How to Choose and Implement an ASC Information System

Five years ago, most ambulatory surgery centers used computers only for billing and scheduling. Today, ASCs are relying on computers to do a whole lot more-including storing, organizing, and summarizing clinical, financial, and materials data. For many, the computer is becoming an essential tool for streamlining administration, negotiating contracts, reducing case costs, and targeting growth areas. As Brian Campbell, chief operating officer of the Atlanta-based ASC network Surgicoe Corporation puts it, "You need a system that can help you educate physicians to make good decisions."

Given the growing role of computers in the ASC, proper software selection and implementation is essential. Literally hundreds of decisions must be made to get the program up and running, and the impact of those decisions can ripple through the organization for years. To help you make the best software decision for your facility, we asked users of the three primary ASC information systems to share their experiences.

Scheduling modules that show a grid of today's appointments are a basic component of ASC information systems. This AdvantX module includes OR scheduling, optional recovery care scheduling, surgeon's preference cards, and block maintenance.

Selection
Choose an ASC-specific package. Managers may gravitate toward programs they used in their past hospital or practice jobs, but experts advise against trying to adapt any of these systems to the ASC. ASC-specific programs are unique in that they combine three primary features essential for running an ASC. First, they allow you to input important clinical data that a practice scheduling program does not, such as the type of anesthesia and diagnosis. Second, they allow data-sharing throughout the system so you don't have to re-enter information when you switch from one function to another. Third, they allow relatively easy data retrieval so you can analyze case costs, resource consumption, physician performance, and other factors that together determine your center's overall performance. "Hospital-based systems may be able to provide these reports," explains Roger Pence, ASC consultant and president of Edgerton, Ohio-based FWI Healthcare, "but you may need a software engineer to write the report program before you can access your information."

Occasionally, there are reasons to break this rule. For example, one ASC had to choose a hospital program because the local hospital mailed out all of its patient bills. Software compatibility was imperative.

Get maximum reporting capabilities. The ability to retrieve the information you need in the format you need is essential. Users recommend buying software that offers a lot of standard reports and the flexibility to extract data to design your own reports. "Some companies hide the fact that users can extract data themselves," claims Dave Dooley, manager of information systems at Mississippi Valley Surgery in Iowa, "and when you go to them for a report, you get charged for it." Mr. Dooley ensured full access to his database by writing an "open database connectivity" clause into his contract, which guarantees that the program will adhere to a known set of interfaces. Essentially, this allows him to get help from any local programmer when he wants to create non-standard reports, rather than go back to the software maker.

Whether or not you want total control over your program, keep in mind that you're likely to need custom reports at some point, and you'll probably need some form of outside assistance to obtain them. Defining your reporting needs up front will help you determine not only which system is most likely to meet most of your needs, but how you will obtain custom reports when needed. Here are some examples of specialized reports you may need:
- State reports. "In Maryland," says Jerry Henderson, executive director of the Surgicenter of Baltimore, "we need to do census reports that include the patient's zip codes, race, age, and county."
- Detailed case-costing reports. If you do orthopaedic procedures, you may need more detailed case-costing capabilities than centers that do more predictable procedures like cataracts and endoscopies. The same orthopaedic procedure can vary in cost by $1,000 or more due to differences in supplies, time, and staffing.
- Detailed CPT code analyses. You may wish to sort CPT codes by code volume and by volume according to doctor, or analyze your reimbursements when two CPT codes are billed together, since the second code is reimbursed at a lower rate than the first. "We need to do micro case-costing down to every penny so we can get our contracts to a closer degree of certainty," notes Mr. Dooley.
- Collections reports. Not all ASC packages have a collections module, and one user of a system that does notes that it is currently being refined by the maker due to several deficiencies. Larry Fischer, executive director of the Southwest Ohio Ambulatory Surgery Center in Middletown, Ohio, notes that he uses four collection agencies, and he would like to see collection reports showing the number of accounts per agency and total balance per account.

Ensure your comfort level. The user-friendliness of a program is very important because the staffers who use your system may be used to DOS-based systems, or they may be unfamiliar with computers altogether. All three ASC packages are Windows-based, which makes them all user-friendly, but they follow different logic. For this reason, it's important to demo the programs and see which system is most intuitive for you. "It partially comes down to which one you feel comfortable with," says Mr. Pence. Mr. Campbell, an AdvantX user, notes that Surgicoe took an especially hard look at the logic of the billing component. "Patient registration to scheduling to charge entry, to the back office follow-up-all these things needed to be intuitive," he says.

Find good tech support. A vendor that is there when you need help and is capable of solving your problems quickly is worth its weight in gold, agree the users we interviewed. "When support is good, you can forgive a lot of sins," says Ms. Henderson.

Implementation
Build your database first. Users and ASC consultants alike strongly advise building your database before going live. Entering all of the information necessary to create an electronic inventory and preference cards is time-consuming, but experts say if you don't do it beforehand, you will not get it done. The result of such a piecemeal approach, says Anne Dean, ASC consultant and president of Anne Dean Associates, is inefficiency. A multispecialty ASC that performs 400 cases a month, for example, is likely to invest 32 hours every month performing manual inventory, plus an additional 16 hours a month manually logging medical records and completing infection control surveys. "We didn't have the staff to input all of our 3,000 various inventory items, and it is extremely time-consuming to value inventory because we have to manually check invoices by product to determine our costs," says Mr. Fischer.

Build your database accurately. Haste makes waste, especially when it comes to database construction. For example, it's essential to use one set of universal terms when inputting your inventory items. Otherwise, when you automate inventory, you may end up with three or four different descriptions for the same item, and potentially quadruple the inventory you need for that item. Entering other items incorrectly, such as fee schedules and contract terms, can cause a host of other problems. "If you enter across-the-board percentage discounts and don't take the time to accurately enter the terms of each individual insurance contract, you'll get a skewed view of your income," warns Kirk Long, administrator of the Park Place Surgery Center in Lafayette, La.

Ensure adequate training. The functionality of any software is highly personnel-dependent. "Lack of training is always the biggest problem," says Ms. Dean. To help ensure adequate training:
- Don't schedule training so far in advance that the users will forget how to use it. "We suggest training two weeks before you go live," advises Ms. Dean.
- Use your own inventory and CPT codes while learning the system, rather than a make-believe database. Several users say this approach helped them visualize how the software applied to their practices.
- Send key people off-site for training. "Otherwise, people are too distracted," says Ms. Dean.
- Consider extra training. "Before we upgraded, all of our users were DOS-based," notes Rita Richmond, of the Cypress Surgery Center in Visalia, Calif. "I sent the whole staff to be trained on Windows ????-??95." You may also want to provide training for the data analysis programs that interface with the ASC package.
- Repeat training. Mr. Pence advises all of his clients to repeat training in six months to a year so new employees can learn how to use the system effectively. "ASCs grow, and you may have 12 employees a year after you started out on the system with four," says Mr. Pence.