With the federal government calling for electronic health records for all patients by 2014, surgery center administrators are thinking about information systems a lot these days. Many centers already use software to create patient databases, automate workflow, capture clinical information and order supplies.

You can do this with a handful of programs or just one or two. Choosing software to run your surgical facility is not much different than choosing software packages for your home computer. You have to consider cost, how intuitive the program is and whether you'll be able move data from one program to another. The software firms focusing on the outpatient surgery market are getting closer to offering ASC enterprise software, the soup-to-nuts programs that do everything. While not all the systems out there are exactly comparable, here's a guide to enterprise software for ASCs.

Products: AmkaiOffice and AmkaiCharts.

Software platforms: Windows with SQLServer, Oracle, Java and Linux.
Scalability: Unlimited. Requires clustering technology as database grows.
Security technology: HTTPS.
Pricing structure and typical cost: Capital investment or subscription. Starts at $18,500 for capital acquisition and $12,500 for initial subscription rate.
Scheduling: From surgeons' offices, with conflict checking.
Patient tracking: Tracking page refreshes every 30 seconds.
Patient
Registration: Patient data entry at kiosk. Clinical information transmitted between physician offices and ASC.
Medical record forms: Custom forms and chart packs.
EHR: Data capture based on clinical duties and surgical specialty. Real-time measures and alerts. CPOE module available.
Pathology import: Interfaces with lab systems.
Dictation: Routes transcription to EHR. Voice recognition is optional.
Case manager: Case data used by AmkaiOffice for analyses.
Payer contracting: Contracting for procedures and billable supply resources on carrier level.
EDI with claims clearinghouses: Interacts with several clearinghouses.
Vendor EDI: No.
Workflow manager: Automatic task lists. Supervisor notifications, reassignment and alerts.
HL7 connectivity with other systems: Supported.
Credentialing: HR module tracks credentials and creates alerts during scheduling.
Real-time case costing: Forecasts based on budget. Supply costs and fixed costs can be used based on flat rate or "per-OR minute" rate.
Ad hoc reports: No. State-specific reports available.
Training and education: Learning center, on-site and Web-based.
User comments: The Laser Spine Institute in Tampa, Fla., began with AmkaiOffice software in May and goes online with AmkaiCharts this month. Management was looking for a comprehensive system developed by one company with which to go paperless, says Richard Harwell, an IT specialist at the facility. Staff use tablets and computers on wheels. Mr. Harwell has been working with Amkai to build a formulary and custom forms. He appreciates Amkai's flexibility. "They've done enhancements right on the fly," he says.
Web site: www.amkai.com.

Product: HSTpathways.

Software platforms: Microsoft .NET environment with Windows 2005 network operating system, Microsoft SQL Server for database management.
Scalability: Currently used by a multi-center firm with nine ASCs on one database. HST says 20 ASCs on a single database may be practical.
Security technology: SSL, HTTPS, Single Sign On integrated with Microsoft's active directory and direct authentication.
Pricing structure and cost: $15,000 to $60,000 for an independent ASC. Multi-center, subscription-based and pay-as-you-go pricing available.
Scheduling: User screens match workflow. Block times, conflict checking and remote surgeon scheduling.
Patient tracking: Status and time logs of patient progress.
Registration: Custom forms and batch printing.
EHR: No. Interfaces with other packages, most notably ProVation. HSTpathways includes document scanning and management system.
Case manager: Includes implant logs, quality indicators and clinical checklists.
EDI with claims clearinghouses: Manages all claim form types, claim batches, regeneration of claims and remediation. Partners with Transworld for past-due patient accounts and claims.
Vendor EDI: Real-time, two-way interface. Electronic PO feature in production.
Workflow manager: New task automation feature due in 2009.
HL7 connectivity with other systems: Supports multiple interfaces. No requirement for Microsoft BizTalk.
Credentialing: Staff certification integrated into case information and cost accounting. Physician credential data integrated into scheduling. Warns of conflicts or deficiencies.
Real-time case costing: Data extraction and reporting across enterprise.
Ad hoc reports: Custom reports generated.
Training and education: On-site training, classroom learning center and WebEx sessions.
User comments: A simple client interface, interoperability and Microsoft SQL compatibility helped Meridian Surgical Partners choose HSTpathways. "We wanted to make sure that we had some scalability," says Matthew Petty, Meridian's senior VP of IT. Every night, corporate extracts information on transactions, CPT codes, payors and accounts receivable to generate reports.
Web site: www.hstpathways.com.

Products: ProVation EHR and ProVation MD.

Software platforms: Windows, Unix and Linux.
Scalability: Unlimited on a single database.
Security technology: SSL.
Pricing structure and typical cost: ProVation
EHR: $10,000 per site plus $10,000 per additional room, includes three complimentary interfaces. ProVation MD: Price varies by procedure volume.
Scheduling: Integrates with practice management software (PMS).
Registration: Must use PMS. EHR program used for pre-admit call and check-in data collection. Physician completes pre-anesthesia assessment in EHR.
Medical record forms: Library of customizable nursing and workflow forms.
Pathology import: Receive and store pathology results from supported vendors. Physicians review and sign pathology results electronically.
Dictation: ProVation MD software replaces dictation and transcription for physician notes.
HL7 connectivity with other systems: HL7 interface applications (ADT, SIU, ORU, and Charges) and interconnectivity with other software vendors.
Ad hoc reports: Query-writing tool allows users to choose data elements. Queries can be exported into Excel.
Training and education: Classroom training in Minneapolis, on-site and on CD-ROM.
User comments: AtlantiCare Surgery Center has used ProVation software since 2005. Each patient's documentation begins with the creation of the nursing notes during the pre-op phone call. The electronic forms are patterned after the paper documents that the center used before, says Laura Applegate, RN, clinical care coordinator at the surgery center. Notes document pre-surgery information, personnel in the room, timeouts, sponge counts, patient discharge information and who drove the patient home. Finally, the document is locked and can be viewed in the read-only mode.
Web site: www.provationmedical.com.

Product: SourceMedical Vision.

Software platforms: Windows, Unix and Linux.
Scalability: Unlimited on a single database. Has been tested to handle 5,000 users.
Security technology: SSL and HTTPS.
Pricing structure and cost: Facility license, plus monthly support fee based on number of users. About $35,000 for license for 10 users, setup and training. Per-case pricing available.
Scheduling: Allows remote scheduling from physician's office.
Patient tracking: Patients monitored in real time.
Registration: Patients create history and physical file after receiving an e-mail invitation or a card that directs them to the facility's Web site.
Medical record forms: Custom admitting forms and chart packs.
EHR: Requires SourcePlus EHR module.
Pathology import: Supports EDI ordering and results retrieval from labs.
Dictation: Physician notes e-mailed from transcription service and attached to EHR.
Case manager: Used for billing, cost analysis, compliance and inventory management. EHR module replaces case manager when installed.
Payor contracting: Tracks reimbursement based on contracts. Sends alerts for discrepancies.
EDI with claims clearinghouses: SourcePlus RCM module includes online eligibility function and claims scrubber.
Vendor EDI: Purchasing module for ordering, confirmation and electronic invoicing.
Workflow manager: Generates flags and reminders. Alerts sent to colleagues or supervisors when tasks are not completed.
HL7 connectivity with other systems: Supports HL7, X12, XML and cXML.
Credentialing: Tracks credentials, vaccines and insurance. Alerts for lapses.
Real-time case costing: Cost analysis as soon as case is finished.
Ad hoc reports: Custom report writer.
Training and education: Classroom, Web seminars, on-site training and staff certification.
User comments: Bill Hazen, RN, administrator of the Surgery Center at Pelham in Greer, S.C., uses SourceMedical's Vision to follow the flow of patients. "I can look from my office and tell where every patient is," he says. Mr. Hazen also keeps track of expenses down to the penny. The system tracks supplies used, employee hours and fixed costs. Mr. Hazen generates a case-cost analysis as soon as a case is finished. "I can show [a surgeon] whether we made or lost money."
Web site: www.sourcemed.net.

KLAS Research
www.klasresearch.com
KLAS is an independent firm that researches and rates healthcare technology including products for ambulatory surgery.

Certification Commission for Healthcare Information Technology
www.cchit.org
CCHIT is a certification organization for EHR products. The group publishes The Physician's Guide to Certification for EHRs, available at www.cchit.org/files/CCHITPhysiciansGuide08.pdf