'Every ASC Should Have SIS': Livonia's Decade-Long Transformation

Situation

Livonia Outpatient Surgery Center (LOSC) in Livonia, Michigan, opened in 2011. This single-specialty ophthalmology ASC runs two operating rooms (ORs) that handle roughly 4,000 cases annually. The center's most prolific surgeon performs 40 to 50 cases in a single day, which sets a high bar for how fast documentation and scheduling must move.

For its first several years of operation, paper charts and the center's legacy system created delays in an environment where speed and efficiency were key:

• Four to five nurses spent several hours each day assembling charts, chasing signatures, and calling patients.
• Paper records occupied floor space inside the ASC, and the center paid for offsite storage and for buying and stocking charts.
• Manual documentation pulled clinical staff away from patients and operational tasks.

Laura Picano-Wilson, RN, CNOR, CAIP, joined the center a few months after it opened and worked in clinical and administrative roles before becoming facility administrator, the role she fills today. Picano-Wilson's hospital background gave her firsthand experience with electronic records, and she pushed to move LOSC to electronic documentation.

The Solution

LOSC became Surgical Information Systems' (SIS) first SIS Charts™ early adopter in 2017, moving away from its cumbersome, paper-based processes. In 2018, the center transitioned to SIS Complete™, becoming one of the ASC management platform's earliest adopters and connecting scheduling, patient communication, billing, and analytics on one platform.

SIS Complete's subscription-based cloud model kept the transition simple, avoiding servers and the need to hire specialized IT staff. LOSC deployed workstations across the facility and put the system to work right away.

Simplified Scheduling & Billing

LOSC's referring physician offices use the SIS Link™ electronic scheduling system. When a practice submits a request with insufficient detail, such as missing supply information, LOSC can push it back to the physician's office. "We love SIS Link," said Picano-Wilson. "We like being able to reject a case if it does not have enough detail." Every message is trackable, so nothing gets lost, and no one needs to guess where a case stands.

As a single-specialty center, LOSC performs a limited set of procedures, meaning coding is repetitive. The revenue cycle workflows in SIS Office™ let the center's single biller work efficiently, submitting claims not long after physician documentation is finalized. "SIS Office helps our biller work so efficiently that she will occasionally run out of work," said Picano-Wilson.

Engaging Patients at Scheduling

Patient adoption of the SIS Exchange™ portal was gradual but successful. Initially, LOSC provided informational paper flyers to the physician offices to share with patients. Over time, LOSC's largely older patient population grew more comfortable with the digital tools.

Text-based communication also reduced the center's reliance on physician offices to relay information. Case requests now trigger immediate outreach to patients. "We don't even rely on paper flyers anymore," said Picano-Wilson. "Once we accept the case request, we start communicating with the patients right away." Patients complete questionnaires in SIS Exchange, then a staff member calls them before surgery to verify their responses.

Charting Efficiency That Stood the Test of Time

Before transitioning to electronic documentation, LOSC struggled to manage bulky file cabinets and the growing costs of physical storage. Adopting SIS Charts and SIS Complete eliminated the need for extensive on- and off-site storage. Removing on-site paper storage freed up space for four staff workstations and locker rooms, and it ended the recurring cost of buying and stocking paper charts.

Livonia configured SIS Charts to match existing intake and discharge workflows. Nursing staff found the charting flow intuitive and aligned with how they already worked, with each screen following the step-by-step order used with patients. This has helped simplify onboarding, allowing Picano-Wilson to bring new hires up to speed in half the time it used to take. "I have never had a nurse not fall in love with SIS. They find that it's easy to use and nice to look at," she said. "Hiring does not scare me anymore, and I’m not worried about retention, either: My nurses tell me they don’t want to go anywhere they can’t use SIS Charts.”

Charting at LOSC is now fully electronic and faster to complete. Pre-loaded operative note templates let physicians document in a few clicks. CRNAs chart In and Out times along with ASA scores. The use of the Surescripts medication history and color-coded case flags to highlight critical details like diabetic status help ensure staff is prepared for each patient.

Multiple staff can document in the same chart at once, so nurses complete their sections in parallel rather than waiting in line. A completion percentage bar at the top of each record flags missing items, which speeds up end-of-day review.

Performance Metrics At-a-Glance

SIS Complete's pre-built reports give Picano-Wilson and LOSC's board of directors visibility into the center's performance they never had before the ASC's partnership with SIS. Cost-per-case analysis pulls in staff time inputs and implant log data, giving LOSC a better understanding of what each case costs.

The Surgeon Summary report drives more informed discussions on surgeon volume and total cases with LOSC's board. Picano-Wilson also leverages this report with the surgeons. "I track each surgeon's volume monthly, quarterly, yearly, and year-over-year, which is helpful to have when discussing their performance," she said. Picano-Wilson also uses this report and the Management Summary report to closely monitor cases that were not charted or billed correctly, identify areas for improvement, and avoid potential issues.

Together, these results reflect a center that runs leaner without running harder. LOSC supports its physicians and staff with less administrative work, faster financial execution, and more clinical time returned to patients, and it has sustained that performance.

Conclusion

Nearly a decade after agreeing to be an early adopter of SIS Charts, the decision continues to pay off. What started as a fix for paper-heavy documentation now runs the daily operations of an impressive ASC, with improvements compounding year after year.

"SIS has been money well spent," said Picano-Wilson. Her confidence in SIS Complete extends far beyond LOSC. As part of a management company with over 20 ASCs, she champions SIS across the organization and supports go-lives as those facilities move to SIS Complete.

LOSC's collaboration with SIS has helped shape solutions that now power over 1,500 ASCs. "SIS has absolutely been a trusted partner to our long-term success at Livonia," said Picano-Wilson."Every ASC should have SIS."

Ready to Operate Smart™ like Livonia? Book a demo to see how SIS Complete can streamline clinical documentation, accelerate your revenue cycle, and give your staff more time for patient care.