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Perspectives on OR Automation

September 29, 2010
by Mark Hagland
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Interview: Rick Corn, Vice President and CIO, Huntsville Hospital

This summer, the Alpharetta, Ga.-based Surgical Information Systems LLC released the findings of a survey of healthcare IT and healthcare executives regarding issues around efficiency and effectiveness in the operating room (OR) and perioperative areas of the hospital. CEOs, COOs, CFOs, CNOs, OR directors, and CIOs (16 percent of respondents were CIOs) responded to the survey, which found that quality outcomes and financial results, in that order, were the largest concerns of those surveyed. In addition, 91 percent of respondents rated the success of the perioperative department as either extremely important or important to the overall success of their hospital organization.

The most negative trends identified by survey respondents were government initiatives and declining reimbursements, while the most positive trends identified were government initiatives, better physician relationships, new technology, and increases in patient volume, in that order.

Against that backdrop, HCI Editor-in-Chief Mark Hagland interviewed Rick Corn, vice president and CIO at Huntsville (Ala.) Hospital regarding the findings of the survey and their implications for CIOs and their teams. Corn’s organization is an SIS customer.

Healthcare Informatics: According to the survey, 91 percent of hospital executives rated the success of their perioperative departments as extremely important or important to the success of this hospital. What does that result say to you as a CIO?

Rick Corn: What it tells me is that that needs to be an area of focus from an IT perspective, so that we’re able to help facilitate efficient running of that area. From there, you cascade down to a whole raft of issues—trying to identify ways to reduce costs, and ways to help better document the care; and in some instances, that would translate into better reimbursement [through improved charge capture].

HCI: When you consider that the majority of hospitals still don’t have perioperative information systems, what does that say to you?

Corn: Hospitals have evolved based on the perspectives of the executives and the folks who lead those institutions. Historically, you go back a number of years, and everything was financially oriented; and it’s only in recent years that clinical applications have really come together into anything other than separate, stovepipe ancillary applications.

HCI: And now you’ll have to drill down into some of the core care delivery processes of the hospital in order to become more cost-effective in this era, right?

Corn: The question that was posed was around perioperative, though I’ll bet you that the percentage of hospitals that have a surgery scheduling system is much greater. And so there are stovepipes within stovepipes, among systems right now. And so you’ve got the scheduling stovepipe, and then the perioperative care-related systems, and then the anesthesia systems that are separate, and then the PACU [post-anesthesia care unit] and recovery areas, and the systems to support those functions. And the nature of those ancillary systems is that they’re developed separately, but now we’re looking to integrate those systems.

HCI: So it really falls to you as the CIO, working with clinician and other leaders, to strategize around all this, right?

Corn: In the broader sense, yes. And it’s not like we’ve got everything figured out. While we feel like we have done a pretty darn good job with efficiency and patient flow, we’ve still got a ways to go. We’re now trialing an analytics from SIS, in order to figure out where opportunities remain to improve operations within the surgical arena. So with that, I think we will find ourselves sitting around with IT, anesthesia, and OR management, and strategizing, and figuring out, OK, with all the opportunities we have here, where do we think we can get the most bang for the buck, in terms of incremental investment?

HCI: The OR is a key financial driver for the hospital, generating up to 70 percent of the revenue, 60 percent of the operating margin, and 40 percent of the supply costs, on average, for hospitals; clearly, the OR is a rich parcel of land to plow for opportunities, right?

Corn: I think so. Along the continuum, when I think of financial and quality issues, I think of them as being along a continuum, if you will.

HCI: So when you drill down into care delivery processes, you will find the cost and quality issues in the same places, right?

Corn: Absolutely. And oftentimes, improved quality will result in improved financials; a good example is in clinician documentation. By improving our documentation, and by using technology and automation, we will often do a better job of the documentation as a result. And I’m predisposed to believe that will result in better-quality care, and better charge capture as well, of course.

HCI: The survey cites improved surgical team communications, decrease in cost per case, increase in on-time surgical case starts, and creation of a more accurate, legible anesthesia record, as opportunities. Your thoughts?

Corn: We’re still fairly fresh with the use of the anesthesia record module, but I am hearing that the anesthesiologists and CRNAs [certified registered nurse anesthetists] are now focused on what needs to be done in the moment, using that system. And the implication I took from that was that there was a little less chitchat and more focus on the patient and the system, and the documentation, etc.

HCI: Can you speak to the successes that have taken place so far among hospitals that have automated, and the growing awareness of the need for automaton in the industry?

Corn: In our experience, you start in the perioperative area, and then expand into anesthesia, and now we’re beginning to integrate and provide access to PACS within the ORs. We’re just bringing more of the IT-related portions of the care closer to the source of care, in this case, in the OR suite.

HCI: Clearly, there is a growing awareness that automation is going to be a part of the solution going forward?

Corn: I think so. And when you think of where HITECH [the federal American Reinvestment and Recovery Act/Health Information Technology for Economic and Clinical Health (ARRA-HITECH) Act] and meaningful use are going to take us as an industry, I think it’s pretty clear that whether it’s tracking quality measures, or whether it’s requirements related to IT integration into the ancillary areas, that we will have to move forward in those areas. We believe that there’s going to be some modular certification that’s going to be required. Right now, we believe that there are going to be six different systems, and OR will be one of those, where we’ll have to provide modular certification documentation. We’ve got our primary EMR, our ED system, our surgical system, our laboratory system, and a couple more other areas that we believe will ultimately have to be certified down the road.


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