platforms], you saw things in there, like the oncology department, but you don’t have an oncology department in an ASC,” he added. “It was very clear that it wasn’t really a great product, and all they were doing was just kind of taking away different areas and then saying, ‘Oh, this is for ASCs.’”
The cost of systems has been a prohibitive factor as well, especially if no regulation compels them to go digital.
“ASCs are much more price conscious than hospitals overall, and so the price of these EHRs was pretty hard to digest up until probably about three or four years ago,” Luke said.
The best EHR solutions for ASCs cut out unnecessary hospital-centric features, focusing on surgical preference cards, streamlined scheduling and compliance modules, Luke said.
“There is a complexity that is just not needed at the ASC level, in terms of the number of clicks it takes to document something, or the level of reporting that’s required, or that because, like for hospitals, it’s federally mandated to have EHR, whereas ASC is it’s not,” he said.
As more complex procedures like total joints and cardiac interventions move to outpatient settings, more comprehensive digital records and standardized data collection could help demonstrate quality outcomes and cost-effectiveness, Cordio said.
“You’re going to see just a better picture into the quality of care and the effectiveness of care and the competitive advantage that I think we all know exists from performing procedures in the outpatient setting,” Cordio said.
This detailed data enables ASC leaders to make evidence-based arguments for the expansion of covered procedures, which in turn attracts new patients and payer contracts, he added.
“There’s so much paper still in the surgery center space that there’s just so much opportunity for technology that can drive efficiency, reduce cost, reduce risk,” he added.
