When you consider that a surgical facility's revenue stream starts with the scheduling process, you're struck by how the limitations of phone, fax and e-mail can slow that stream to a trickle and how easy it is to lose cases when you play telephone tag with a physician's office staff. There's no escaping the fact that some cases will go elsewhere when your scheduler is in a meeting or at lunch.

Thankfully, there's no shortage of software and Web-based applications that automate the scheduling process. Before you plunk down thousands of dollars on these programs, though, here are 10 key factors to think about.

Built versus highly customizable. Before you even begin looking at programs, decide if you want a system that's already built or one that you can customize yourself. There are advantages and disadvantages to both, and what you choose ultimately depends on your needs and resources.

A system that's already built will be easier to learn, but leaves you with little room for the creativity to customize the system to your center. This type of system might be good if your center doesn't require a lot of extra applications.

A customizable system gives you the satisfaction of adding what you deem is important to your center - you can set reminders, alerts and conflict-checking specific to your facility. If you want it, add it. But remember that you'll need help to build a system with everything you want, which will require more manpower and money.

Interfaces with existing software. If you have other software programs in your facility, you need to make sure that any new scheduling software you purchase will be able to communicate with the existing programs. For example, an existing electronic medical record system needs to be compatible with a scheduling software program; otherwise when you input the patient's medical records in one software program, this information won't appear in the scheduling software. Re-entering the information decreases the efficiency of your facility and creates the opportunity for errors.

Interfacing can also reduce redundancy, which will optimize efficiency in the facility. Information from scheduling should automatically be available to administrative and clinical users of the system. This limited access also lets centers conform to HIPAA privacy standards because only those with access to the schedule can view it, as opposed to a paper schedule that could be left out for anyone to see. Good security management will ensure that your schedules and patient information are seen only by those authorized to view it.

Includes report capability. It's helpful to find a system that will let you build a database to use for internal benchmarking. Many systems let you report cost per doctor, monitor surgeons' volumes and evaluate room utilization, information you can use to create more effective scheduling and internal management of your facility. You can also analyze surgeons' minimum, maximum and average surgery times per procedure, which can provide more accurate scheduling flow and assist in preventing case delays.

"These options can extend the product's benefits beyond the front office to the rest of the staff and to surgeons, letting them track patients and the case flow," says one expert.

Provides conflict checking. By choosing software that tracks rooms, surgeons and available equipment, your center can avoid double-bookings by alerting schedulers to possible conflicts when posting cases. Your software should display surgeon block times, which will prevent you from scheduling another surgeon in that time slot, says an industry source. You can customize your software to block a procedure request in advance if another procedure is already scheduled in that time slot and there are no more ORs available.

Scheduling software can also contribute to patient safety. Some studies have shown that missing or incorrect information in the facility's front office application is often the root cause of mistakes made in the OR, such as instances of wrong-site surgery. With scheduling software, you can keep all the information on a patient together from pre-op to post-op.

Integrates inventory management system. Choose a system that will track supply use through surgeon preference cards; this can streamline your inventory management process. Surgeons and schedulers will welcome a system that makes it easy to update or change preference cards.

"Built-in preference cards enable a facility to capture and manage information on each surgeon's preferences and needs to ensure that the facility is prepared for the specifics of each case for each surgeon," says one industry source. By knowing what kind and how many supplies are needed for a case, you can reduce ordering and save money.

User-friendliness. A system that's difficult to use obviously won't increase your facility's efficiency. Programs now offer touchscreens, pull-down menus and defaults for commonly used words. You want a system that your staff will feel comfortable using, not one that they'll struggle to comprehend.

Web-based scheduling. Another new user-friendly concept in scheduling software is Web-based scheduling, which lets schedulers and surgeons access the schedule anytime and anywhere. Physicians and staff see current facility availability without contacting the facility scheduler. You can eliminate the phone calls and faxes with physicians' offices and also accept appointment requests after-hours and on weekends.

"This application can act as a competitive differentiator for the ASC in attracting and retaining surgeons," says one industry expert, noting that physicians can schedule surgery while the patient is still in the physician's office (regardless of your scheduler's whereabouts).

One note of caution: Physicians who have block time may be reluctant to change scheduling behavior.

Training. Even the best system is useless without a good training program. Some training programs last a few days while others can last for several weeks; this amount of time will vary depending on the complexity of the system and the amount of users who need to fully understand the entire program. Keep in mind that training shouldn't end when your facility goes live; inquire about low-cost or no-cost training sessions and review sessions for ongoing and new users.

Technical support. Nothing is more frustrating than a computer system that suddenly goes down. A scheduling software system is no exception, especially if you lose your schedules. Having a good backup system will help, as will having strong tech support. Make sure you buy from a vendor that has a strong support system and is financially stable and look for a vendor who can access your server remotely and see the problems you're seeing. This allows for quicker fixes to the system. Also, if the company is going to be phasing in certain elements, make sure the rebuilding is going to be in the right order so you don't have to shut down your system for days to add a program. And don't enter into a restrictive contract that will prevent you from going live with upgrades and updates when they become available.

Workflow. How will computerized scheduling affect your workflow? How will the software's logic fit in with your pre-existing processes? How much time and energy will it take to retrain the mental processes of employees? Can you afford the extra hours that might have to be spent on this? You might have to allocate a lot of extra resources just to get the system implemented, not to mention the extra training involved.

Which program is best for you? It's little wonder that scheduling software has become commonplace in ORs in the past several years. Not only can scheduling software let you operate more efficiently and effectively at the touch of a button, but many systems can also help your center achieve optimal case volume, case mix and room utilization. We hope these tips will help you select the program that's best for you.

Amkai
AmkaiEnterprise
(866) 265-2434
www.amkai.com
Price: Depends on requirements and options.
FYI: AmkaiEnterprise combines the features of the company's administration and billing system, AmkaiOffice, with the functionality of its clinical documentation system, AmkaiCharts. AmkaiEnterprise is modular in design, letting the solution grow with your organization's needs, says the company. Optional capabilities include CPOE, anesthesia documentation and patient kiosk.

Cerner Corporation
Cerner Millennium Ambulatory Surgery Suite
(816) 201-0054
www.cerner.com
Price: Not disclosed
FYI: Handling scheduling, registration, documentation, reporting, inventory, billing and collections, Cerner's software provides integration essential to successful management and transformation of care delivery, says the company.

Experior Healthcare Systems
SurgeOn
(800) 595-2020
www.experior.com
Price: Depends on the number of users and modules utilized; average system price ranges from $15,000 to $25,000
FYI: Experior's SurgeOn provides such user-friendly features as scheduling, registration, billing, patient tracking, preference cards, scheduler reports, chart packs, credentialing, a financial dashboard, variance reporting, implant/explant tracking, resource scheduling, block times, patient accounting, an e-business manager, a general ledger, inventory control, purchase orders and more than 500 standard reports.

HST
Pathways
www.hstpathways.com
(404) 387-0597
Price: Depends on size of facility and number of users.
FYI: HST's Pathways, the first enterprise-capable ASC clinical and financial management platform, is designed to be more secure, reliable and scalable than ever before, says the company. The rich and engaging content within Pathways optimizes the workflow and reporting capabilities at both the facility and enterprise levels.

McKesson
Pathways Healthcare Scheduling
(800) 981-8601
www.mckesson.com
Price: Not disclosed
FYI: McKesson's Pathways Healthcare Scheduling system is an enterprise scheduling solution designed to maximize resource utilization, improve throughput and increase patient, staff and physician satisfaction, says the company. The software supports revenue cycle and clinical care processes across the enterprise.

Mediware Information Systems
Perioperative Solutions
(800) 255-3057
www.mediware.com
Price: $25,000 per OR automated
FYI: Mediware's OR Perioperative Solutions enables at-a-glance information for dynamic perioperative environments, says the company. Scheduling is easy with the system's visual layout and color codes to alert staff of conflicts. Automated preference cards further enhance scheduling, enabling efficient planning and set-up procedures with links to patient information and billing to reduce errors and streamline processes.

Mednet
OASIS ' Online Ambulatory Surgical Information Systems (866) 968-MNET
www.mednetus.com
Price: Not disclosed
FYI: Mednet's OASIS is a fully Web-based ASC enterprise management application that will be available this summer. OASIS manages the functions of scheduling, billing, inventory management, document management and reporting, says the company. Physicians' offices can also access their individual block times with rule-defined scheduling.

NexTech Systems
Practice 2008
(800) 490-0821
www.nextech.com
Price: The system is modular (a la carte), so pricing varies.
FYI: NexTech's Practice 2008 is fully integrated practice management, marketing and electronic medical records software designed specifically for plastic and reconstructive surgeons. Developed by working closely with plastic surgeons, Practice 2008 has become a comprehensive, modular application for prospect tracking, scheduling, financial reporting, marketing, inventory, NexForms (includes ASPS consent forms), NexSpa and NexEMR, says the company.

Picis
CareSuite
(781) 557-3000
www.picis.com
Price: Varies depending upon facility size and number of ORs.
FYI: Picis' CareSuite provides seamless data sharing across perioperative care areas, says the company. The product also offers integrated clinical documentation; scheduling and patient tracking; powerful data analysis tools; comprehensive quality management; proven multifacility functionality; surgeon picklists and preference cards; advanced pre-op and PACU documentation; sophisticated remote office capabilities; and integrated PNDS standards.

SourceMedical
SourcePlus WebSuite
(800) 719-1904
www.sourcemed.net
Price: About $300 per month; varies based on facility's monthly case volume. The initial implementation fee is $2,500 and includes server setup, training and other support.
FYI: SourceMedical's SourcePlus WebSuite lets the physician's office view its surgical schedule, add cases, cancel blocked time and communicate with the surgical facility via a secure Web-based connection, says the company. The facility decides on the level of accessibility to the schedule as well as which the physician's offices will have access. The physician's office won't see your full schedule, but rather a suggested list of time slots for performing the type of procedure needing to be scheduled, says SourceMedical.