Last month, the Atlanta-based Surgical Information Systems (SIS) released a survey of c-suite-level healthcare executives that queried them on their current plans and perspectives in the perioperative operations area, including the operating room (OR). A number of key findings emerged, including the following:

> 87 percent are planning to make some kind of enhancement to their perioperative area in the next year;
>  78 percent plan to reduce perioperative costs in the next year (with that figure representing a 34-percent increase in perioperative cost reduction projects since 2010);
> 31 percent see overall financial performance as their top work concern, while 28 percent cite quality of patient care, and 16 percent say meeting meaningful use requirements;
> Asked to named what they saw as the most important approaches to financial improvements in the perioperative area, survey respondents cited “implementing cost control strategies” (24 percent); increasing volumes (23 percent); and decreasing costs of supplies, implants, and materials” (15 percent) as most important;
> 59 percent see the perioperative area as being a high or extremely high priority area within the hospital for investing in IT improvements (and among those who see it as such, 67 percent cite meeting meaningful use requirements as a driver).

Among the 82 hospital executives responding to the survey, and representing 70 hospitals, the majority (78 percent) were CEOs, COOs, CFOs, CIOs, CNOs, and chiefs of anesthesiology, while 22 percent held other hospital titles.

Karen Armstrong, R.N., senior vice president and CIO at the Williamsport, Pa.-based Susquehanna Health, a three-community-hospital system, and a customer of SIS, spoke recently with HCI Editor-in-Chief Mark Hagland regarding the results of the survey, and her perspectives on its findings. Below are excerpts from that interview.

Are you at all surprised by the 78 percent finding, regarding c-suite executives’ push for cost reductions in the perioperative area?

Not at all. Generally, I think everybody would be looking to do that in today’s healthcare environment, not only in the perioperative area, but everywhere throughout the hospital.

Karen Armstrong, R.N.

How difficult will it be to make these changes in the perioperative area, given how clinician-controlled that area remains?

Well, people need to understand the operating environment right now, and hospital executives have the obligation to explain what’s going on to the clinicians, particularly physicians. And having come up through the ranks as a nurse and then an administrator, I do see a shift in physicians’ awareness of things recently. They’re realizing that the hospital won’t survive without them; and they won’t survive without the hospital. And I see physicians kind of getting into it and really getting it. And it’s been fun watching them learn the new EHR [electronic health record].

When did you implement your EHR?

We went live with our perioperative solution this September; in terms of our EHR, we’ve been live on Siemens Soarian since 2004.
Until recently, the usable data and analytics have not been there in the perioperative area, correct?
Absolutely; it was a manual effort, if you could get to it at all. And surgeons and other physicians are scientists; you have present to them accurate, credible data, or they’ll question it.

Are you and your colleagues in a similar place with other respondents, with regard to the question around the most important approaches to take to improve financial performance in the perioperative area?

Yes, we are, though I would add quality improvement there. In the future, it will all be about value-based purchasing, and our financial reimbursement will be all about quality.

Especially in surgery.

Exactly; and the reason you implement a perioperative information system with metrics is so that you know how you’re doing on quality.

Will the OR be a major focus for your efforts?

Oh, absolutely.

What will the biggest challenges be for you in leveraging IT in this area?

I think the biggest challenge is that it’s an extremely complex type of system to install—and you have to have the buy-in and cooperation from all levels in the OR—from the anesthesiologists, the surgeons, the nurses, the support staff. And these are very expensive systems, and you have one chance, and it has to work.

What makes it so complex an undertaking?

There are numerous modules, and in addition, it has to integrate with the hospital information system, and the documentation pieces have to flow back and forth so that everybody knows what went on in the OR, and so on. So it’s important that we capture all the metrics that ensure quality. So you have to know about the complications—surgical complications are one core measure to report under meaningful use.

Another piece of it that sometimes people don’t talk about is retention and recruitment of your staff and surgeons, as well as anesthesia. If I were trying to be recruited somewhere, I’d say, well, gee whiz, if they’re not automated, how are they doing anything else right? So perioperative information systems will be a key tool for recruitment, particularly if specialists trained at a hospital that already had one of these.

The last piece of this is that with a perioperative system, you have to think about your patients, and about their families as well. If you’re able to track your loved one, that provides great piece of mind; and that all contributes to the whole patient experience, if the family’s comfortable, and so on.

Did any of the survey results surprise you at all?

Not at all; I was happy to see that quality of patient care was so high on the list of work concerns.