Narrator:   0:06

Welcome to the Advancing Surgical Care Podcast brought to you by ASCA, the Ambulatory Surgery Center Association. ASCA represents the interests of outpatient surgery centers of every specialty and provides advocacy and resources to assist them in delivering safe, high-quality, cost-effective patient care. As with all of ASCA’s communications, please check to make sure you are listening to or viewing our most up-to-date podcasts and announcements.

Bill Prentice:   0:37

Hello, and welcome to the Advancing Surgical Care Podcast. My name is Bill Prentice, I’m the CEO of ASCA and the host of this episode and I'm joined by my colleague, Alex Taira, ASCA’s regulatory policy and research manager to interview Dr. Jigar Patel from Oracle Cerner. Hi, Alex, how are you today?

Alex Taira:   0:53

Great. Thanks for having me, Bill.

Bill Prentice:   0:54

Great. Well, we've invited Dr. Patel to the podcast because Oracle Cerner is an ASCA affiliate and a leading supplier of health information technology products and services worldwide, including Electronic Health Record, EHR, systems. Also, technology remains a topic of considerable interest to our members. In fact, ASCA began working with the stakeholder group of electronic record providers almost 10 years ago to try and win adoption of a national certification standard for EHR in ambulatory surgery centers. But for a host of reasons, which we will discuss in a moment, we still do not have a national standard for ASCs and unlike hospitals, we also lack the financial incentives needed to move us closer to industry wide adoption. But before we go any further, I'd like to introduce our guest, Dr. Jigar Patel is Chief Medical Officer for the For-Profit in Emerging Markets client segment at Oracle Cerner, where he leads a multidisciplinary team responsible for advising clients on their informatics and technology needs and highlighting value achieved by Oracle Cerner. Dr. Patel has led clinical teams and strategies across numerous Oracle Cerner segments over his 15-year career. Prior to joining Oracle Cerner, Dr. Patel was an assistant professor of Pathology and Laboratory Medicine at the University of Kansas Medical Center. Dr. Patel, welcome to the podcast.

Jigar Patel:   2:11

Thanks for having me today, Bill. I really appreciate it and look forward to the robust conversation.

Bill Prentice:   2:16

Well, great. So, in my introduction, I briefly summarized some of the challenges that ASCs face when considering the purchase of an electronic health record system. You and your colleagues must talk frequently with ASCs about new technologies and advancements. So, what are you hearing from that?

Jigar Patel:   2:30

Yeah, it's there's a lot of things that go into adopting technologies at ASCs. The thing that's always the specter in the background is the cost to provide care at ASCs. We have to keep in mind overhead costs and IT becomes a part of that overhead cost. And because the reimbursement is lower, the margin has to be preserved in some way and that's by managing cost very, very effectively, as you all know. So with that comes IT infrastructure as a cost that can be burdensome, or at least a significant portion. And that significance, maybe not the right word, but can be a portion that has to be accounted for. And in a hospital with robust facilities and those sorts of things, it is less of a concern. We see a similar kind of IT cost and burden in smaller clinics as well. So, ASCs fit into that category of if I'm not attached to the big house, how does that affect my overall costs for providing care in that venue of care? So that's, that's number one. Number two, most large systems like Oracle Cerner, are designed and built for large operating suites that have a lot of different procedures and have a lot of regulation and things that the organization wants to improve. So, the data that's needed for those types of procedures also is more robust and that affects how you implement the design, an electronic medical record for surgical venues of care.

Bill Prentice:   4:11

So, if I could just jump in there, Jigar, I think one of the things you're talking about is the need to tailor the systems to something to fit into both the smaller physical environment and the smaller, the leaner, financial environment of an ambulatory surgery center.

Jigar Patel:   4:26

That's exactly right, Bill, I think it is, that's a good consistent way of saying that the systems are overwrought, over engineered or heavy weight in many regards for that venue of care. So that's very, very important. And as always with any electronic medical record or electronic health system, is we want to tailor the experience for the end user and I will be the first to admit as a person that's been doing electronic medical records and technologies in healthcare settings for 15 years, we have a ways to go in usability still. Some people won't want to hear that but as a industry healthcare, we're behind from a usability perspective.

Bill Prentice:   5:06

Well, I think that's absolutely right. And I think that's what we're seeing on our side as well. In fact, you know, 10 years ago, you know, we heard a lot of concerns from our members with respect to any kind of mandated electronic health record or digital recording system and a primary objection was that physicians are strongly attached to their own individual methods of doing things and we're very skeptical of new technology. And here we are, despite the great work that you and everyone the EMR community has been doing for the last 10 years, we estimate this still only 50% of ASCs have EHR capabilities. So, building off your answer to my last question, why is that? And what challenges are ASCs facing due to these barriers? And in your opinion, for those ASCs that are not leveraging or using an EHR, how is their clinical experience being impacted?

Jigar Patel:   5:58

Yeah, let's talk about what I call the healthcare as local problem. And that is to say, we, as a country, as a community of medical providers, want to standardize care. But it seems to break down almost universally with a physician that says, I have this specific way of doing things. And our job as technology providers is to allow some flexibility, without letting them go off the ranch, so to speak, that's also hard from an organizational perspective, to really monitor and appease, because I will often say a hospital CEO’s primary job is to have happy physicians. And that is, if there are barriers that are perceived by the physician or the community that that makes it harder to work at this institution that the CEO is often going to try to remove those barriers and an EHR is one of them. We, as a technology and as an industry, have also become indirectly an arm for regulation, an arm for oversight, and an arm for quality, and an arm for data. And we talk a lot about physician burnout and EHRs being a contributing factor, we happen to be a convenient way to put it in front of providers. So, we'll acknowledge that and say yes, and I've already mentioned usability, that usability has to be improved. And we continue to try to improve it but we're also at the mercy of other things. And Alex may have some comments from a regulatory perspective, because we are an easy arm into that specific operational need for hospitals and ASCs.

Bill Prentice:   7:41

Sorry to interrupt, I just on that point of, you know, obviously, that the frustration that you know, the physician committees had in the past, and one of the reasons they moved to the ASC environment, of course, is to take back their clinical lives to take back your days, give them more freedom to operate the way they want to, and to be able to be more efficient. Where can an EHR come into that equation? You know, recognizing that, obviously, in prior generations, they viewed it as a impediment to that efficiency and providing that lifestyle but can we get to a point where the EHR actually will fit into what the ASC model is all about in terms of creating that flexibility and that freedom for the physician?

Jigar Patel:   8:26

Absolutely. I think that move to mobility and the ability to do more things in different venues easily, is where we want to move the industry, the capability for EHRs to be accessed remotely is important today, the ability to do things mobiley is also important. And in a lot of instances ASCs in surgical hospitals, physicians are often part owners, or at least part of a joint venture to continue to support those. So, we want to have to respect them as owners of the facility as well. I do think there can be and should be a radical rethink of process to facilitate the use of technology, I often find the barrier coming in the door is, “but we've always done it that way” and if you take the opportunity, some time to think about that, and re-engineer it, you can gain efficiencies. Now that takes work and effort and people would argue that's a problem in and of itself, we're busy, and we want more time with our families and our friends.

Bill Prentice:   9:31

Great. Hey Alex, I think you have a question.

Alex Taira:   9:34

Thanks, Bill. Dr. Patel, my question was for those of us who work on developing new regulations or maintaining regulatory compliance, we can get pretty deep in the weeds, but I noticed someone like you, who's focused on regulatory compliance and the benefits of using these new technologies to improve the administration of surgery centers, can you talk a little bit about how EHR systems can actually improve the delivery of health care at an ASC and also measurably improve the patient experience?

Jigar Patel:   10:00

The biggest difference between maybe 20 years ago when EHRs were not the norm and today is data. The data is accessible and portable, and has in the world of advanced analytics, machine learning, AI, big data, that level of information, can transform industries, it has numerous times and other industries. And that's where we have to look to how do your analytics, improve medical care? How do you improve the patient outcome? How do you make operations better, more efficient, at a lower cost? And then financially? How do you get those dollars that you deserve for the services you've provided back to you? And that's the core of what information technology does in healthcare. And if we can glean insights from that data, that rich data set we've collected, then we can do more with it. Part of the problem with that data is it's really complex, more than in any industry. I've joked for years, I learned several languages in my life, English and medicine were the first two. And medicine is its own language and the translation to an IT system is another language and another reason I have a job every day.

Bill Prentice:   11:26

And we're glad you do. So, I'd like to follow up on Alex’s question where he talked about you mentioned patient experience, and you're talking about some aspects of it and your prior answer. But as you know, most of us today have smartphones with facial recognition, electronic payment capabilities, we can have our travel documents stored on and most also have the ability to airdrop files from our phones and make electronic retail payments, you know, at the touch of a button. Yet, when most of us visit a doctor, even a doctor we've seen multiple times, we're still handed a clipboard with several pages of paper forms to fill out and those same physician offices will make us take our hard copies of our identification and health insurance cards and go copying them again. And I'm not even talking about sharing medical records and the standards needed to accomplish that, but simply what is holding us back from eliminating those clipboards and paper forms while we continue to work towards adopting national standards for the handling and management of health records within ASC?

Jigar Patel:   12:25

Yeah, Bill, the first answer to that question is something we've talked about previously. And that's rethinking the process by which you take care of patients. The digitization at the front door from a health insurance card perspective, from a driver's license perspective, etc. is gotten much better. And that is generally pretty accepted that rescan of a document happens pretty regularly. The paper clipboard, I experienced it myself, and I'm frustrated and some purveyor of information technology knowing they have an electronic medical record. And part of that is a redesign and rethink about thought process. But in getting to the patient experience, the use and the improvement of patient portals and other digital inputs to make those things much easier is getting there. I will say I had some minor surgery done a number of years ago and sure enough, that electronic medical record was capable of sending me a questionnaire ahead of time, the practice decided not to use it for many different reasons. And I was like I did what was asked of me here, why am I doing this paper again. So it is a change in practice. So, it becomes in part, a change management endeavor to make that change, stick and really work for the patient, knowing that more and more patients expect to get their laboratory results as soon as their resulted. They expect to see their progress note from the visit with their doctor, as soon as they get home. Those things are becoming the normal and I think patients have a right to say, I have my phone here, what do you, I can do everything I want in my life right here, why can't I do my healthcare here? And we're getting there slowly but surely, the big thing that's in the background that is a barrier in some areas is security. And that is the securing of healthcare information. I had read an article a number of years ago when I was looking at in preparation for this kind of the latest statistics. And there was an article that was from the beginning of this year that estimated your credit card information is worth $5, but your healthcare information is worth $1,000. So not only from a how do I secure that at a level that is important for you as a person and your security, but then there is a secondary market for these sorts of things that we have to shut down and keep from people stealing identities. Healthcare data is rich in a lot of ways. And that way, it's something that needs to be kept in mind as we try to make records more portable, and make them easier to access holistically, we've made leaps and bounds of progress in interoperability, the sharing of records between health systems. And that is an immense advantage from when I started in the industry but it's a lot more data. So systems have to be smarter and helping providers interpret that data so that they can glean things they need. And we're not there yet on those sorts of things. So how does a smart system pull out the relevant medical information and present it in a smart way, as opposed to in an analog world of a physician flipping through a paper chart? So how do we, how do we make that data more liquid is still something that has to be addressed in a smart way?

Bill Prentice:   15:49

Got it. So, I'm still going to be handed that clipboard, but what I'm getting in return is I'm keeping my blood panel off the dark web.

Jigar Patel:   15:56

That is correct in part, I think patients should take the opportunity to say to providers, I do everything on my phone, why can't I do this on my phone? And challenge.

Bill Prentice:   16:05

That's right. I think that's a great point, just, you know, challenge the medical community to kind of push this forward a bit. Well, listen, I want to get you out of here in a few minutes, but I have one last question. In terms of information technology. And as we look to the future, what do you believe will be crucial for the ASC community to use to maintain a successful business operation, and clinical efficiency while trying to integrate this into their practice?

Jigar Patel:   16:30

Oh, this is gonna sound funny, I think, Bill, but it's a little bit of patience. And the patience is in how do I adopt, design and implement systems to improve long term, the patient experience, the medical care, operations and finances of those ASCs. Technology is ever evolving more than anything else in our lives and we will get there. So there's a little bit of patients in us as a provider of of information technologies, that we will need a little patience from you. But we'll also need some patience when you're going through the process of putting in new technologies, because they're not always easy to implement. We want to make those easier but that's the takeaway I'd have.

Bill Prentice:   17:15

Great. Well, Dr. Patel, thank you for joining us today for this insightful and informative discussion. We appreciate your time and appreciate Oracle Cerner’s participation in the ASCA affiliate program.

Jigar Patel:   17:26

Thank you. Pleasure to be here.

Bill Prentice:   17:28

And Alex, thank you for the important work you and your ASCA colleagues do every day to advocate for our members and on the issue of electronic health records, and the many other regulatory issues that you work on.

Alex Taira:   17:39

Thanks for having me, Bill.

Bill Prentice:   17:40

Well, as always, we invite our listeners to share feedback or suggestions for future podcast and this now concludes our ASCA podcast and we thank you for listening.