Ensuring the Hospital’s AIMS Produces the Business Information Your Practice Needs

Historically anesthesia information management system (AIMS) adoption has lagged significantly behind overall hospital electronic health record (EHR) adoption. However, in more recent years, the pace of AIMS adoption has accelerated with the implementation of meaningful use and with the increasingly apparent “gap” that a lack of electronic anesthesia encounter information leaves in a patient’s electronic clinical record.

“In 2014, about 70 percent of hospitals in the U.S. had some form of electronic medical record and 45 percent of anesthesia practices utilized electronic anesthesia records, otherwise known as anesthesia information management systems (AIMS).”

Unfortunately as hospitals increasingly adopt AIMS solutions, anesthesia providers (let alone anesthesia practice management teams) have had little input in the selection, build and implementation of the AIMS. However, input from anesthesia providers and practice managers is essential in order to get optimal use and benefits out of a system, regardless of the organization’s stage of adoption.

For new AIMS implementations/conversions, even if your practice has little input in the selection, we encourage you to have a say in the selection, build and implementation; for existing AIMS systems, we encourage you to get to know the system and seek opportunities to gather the business information your practice needs (and not settle for what you are given).

Recommendations for New AIMS Implementations

1. Be Involved
2. Optimize System Functionality
3. Ensure Long-Term Success

Be Involved

Having the right team members and representation is a critical first step to a successful implementation—regardless of the system selected. Most hospitals (and even anesthesia providers) neglect to consider the valuable contributions that anesthesia business professionals (practice managers, HIM professionals, quality analysts, end users) can make during the build, planning and adoption of a system.

When the business professionals are present in the process they are able to provide valuable insight into data needs and assess opportunities to capture key information that benefits not only the practice but the hospital as well. Following the ideal EHR state of “capture once, use multiple times,” key information that can (and should) be captured once and used multiple times includes:

• Clinical practice data points that have an economic impact downstream (e.g., medical direction, type of anesthesia, anesthetic agents, postoperative management of pain and nausea/vomiting).
• Operational practice data for benchmarking, performance improvement initiatives, hospital contracts.
• Quality performance data for reporting and compliance (e.g., PQRS, meaningful use, and incentives).

How can you get involved? Attend training sessions and/or seek out training materials and ask questions of the vendor regarding integration/reporting capabilities. Knowledge is power.

Knowing and understanding system functionality and capabilities upfront—along with limitations—enable group practices to better utilize and leverage the data available in the system and, backing up a step, adeptly support the anesthesia providers in the accurate capture of required data elements. We also recommend that you get to know the hospital’s internal technical expert—the person who is or will be trained to know where the data elements exist and how to export data from the database should it be required for reporting and/or ad hoc report development.

Optimize System Functionality

There are several opportunities to be involved in a system implementation/ conversion and help ensure a smooth and optimal implementation for the anesthesia practice.

1. System Build: Get involved early on in the project, during the system build. Getting involved early on provides greater assurance that the data collected is “useable” data by both the practice and the hospital.

During the build, keep the following build “best practices” in mind:

• Establish clear data definitions and terminology that are universally understood (encourage the OR and anesthesia to work off the same data dictionary).
• Use standardized terms to allow for accurate analysis down the road (i.e., for quality measurement and improvement, ensuring data comparisons are “apples to apples”); don’t use multiple terms that describe the same thing.
• Minimize free text fields; use codified entries and lists to generate cleaner data which allows for smoother integration and data extraction.
• Minimize number of fields; don’t create different fields that capture the same information.

2. Testing: Participate in system and process testing prior to implementation go-live. Ensuring that the hospital’s AIMS will get you the business information your practice needs requires system and process testing prior to going-live. During testing:

• Obtain a written testing plan from the vendor and/or enlist the help of your consultants for development of a plan.
• Test and validate record, data and billing service access prior to go-live.
• Have providers document real case scenarios and transmit the data to the anesthesia business office, business intelligence software and billing services and then have the billing office and business professionals evaluate the data received.
• Identify and resolve issues/gaps before go-live to prevent lost revenue and claim denials.

3. Policies and Procedures: Assist in the development of policies and procedures for minimally required and/or best practice data entry and data capture; for amending records; for acceptable time frames for post-case modifications such as Late Entry, Addendum and Corrections; and for down-time processes (when users are forced to revert back to paper documentation due to technical problems). Not having a clear and concise processes for such situations can result in significant gaps in quality/ reporting data and potential for missed charges and lost revenue.

4. Interfaces/Integration: Work with the IT department and vendor representative to build a bridge for data transmission from the hospital AIMS to the practice management and billing companies for facilitating the transfer of key data for billing, compliance reporting and quality reporting. AIMS integration with billing (done the right way) eliminates:

• Duplicate data entry
• Manual tasks
• Inconsistent data

If integration is not possible, look at opportunities to develop auto-generated reports that are electronically transmitted to the billing department in a useable format and/or work with outside services to develop the reports needed. Lastly, investigate available reporting capabilities and/or supplemental business intelligence software integration and dashboard data display for near real-time analysis of practice performance.

5. Implementation: During a go-live, hospitals and IT departments should recruit a support team of super users to assist the healthcare providers with questions, problems and support as they adjust to this new clinical documentation process. Having a robust support team with adequate coverage ratios is crucial to the success of the go-live. The support team needs to be available as soon as providers experience problems. Otherwise, key teaching moments will pass and obstacles will trigger workarounds and end-user frustration with the system.

Equally important are resources during go-live to audit the anesthesia documentation (as near to real-time as possible) for accuracy and completeness and to assist users with timely corrections to ensure accurate quality data correction and billing, preventing delays and denials. The auditors need to pay particular attention to fast-paced cases such as endoscopy and procedures performed outside the operating room such as interventional radiology, cath lab and MRI.

Establishing a clear communication process to relay issues and findings to anesthesia providers and partnering with the anesthesia providers and IT resources to establish processes or to minimize these issues (e.g., alerts, prompts, mandatory fields, other tools to promote efficiency and compliance) will help mitigate the impact on data accuracy and availability. Developing a simple, organized issues list to capture, detail, troubleshoot and track issues will aid in the communication.

With a new documentation process moving from a narrative-free text type documentation to codified choice selection, anesthesia providers can feel anxious, rushed and overwhelmed, easily overlooking key elements such as times, procedure notes, relief personnel, quality indicators, all of which can significantly impact claims submissions.

Ensure Long Term Success

Once your group’s AIMS is live (and the dust settles) it is important to establish a regularly scheduled process for auditing the data capture. Insight into and recommendations for auditing to ensure the AIMS data you are receiving on a go-forward basis is accurate, timely and useful are discussed in the next section of this article.

Continue to seek opportunities to be actively involved in upgrades and enhancements and to utilize the data being captured by the system (refer to the subsequent section of this article on “realizing the clinical and operational data value.”

Recommendations for Existing AIMS Systems

1. Assess Functionality
2. Audit Data Capture
3. Optimize Functionality and/or Data Captured
4. Realize Clinical and Operational Data Value through use of Business Intelligence (BI) Tools

Assess Functionality

Learn what the AIMS is capable of capturing. We would encourage you to seek out AIMS training materials and opportunities and observe the data capture flow from preop through PACU (it would be good to conduct observations on more than one provider—including a super user as, although we’d like to think there is standard documentation practice… that isn’t always the case).

Additional opportunities to learn more about the system include reaching out to other groups who use the system for AIMS functionality tips and tricks (that can then be shared with your providers) and joining online user group forums.

Audit Data Capture

Once you have an understanding of the functionality and capability of the system, we recommend establishing an ongoing process for auditing data capture completeness and accuracy. Similar to work performed during the implementation phase, the audits help ensure that data is being captured accurately and timely on time for billing, compliance and quality reporting use. billing efficiencies and decrease time bills remain in accounts receivable. Monitor and correct processes that result in services that are unbillable due to inaccurate or missing documentation.

Areas in which to be mindful of risks include:

• Supporting documentation (additional lines/blocks; medical direction)
• Missing documentation (procedure notes, ultrasound images)
• Accurate times (relief)
• Inconsistent documentation from one provider to the next

Optimize Functionality and/or Data Captured

Based on the results of your functionality review and data capture audit, you will be able to identify gaps in what is or could be available vs. what is coming across to the practice in a useable format.

Look for opportunities to take the next steps in optimizing and automating the anesthesia services processes. Even with the implementation of AIMS systems few practices incorporate use of the anesthesia professional coding tools, electronically capture professional fees or electronically transmit billing information to their billing services departments.

We recommend working with the anesthesia providers, AIMS system IT resources, vendors, report experts and AIMS consultants to address gaps and ensure that the system is being optimally utilized.

Realize Clinical and Operational Data Value through use of Business Intelligence (BI) tools

Most commercial AIMS systems, particularly enterprise-wide systems, fall short when it comes to reporting and collective data gathering for clinical and operational analysis. Getting the meaningful data out of your AIMS System and transforming it into actionable information requires the use of BI tools; analytics software, integration technology and data warehouses that can collect the data and create useable data dashboards, performance scorecards, data mining and interactive, customizable reporting. Investigate what BI tools your healthcare organization has available and explore opportunities to utilize that data for tracking patient outcomes, compliance and process improvements through evidence-based decision making. BI tools also provide predictive analytics, the ability to forecast and monitor trends which can assist in cost saving operational budgeting and strategic planning.

Using BI tools can be a little intimidating and takes an investment of time to become educated on how to use these tools and to create dashboards and reports specific to the needs of anesthesia services. Investigate what resources (business analysts) are available through your healthcare organization to assist with getting the right data out of your AIMS System. Utilize industry experts to develop a practice management program that includes the dashboards, scorecards and custom reports needed to optimize use of the AIMS data. This expert team will validate the data for accuracy and educate your clinicians and business professionals in not only the BI tool functionality but also help to build trust in the data so that this data can be used with confidence.

Conclusion

An AIMS system is far more than an EHR. It is an accumulation of electronic data that can be explored and analyzed to improve patient outcomes, establish evidence-based criteria for process improvements and enhance decision-making at an organizational level. Whether it is a hospital purchased or anesthesia practice owned system, enlist the services of the anesthesia business professionals (practice managers, HIM professionals, quality analysts) to provide valuable insight into data needs and assess opportunities to capture key information ensuring the AIMS System produces the business information your practice needs.