Based on our monitoring of IT trends in other healthcare markets, along with our frequent discussions with independent and networked ASC leaders, we see the following macro IT trends impacting ASCs over the next five years.
1. Clinical, administrative and financial workflows combine
Nearly all ASCs use software applications to manage activities such as OR scheduling, patient registration and accounts receivables. More advanced facilities have automated preference cards, inventory management, staff and physician credentialing, cost analysis and more. What is missing today in over 85 percent of facilities is the transformation of the clinical documentation and workflows from paper into a structured electronic format.
Numerous reports, including a recent study by the GAO, confirm the tangible benefits of clinical automation. We realize that benefits within an ASC environment may seem less dramatic or difficult to measure, but our clients report that implementing an EHR results in savings of $15-20 per case due to improved efficiency by having multiple staff access the chart simultaneously and reduced paper expense and handling. Other benefits include immediate access to data that is nearly impossible to assimilate with paper records, the ability to easily access and share records with providers and other parties and, long-term, the ability to connect to centralized health records.
Facilities have numerous options today for implementing an EHR system, including specialty-specific EHRs, physician practice-focused EHRs, acute care EHRs as well as document scanning and storage tools that claim to provide the benefits of a true EHR system. Based on our research and experience, we believe the type of solution that will obtain ultimate acceptance and market share is a solution that truly eliminates any boundaries between the operational, financial and clinical application functionality.
Absent a government mandate or financial incentives, we expect that ASCs will continue to explore the benefits of an EHR system and that, as the applications mature and costs are reduced, the majority of ASCs will implement an EHR system over the next five years.
Lastly, we hear that mobile devices, such as the iPad, will revolutionize the delivery of medicine. We believe that mobile devices will be part of a well-constructed EHR strategy because of their flexibility, improved user interfaces and data access outside the facility, but improvements in design, security, standards and reliability are necessary before more widespread adoption is practical and expected.
2. Mid to large ASC companies shift to enterprise solutions
Companies that own or manage multiple ASCs have longed for a web-enabled IT platform that will facilitate consolidating all facilities into a single database — eliminating the need for individual servers, databases, and onsite IT resources. The benefits of an enterprise platform include improved security, centralized data backup capabilities, hardware failover and redundancy and overall lower IT infrastructure costs. An enterprise solution also incorporates improved reporting by supporting standardized data across all facilities and consolidated analytics and reporting for all facilities when needed or where appropriate.
Once the enterprise database is established, which in our experience is the primary challenge for most organizations when shifting to an enterprise solution, ongoing data management becomes greatly simplified. For example, an enterprise payor library eliminates the need to maintain a payor library for each facility and provides for standardized reporting. As an added benefit, onboarding new facilities is faster and easier when adding a new organization to the enterprise database.
3. Compliance and oversight requirements increase
Facility leaders will recognize and agree that reporting and oversight requirements from CMS, state agencies, accrediting bodies, payors, industry associations and other entities have increased. We view this as a trend that will continually expand as our industry matures and competition for limited reimbursement dollars increases. Cost and quality reporting, while deferred for the moment, will likely be upon us shortly. Also, we believe that EHR utilization reporting, in the form of Meaningful Use requirements as defined by the Office of the National Coordinator for Health Information Technology, will impact ASCs in the next 3-5 years. Having an IT solution that can provide the information necessary to comply with these requirements will be critical.
4. Connectivity and interoperability play a larger role in daily operations
The need to electronically connect to stakeholders to improve service levels, reduce errors, and reduce costs is continually increasing, and ASCs can benefit from improved connectivity. Unfortunately, unlike the financial services sector and other mature industries, the U.S. healthcare industry still lacks common transaction and information standards, with each technology vendor, payor, etc., having their own proprietary or modified versions of communication and transaction formats. This lack of standardization has required the use of middleware and expensive translation layers to make information exchange possible. The network environment is slowly improving, but will remain an industry challenge as no single body or agency has the authority or critical mass to establish and enforce standards.
The graphic below visualizes our view of a connected world from an ASC or specialty hospital perspective. On a positive note, as each connection point becomes available we observe quick adoption by our clients where we can demonstrate short-term financial returns.
Looking ahead, ASCs can be expected to connect to Health Information Networks (HINs) as part of a regional or market-based network. Examples of HINs may include Accountable Care Organizations (ACOs), Health Information Exchanges (HIEs) and Regional Health Information Organizations (RHIOs). At the heart of the HIN will be a clinical repository and master patient index as the backbone of the network, allowing all credentialed providers to update and retrieve clinical information. This will not eliminate the need to maintain a local electronic health record within the ASC. The ultimate question is whether the government, local markets, payers, or some other body will dictate mandatory participation in a network.
5. ASC business process outsourcing utilization expands
While not truly an IT initiative, Business Process Outsourcing (BPO) success is heavily dependent on IT and will see an increasing role within the ASC market. BPO allows provider organizations, such as ASCs, to outsource common functions to highly specialized providers. Benefits include increased efficiency and performance, reduced risk, predictable costs and the ability to focus on healthcare delivery instead of complex tasks that could potentially be better performed by a third party. Operational outsourcing possibilities include coding, transcription, billing, contract management, eligibility confirmation, claims and statement processing, surveying, etc. As an example, we have seen a dramatic increase in the number of ASCs utilizing third-party patient satisfaction surveying, primarily to reduce costs and improve reporting via accessing online tools and benchmarking comparisons that are not available to the typical ASC without outsourcing this function. We expect that as the ASC industry matures and puts more focus on internal improvements to obtain better financial returns and improved performance, BPO and IT-driven interaction will play increasingly important key roles.
Conclusion
In summary, available new technologies, increasing requirements from outside agencies, and an overall desire by ASC operators to improve service and financial performance, will lead to an increased reliance on IT. We believe the trends we have outlined summarize, at a high level, how the market will respond to challenges and opportunities by leveraging IT.
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