Electronic Health Reporter

By Dr. Veronica Diaz, medical director of orthopedics, Modernizing Medicine.

The growing preference for outpatient orthopedic surgery is much more than another pandemic-inspired trend. Recent advances in medicine over the past few years have made procedures, even those as intensive as total joint replacements (TJR), safe to conduct in the outpatient or ASC setting.

Now, surgeons can capitalize on regional anesthesia and tranexamic acid to minimize blood loss and GPS software to improve the precision of implant positioning, all factors which ensure the patient can recover comfortably in their own home, not the hospital.

While these advances make outpatient TJR procedures possible, the digital transformation in healthcare makes it preferable. Specialty-specific digital tools are crucial for the transition to outpatient surgery, reducing the burden on physicians, limiting a patient’s time spent out of the home, and lowering costs for both patients and physicians.

Physician 

As has been widely reported, inefficient electronic health record software can intensify burnout instead of mitigating it. Physicians that spend extensive time documenting, especially after hours, report higher rates of burnout, and programs that are click-intensive and data-heavy contribute to this phenomenon as well.

These pitfalls are especially burdensome in the ASC setting because it is a site of care that may be separate from a patient’s primary care office or hospital system. In order to best understand a patient’s medical history and effectively communicate with their other physicians and specialists, ASCs need interoperable EHR systems that minimize manual data entry.

EHR adoption is already especially challenging within orthopedics, as this is a specialty that covers a wide age range, from children to older adults, and encompasses integumentary, neurovascular, and musculoskeletal systems across the entire body. Therefore, on top of the challenges of finding software that mimics the workflow of outpatient care, it must also capture the nuances of the orthopedic specialty. It should streamline workflows and predict and suggest codes, reducing overall clicks and time spent within the system, so that the physician can dedicate that time to the patient.

Patient

For the patient, integrating telemedicine ensures they do not need to travel for every pre-op or follow-up appointment. Even after major joint replacement surgery, surgeons can effectively conduct these visits digitally. They can communicate with patients about MRI findings, assess wound healing, measure range of motion, and develop management strategies for postoperative pain control virtually. Taking it a step further, advances in remote patient monitoring technology can assist clinicians in passively tracking vital signs and keeping an eye on patient recovery in between appointments.

All of the innovation in this realm is especially beneficial for older adults, who comprise the vast majority of TJR recipients. Limited mobility and a general sense of social isolation in this population make hospital stays especially undesirable and increases the preference for home care. Therefore, limiting time spent in the healthcare facility just may be the key to patient satisfaction

Cost

The ambulatory setting is rife with opportunity, not only for cost containment by eliminating the overnight stay, but also for revenue generation.

The best digital tools for perioperative care will capture all billable and reimbursable services, including patient education, medical optimization, implants, medication-related costs, durable medical equipment and rehabilitation services. As ever more emphasis is placed on delivering value-based care, the integration between documentation, coding, and billing will be critical for the continued success of the involved entities.

As new technologies and treatments become available, physicians need an EHR that can keep up with these changes, suggesting the codes to support reimbursement. This became especially apparent with the overhaul of evaluation and management codes in 2021.

Orthopedic procedures such as total joint replacement are on the cusp of a transformation, and the shift in point of care from inpatient to ambulatory settings continues to gain traction. Streamlining the workflow around these procedures, with specialty-specific EHR and telemedicine systems, has the potential to advance patient care across the entire care continuum, whether patients are physically in the office or not.