RUNNING HEADER: FEASBILITY STUDY
EHR Feasibility Study for an Ambulatory Surgery Center
Terresa L. Roulhac
HTM 692 Health Informatics Capstone
National University
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TABLE OF CONTENTS
1.
EXECUTIVE SUMMARY..........................................................................................................
2.
EHR SYSTEM AND SERVICES................................................................................................
3.
REQUIREMENTS/TECHNOLOGY CONSIDERATIONS.................................................................
4.
PROPOSED PRODUCT/SERVICES............................................................................................
5.
COMMUNICATION STRATEGY..............................................................................................
6.
ORGANIZATION AND STAFFING...........................................................................................
7.
SCHEDULE...........................................................................................................................
8.
FINANCIAL PROJECTIONS....................................................................................................
9.
FINDINGS AND RECOMMENDATIONS...................................................................................
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1. EXECUTIVE SUMMARY
The goal of this study is to give valuable information for Ambulatory Surgery Centers
(ASCs) considering adopting an electronic health record system (EHR). ASCs offer
patients a convenient way to receive treatment that was once only rendered in the hospital
setting. ASCs have shown an excellent ability to improve customer and quality care while
simultaneously lowering costs. The table below displays the cost comparison of ASC v.
Hospital Outpatient Department. (ASCs: A Positive Trend in Health Care, n.d.).
Table 1.
As healthcare technology moves forward towards electronic based documentation, the
ASCs face the need to convert from the current paper-based system, while maintaining
quality care and reducing costs. ASCs have shown cost effectiveness with the old system,
but as technology advances the need to move from paper-based system to an electronic
system is imperative.
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Currently there is no mandate for ASCs to update to EHR system, however, ASCs
can benefit from early implementation. With hospitals and physicians offices currently
being mandated, ambulatory surgical centers will eventually be mandated in the future
(Staff, 2013). Even without the support of government incentives ASCs should move
forward with implementing an EHR system. Patient safety and quality outcomes are
critical factors of a ASCs reputation and long-term success. Often critical information is
missed in patients charting because of inconsistency and mistakes. The cost of paper
charting over time is expensive due to the amount of money spent on buying paper,
copying and assembling records, record retrieval, and backup systems. The lack of
efficiency and interoperability are more reasons why ASCs should move towards an
EHR. Paper-based ASCs do not automatically capture images and other patient-specific
values directly to the patients file. Not having proper interoperability and efficiency
effects the patient, physician and staff satisfaction. Physicians using paper-based systems
cannot access their schedule or patients charts, and need to carry paper files around with
them. Standing orders are also a problem in a paper-based system; as well as maintenance
of credentials, and certifications. ASCs that do not have a EHR must trust that
communication skills of staff in the center, and results are often inferior to those ASCs
who are using an EHR system (10 Reasons Your ASC Needs an EMR now, n.d.).
EHR Opportunities
There are ten major areas of opportunity for the ASC with the implementation of an
EHR system. Patient safety and high quality of care are essential when the ASCs decide
to invest in an EHR. The EHR supports and improves both areas. Boosting profits is
another benefit that the EHR can give to the ASC by helping with the identification of
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historical patterns, and benchmark data. Also, the current paper-based system is costly,
and the EHR can cut costs over time by eliminating the time consumed for paper related
tasks. Efficiency in the operating room has always been a concern for the ASC.
Automatically capturing images and accurate patient-specific information from
anesthesia and surgical monitors is another advantage of the EHR (10 Reasons Your
ASC Needs an EMR Now, n.d.).
The EHR addresses staff, patient, and physician satisfaction concerns. Physicians
would have quicker access to schedules, and patient information allows for a smoother
workflow. Staff would have the necessary tools to reduce patient errors, and increase
patient satisfaction. Reduction in wait times can enable the patient to be seen quicker and
more efficiently (10 Reasons Your ASC Needs an EMR Now, n.d.).
The ASC must stay current with accreditation requirements. The EHR enables the
ASC to access the information and allows surveyors the ability to leave the center with
documentation proving patients are receiving consistent, high-quality care while
maintaining regulations and standards. Although there is no requirement for ASCs to
report to CMS at this current time, there will be plans to do so. ASCs will be mandated to
report Medicare program information by specific deadlines that will reduce Medicare
payments, if applicable. The EHR will make the process of reporting to CMS easier with
the use of safe surgery checklists that help staff by prompting them to check equipment
when needed. Every ASC is constantly concerned with HIPPA and adhering to rules and
regulations for the safety and protection of patient information. Currently, the ASC relies
on communication skills of the healthcare providers; the EHR allows for a universal
language and consistency for patients to patients. The universal language helps protect
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physicians and contains all information required that protects the organization (10
Reasons Your ASC Needs an EMR Now, n.d.).
Table 2. Briefly describes how the EHR can help improve the ASCs ability to move
forward with technology and increase patient care while maintaining costs.
Current Issue
Patient Safety &
Quality Outcomes
Table2. Benefts of an EHR for ASCs.
Benefit Factor
Enhances Patient Safety and
Quality Outcomes
Return on Investment Boost Profitability
Costs with Paperbased system
Reduce Costs
Efficiency
Improves OR Efficiency
Physican Complaints Increase Physican Satisfaction
Patient Complaints
Increase Patient Satisfaction
Staff Complaints
Increase Staff Satisfaction
Non-Compliance
with CMS surveys
Ensure Compliance
Increased Clinical Reporting
Inadqueate Reporting
and Quality Outcome
Quality Measures
Requirement
HIPPA & Legal
exposure with Paper- Mitigates Risk
based system
*Standardized processes lower errors, electronic flags and alerts
warn healthcare providers and identifypossible harms to
patients.
* Statistic information is provided bythe EHRaidingin case
costinganalysis, optimizes schedules of staff, equipment, and
patients.
* Provides benchmark data
*Reduction of overtime related with the elminiation of paperbased tasks.
* Automaticallycapturingimagingand patient information; allows
for faster more efficient charting.
* Templates elimiinate reptitive charting.
* Easyaccess to schedule and charts.
*Automation of standard orders and procedures
*Increase in competitve recrutingadvantage
*Reduction in wait time
*Simple registeration with EHRsystem
*Tasks are completed quicker and more efficient
*Increased productivity/less time documenting
*Increased qualitycare
*Quick access to accreditation information
*Quicker surveryor documentation feedback
*EHRaid the ASCin protection of reimbursements and helps
meet requirements.
*Future safety checklists will be easilyreported.
*Reduces legal exposure
*Eliminates regulatory sanctions
*Improves HIPPAA compliance
("10 Reasons Your ASC Needs an EMR Now", n.d.).
There are many products and services that ASCs can choose. Understanding many
systems have proven beneficial to other centers helps determine what will work with the
organization.
2. EHR SYSTEM AND SERVICES
EHRs allow staff to use less time documenting and recording health information that
improves the accuracy of documentation without continuously handwriting the
information into the medical record. EHRs provide surgical centers with a more accurate
way to receive accreditation, licensure and ensures the center is compliant with
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regulations. It also allows the ASC to have access to medical records and a more portable
way for providers to treat and care for patients.
Best Practice Review of EHR Adoption in ASC
Some ambulatory surgical centers have successfully implemented electronic medical
record systems for their specializations. These centers provide various services. For
example, The ASC in Eatontown, N.J. selected ProVasion MD Software to help with the
documentation of their gastroenterology procedures. The center in Montrose, Colorado,
Black Canyon Surgical Center elected to use Cyramed EHR. Black Canyon has three
operating rooms and has joint ventures with the Memorial Hospital in Montrose that
includes urology, orthopedics, podiatry, ENT, and pain management. The Eye Center in
Lynchburg, VA chose SRS EHR for it ability to accommodate its high-volume of multiple
surgical procedures. And the Southpoint Surgery Center in Jacksonville, Florida also
chose ProVation Medical Software for its multispecialty center. The center has two exam
rooms, a dedicated laser room, and performs general surgery, gynecology,
ophthalmology, pain management, otolaryngology, and plastic surgery procedures
(Dydra, 2013). It is important for ASCs to look at pros and cons for an EHR system to
determine what is most important for the organization.
Looking for same day surgery compatible programs and services that are not too
expensive and will fit the immediate needs of the center with possibilities of
future growth.
There are some benefits for the implementation of EHRs in the ASC settings.
o Assisting in Delivering a Higher Quality of Care
o Optimizing Facility Management
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o Increase efficiency of day to day operations
o Productivity increase
o Accelerate Cash Flow
When considering products for ASCs, take into account the amount the ASC is
willing to invest and which aspects are priorities.
o Types of software considerations include management and clinical
software, billing software, inventory software, reporting software,
scheduling software, EHR software, ADD -on products, software
deployment options, and billing services.
Determining risks are also important when deciding what type of EHR systems works
best for the ASC. Internal risks include interoperability with current vendors systems,
competency of staff to use the EHR, how well will the EHR document infection control
and sentinel events. External risks include the impact on the community, anti- kickback
and antitrust laws, and Stark Laws (Jacobs, Jose, Lenhardt, Locke, & Lynn, 2013). Stark
law, governs physician self-referral for Medicare and Medicaid patients (STARK
LAW- Information on penalties, legal practices, latest news and advice, n.d.).
3. REQUIREMENTS/TECHNOLOGY CONSIDERATIONS
Many proposals depend on technology to help succeed in managing and
monitoring many business and clinical aspects of healthcare operations. Technologies
can be developed to cater to an organizations needs and may be outsourced to a
service provider or internal. Cost is the primary determining factor when deciding
which path an ASC should choose for its organization.
Best Practice in the field should include:
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o ICD-10 ready
o Pay for it to be a billing system
o Doctor use considerations
o Offers for the patient
Potential patient portals
Stand alone surgery center (Free standing cloud scheduling)
Staff ability to input and change patient information
HIPPA considerations
Other issues to consider:
1. Lack of mandate for ASCs to incorporate EHR systems
2. The penalty for doctors who work at facilities with no EHR system
3. Lack of incentive for ASCs to place EHR systems into their facility.
([Link]
Determining software that meets the particular needs for the ASC is important. As we
as preparing for a disruption in workflow and return of investment once the EHR has
been purchased. Avoiding unnecessary interactions with humans with the system are also
considerations that the ASC must take into the decision-making process (Fields, 2010).
4. PROPOSED PRODUCT/SERVICES
The target market for EHR implementation is the ASC or Ambulatory Surgical
Center. There are many EHR systems that can benefit the ASCs. Choosing the right
system or product is necessary for the success of any organization. For example,
SourceMedical is the largest provider for ambulatory centers solution and revenue cycle
management. The company has over 30 years of experience with over five thousand
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satisfied customers. Source Medical offers a vast range of solutions and improvements
are available (Ollayos, n.d.). Many EHR systems provide seamless integration of clinical
and administrative software. Other EHR systems provide many of the same benefits and
options as SourceMedical. Choosing the right system will depend on the ASCs individual
needs. Other EHR options include Care360 EHR, eClinicalWorks, Soapware, and
EpicCare Ambulatory. Care360 EHR provides two versions for purchase. Care360
Practice solutions that mirrors many of the options of SourceMedical, but it also has
Care360 Enterprise solutions that are geared specifically for hospitals and the
accountable care organizations (EHR Software Care360 Cloud EMR by Quest
Diagnostics: Care360, n.d.). eClinical Works provides a streamlined process
management that is customizable and helps providers in the exam room, office or at
home. It gives providers the ability to access patients information and has a built-in
management of the disease. There is no start-up cost, but prices for eClinical Works
varies from $449/mo., $599/mo. per provider, and/or 2.9% per revenue cycle
management (Pricing eClinicalWorks, n.d.). Soapware provides many different
products that ASCs can benefit from. For example, PQRS is a tracking product that helps
a provider collect data easily that can be submitted for quality reporting without the
hassle. Soapware also has 11 integrated products, over 200 interfaces with labs, health
information exchanges, and hospitals. Amber Technology, WelchAllyn, Gateway, and
Midmark are just a few of the current interfaces and integration partners
(Interoperability SOAPware, n.d.). EpicCare Ambulatory allows physicians to
personalize their system with minimal required training, it also features speech
recognition for capturing narrative notes, NoteWriter that captures discrete patient
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observations, and options for telemedicine allowing for cost savings and patient
engagement opportunities. The system also connects to the hospitals with an integrated
record that shares its database with EpicCare Inpatient Clinical System; it interfaces with
Epic Connectivity, and Epic Interoperability for record exchange (Epic: Ambulatory
EMR, n.d.).
The components of clinical EHR software include Billing, Inventory, Reporting, and
Scheduling. SourceMedical offers four options to choose from. Vision, Vision SH,
AdvantX, and Surgisource. Each option can be customized to meet the needs of the
center. SourceMedical also offers billing services, Client Services, HITECH and EHR
resources, Regulatory Information and Webinar/Events (SourceMedical | Client
Resources, n.d.).
The Billing Software can to capture information for implant reimbursement for the
contract manager. It also reports actual reimbursement amounts versus the amount billed.
ECS submission claims are exclusive as well as printing of individual line items. The
software also creates personal letters for mass mailing, and batch charges for particular
transactions (SourceMedical | Client Resources, n.d.).
The Inventory software from SourceMedical provides opportunities for growth by
providing in-depth reporting on costs of supplies. Maintenance of inventory allows for
optimization of the inventory. Cost savings are achieved with the discounts from vendors
and reduction of costs with last minute orders. The automated process generates supply
orders that are determined by actual facility needs, and the visibility of the supply chain
allows the ASC to track utilization and order history (SourceMedical | Client
Resources, n.d.).
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The Reporting software helps administration staff with scheduling. Census
information is readily accessible with the software as well as reports for the state, which
include surgical and FASA outcomes. Nursing documentation is easily recorded and
credentialing information can be provided at a touch of a button. Management is able to
created summaries of facility utilization and receives information on charges/revenue that
has been collected. Resource reports for tracking and orders purchased are also easily
created with the reporting software (SourceMedical | Client Resources, n.d.).
Billing Software has the ability to capture information for implant reimbursement
for the contract manager. It also reports actual reimbursement amounts versus the amount
billed. ECS submission claims may be excluded as well as printing of individual line
items. The software also creates personal letters for mass mailing, and batch charges for
specific transactions (SourceMedical | Client Resources, n.d.).
Inventory software provides opportunities for growth by providing in-depth reporting
on costs of supplies. Maintenance of stocks allows for optimization of the inventory. Cost
savings are achieved with the discounts from vendors and reduction of costs with last
minute orders. The automated process generates supply orders. Orders determined by
actual needs of the facility and the visibility of the supply chain allows the ASC to track
utilization and order history (SourceMedical | Client Resources, n.d.).
Scheduling software helps with conflicts with real-time scheduling enhances patient
searches by combing patient names, social security numbers, date of birth, and medical
record number. The multiple appointments screen allows the user to have a quick view of
the days schedule with minimal demographics (SourceMedical | Client Resources,
n.d.).
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5. COMMUNICATIONS STRATEGY
Establishing a customer base is important for any organization, free bulletin boards
can be initially used to showcase the ASC and the new EHR system. Also, Referral
Networks are instrumental for an organization to market itself. Referrals include rewards
and customer rewards. The Internet and social media is also an excellent way for an ASC
to announce their new technology, and how they compare to their competitors (Beattie,
n.d.). Benchmarking is one of the best ways for an organization to differentiate itself from
competitors. The definition of benchmarking is the measurement of the quality of an
organizations policies, products, programs, strategies, etc., and their comparison with
standard measurements, or similar measurements of its peers (What is benchmarking?
definition and meaning, n.d.). Benchmarking concentrates on best practices, continuous
organization improvement, and partner share of information, the need to maintain a
competitive edge, and the ability to adapt easily based on the needs of customers or
patients (Stroud, 2015). The target audience will be the ASC management, staff,
stockholders, and ASC partners.
Benchmarking is key to helping an organization decide what will work within their
organization. A number of case studies provide strategies for properly marketing and
implementing EHRs and the benefits for the ASC.
There have been a number of studies showing how cloud-based systems help with the
cost and maintenance concerns for ambulatory surgical centers. For example, the Oak
Brook Medical and Surgical Center in Illinois wanted to remove the redundancy and
costs related to the use of paper products. Oak Brooks Medical and Surgical Center was
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hesitant to commit to investing in costs or dedicate the square footage needed for a
climate-controlled space necessary for the server.
The center compared many different products and adopted the SourceMedical Vision
OnDemand application. SourceMedicals single database offers organizations the ability
to transfer existing paper forms to an electronic format without disrupting the workflow,
which results in a fast adoption and an increase in productivity (ASC Software | Vision,
n.d.). The application was customized specifically for Oak Brook. The initial cost for the
system was $20,000 - $25,000; inclusive was the one time charge of software licensure.
The software is not owned by Oak Brooks; therefore SourceMedical is responsible for
any and all upgrades and system maintenance. Oak Brook does pay monthly fees and
saved 20 30% within the first year of using the cloud (Cloud-based management
system eases costs and maintenance concerns for ASC, 2013).
Oak Brook saw improvements in productivity, a rise in per-visit net revenue,
increased security and overall savings. Also, manual tasks have been reduced and the
center has been able to predict lower monthly expenses. Oak Brook offered these insights
to other ASCs to move towards a cloud-based system:
1.
2.
3.
4.
5.
6.
7.
8.
9.
Consider your hardware needs.
Support and Service are key.
Find down spots (where WIFI can be lost).
Pick one provider for Internet and cloud services
Inquire about customization
Learn the interoperability of your vendors system
Ask about integration with additional services
Be cautious with add-ons
Inquire about the longevity of the vendor. (Cloud-based management system
eases costs and maintenance concerns for ASC, 2013).
Affordability is important for an ASC to adopt any new type of technology. Stratham
Surgery Center in Stratham, New Hampshire decided to open up with an EHR versus the
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standard paper that most ASCs start with. The center was prompted by increased
productivity, a streamline of workflow, and improved patient care. The center researched
and narrowed the search to three options. The center also chose SourceMedicals Vision
EHR. The key determining factors for choosing this option were price and ease of use.
SourceMedicals library of forms helped speed up the set-up process for the facility. Staff
and SourceMedical worked closely to customize the exact needs of the facility.
Examples include billing staff having instant access to charts improving workflow and
created a more efficient process. Scheduling was improved with on-demand information
access and e-prescribing alerts for the staff of possible drug allergies, which increased
patient safety (Affordable EHR Offers Easy-of-Use and Consistent Workflow in ASC,
n.d.).
Streamlining cost associated with billing can also improve case costing for ASCs. A
Tri-Cities Surgery Center hired a project manager to select a web-based solution to help
with the control of clinical and financial information. The system required needed to meet
four key system requirements. The system needed to have a broad revenue cycle
management cycle, a system for scheduling, inventory management system, and a
regulatory compliance component. SourceMedicals Vision Management System was
chosen for by this third ASC for the benefits it offers.
Speed of reimbursement
Increase is staff efficiency and productivity with EHR specialization.
Industry regulations standards were adhered to.
Supports excellent patient care.
Offered internal quality assurance programs.
Inventory manager controls costs.
The center was able to achieve success in all four areas of concern with
SourceMedical. The results included minimal claims denials and an practical statement
cycle. The system also helped create an efficient workflow process synchronizing
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patients, schedule blocks, and resources. Day of surgery delays were avoided with
complete demographic information. Case costing was the largest issue that
SourceMedical helped the center overcome. The center was able to control the case
costing capabilities by utilizing system data, by determining which cases would increase
profitability and which ones would not. The management team was able to request higher
reimbursement rates with the information that was in hand (Ollayos, n.d.).
EHRs are also marketing tools to help key members see the benefits of switching
from paper to an electronic medical record. EHRs provide ambulatory service centers
with a lot of information that can be used to help detail cost and analysis. EHR help
market directly towards prospective patients by targeting a particular age and location.
The investment of an EHR is valuable to more than just the patients, but it can be a tool
to recruit surgeons that are more accustomed to new technologies versus paper. EHRs
appeal to new staff and outcome and quality data can easily be provided showing the how
important patient outcome is (Macies, 2013).
6. ORGANIZATION AND STAFFING
Organization is important when deciding to introduce new technology to the
ambulatory surgical center. Choosing the correct vendor will allow the ASC to receive
proper support and ensure that the needs of the organization are correctly represented.
Also, customization is important, the chosen product should have templates that can be
adapted to the needs of the ASC. At the present time, there are no requirements for the
ASC to meet meaningful use, it is important to have forward thought and incorporate
those requirements to prevent future headaches. Also, another part of the organization is
creating the right team to install the EHR to guarantee that all facets of the organization
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are properly represented and a part of the decision-making process and planning.
Orienting the physicians on the system first enables the ASC to create champions of
physicians preventing negative comments of the EHR system.
With any new product or service, there may be a need for additional staffing or for an
organization to restructure in order to accommodate the change. These are important
considerations as they may result in increased costs or require an organization to change
its practices and processes (Watson, & Alicea, n.d.).
Options for organization and staffing
Cross-training current staff to the new products
Hiring interns and/or new staff
7. SCHEDULE
Before the ASC can move forward with the plan for the EHR implantation a lot of
administration decisions must take place. For example, the initial consultation, design
requirements, secondary data collection, primary data collection, analysis and
validation of the data for prioritization, recommended action plan, establishment of
the action plan, and a plan to monitor the progress are all a part of the necessary
planning for the new technology (Wyland, 2012).
Once the decision is made to move forward with an EHR system the ASC has
certain milestones and a timeline for completion. The schedule for the EHR gives the
ASC a timeline for completion. For example, approval for purchasing the EHR could
take six months. Once approval has been made, the schedule will include timeframes
for installation of software/hardware, the training of staff, the trial of systems,
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completion of the rollout, go live date, and feedback via surveys. It will include a
Plan and Budget for approval.
Table 3. Shows a snapshot of activities involved with a timeline schedule once the
plan has been established.
Table3. Exampleof aTimelineforEHR(1yearroll-out)
Date
Oct - 15
Jan -16
Mar -16
Jun -16
Jul-16
Sept -16
Oct -16
Activity
Projected approval of electronichealth record
Installation of EHRsystem
Trainingfor trainers byvendors
Trainer for all end users
Testingbeginsof EHRsystemin administration dept.
Staff surveysviaemail
Approval of completion of rollout to entire ASC
EHRsystemgoeslive
Patient & Staff surveys sent out viaemail/text
Creating a plan helps to limit the amount of disruption of a workflow when
implementing new technology. The plan includes the timeline, budget approval,
whether the additional infrastructure is needed, training, a rollout of the EHR on a
trial basis prior to going live, and feedback of the system. A proper budget allows the
organization to adequately staff and provides the initial decision-making framework
(Heitkamp, n.d.). The ASC will also have the necessary information to decide which
product the organization can actually afford, as well at possible ongoing costs of the
new technology. A guide for milestones include the following:
Infrastructure and hardware placement (if applicable): Many ASCs must take
into consideration whether new infrastructure will need to be found, or if
upgrades to the current one. Determining locations of hardware is another part
of timeline and milestone completion.
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Training of new software: Training of staff is also a part of the planning and
timeline. Questions that will need to be asked include.
o Who will be trained initially?
o Where and when will training take place?
o What will the training entail?
o How often will refresher courses be available, and will the course be
available online.
o Will outside vendors be available once training has been completed?
Rollout of trial basis: The trial basis allows the ASC to evaluate the EHR and
allow for staff to become familiar with the change from a paper-based system
to an electronic form of documentation.
Feedback: Feedback is important to determine if the goals were met with the
new technology. Feedback also allows the ASC to determine what is working
and what needs to fix or customized to meet the needs of the organization.
8. FINANCIAL PROJECTIONS
Benefits of quality patient care and improved workflow are benefits that easily
outweigh the initial costs of electronic health records (Shaw, 2013). The return on
investment from purchasing an EHR system include a decrease in staff hours from
manually working on medical records, less time spent charting and auditing from the
medical record and nursing staff. Hours saved on generating reports and assembling
patient charts are additional returns on investment from the purchase of an EHR
system. Additionally, the EHR provides staff the ability to train on electronic
documentation versus manual, and the reduction of redundant documentation. Other
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return on investments includes savings of coding costs, costs for securing space, longterm storage use, and costs related to faxing and mailing patient information.
(ONeil, 2011).
There are numbers of factors involved in financial projections. Most organizations
start with upfront costs, yearly costs, and 5-year total cost of ownership (TCO).
According to [Link]., the cost of purchasing an electronic health record ranges
from fifteen thousand to seventy thousand dollars per provider. On-site and website
EHR deployment will also vary the amount the ASC will pay for the system. The
example below shows the costs estimated by Regional Extension Centers for an onsite EHR deployment versus web-based deployment ([Link], n.d.).
Cost
Estimated
Average
Cost
Upfront
Cost
$33,000
In-Office
Yearly
Cost
$4,000
5Year
TCO
$48,000
Upfront
Cost
SaaS
Yearly
Cost
$26,000 $8,000
5Year
TCO
$58,000
@ [Link]
When calculating costs, there are five main areas for the ASC to look at.
Hardware costs involve computers, database servers, scanners, tablets, and printers.
The software for the EHR includes applications, and future upgrades that the system
will need. Implementation assistance is also a cost that the ASC will need to factor
into the budget. Contractors, consultants, attorneys, electricians, and support of the
workflow design are all included in the implementation assistance. Training, Ongoing
Network Fees, and Maintenance are the components of the budget ([Link],
n.d.).
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As mentioned earlier, ASCs should move towards the implementation of EHRs
despite the lack of incentives. The Electronic Health Records: A Guide for Clinicians
and Administrators shows the savings of and EHR over fives years in the graphs
below as compared to ARRA incentives that represent 29% during the time frame
(Thorman, 2009).
The graphs show a larger savings from the implementation itself versus the
incentive reward.
9. FINDINGS AND RECOMMENDATIONS
The focus of purchasing an EHR is to manage a more efficient ASC while reducing
cost and improving patient care. Benchmarking shows many products designed to aid the
ambulatory system to move forward to EHRs. As technology continues to grow, the
benefits for ASCs to obtain a system that will allow growth and increase revenue is vital.
There are many options available that have proven successful with other ambulatory
centers across the nation.
Table 4. Shows quantifiable costs, qualifiable costs and benefits for ASCs moving
forward to implement an EHR system.
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Table4. FindingsandResults
QuantifiableCost:
*Labor
*End user Training
*Equipment
*Software
*Services
*Facility
QualifibaleCost:
*Staff training
*Systemconfidence
*Dedicated resources
*Product pricing
Benefits:
* Decreased medical record staff
*Reduction in time auditingcharts
* Hours saved on chart assembly
* Nursingdocumentation reduction
*Reduction chart configuration
* Reduction redundant documentation in mulitple
systems
* Dictation systemelimination
*Codingcostssavings
*Increased Patient satification
*Patient medication reconciliation
*ASCimage improvement
*Eliminiation of lost medical records
*Increasd Staff and Physician satisfaction
*Easier medical record auditing
*Increased Interoperabilty
*Clinical decision support buildingtools
*Recruitment for younger healthcare providers
As healthcare technology advances, ASCs should move forward with the
implementation of a customized EHR system. The system chosen should meet the
individual needs for the ASC. EHRs improve patient safety by decreasing the number of
medical error with electronic flags and alerts warning healthcare providers of possible
harms to patients. ASCs improve cash flow with billing software that captures
information and report actual amounts of reimbursement versus billed amounts. Cost is
another benefit of an EHR system. EHRs reduce cost by optimizing schedules of
equipment, staff, and patients. EHRs also improve the workflow with templates allowing
for faster more efficient charting (10 Reasons Your ASC Needs an EMR Now,n.d.)
Technology is everywhere in the healthcare enterprise, and ASCs need to adapt to
continue effectively providing quality care. Risa Lavizzo-Mourey put it best when she
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23
said, Electronic medical records are, in a lot of ways, I think the aspect of technology
that is going to revolutionize the way we deliver care. And its not just that we will be
able to collect information, its that everyone involved in the healthcare enterprise will be
able to use that information more effectively, (Lavizzo-Mourey, n.d.)
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