Becker's ASC Review

16 Executive Briefing: Gastroenterology HIT H ealthcare is becoming more data-driven than ever be- fore, and electronic health records are helping providers gather and trend large datasets to improve the value of their services. Defining quality All stakeholders are interested in the highest-quality care for the lowest cost, and endoscopy centers are in a great position to le- verage data that will save lives. "The current registries of patient information are in their infancy, measuring very few conditions and within those conditions they are only measuring certain parameters," says Joe Rubinsztain, CEO of gMed. "It's a start and most endoscopy report writers are going to be able to submit to those registries. However, as time goes by, those registries will expand in scope and the require- ments for data collection will change. Patients aren't solely treat- ed in the ASC, and data will be collected outside of their walls. Those registries will ultimately require information from an EHR that fully-integrates the medical office with the Endocenter " When the framework exists, these registries have great poten- tial; in the meantime, providers face several challenges with data gathering and quality reporting. First and foremost, there isn't a clear definition of quality. The definition varies between payers, patients and government regulations. "Some people confuse process measures with outcomes mea- sures," says Mr. Rubinsztain. "Additionally, there are very few payers who are currently paying for quality because they define quality in their own way. We need to understand that patient out- comes, satisfaction and associated costs are equally important in defining the value of care." Coping with change One of the biggest hurdles to data gathering and EHR integra- tion is the anxiety and uncertainty in healthcare today. "From my perspective, the biggest challenge is 'just change,'" says Chris Oubre, CIO of Covenant Surgical Partners. "Whether the change is from a paper system to an EHR or from one system to another, overcoming the change itself can be the biggest hurdle." Specifically, the two biggest challenges for GI centers are: addi- tions to the legacy process and integration with other entities and the associated systems. Mr. Oubre notes that the system/process change has been more challenging than the system/EHR change, and the new systems don't always communicate well with others. "For GI centers that are trying to connect and share information with physician practices, the referring physician, the anatomic pa- thology laboratory or the quality consortium, that integration can be difficult if not properly planned for," he says. "Connectivity and communication with the physician practice is critical. Since the majority of patient encounters at the ASC start and ultimately end with an encounter in the physician practice, capturing and sharing that information is extremely important." Going paperless Ideally, there would be a common electronic system between the ASC and physician practice to tightly integrate the two organiza- tions. However, going completely paperless is rare. A holistic sys- tem incorporating demographic information, scheduling, history, pathology, patient consent and notes from the referring physician are difficult to maintain. "I do believe that the goal should be to 'throw as much technology' at manual processes within the GI center as possible," says Mr. Oubre. "Not only does this allow the center to potentially reduce labor costs — which is always the highest cost for the center — but also reduces the chance for human error." Operational efficiency is always important to surgery centers, and adopting EHR could be disruptive initially. However, with time, the electronic systems are designed to improve efficiency and fit seamlessly into an ASC's workflow. "Over time, people are understanding that the only way they are going to be able to drive efficiency, decrease costs and increase outcomes is by automating processes and delivering usable in- formation to the physician," says Mr. Rubinsztain. "Full integra- tion can decrease operational costs and provide data analytics so clinicians can manage outcomes and improve quality. This is the time to look at full automation and become engaged in holistic treatment of the GI patient." ICD-10 implementation EHRs will also be helpful when the healthcare system transitions to ICD-10. The new implementation deadline is Oct. 1, 2015 and unprepared providers stand to incur significant losses. "There are many centers that haven't worried about ICD-10 yet because they are overburdened by regulations," says Mr. Rubinsz- tain. "There are larger practices that are starting to make the con- version and grow, but the smaller groups are more transactional." The ICD-10 code sets are more complicated, but the right soft- ware can automatically generate the appropriate ICD-10 codes from the procedure report, but there are only two systems on the market doing that today. "As the ICD-10 deadline grows closer, now or later — but I would recommend now — any ASC considering an ambulatory EHR should only select a system that can automatically calculate their codes," says Mr. Rubinsztain. "We recommend centers adopt this technology as soon as possible. If they wait until the last minute, they'll see a significant dip in revenue from claim rejection." n How EHR Contributes to GI Center Value: Clinical Quality & Profitability By Laura Miller "Full integration can decrease operational costs and provide data analytics so clinicians can manage outcomes and improve quality. This is the time to look at full automation and become engaged in holistic treatment of the GI patient." – Joe Rubinsztain, CEO of gMed

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