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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."

# posted by Medical Information : 2:34 AM