Healthcare Triangle Standardizes Across Surgical Areas for ASC to HOPD conversion at Great Falls Clinic Hospital

The Client

The Great Falls Clinic is a multi-specialty group medical practice emphasizing primary practice care, medical specialties and urgent care. Founded in 1917, the Great Falls Clinic is the fourth oldest medical clinic west of the Mississippi. As a leader in the Great Falls medical delivery system, the Great Falls Clinic works hard as a team of providers to institute positive change for patients throughout Montana. The combination of physicians and employees working together to improve patient care is their commitment and is defined as “Team Care.”

The Challenge

In 2018, Great Falls Clinic Hospital, a 19-bed, acute care, general community hospital with an associated ambulatory surgery center (ASC) and multiple outpatient clinics, made the decision to convert the ambulatory surgery center to a hospital outpatient department (HOPD) and to standardize surgical services, documentation, workflows, and charging across both surgical areas. At that time, the hospital surgery department utilized NextGen Clinical and NextGen Surgical for perioperative documentation, NextGen Financial for charging, and Athena for preadmission testing. The ambulatory surgery center used HST for surgery scheduling and paper for perioperative documentation. During the implementation of MEDITECH Expanse, the decision was made to convert the ASC to HOPD and to standardize processes as much as possible.

The Work

Healthcare Triangle (HCTI) was engaged to provide clinical project leadership for workflow analysis, build, implementation, and adoption of MEDITECH Expanse with a goal of standardization of processes across surgical areas (the hospital surgical suite and the outpatient surgery center). With a focus on standardization and improved patient safety, HCTI accomplished the following:

  • Documentation of current state workflows, gap analysis, and development and documentation of future state workflows based on facility policy and AORN/ASPAN guidelines. Workflow documentation was done utilizing Business Practice Management Notation (BPMN) graphical representation
  • Engagement of a multidisciplinary team to analyze best process for standardized charging mechanisms. The facility made the decision to utilize time charge rules for both surgical locations. HCTI provided leadership and guidance on structure and build of time charge rules
  • Engagement of a multidisciplinary team to develop future-state workflow for preadmission testing
  • Core team guidance for documentation build and standardization across surgical areas.
  • Core team guidance for standardization of preference cards
  • Staff engagement and streamlining of electronic nursing documentation for fast movement areas such as endoscopy
  • Staff engagement and streamlining of electronic nursing documentation for procedural sedation


With the guidance and assistance of HCTI, the hospital and surgery center sites rapidly and successfully implemented standardized documentation and charging workflows in MEDITECH Expanse. Adoption of nursing documentation at the surgery center site was of concern, as previous attempts at electronic documentation had been abandoned in favour of paper. The surgery center staff successfully adopted electronic documentation practices for all perioperative phases and for procedural sedation. Staff at both sites voiced overall satisfaction with the system and time requirements for documentation. Additionally, the transition to time charging was successfully accomplished to ensure standardization of billing across surgical areas. The outcome of this project has advanced Great Falls Clinic toward their goal of standardization of surgical processes.

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