SATISFIED STAFF Stacey Reagan, RN, clinical director at PCET Surgery Center in Knoxville, Tenn., benefits from working with EMRs.

Besides improving the accuracy and thoroughness of your op reports and claim forms, electronic medical records can have a huge impact on the efficiency of your surgical facility, driving more volume and revenue to your ORs. Just ask Robert Foglia, MD, the division chief of pediatric surgery and the surgeon-in-chief at the University of Texas Southwestern Medical Center in Dallas. In 2006, Dr. Foglia spearheaded EMR implementation at UTSMC. At the time, 14% of cases were cancelled on the day of surgery, just 12% of first cases started on time and surgeons used only 47% of allocated block times. “Obviously, not good numbers,” he says.

Four years later, when Dr. Foglia measured the impact of using the EMR system on operational, financial and quality performance measures, the turnaround was staggering: Case volume jumped by 35% and surgical revenue increased by 53%.

The numbers, while impressive, were only part of the story. “You can put processes in place, but you also have to change the culture,” says Dr. Foglia. “The only people who like change are babies with wet diapers.”

Patience pays off
Surgical facilities typically lose efficiency during the initial months of EMR implementation, says Dr. Foglia. First case on-time starts at UTSMC dropped from 30% to 22% after the EMR was launched, but eventually rebounded and steadily increased to the current mark of 80%.

Brace yourself for inevitable pushback from staff and surgeons who’ll pine for pen and paper. This is such a nuisance, they’ll say when the electronic system goes live. But wait for the aha moment to hit months later, says Dr. Foglia. That’s when the useful data starts pouring in, the numbers you couldn’t get before. For example, UTSMC can now track the room turnovers of specific OR teams with the aim of limiting the unproductive time that Dr. Foglia says eats up an hour or 2 of a surgical day.

Alana Booth, RN, CASC, was trapped in the old school of thought of preferring pen to mouse. She’s the administrator of PCET Surgery Center in Knoxville, Tenn., which has been equipped with EMRs since opening in January 2013. Working with the technology from the jump was an advantage for Ms. Booth’s staff, many of whom came from a nearby hospital with electronic documentation, but she admits to having reservations.

“I had worked in several multi-specialty centers that did not have EMRs,” she says. “But I’ve absolutely changed my thinking and now love documenting cases on the system.”

Her EMR’s reporting tools “make us think about what we could do to improve all aspects of our center,” says Ms. Booth. “There’s so many of them. We’ve only scratched the surface.”

Like most EMRs, Ms. Booth’s system is programmed so staff must fill certain fields before they can progress through the file, so easily overlooked fields such as patients’ arrival times are always documented. That ensures Ms. Booth is analyzing complete data when using the system to assess the facility’s clinical and business performances.

Cheri Sarasin, RN, charge nurse at the Memorial Spine and Neuroscience Center in South Bend, Ind., remembers the facility’s failed attempt at trying to hammer the square peg of a hospital-specific EMR into the round hole of her surgery center’s needs.

She was also a key player when the center’s staff and leadership worked with an EMR vendor to transition to a customized system that fits their specific documentation requirements, including templates for regularly run reports, user-friendly drop-down menus, physician-specific discharge directions, constantly updated medication lists and safety checklists.

“Keeping the system current with frontline needs is an evolving process that’s made easier by the staff-driven adaptability of the interface,” says Ms. Sarasin. “The program is totally set up for our ASC. The whole process has been great for all of us.”

DATA ENTRY Scrub technician Alicia Cotner, CST, inputs case info that’s used to make real change at PCET Surgery Center.

Drilling down
Electronic records collect large amounts of hard data so you can identify areas of needed improvement over time instead of taking action based on assumptions and anecdotal evidence. For example, you can drill down to the block utilization rates of surgical services or individual surgeons. EMRs let you recognize surgeons who are dragging down the averages or outperforming their peers. “That information was very hard to get before,” says Dr. Foglia. “Now we can pull the data with 3 or 4 mouse clicks.”

UTSMC established a policy based on the cold hard facts generated by its EMR: Surgical service block times that fall below 10% of the hospital’s average utilization rate for 3 months are reallocated to specialties with case volumes that justify more time in the OR.

The data isn’t necessarily used as punishment. In fact, some surgeons or services might not be aware they’re lagging behind in certain performance measures. “We don’t say you ought to do this,” says Dr. Foglia. “We find a reason that they would find value in.” Fixing block time utilization benefits surgeons’ reimbursements, too, right?

That initial pushback you faced during the system’s rollout? It’ll be replaced with a hunger for data staff and surgeons need to make change happen. For example, Dr. Foglia says EMRs can identify surgeons with the highest supply spending. Now consider the most frugal surgeons. Are they achieving positive clinical outcomes? Bringing the facility’s mean spending down to the level of the cost-conscious docs is where real savings happen. It also creates a partnership between the surgeons and the facility’s leadership as both work in concert to slash expenses.

Dr. Foglia’s hospital performs about 14,000 cases in the main OR and about 6,000 cases in the facility’s surgery center. Hospital leadership wants to move about 1,500 outpatient cases to the ASC, which would improve patient satisfaction and free up time in the main ORs for adding or expanding surgical services. By shifting cases and relying on EMRs to improve operations management, the hospital’s administration expects to increase surgical volume by 4% over the next decade without adding another OR — which would have cost roughly $7 million. “We’d rather use those dollars to improve the current perioperative services,” says Dr. Foglia.

Plenty of positives
“There are many benefits to using EMRs that you won’t even realize until you implement a system in your facility,” says Ms. Booth. But realizing the true perks takes time. There will be growing pains. Be patient. It’s a dynamic process — you can keep drilling down into data to never stop improving.

Make the system work for everybody. “If surgeons are happy, there’s less chance they’ll fuss at nurses and scrubs,” says Dr. Foglia. “And if nurses and scrubs are happy, retention rates improve.” When the attitude of the entire surgical team lightens, patients will sense that your staff and surgeons enjoy what they do and care about where they work. You’ll get cases scheduled efficiently, achieve the best possible surgical outcomes and provide the best experiences possible for the patient’s family.