ASCA Survey Shows Mixed Usage of EHR among ASCs

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ASCA Survey Shows Mixed Usage of EHR among ASCs

Cost was the biggest factor cited for centers that had not implemented the technology

In late April 2021, ASCA conducted the second survey in its new, bimonthly survey series named 60-Second Survey. Each survey asks fewer than 10 questions on a current topic and takes approximately a minute to complete. The topic changes survey to survey, and each will be aimed at taking the pulse of the ASC community and helping ASCA better serve its members and the ASC industry at large.

The April/May 60-Second Survey asked about electronic health record (EHR) usage by ASCs and received 260 responses in 10 days.

60-Second Survey


According to the Office of the National Coordinator for Health Information Technology (ONC), the federal agency in charge of health information technology (health IT) standards, 86 percent of office-based physicians and 96 percent of non-federal acute care hospitals are using an EHR. High EHR uptake by physician offices and hospitals can be traced back to the Health Information Technology for Economic and Clinical Health (HITECH) Act of 2009. This legislation included two major actions to stimulate EHR usage: it authorized billions of dollars in stimulus payments to hospitals and physicians to fund EHR purchase and implementation, and set new requirements for the hospitals and physicians that would have to certify EHR usage or risk incurring reimbursement penalties. The results speak for themselves, although the high penetration in hospitals and physician offices is not necessarily indicative of clinician satisfaction as these systems have been forced into their workflows. Many other sites of service, including ASCs, were left out of HITECH Act stimulus funds for EHRs. The result is much lower health IT adoption by ASCs and other similarly specialized sites of service such as skilled nursing facilities (SNF), long-term care hospitals, rural health clinics, etc. Many of these settings do not have the financial means of a hospital or large physician group and find it difficult to finance and staff a complicated technology implementation.

Survey Results

Ascertaining the proportion of ASCs that use an EHR has been murky at best so far. Vendor estimates have previously estimated adoption at 20 percent of ASCs, although new facilities are more likely to implement an EHR right from opening. This survey gave insights into the state of EHRs in ASCs, although the wide variety of ASCs—in both size and specialty—make it hard to draw any definitive conclusion from a small sample. In addition, ASCs that use EHRs were probably more likely to respond to the survey than those that do not.

The survey revealed that 54.6 percent (142/260) of respondents use an EHR in their facility, with SIS/Amkai (29 percent), HST Pathways (18 percent) and Epic (9 percent) being the most used systems. There was no significant difference in EHR adoption between single- and multi-specialty facilities. At 62.2 percent (69/111), a majority of solely physician-owned ASCs reported using an EHR, a higher proportion than other ownership types. Among those centers using an EHR, 73 percent (102/140) would recommend it to other facilities, with increased operational efficiency and data for benchmarking the most cited benefits of having an EHR. Cost was the biggest factor cited for centers that had not implemented an EHR, with 65 percent (74/113) of respondents reporting that they intend to remain on paper charts until required to change.

ASCA EHR Advocacy

At this time, there is no federal requirement for ASCs to use an EHR. ASCA staff continues to advocate for ASC-specific standards and maximum regulatory flexibilities. A group of ASCA member vendors holds occasional roundtable calls with ONC to ensure the most up-to-date, compliant products are available to ASCs and to educate ONC staff on the unique nature of ASCs compared to hospitals and physician offices.

ASCA members can access a PowerPoint with a full breakdown of survey responses. Please write Alex Taira with any questions or ideas for future 60-Second Survey themes.