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Wednesday, November 23, 2005

Physicians at Harmony Ambulatory Surgery Center in Fort Collins, Colo., opted for efficiency when they first opened their doors in 2000. They bypassed traditional dictation and transcription options for the clinical documentation that follows gastroenterology procedures, and instead selected ProVation MD with its GI module. Right out of the gate, they chose IT, time savings, cost savings and a one-and-done approach to documenting the surgical experience.

Harmony's Administrator Rebecca Craig, R.N., says, "Our physicians had vision. They knew that all aspects of clinical documentation are moving in an electronic direction. Even though we didn't have an EMR in 2000, the physicians still wanted a procedural documentation system that could download to one." Turns out, it was the right decision.

Harmony Ambulatory Surgery Center is affiliated with Poudre Valley Hospital and is a 27,000 square foot, multispecialty ambulatory surgery center (ASC) offering general, orthopedic, plastic, GYN, urology, ENT and ophthalmology surgery, and GI and pain management services, with the availability of six overnight beds for those who need more care than a same-day discharge affords. Accredited by JCAHO, the center includes four operating rooms, two gastroenterology endoscopy rooms and a pain management room, plus separate admission and recovery areas. The original five GI physicians have increased their numbers to eight GI physicians, and the ASC handles more than 700 cases per month.

Originally hired as the organization's clinical director, Craig says the software works so well that Harmony added ProVation's pain management module in 2003. In fact, the ASC hasn't yet identified an EMR product that physicians like well enough to purchase and has suggested to ProVation that the vendor consider developing an EMR product as well.

Software at Work

Immediately after completing a procedure, Harmony physicians sit at a workstation and complete their clinical documentation via ProVation MD. In large part, documentation is completed by a series of pull-down screens and menus in which doctors make choices and click, although the system does permit physicians to key in free text as an additional component of their post-operative documentation. As they pull down, point, click and select, the software suggests appropriate ICD-9 and CPT codes for the coding and billing tasks to follow. The physician can accept the suggested codes or change them, if he wishes. The entire package was designed to offer physicians a robust menu of automated options for post-procedure orders, patient instructions, letters to patients with physician impressions and recommendations, recall functions and pathology results tracking, while still allowing and encouraging individual input from physicians who want to generate it.

The physician can also verbally dictate into the system, see his words as text on the monitor and self-edit the text for greater clarity. Craig says most physicians maximize their use of the system's menu-based suggestion and selection features, although several physicians are comfortable keying in free text, and at least one or two regularly use the voice recognition and self-edit features.

When the physician is satisfied with his report, he signs it electronically. The physicians' signatures have been scanned into the system, and each physician has his own password that only he knows, so that only he can sign his own reports. Once a report is signed, the physician pushes another button to print, and the information is not only printed but also pushed forward to multiple next-step users.

One copy of the report automatically goes to the physician's office, whether he is located on-campus or off-campus. Another copy is sent to the coder/biller of Harmony Ambulatory Surgery Center. Another copy is sent directly to the nurses' station. The nurse has the operative report, along with any subsequent orders, discharge instructions and aftercare recommendations for patients heading home, which expedites the discharge process.

Craig says that for physicians who primarily use the system's pull-down menu and selection options, a typical operative report might take five minutes. For physicians who want to key in free text or use the dictation and text-editing functions, the time requirement might expand to seven to 10 minutes. She adds that the nature of pain management treatment also might require documentation time beyond the typical five minutes.

One and Done

"Our physicians don't enjoy having to come back to functions again and again to complete them," says Craig. "After the procedure is done, they want to complete their documentation, and this system allows them to do that. We have no extraneous phone calls, no moving of files or pulling of charts, and we have no three- or four-day turnaround times between the procedure's completion and a physician's signature on the op report. The physicians appreciate us helping them to be more efficient with their time which, in turn, allows them to spend more time with their patients or to see additional patients."

She says the software also helps the organization comply with JCAHO requirements in a way that doesn't add work to anyone's plate. JCAHO requires physicians to have available a brief summary following a surgical procedure. For physicians who use typical dictation and transcription services that may result in a two- to four-day turnaround, this requirement compels the physician to generate a short, handwritten summary of what took place immediately following each procedure. But with ProVation MD, the physician can generate a complete operative report in the same amount of time it would take to generate a handwritten summary, meet JCAHO requirements and still complete the case and move onto the next with no re-dos.

Once the physician electronically signs his report and the coder receives her copy, she can begin to verify codes for billing. The organization has but one coder/biller. "She's kept pretty busy," says Craig, and yet she admits that Harmony's coder increasingly functions as a verifier and auditor of the system, because the accuracy of the codes suggested by the software is so high. In fact, Craig estimates a time savings of 15 coder minutes per case because of the application's efficiency, a significant factor when coding more than 700 procedures per month.

Savings Beyond Time

The old adage "time is money" is an old adage for a simple reason: It's true. In a surgery center, every activity and supply has its price. Transcription services, often costing 12 cents to 18 cents per line, can add $1,000 a month to the budget of an ASC like Harmony Ambulatory Surgery Center. Right off the bat, Craig figures that the software saves her organization $12,000 a year minimum in transcription costs alone for the pain management service line.

She says that because the GI physicians started their practice at Harmony with ProVation MD in place, the organization didn't track for return on investment. But implementation of the pain management module in 2003 allowed Harmony to track for ROI and "it was extremely fast, seven and a half months." The center's coder/biller gets her copy of each operative report the same day, which means Harmony gets most bills out the door within 24 hours of a procedure, or 48 hours at the latest, rather than the typical three or four days required with outside transcription services. A bottom line impact of this efficiency is that procedures documented with the ProVation software typically spend less than 30 days in accounts receivable.

Craig says Harmony Ambulatory Surgery Center will be a ProVation beta tester for their new general surgery module and expects to go live with that component at the end of September. "Our general surgeons perform a high volume of laparoscopic procedures, so we are looking forward to realizing the same efficiency in that area that we have seen in the GI and pain management specialties."

In the hard-to-quantify arena, Craig is quick to say that it's not software alone, or even the bottom-line impact of the software, that make the partnership a favorable one. "ProVation has offered us excellent support. A lot of vendors are quick to make promises, but only a few regularly deliver on those promises. We have a partner that does."

The ProVation MD product is a specialty-specific one that currently offers modules dedicated to gastroenterology, orthopedics, cardiology, urology and pain management. But forewarned is forearmed. The development folks at ProVation Medical should probably expect a little additional nudging about that EMR needed by Harmony Ambulatory Surgery Center. After all, another old adage dictates: When you find something you like, stay with it.

COPYRIGHT 2005 Nelson Publishing