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Changing the Perception of Health IT:From Albatross to Safety Aid By Gregory Bray, MD Medical Director, Chief of Anesthesiology Indiana Surgery Center Noblesville, Ind.  Truth be told, many physicians view health IT as a necessary albatross. Yes, it's worth the effort to automate processes, improve revenue capture and free clinicians from a certain amount of administrative tedium. But what many of us don't fully realize (often until after implementation) is that the electronic health record (EHR) is a phenomenal patient safety aid. It has the power to help us revolutionize the way we practice, creating invaluable potential for advancing outcomes-based medicine. We also found that our electronic health record delivers dividends on other promises: capturing revenues, streamlining processes, supporting clinician productivity and improving patient satisfaction. If It Works Here, It Will Work Anywhere When leaders at the Community Health Network – with five hospitals and 12 surgery centers – began evaluating IT systems for the surgical suite, we had many questions. Does IT really make a difference in organizations other than academic medical institutions? How will it perform in a for-profit, fast-paced, community hospital setting? What impact will IT and the accompanying process change have on us as we work to improve patient safety? Challenged by slipping revenues and increasingly cumbersome manual processes, we knew IT was the right move. And because of its challenges, we felt that if the solution worked at our Indiana Surgery Center (ISC) in Noblesville, it would work at any of our surgical suites. ISC's operational challenges included:  A manual drug capture process, which meant lost revenues. Claims often returned due to incomplete documentation, requiring hours of validation. Time-consuming coding processes, which sometimes missed comorbid conditions.On the clinical side, we faced what physicians everywhere are facing — increasingly complex patients, polypharmacy as the emerging norm, and a rampant increase in drug allergies and hyper-allergic reactions. Medication management alone defies the brain's capacity to retain and cross-check information. It was time for a change. Maximizing Revenues, Saving Time After implementing integrated surgery information solutions at the Center, we began to see improvements: Electronic anesthesia documentation and streamlined medication management helped greatlyimprove drug charge capture. ICD-9 codes assigned at the bedside now enable physicians to assign a diagnosis-related group(DRG). If acuity rises, the DRG assignment changes, enabling maximum reimbursement. Based on ICD-9 codes, the solution specifies comorbid conditions. It also registers AmericanSociety of Anesthesiologists (ASA) modifiers, such as body mass index (BMI) and age extremes, all of which help improve revenue capture. An electronic record for anesthesia helps reduce claim rejections, leading to fasterrevenue recognition. System-assisted coding enables anesthesiologists to review procedure notes and quicklyassign CPT codes. Billing agents spend less time processing claims because they no longer have to touch themmultiple times. In terms of compliance, the solution captures surgery start and stop times, and aids in meetingJoint Commission and other regulatory requirements, such as Surgical Care Improvement Project (SCIP) measures, and CMS core measures. The Real Eye Opener: Patient Safety Supports Then came the eye opener of how IT could help us improve patient safety. IT enables us to: Scan all medications prior to delivery and receive instant alerts for contraindications andside effects. Integrate pre-op, intra-op and post-anesthesia care unit documentation, better preparingphysicians and decreasing time between cases. Receive reminders to administer medications during surgeries, particularly helpful during longer-than-expected cases. Clinical productivity and performance are also improved: Our integrated solutions automatically build a comprehensive electronic health record. With less paperwork, we are able to focus more on patients. Clinicians can compare their outcomes with best practice-based outcomes, putting evidence behind suggested changes in workflows and protocols. Physician leaders can easily create and share performance reports, decreasing meeting time. The technology documents clinician performance, providing documentation tomaximize reimbursement. Like the airline industry's black boxes, the solutions provide a valuable record of physician actionand intervention if a question of malpractice arises. IT: A Necessary Safety Aid for Better Medicine Since leaving residency, I haven't seen any device that helps anesthesiologists affect patient safety as much as this technology does. And the improved revenue processes certainly promote financial health as well. Accordingly, Community Health Network leaders look forward to rolling out the complete integrated system in our surgical suites across the enterprise. Because now we've seen for ourselves: the IT works well here, so it'll work well anywhere in our system. Greg Bray, M.D. is the Medical Director of the Indiana Surgery Center, Noblesville, Ind., part of the Community Health Network, where he has been integral in the selection and implementation of the center's electronic health record. He holds an undergraduate degree from DePauw University and a medical degree from the Indiana University School of Medicine. Dr. Bray is Board Certified by the American Board of Anesthesiology, and a member of the American Society of Anesthesiologists, the American Medical Association, the Indiana State Medical Association, and the Indianapolis Society of Anesthesiologists.   |
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