Technology has been steadily transforming the practice of medicine, but the field of anesthesiology has not quite kept pace. Documentation is still largely a pen-and-paper enterprise, and that's costing practices time and efficiency, affecting the bottom line.
As more and more practices are ditching pen and paper and moving to electronic health records, however, vendors such as athenahealth, MedEvolve Practice Management, Mercury Medical and Recordation are offering software platforms or cloud-based services for anesthesiologists.
And even some of the former tech skeptics are now admitting that the tools help their practices operate at new levels of efficiently, reduce costs, enable them to more easily meet MACRA and MIPS criteria and even spend more time concentrating on patients.
James Faust, MD, a Southbridge, Massachusetts anesthesiologist affiliated with Harrington Memorial Hospital, said that despite the advantages of moving to an automated, paperless system, there was some initial resistance in the field.
"When you're with a patient you've got to be vigilant," said Faust. "A lot of people were worried that if we were married to a keyboard, the vigilance would decrease. That was one of the concerns. The second was medical and legal concerns. If you have an automated blood pressure cup and the doctor leans up against it, it gives a false reading. A lot of people were concerned that if everything is automatically recorded, from a legal and medical perspective, that would be a risk."
Faust, who has been utilizing Recordation since April, said the concerns were unfounded.
"Neither of those things have panned out, at least in my experience," he said.
Since implementing the platform, Faust said his practice has been operating more quickly and efficiently. And a nice benefit to not hurriedly writing everything down is that the information collected is perfectly legible -- which wasn't always the case in the past.
It makes reporting a lot easier, too, he said.
"MACRA and MIPS, for anesthesia, there's very specific criteria we need to report in order to get a percentage of our Medicare revenue by the end of the year," said Faust. "That's automatic now. The same thing goes for something we call medical direction. If you come in to have a colonoscopy, we provide anesthesia for that. More and more insurance companies are going to say, 'We not going to pay for anesthesia for a colonoscopy until we have some data showing that this is necessary. Now it's automatic, right there in the record."
Likewise, if there's significant bleeding that occurs during a hip replacement, anesthesiologists would have to scramble and jot down information to keep an accurate record. Now, with the data collected electronically, the focus is on the patient, said Faust.
Approaches like this are helping the smaller, independent practices survive, he said.
"Job security for anesthesiologists is changing," said Faust. "More and more anesthesiology services are being provided by large anesthesiology service providers. These are companies that are nationally set up and have hundred of anesthesia care providers, and they will bid for the anesthesia service agreement, and they'll win it and they'll provide those services. Partly they're able to do that because they're enormous companies with entire departments set up to negotiate with those smaller hospitals. For private groups like mine, it's a lot of work for us to be able to do those things."
Big upsides for smaller providers
Digital transformation has the potential to change the picture significantly. It's often difficult for smaller, rural or community hospitals to justify purchasing larger systems, as there's little there to really justify the return on investment. A scaled down, but the still-effective technological approach is more feasible, with a monthly fee that can be halted and resumed at any time, an install period of about a week and a low burden on a facility's IT department.
The technology mimics what anesthesiologists are doing with pen and paper, but does so much more efficiently, vastly improving workflow. And with the information in an electronic format, the data, and the process, can be analyzed much more readily.
"They are improving their processes," said Recordation founder Douglas Keene, MD. "Those smaller hospitals, unless they can show that they're looking at the data and they're competitive, they're not going to be around in a couple of years. The people who can show their data and show they're improving their processes, those are the facilities you're going to see stick around in the future."
Keene added that by making things electronic, anesthesiologists can more easily connect and share information, and patient monitoring and documentation can finally be dragged out of the stone age.
"It frees doctors up so we can pay more attention and focus on our patients," said Keene.
Between blood pressure readings, EKG machine data and the like, information is being spat out at anesthesiologists constantly. Recordation captures that data electronically, in real time, which comes with a host of advantages: More information can be gleaned simply by looking at the patient's monitoring screen -- which is being recorded in the background -- and multiple pieces of information can be presented in the same place. It's like a pilot's cockpit, providing a wealth of data in one place through digital displays.
"Unless you have a process that gives you a baseline, you can't make any steps to improve your process," said Keene. "Without that information, most surgical centers and ambulatory centers are at a disadvantage. We're taking that information and making it really easy for our practitioners."