Software developers are focusing on the ASC market and offering more to address some of your most pressing problems. Here are 10 advances you should know about.
Look for a 10.1 version of ORSoft from Per-Se Technologies in September. This facility-wide scheduling system with a perioperative emphasis is resource- and rules-based. You set the parameters for scheduling, the system automatically enforces them.
"We have all resources in the system, including humans and equipment. If a piece of equipment needed for a procedure is in use at the time we try to schedule, the system won't let us schedule then," says Altoona (Pa.) Hospital's Mike Wertz, RN.
The 10.1 version consolidates conflict messages to one page, halving the number of clicks.
Using Web-based technology from Picis, the surgeon goes online from any location and books into his block. The system doesn't let surgeons squeeze in a case, nor does it let them schedule a case for which they're not credentialed.
"We've built in historical information on the time it takes a given surgeon to complete a case, credentialing and so on. It eliminates a lot of phone calls and faxes," says Picis President Joe Smith. He says surgeons like the convenience of direct control over scheduling.
SurgiNet Anesthesia Management Information System records anesthesia care intraop. The anesthesia provider uses touch screens to navigate the system while being connected to medical devices that automatically enter data. Clinicians can directly access the interactive patient record any time during the case. The healthcare information technology company, Cerner Corp., has a patent pending on its preemptive medication-checking feature that identifies patient meds during the pre-anesthesia assessment; the system checks these against the anesthesia-care plan. The remote monitoring solution lets supervising anesthesiologists manage up to four cases from one location.
You can integrate SurgiNet with bedside devices, pumps and monitors to automatically add data to the electronic medical record. Access to completed perioperative nursing documentation lets the PACU nurse prepare for the patient's arrival, says Sue Tarkka, marketing manager for Cerner's perioperative solutions. Ms. Tarkka says that as healthcare organizations convert from radiology films to digital images, images will be viewed in the OR. Cerner's Radiology Information and PAC solutions let clinicians view images at any time or location.
Prescient Vision is a new integrated software system from Prescient Healthcare Systems. Alliance Surgery is implementing the Prescient Vision in its operations center in Atlanta and four other facilities.
"It's important to centralize and maximize resources, putting all data in one place. It's not cost-effective to have an information technology (IT) person at each center," says Glen Pridgen, Alliance vice president and IT director. "This system places all data here, with minimal IT needs."
Mr. Pridgen says Prescient Vision uses improved Web-based technology to make the system run more like a program than a Web page. He praises its streamlined report-writing feature.
In May, EndoSoft released a more integrated software product for endoscopy. Philip Grossman MD, FACP, FACG, medical director and chairman of Kendall Endoscopy and Surgery Center in Miami and a healthcare technology consultant, says he likes the system because it reduces duplicity.
"You click once on the data elements," he says, "and it fills in a background template. This produces pre-determined clinical reports. For each patient, the entries migrate to the correct home, important elements are highlighted, and the information is stored."
He particularly likes that the system generates letters to referring physicians and a pathology request when endoscopy notes are entered in the procedure room, and offers companion nursing information.
Web-based technology lets patients go online and register with demographic information, check scheduled appointments and inquire as to account balances. SurgeOn-SurgeryCenterSoftware Solutions from Experior Corp. offers HIPAA-compliant Web access whereby patients and surgeons can use the same features to review scheduled and access patient information online.
"This will be used more as people become more accustomed to sharing information online. You don't have to maintain a significant Web system and you don't need a system administrator," says Jim Freund, Experior's vice president of corporate development. "In fact, with our E-Tech program, we can perform just about all system functions remotely."
CTQ Solutions offers electronic patient satisfaction surveys, delivered via e-mail to the post-op patient. The survey results are provided each month to the facility, and benchmarked against national patient satisfaction data.
"The indicators totally encompass the patient experience, from pre-admission to post-discharge. The survey captures all the key indicators and it's customizable," says Marilyn Christian, RN, vice president of clinical operations for Foundation Surgery Affiliates in Oklahoma City, Okla, which e-mails the surveys to patients in its 13 facilities in Texas, Penn-sylvania and New Jersey. Patients without e-mail access get a paper survey that is then entered into CTQ's secure Web site as if the patient had submitted the response electronically. She says the response rate is 50 percent higher than it was with mailed paper surveys the centers sent out itself. Calculating the staff hours spent on mailing the surveys and compiling them, she's saving money by using CTQ. "I like e-mail because people get touched four times: When they come in, we tell them they'll get the survey, they get the survey and, if necessary, a reminder in 15 days and then another in 30 days," says Ms. Christian.
Improvements in voice recognition (VR) technology are making it easier for surgeons and facilities to create and share patient records. ChartLogic uses VR as a hands-free way for surgeons to navigate through the system.
"The system customizes features for medical specialties. It also connects to diagnostic equipment appropriate to specific specialties," says Romy Humphries, marketing manager for ChartLogic.
Dover Orthopedic in Dover, Ohio, has been using Chart Logic since early 2003. Now virtually paperless, it has its four surgeons using the VR feature nearly all the time.
"Some physicians take to it well, and others have to be helped along," says Marilyn Orr, MBA, practice administrator.
One device that has helped is headsets for physicians. They tried hand-held devices, but docs weren't speaking directly into the microphone. The headset eliminates the problem.
"VR is what attracted our surgeons to this product. We are built for speed, and this system is fast," says Ms. Orr.
Web-based technology is offering an alternative for medical transcription. Surgical Notes offers secure, online access for physicians, who may either call in to give dictation or use a hand-held digital recorder.
"We have four centers and 50 surgeons on this system," says Bridget Gibbons, vice president of finance for Regent Surgical Health in Chicago. "A lot of them were not that accepting of the change, but now 99 percent of them dial in. It gives us great accessibility of records, document retention and incredibly easy search capability."
Previously, she says, they had a smorgasbord of transcription handled at each center. Now she says there's more consistency and documentation compliance - and at a 7 percent to 8 percent cost reduction over the old system, she says.
Better billing and collections
GHN Online uses Web-based technology to connect facilities with health insurers. When a patient comes to a facility, GHN provides immediate online verification and eligibility information. The system replies to acknowledgements from the carrier, then automatically submits a rules-based claim (for example, it won't submit a claim that's incorrectly coded or lacks documentation) to the insurer. The insurance company remits directly to the facility's account, and the facility receives indication it's been paid.
"We are a few years ahead of the market. What Visa did for banking, GHN is doing for healthcare on the administrative side. There is two-way communication between GHN, the provider, employer, payer, patient and bank. We are managing the entire cycle, including the revenue side," says GHN Online CEO Azadeh Farahmand.
She notes the administrative cost for submitting claims is now estimated at $25 per claim. GHN greatly reduces this cost and speeds payment.
"We are bringing real-time service to health care," she says.
SurgeOn-SurgeryCenterSoft-ware Solutions also offers electronic submission and remittance of payment in the HIPAA compliant ANSI code sets.
"You can submit directly to carriers or use a clearinghouse to get your claims submitted. The client can submit and remit, and track collections. The E-Business Collections module helps lower AR days significantly. The system is all customized and user-driven," says Mr. Freund.
Source Medical offers an automated accounts receivable tool called Collector's Desktop. Available since last year, it's getting positive reviews.
"The follow-up is great, it's easy to go through accounts, and all information is at your fingertips. As soon as you bill, it assigns a follow-up date, so nothing is slipping through the cracks," says Tracy Cristello, business manager for Surgery Center of Baltimore.
Ms. Cristello says her department has reduced AR days and has reduced staff by one-and-a-half full-time equivalents.
As ASCs invest in wireless networks, you'll see more wireless applications. SurgiNet is looking at wireless tablet PCs for anesthesiologists to carry into the PACU to complete anesthesia documentation. Ms. Tarkka expects OR clinicians will prefer wireless tablets because they offer flexibility.
SurgeOn-SurgeryCenterSoftware Solutions offers a patient-tracking feature that shows where a patient is at any time. Staff can input notes for family members to read at computer stations in the waiting area. Patients are tracked through manual input, but there are plans to incorporate a bar code system.
Picis offers a patient-tracking system that proactively manages cancellations and delays. If a patient is expected at registration at 7:30 a.m., but doesn't arrive, the system automatically e-mails the appropriate staff.
"It's very expensive to have cases delayed or cancelled. This system can also help manage surgeon punctuality. When the patient is ready to go into the OR, it can text-message the surgeon," says Mr. Smith.
The Picis system will have an infrared/radiofrequency (RF) technology for passive tracking in 2005. Wall-mounted sensors will automatically sense when a patient, doctor, nurse or piece of equipment moves.
SurgiNet Surgery and Anesthesia Information System can read for patient identification or managing inventory. And passive tracking systems let you track the patient from arrival to discharge from the PACU. Ms. Tarkka predicts barcoding will be used more during medication administration to enhance patient safety.
Better reports, better decisions
New interfaces are providing easier ways to customize reports. Carolyn Evec, the administrator of Surgery Center of Beaufort (S.C.) says Medibis is providing the reports she needs in much less time.
"We're looking at adding a new service, and I wanted to do a cost/benefit analysis. I could have gotten it from my management software, but it would have taken a lot of massaging the data. Medibis does it for me," says Ms. Evec. "Last year, I was doing a cost analysis by specialty. It took me many hours and spreadsheets. With Medibis, it's just a few clicks."
She says it cost about $1,500 to subscribe to the Web-based technology, plus an ongoing fee.
Paul Davis, senior vice president at Health Inventures in Superior, Colo., says he is using Medibis to create an "electronic data warehouse." The software lets him store data from 35 surgery centers, then makes the data available to the individual centers. He produces detailed reports with the aggregate data.
"It's too laborious to slice and dice this data out of a transactional system. We can look at data based on different criteria," says Mr. Davis. "For example, we look at an individual CPT code and determine cost by physician or by payer. Let's say 10 physicians performed the same CPT code with different costs. Why were there differences? It helps us establish what is an appropriate cost."
Source Medical offers Decision Support System (DSS) that helps facilities mine data in different ways. DSS can place the data into Source Medical reports or other report formats specified by the facility.
"With DSS, you can run data every Friday night and have the reports ready Monday morning," says Craig Veach, vice president for Source Medical.
Drowning in your inefficiencies?
There's no doubt, says Dr. Grossman, that there's an enormous lack of efficiency in healthcare, much of which is related to duplicative actions.
"How many times is the patient asked for the same information? Does a staff member have to physically walk somewhere to get a record? Are two professionals redundantly serving the same patient?
"If those inefficiencies were taken out of the system, the same facility could treat more patients for less cost," says Dr. Grossman. "There are countless examples of hospitals going out of business and ambulatory surgery centers closing. In many cases, these were good providers who drowned in their inefficiencies."