Tansie Stewart, Grant Luke, and Max Gregori.Advancements in technology are remaking operating rooms, administrative back offices and patient care across the health care sector.
Yet for many ambulatory surgery centers (ASCs), the adoption of electronic health records (EHRs), artificial intelligence and other tech tools remains uneven at best.
“ASCs are probably behind the times,” Tansie Stewart, CEO of the Texas Health Surgery Center Park Hill, told Ambulatory Surgery Center News at the Investment & Operations conference. “It’s not regulated for us, right, at the surgery centers. The hospitals have all been kind of forced into that, and the ASCs have not yet.”To that point, there has been less governmental pressure for ASCs to implement EHRs, leaving them to weigh the benefits of digital solutions against tight profit margins.
For Stewart, who oversees a multi-specialty center performing about 600 cases a month, decisions about technology come down to whether a tech solution meaningfully increases patient satisfaction without costing too much.
“We do the paperwork, we input the charts, we break down the charts, we build the charts, we print the charts,” she said. “We have all of these things that can be replaced by an EHR. [There’s] the cost of the EHR, of course, compared to the staffing method. It really just comes down to what money can I save in my staffing and medical record storage building, in paper goods and things like that.”
Justifying an EHR expense means looking beyond the initial investment, Max Gregori, director of business development at Integrity Healthcare IT Solutions, said at the conference.
“Ultimately, with EHR adoption, we have to come back to the cost factor, the time element that’s required up front,” he said. “But what we like to encourage centers and operators to do is to look beyond that. Don’t just look at the upfront financial element, but look six months down the line: How much more efficient can your workflows be?”
Integrity Healthcare IT Solutions provides managed IT, advisory and hardware services for ASCs.
Furthermore, many nurses and physicians in ASCs associate EHRs with bulky hospital systems that have a reputation for frustrating workflows, Grant Luke, a strategic account manager at CapExpert, said at the conference.
EHR vendors, meanwhile, often struggle to demonstrate immediate returns, especially when administrators are juggling limited operating budgets and staff shortages.
Colorado-based CapExpert is a health care supply chain platform.
“A lot of these nurses were coming from hospital systems where they had an absolutely wonderful time working with the EHR, and so you have this historical bias going in of, ‘I don’t want an EHR in my facility,’” Luke said jokingly. “That’s partially because ASCs pride themselves on not being a hospital.”
Grant Luke and Max Gregori.
Balancing priorities
With private equity-backed management companies increasingly influencing ASC operations, balancing corporate ambitions with on-the-ground realities can be tricky, Gregori said.
To make it more complicated, management groups often focus on big-picture issues and data analytics, while local ASC leaders simply need to ensure that day-to-day processes run smoothly, he said.
“From management companies, they really have a top-down approach,” he said. “So the two things, in my experience, they care about the most are scalability and standardization.”
By rolling out cloud-based solutions for tasks like scheduling and billing, they can gather data to help with performance in areas such as case costing or block-schedule optimization, which can be an advantage.
“They can generate a much better image of the performance of their individual centers, which is extremely difficult to do when you’re charting on paper,” Gregori said.
Luke agreed that adopting ambitious technology can pay off in the long-term.
“So within the ASC space, you see pretty high variability in terms of what we’re adopting,” he said. “Those folks that can make those decisions with speed are those that are able to be more progressive and take advantage of these technological solutions earlier.”
Still, multi-facility organizations may require lengthy requests for proposals (RFPs) and top-down buy-in before adopting new tools.
Meanwhile, operators such as Stewart care most about whether systems actually work to support patients and staff.
“At the ground level, the thing I’m worried about is, ‘Can I get badge access? Does my internet work well? If I’ve got an EHR, is it working well, and does it integrate with whatever, you know, all of the other systems that I have?’”
AI in the ASC
Few technologies have made as many headlines recently as AI. Yet for ASCs, while AI can streamline administrative functions and coding tasks, it is not a magic bullet.
Artificial intelligence is essentially machine learning that “replaces things that have very low variability,” like certain repetitive administrative chores, Luke said. Freed from drudgery, staff can focus on clinical priorities, he added.
“You’re giving this algorithm as many variables as possible to come to the same conclusion,” he said. “And so what this AI is really used for is things like administrative tasks, for creating templates so that doctors can sign off on those faster.”
Although AI could also help in areas like payer negotiations or post-operative monitoring, high-touch patient care remains vital, Stewart said. While AI can help organize data or expedite coding, human interaction at the bedside is central to the ASC value proposition, she added.
“I don’t believe that AI will ever reduce our nursing care,” she said.
