Image by Pexels from PixabayWhile once mostly used mainly in hospitals, electronic health record systems (EHRs) are growing in popularity in outpatient settings.
Yet integrating EHRs in the ambulatory surgery center (ASC) setting, where margins are tight and staff limited, is no small feat. Loyola Ambulatory Surgery Center President Melissa Rice said the payoff is worth it.
“Upfront, it could look a little mundane, but it also then saves you time on the back end,” Rice said on ASCA’s Advancing Surgical Care Podcast. “I don’t have to spend two nurses’ salaries three hours a week to then do chart audits. It’s already done. It’s already automated.”
Rice is also an administrator with the Loyola Ambulatory Surgery Center at Oakbrook Terrace.
For her ASC, adopting an EHR was not a quick decision, Rice said. The process took about two years of evaluation and site visits to determine which system would best meet her center’s needs.
“We definitely went out in the market and looked at all the different players that were specific to ambulatory surgery centers, and there are a lot of great ones out there,” she said. “Ultimately, it did come down to finances and how well it worked for us, our specific ASC.”
Key clinical leaders were also brought into the decision-making process early, including a physician, the center’s director of nursing and an anesthesia provider, Rice said.
“Having those players engaged early was critical,” she said. “They understood where we were headed and what compliance and workflow issues had to be addressed.”
While the selection process was deliberate, the implementation phase still came with hurdles, Rice said. Staff members initially resisted leaving paper records behind.
“Upfront, 100% resistance across the board,” she said. “But once we started to show them how a lot of it was going to help their charting and was going to take them away from looking at the paper, to actually focus on direct patient care, it was a kind of an aha moment for them.”
The first two months after the launch were especially difficult.
“There were a lot of mistakes, but … I told them, ‘You get the important stuff [right] first; we could always go back and look back at it,” she said. “Having that mindset as a leader, but also being there and in the thick with your team, really helped adoption.”
And having younger, tech-savvy hires take the lead on teaching how to use the system also helped, she said.
“I had some newer staff that were really excited about teaching and helping out,” she said.
Despite the challenges, Rice said the benefits of EHR adoption have been significant for both her patients and employees. Cloud-based access has made it easier for physicians to sign off on records remotely, while patients can log in to update their own health information, she said.
“It’s been really great to have that direct communication with the patients, because that also makes them comfortable, because they’re able to see it,” she said.
Since Loyola is a teaching facility where all providers are employees, Rice said her experience was smoother than it might be in physician-owned centers.
Still, physician engagement can be a sticking point no matter what, she added.
“There was a very big difference from physician-owned to non-physician-owned,” she said. “The non-owner providers [couldn’t] have cared less. They didn’t understand that there was a financial impact up front, but it was also going to play itself out and be great. They also weren’t there as much either. So there was a little bit of a learning process, but they came around.”
Because surgery centers face tighter margins and leaner staffing than hospitals, EHR adoption can be daunting. But the long-term payoff makes it worthwhile, Rice said.
“We should look at how it is going to service our patients, first and foremost, and then secondly, how it is going to take away the mundane aspect of charting and really focus back on direct patient care,” she said.
EHRs can be useful systems to communicate across providers and for vendors to adapt based on ASC feedback, Rice said.
“The more that we use our voices and talk back to the vendors and let them know what works and what doesn’t work, the better it will be,” she said. “A lot of the vendors have been listening, and I think we are headed that way.”
Rice added that with large systems like Epic, one of the largest EHR system providers in the United States, shaping expectations for information sharing, ASCs will need to remain active in advocating for systems that improve patient access to records while also reducing the documentation burden on clinicians.
“Once we can get to where everyone has the same information, I think it’s going to be a good thing,” she said.
