In the anesthesiology field, the adoption rate of electronic health records is very low — possibly in the single digits. But since these systems were first introduced, advances in technology have made it much easier to achieve integration between systems.
As a result, the barriers that once blocked successful adoption are rapidly disappearing. Such advances are now much more flexible and fit into the anesthesiologist's workflow without being a disruption to his or her day. We saw this first hand when we revamped our own clinical documentation efficiencies.
Resource Anesthesia is a multi-state anesthesiology management company that provides anesthesiologists and certified registered nurse anesthetists to hospitals, surgery centers and physicians' offices. In our model, we provide local teams that are assigned to a specific facility. We then support those teams from a management level with tasks such as employee retention, medical coding, billing, collections and documentation monitoring that supports quality oversight.
Federal initiatives such as the Surgical Care Improvement Project and the Physicians' Quality Reporting System were causing the facilities and physicians' offices we serve to perform an increasing number of chart and surgery record audits. Additionally, we were spending considerable time in our own office, working to track down missing information or obtaining copies of information by contacting our various surgeons' offices.
All this extra time spent was due in part to our use of paper and pen to document patient care — without making it actionable in any way. The provider would document a patient's care and would make a copy — usually a scanned image that would be sent to our office and our biller/coder through a secure process. However, there were often data points missing, or a crucial section would disappear by the time that anesthesia record made it to the hospital records department. Nothing was being flagged and corrected at the point of care.
The advantages of using an EHR system were clear: We needed to easily document and validate that our providers were hitting all the SCIP points and PQRS data points, so that billing would flow smoothly and our providers would get paid in a timely fashion. But with anesthesia, we also needed a flexible system that could fit into the workflow without being a disruption. It also needed to be portable. This is because our anesthesiologists and nurse anesthetists work in multiple locations within the surgery department itself, while others also go to other departments in the hospital to provide services, such as the ICU or radiology departments.
Finally, it was extremely important not to interrupt patient flow through any facility. That's our entire focus, in fact. The interaction of the provider with those locations needs to not slow down the process of the patient moving efficiently through the facility and getting discharged to home. So with traditional data entry, that real-time guidance and support cannot be provided if the provider makes an error. But a personalized level of clinical documentation that takes into account a provider's workflow can help with proper coding in real time, as opposed to having to correct the error hours, days or even weeks later.
We came across a clinical documentation solution powered by Shareable Ink, which now powers all our offerings to clients. This form of enhanced clinical documentation allows us to be more thorough in our reporting. Our anesthesiologists now have a greater ability to look back easily at previous patient interactions for review. At the same time, it hasn't changed the way that patients flow from point to point through the facility, nor has it truly changed the way we work.
Provider documentation is now an automatic byproduct of the patient encounter, as opposed to a separate, time-consuming event. It makes no difference if clinicians use an iPad, digital pen and paper, or online forms — the system allows each clinician to use the tool that best suits his or her personal style and work environment. So if they are comfortable with a digital pen and paper already, there is no reason to change.
The process of implementation was easy. We had to make sure we were using good, current methodologies of obtaining data and information, which was already in place. We then put together our forms and documents into a format that came through our new solution, and then submitted it to each facility for approval, through best practices.
Because we were implementing a web-based system, there was little to do to integrate into the hospital's system, such as software installation and other similar tasks. The hardware itself was simple. As far as training, we completed everything in one day for our entire staff. It truly was only a matter of hours until everyone at Resource Anesthesia was up to speed and competent using the system.
For our clients, the ROI of enhanced clinical documentation has been extremely noticeable. Because they are accessing multiple documentation systems, they don't need to spend as much time auditing charts and records. The new system provides instant access (or "current time") data. Our clients are able to look at a charge in real time that was created in an anesthesia medication system and compare it to the anesthesia record that was uploaded to the EHR. The outcome is that there is no delay in having accurate information at any different time.
Additionally, the new EHR system is forcing us to increase our accuracy and our legibility as a matter of course. Because of this, our audits have dropped dramatically. In one facility, we have gone from a 100 percent audit rate of every piece of pharmacy charge to random audits, where they are just validating the accuracy of the system. These audits come in the form of pulling charts and statistical samples based on a monthly or quarterly basis, as opposed to daily audits. They’re using this sample to validate the accuracy of the system — that it’s still getting all the charges it's supposed to be getting, and that we are accurately documenting our care. The full-time employees no longer have to spend half a day (each day) auditing anesthesia records and then comparing them to the charges. So the reduced man hours is one of our most noticeable ROIs as a result of our new enhanced clinical documentation system.
The main benefit of this new system is that we are seeing an increased level of provider satisfaction in an area where approval ratings are historically low. They like that it's unobtrusive and easy to use. It hasn’t changed their workflow one bit. They can look back at the quantity of care, as well as different things like SCIP or PQRS indicators and whether they hit all their data points.
Most importantly, the anesthesiologists and nurse anesthetists like being able to demonstrate the quality of care that they are providing to patients. Our client providers aren’t focused on staring at a computer screen or laptop when speaking with patients. They are able to interact more efficiently without any physical barriers, because the pen and paper haven't really gone away. Data are just being recorded, stored and shared more efficiently so that more of the provider's focus is where it should be — on assessing and caring for the patient.