TIME SAVER A successful program can cut pre-admission phone calls from 30 or 35 minutes to 10 or 15.

Online pre-admission is likely the wave of the future, and many early adopters are riding high, thrilled with the improvements they're seeing and the time they're saving. Still, it hasn't been smooth sailing for everyone. Many say they've had to swerve through a variety of obstacles, and some say they're still struggling. A few even wonder if the switch was worth it.

The good news is that what they've learned can help you make sure you end up on top of the wave, not flailing beneath it — if and when you're ready to make the transition.

"Our patients love the ability to do it from home," says Susan Alexander, MSN, nurse manager at the Reading Hospital SurgiCenter at Spring Ridge in Wyomissing, Pa. "Many do not have the ability to talk to us when they are at work, and they work the same hours that we do. This gives them the ability to enter their history and read educational materials from the comfort of their own home with no phone tag."

That's the goal, of course. Patients who love the convenience. More thorough, more legible information. And a turnkey system you can just plug it in and make your efficiency soar. If only it were that easy. Unfortunately, there can be another side to the coin.

The help you need
As you'd expect, on the satisfaction continuum, most of the people we heard from in a recent Outpatient Surgery Magazine survey about online pre-admissions fall somewhere between unbridled enthusiasm and utter dismay. Only about 29% said they were extremely satisfied with their online systems, 60% said they were satisfied, but not thrilled, and 10% said they were dissatisfied.

Those numbers seem less surprising when you consider that 45% said fewer than half of their patients were actually using the system, and another 26% pegged the number of users at somewhere between 50% and 70%. In other words, only 29% were hitting the 70%-or-better sweet spot they'd no doubt envisioned.

Why are the numbers so low? "Our MD offices have not been forthcoming to patients to fill out the information from home," says Holly Sousa, RN, BSN, MS, CNOR, director of perioperative services at Beth Israel Deaconess Hospital in Needham (Mass.). "So the pre-admission nurses who should only be reviewing them are actually creating them. That's time-consuming. I think if patients were made aware of this from the beginning, our success rate would be awesome."

Several others echoed Ms. Sousa's complaint.

"The biggest challenge has been getting physicians' offices to cooperate and provide the information to the patients," says Penny Nichols, MBA, administrator of the Crescent View Surgery Center in Metairie, La. "When you're starting out, expect there to be a trial period and expect it to be a little more work up front to get the patients and doctors offices in the groove."

One suggested solution: "We provide the physicians' offices with informational pieces to go into the surgical packet, and one part of it is instructions on how to conduct the online assessment," says Andrea Fann, CASC, administrator of the Orthopaedic South Surgical Center in Morrow, Ga. "When we rolled it out, we stressed to the physicians that this is really for the patients' convenience. We pointed out that when we had someone calling, a lot of times patients would be at work, where they couldn't talk or they didn't have their pill bottles with them. So when they do it online, it's more thorough."

After all, Ms. Fann tells them, getting more thorough information and getting it more promptly is to everyone's benefit. "Patient satisfaction is the way I address it with them. It's more convenient and it helps both of us out. There's less chance of something showing up at the last minute that might force the case to be canceled because the patient has to get medical clearance."

One of the key features of the product her center decided to use, says Ms. Fann, is the ability to run reports showing the compliance rates for different physicians' offices. "I can break it down by doctor and see how many patients did their assessments over the phone and how many did them online. If I have 60 or 70% who did it over the phone with a given physician, that tells me who I need to follow up with."

Her persistence has paid off. Roughly 75% of her patients are now using the program, says Ms. Fann. And the benefits are significant. "Our pre-assessment nurse still calls the patients to make sure there aren't any questions and to go over instructions," she says. "But now instead of spending 30 to 35 minutes on the phone, it's more like 10 or 15. That lets her help out with covering breaks on the floor when people need to step out."

The key, Ms. Alexander agrees, is going the extra mile to get docs' offices onboard. "Make sure that your teaching materials for your surgeons' offices are very helpful, so the patients have step-by-step instructions," she advises. "Also make sure your office surgery schedulers are familiar with the perks of the product so they can promote them to the patient."

Which vendor?
With more and more companies offering pre-admission software, it's an increasingly competitive market. But for the investment to be worthwhile, not only do you need patients to use it, you need to make sure you'll be getting the information you need.

Think through the details before you take the plunge. "Make sure that all of the information that you need is collected and on the first build of the product," says Lisa Gray, pre-op and PACU manager at the Surgicenter of Kansas City (Mo.). "It is very slow to make changes later."

EASY ACCESS Patients are more likely to have all the information you need when they're home.

"Up-front planning meetings with the vendor to outline your needs are a must," says Janet Ward, RN, director of surgical services at Commonwealth Orthopaedics in Herndon, Va. "The time we spent with our rep was the key to our successful roll-out."

Take nothing for granted, warn others, and don't be shy about seeking guarantees.

"Make it as easy as possible for patients to access," says Rosemary Hagan, BSN, clinical director of the Orthopedic Surgery Center of the North Shore in Peabody, Mass. "And if you convert to EMR, make sure it's compatible."

That's something Donna Durden, MBA, administrator at the Murdock Surgery Center in Port Charlotte, Fla., learned the hard way: "When it comes to compatibility with your EHR, get it in writing. We were told that our system was compatible. Turns out it was not. So we have to scan each document into our EHR. Not ideal."

"Make sure the company delivers what it sells," echoes Anna Lagsding, RN, director of nursing at Lakeside Surgery center in Omaha, Neb. "It's been more difficult to customize the forms than they said it would be. They wanted us to use other facilities' reports, and they made it seem like a hassle when we wanted to change the forms."

"Visit a facility that's using the application to make sure it works how you want it to," says Jayne Hildebrand, MBA, CASC, CHFP, CPC, business office manager at the Surgery Center of Cedar Rapids (Iowa).

No miracles
Ultimately, say many, it's a question of knowing what to expect and of maintaining perspective.

"Don't expect a miracle overnight," says Jenna Pon, ADN, BSN, administrator at the Outpatient Surgery Center of La Jolla (Calif.) "It takes time getting used to navigating through the system and familiarizing yourself with where to find certain information." "Have a timeline and add a year to it," suggests another administrator.