It’s Time to Go Digital in America’s Ambulatory Surgery Centers


Tomorrow I fly to San Francisco to provide a keynote presentation at the annual meeting of the California Ambulatory Surgery Association, also known as CASA.  I'm looking forward to the trip not only to meet the membership of CASA, but also to have dinner with my daughter who is located in the Bay Area.  For that reason alone, speaking at an industry conference in San Francisco is always an easy "yes" if I have room in my schedule.

So what am I going to say to the membership of CASA?  Consider this.  According to a 2008 national survey of ambulatory surgery center administrators conduced by Renaissance Research, 82 percent of America's centers are still doing their work on paper.  In other words, only 18 percent of centers say they are currently using an electronic record system.  Stated reasons for this included the lack of an interface with administrative software, lack of capital investment, and lack of personnel to implement IT systems.

Of course, the 82 percent "no EMR" figure pretty much matches the state of the state across all of America's physician practices which puts us behind nearly every other industrialized nation on earth.   But compared to other kinds of medical facilities in America, ambulatory surgery centers are perhaps more vulnerable to another alarming trend; the globalization of care.  After all, what is it that ambulatory surgery centers do?  They provide out-patient, elective surgical procedures.  And what kinds of services are more and more Americans seeking from providers based in other countries? What is it that fuels medical tourism? And what did more than 750,000 Americans leave the country to get done last year alone?  Outpatient (and inpatient) elective surgery!

A study by Deloitte that was recently published in The Economist suggests that by 2012 as many as 10 million Americans will be seeking medical treatments overseas each year.  That number is expected to reaimagech 15 million by 2016.   The net loss to the American medical economy is estimated at $162 billion. Medical centers in places like South Korea, India, Mexico, Thailand, the  UAE, and elsewhere will be providing high-tech, high quality care at just 15 to 30 percent of the cost for similar services in America.  And because these state-of-the-artimage, foreign facilities like Bumrungrad in Thailand or Wockhardt in  India have all-digital records, they will be able to mine their data to provide complete cost and quality transparency in comparison to their American competitors.  Their IT investments and competencies also set the stage for them to use the most contemporary web-based technologies to recruit patients, monitor outcomes, and excel in customer relationship management.

Many surgeons in the desert Southwest have already told me that their fiercest competition comes not from colleagues across town, but from facilities located across the Mexican border.  You've probably seen ads from some of these centers in frequent flyer magazines and newspapers.  You can expect the competition from such centers will only increase as millions more aging Americans seek ways to take the the bite out of ever-increasing, out-of-pocket healthcare costs.

So, what will I tell the membership of CASA?  Unless you find a way to beat these competitors at their own game by being just as good and being able to prove it, just as digital, and just as efficient; in the years ahead you may very well find a dwindling supply of patients to grow your business. 

Bill Crounse, MD  Senior Director, Worldwide Health   Microsoft Corporation 

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