ELECTRONIC ENHANCEMENT EMRs will make your facility more efficient and create a much safer environment for your patients.

Let's cut through the marketing speak and discuss the ways EMRs help you run a better surgical business.

1 Easier charting
Without EMRs, a staff member has to pull and prepare charts for the next day's cases. The chart moves through the facility with the patient, but nurses in pre-op and the anesthesia provider in the OR might fight over who needs it more. At the end of the day, you're left with a stack of folders stuffed with loose sheets and forms, which must be organized and submitted to billing. You then have to hunt down the charts before placing follow-up phone calls to patients. With EMRs, all clinical information is scanned into the system and available with a few mouse clicks. Multiple staff members can access records simultaneously without running around to track down the chart they need. For example, a staff member in the billing office can be coding operative notes while a nurse making post-op phone calls reviews the clinical data. Plus, file cabinets aren't taking up valuable space in your facility.

2 Coordinated care
The patient's chart is automatically created and updated in the system, and multiple caregivers can view patient data simultaneously and from different locations. All of the users collect and input data in real time, so patient safety is significantly enhanced.

For example, an anesthesia provider in the OR can access the next patient's chart to assess allergies and the health history before reaching the patient's bedside in pre-op. The nurse in recovery, who's trying to manage a patient's uncontrolled pain or PONV and has exhausted the treatment options ordered by the anesthesia provider, can contact the provider electronically and request feedback based on the notes she's inputted into the EMR. The anesthesia provider can review the situation, place the next medication order and determine if he's truly needed bedside. He can also track the patient's condition after he's given an order to determine if the treatment was effective in reducing the patient's pain or controlling the PONV. That real-time monitoring from afar is impossible with paper records.

3 Streamlined billing
We created automated operative notes in our system based on templates developed with input from surgeons. Data collected throughout the case — blood loss, type of anesthesia, implants used and the post-op diagnosis, for example — auto feed into the op note template.

At the end of the case, the surgeon clicks on the case's tab, reviews the op note and edits it as needed instead of dictating the information that's been automatically generated. He then saves the document and signs it electronically. That's it. He's done in less than a minute and we're ready to bill. There's no more chasing down the surgeon to confirm a code or decipher what happened during surgery.

We also capture more accurate billing information. For example, removing a skin lesion smaller than 2 cm requires a specific code for a smaller reimbursement than if we'd removed a complex specimen. Because our EMR system immediately captures the measurement of a larger lesion at the point of care and automatically records it in the op note, we're much more likely to code appropriately for the case and bill for the higher reimbursement.

4 Easier quality data reporting
Recording and reporting quality outcomes data is required for surgery centers that host Medicare patients or accredited facilities that must collect data for CQI studies. Data is also essential to benchmark and drive improvements in business performance.

If you work with paper charts, a member of your staff has to spend valuable working hours collecting and reviewing charts, and recording needed data. Or perhaps a nurse in the middle of caring for a patient is forced to record quality measures on a separate clipboard. That's another piece of paper to manage and another step that takes the nurse's focus away from patient care.

We integrated quality reporting forms into our EMR system and can call up and organize the data in seconds. Now we have custom reports built into our database that automatically generate all the information we need. There's no longer the need for a nurse or manager to compile data manually, which is a laborious (or is it tortuous?) process.

5 Pre-admission perks
We incorporated a patient portal into our EMR system that lets us receive encrypted information from an unlimited number of patients for $60 a month. It's provided an incredible boost to our pre-admission efficiencies and patient satisfaction. When cases are scheduled, we direct patients to our facility's website, where they access the pre-assessment questionnaire — without the need of a username or password — and fill out the form at their convenience. Once patients submit forms, they're automatically directed to our pre-assessment nurse and anesthesia providers. We've added a phone app to the online portal that notifies the providers and nurses whenever we receive a form. One of our anesthesiologists once responded to an alert on his phone and called the patient minutes after she'd submitted her form. She was impressed.

Our anesthesia providers love this feature. They review patients' forms and let us know which patients are cleared for surgery or who needs additional pre-op tests. The clearances or requests are sent to our pre-assessment nurses, who call the patients to let them know they're good to go or to follow up on concerns the anesthetist raised.

The technology has streamlined our pre-admission process and made it incredibly effective. There's no more calling the patient, waiting for a call back and hoping you get in touch. We also don't have to spend time manually inputting the information the patient notes on the online form. The technology eliminated the need for a full-time pre-assessment nurse and we've had only one day-of-surgery cancellation since launching the patient portal in 2013 — and that was because the patient showed up sick.

We also post patient-specific discharge instructions on the portal. Patients can access the instructions before the day of surgery, so they arrive at the facility better informed and can ask questions in pre-op before sedation is administered. They can also access the instructions when they return home, so they have a clear understanding of what to expect and how to best care for themselves in the critical hours and days after surgery.