How Summit Surgical Center Cut Administrative Time by 62% with Custom EHR

Executive Summary

Summit Surgical Center, a high-volume ambulatory surgery facility in Denver, Colorado, was struggling with commercial EHR (Electronic Health Record) software that was completely misaligned with their operational needs. Despite paying $84,000 annually in licensing fees, the hospital-focused system created more problems than it solved.

Within 12 weeks of implementing a custom-built EHR designed specifically for ambulatory surgery workflows, Summit achieved:

This case study demonstrates how purpose-built software—designed for specific workflows rather than trying to do everything—delivers dramatically better outcomes than one-size-fits-all commercial solutions.

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Client Background

Company Overview

Summit Surgical Center is an independent ambulatory surgery center founded in 2015, specializing in outpatient orthopedic procedures, gastrointestinal endoscopies, and pain management injections. The facility operates 5 surgical suites and processes 3,200+ procedures annually with a focus on efficiency, patient safety, and same-day discharge.

Unlike hospitals that manage complex multi-day admissions, ambulatory surgery centers have streamlined workflows:

• Pre-operative assessment: Quick health screening and consent (15-20 minutes)
• Surgical procedure: Focused, single-specialty operations (30-90 minutes)
• Post-operative recovery: Brief monitoring period (1-3 hours)
• Same-day discharge: Patients go home with instructions and follow-up scheduled

This simplified, high-volume model requires lean systems that support rapid patient flow—not the comprehensive, feature-heavy EHR systems designed for hospital inpatient care.

The Commercial EHR Problem

In 2019, Summit implemented a popular commercial EHR system used by hundreds of hospitals nationwide. The decision seemed logical: proven software, comprehensive features, regulatory compliance built-in, and vendor support.

Within months, the reality became clear: hospital EHR software is fundamentally misaligned with surgery center workflows.

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The Challenge: Software Bloat Killing Efficiency

Summit's commercial EHR was designed for hospitals managing complex, multi-day patient admissions with dozens of departments, hundreds of medications, and intricate care coordination. For a focused surgery center, this created operational chaos.

Specific Pain Points

1. Feature Overload and Complexity

The EHR included thousands of features Summit would never use:

• Inpatient management modules: Bed assignment, nursing shift reports, dietary orders
• 300+ medication formularies: Hospital pharmacy inventory management
• Complex order sets: Multi-department care coordination workflows
• ICU monitoring integration: Critical care systems they didn't have
• Maternity care modules: Labor & delivery tracking, NICU records

Navigating this bloat required:

• 40 hours of training for new staff members (vs. 4 hours for their previous paper system)
• 15+ clicks to complete simple tasks that should take 2 clicks
• Constant reference to manuals because features were buried in complex menus
• Frequent wrong-path errors where staff accidentally accessed hospital modules

2. Surgical Workflow Mismatch

The system was optimized for hospital admission workflows, not ambulatory surgery:

Pre-Op Process:

• EHR required completing 23-field intake form designed for multi-day hospital stays
• Summit only needed 8 fields for same-day surgery patients
• Nurses spent 12 minutes per patient on unnecessary documentation
• Required data: 35% relevant, 65% hospital-specific waste

Surgical Documentation:

• Procedure notes required navigating through hospital-style department hierarchies
• Simple procedure documentation took 8 minutes vs. 2 minutes with paper charts
• Templates designed for complex multi-surgeon cases, not focused outpatient procedures
• Anesthesia documentation included ICU-level detail unnecessary for conscious sedation

Post-Op Discharge:

• System assumed multi-day discharge planning (social work, home health, DME coordination)
• Summit needed simple: discharge instructions + follow-up appointment + prescription
• 18 clicks to complete discharge vs. 3 clicks needed
• Discharge process took 6 minutes per patient vs. 90 seconds necessary

3. Performance and Usability Issues

• Slow load times: 8-12 second page loads during peak hours (hospital servers prioritized over ASC users)
• Frequent timeouts: Staff had to re-login 4-6 times daily
• Desktop-only interface: No mobile access for surgeons reviewing schedules
• Poor search functionality: Finding patient records required exact spelling and navigation
• Cluttered interface: Critical information buried among irrelevant hospital modules

4. Unsustainable Costs

• Annual licensing: $84,000 (priced for hospital scale, not surgery center)
• Per-user fees: $3,500/user × 22 staff members
• Mandatory upgrades: $12,000 annually for features they didn't need
• Training costs: 880 hours/year of staff time learning/re-learning software
• IT support: Required dedicated part-time IT person ($35,000/year) to maintain

Total annual EHR cost: $131,000 (licensing + IT support + training time value)

5. Staff Frustration and Turnover

• 78% of staff rated the EHR as "extremely frustrating" in internal surveys
• 2 nurses quit citing EHR burden as a primary reason
• Surgeon complaints: "I spend more time fighting the computer than talking to patients"
• Lost productivity: Staff regularly stayed 30-60 minutes late to complete documentation

6. Patient Experience Impact

• Longer wait times: Administrative burden slowed patient processing
• Reduced face-to-face time: Nurses focused on screens instead of patients
• Perceived inefficiency: Patients noticed staff struggling with software
• Delayed discharges: Post-op documentation bottlenecks kept patients waiting

The Breaking Point

The final straw came in February 2024 when the EHR vendor announced a mandatory upgrade requiring:

• Additional $18,000 upgrade fee
• 60 hours of staff re-training on new interface
• New features: More hospital modules Summit didn't need

Dr. Robert Anderson (Medical Director) concluded: "We're paying luxury car prices for a vehicle with 90% of features we can't use and don't want. We need transportation that actually fits our needs."

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The Solution: Purpose-Built Custom EHR

Throdl partnered with Summit to design and build a custom EHR system optimized specifically for ambulatory surgery center workflows—eliminating bloat and focusing exclusively on features that delivered value.

Discovery & Design Process (Weeks 1-3)

1. Workflow Analysis

Throdl shadowed Summit staff through complete patient journeys:

• Observed 47 procedures across all three specialties
• Timed every task to identify bottlenecks and inefficiencies
• Interviewed all staff roles: surgeons, anesthesiologists, nurses, schedulers, billing
• Mapped actual workflows vs. how the commercial EHR forced them to work

Key Finding: 90% of EHR interactions involved just 12 core functions. Everything else was bloat.

2. Requirements Definition

Rather than building comprehensive hospital software, Throdl identified the essential features:

Scheduling & Registration:

• Surgical calendar with suite/surgeon/staff assignment
• Patient demographics and insurance verification
• Pre-op health questionnaire (8 critical questions only)
• Consent form generation and e-signature

Pre-Operative Assessment:

• Medical history review (allergies, medications, prior surgeries)
• Vitals recording (BP, pulse, oxygen, weight)
• Anesthesia assessment and clearance
• Pre-op checklist (NPO status, transport arrangements, etc.)

Surgical Documentation:

• Procedure templates by specialty (orthopedic, GI, pain management)
• Surgeon operative notes with voice-to-text option
• Anesthesia record (type, dosage, monitoring)
• Implant/device tracking for billing

Post-Operative Care:

• Recovery vitals monitoring
• Pain management documentation
• Discharge readiness checklist
• Post-op instruction templates by procedure type

Billing & Compliance:

• CPT/ICD code assignment
• Insurance claim generation
• Medicare compliance documentation
• HIPAA audit logging

Reporting & Analytics:

• Daily/weekly procedure volumes
• Surgeon productivity metrics
• Supply usage tracking
• Patient satisfaction scores

What Was Explicitly NOT Included:

• Inpatient management features
• Multi-day care coordination
• Hospital department modules
• Complex medication management
• ICU/critical care functionality

Development Phase (Weeks 4-10)

3. Lean Tech Stack Selection

Throdl chose technologies optimized for speed, reliability, and maintainability:

• Frontend: React for fast, responsive interface
• Backend: Node.js for lightweight, scalable API
• Database: PostgreSQL for reliable data storage with HIPAA compliance
• Hosting: HIPAA-compliant cloud infrastructure with automatic backups
• Security: End-to-end encryption, role-based access control, audit logging

No AI Features: Unlike many modern healthcare systems adding AI complexity, Summit's EHR focused on fast, reliable core functionality without experimental features.

4. User-Centered Design

Every screen was designed with surgical workflow efficiency in mind:

Pre-Op Intake Screen:

• Single-page form with only 8 required fields
• Auto-population from previous visits
• Keyboard shortcuts for common entries
• Completion time: 90 seconds (vs. 12 minutes with commercial EHR)

Surgical Documentation:

• Procedure-specific templates (knee arthroscopy, colonoscopy, epidural injection)
• Voice-to-text integration for surgeon notes
• One-click standard findings (normal exam, no complications, etc.)
• Completion time: 2 minutes (vs. 8 minutes with commercial EHR)

Discharge Process:

• Automated discharge instruction generation based on procedure
• Pre-populated prescriptions for common post-op medications
• One-click follow-up appointment scheduling
• Completion time: 90 seconds (vs. 6 minutes with commercial EHR)

5. Mobile-First Approach

Surgeons and staff could access the system from:

• Desktop workstations (primary use)
• Tablets for bedside documentation
• Smartphones for schedule checking and quick lookups

Responsive design ensured fast, consistent experience across all devices.

6. Integration with Existing Systems

The custom EHR integrated with Summit's existing infrastructure:

• Billing software: Automated claim submission with CPT/ICD codes
• Lab systems: Direct import of pre-op lab results
• Imaging: PACS integration for viewing X-rays/MRIs
• Scheduling system: Two-way sync with patient appointment calendar
• Email/SMS: Automated appointment reminders and post-op follow-up

Implementation & Training (Weeks 11-12)

7. Phased Rollout

Rather than risky "big bang" migration, Throdl implemented in phases:

Week 11 - Pilot Phase:

• Single surgical suite running custom EHR
• One surgeon (Dr. Anderson) and dedicated nursing team
• Parallel operation with old EHR for safety
• Real-time feedback and rapid iteration

Week 12 - Full Deployment:

• All 5 surgical suites switched to custom EHR
• Complete migration of patient records
• Old EHR maintained read-only for 90 days (regulatory compliance)

8. Streamlined Training

Total training time per staff member: 2 hours (vs. 40 hours with commercial EHR)

Training structure:

• 30 minutes: System overview and navigation
• 60 minutes: Hands-on practice with role-specific workflows
• 30 minutes: Q&A and edge cases

Why training was so fast:

• Intuitive interface designed around actual workflows
• Only 12 core features to learn (vs. hundreds in commercial EHR)
• Familiar medical terminology and processes
• Minimal clicks to complete common tasks

9. Ongoing Support

Post-launch support included:

• Direct developer access: Throdl developer available via Slack for questions
• Weekly check-ins: First month monitoring and optimization
• Feature iteration: Rapid updates based on user feedback
• 99.9% uptime SLA: Guaranteed system availability

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The Results: Dramatic Efficiency Gains

Quantified Improvements

Administrative Time Reduction: -62%

Time per patient (intake → discharge documentation):

Before (Commercial EHR):

• Pre-op intake: 12 minutes
• Surgical documentation: 8 minutes
• Post-op/discharge: 6 minutes
• Total: 26 minutes per patient

After (Custom EHR):

• Pre-op intake: 90 seconds
• Surgical documentation: 2 minutes
• Post-op/discharge: 90 seconds
• Total: 10 minutes per patient

Time saved: 16 minutes per patient × 3,200 procedures/year = 853 hours/year recovered

At average nurse salary ($38/hour), this equals $32,414 in labor cost savings annually.

Cost Savings: $84,000/year

Before (Commercial EHR Annual Costs):

• Licensing fees: $84,000
• IT support: $35,000
• Training time value: $12,000
• Total: $131,000/year

After (Custom EHR Annual Costs):

• Development cost (one-time): $68,000
• Hosting & maintenance: $12,000/year
• Support retainer: $6,000/year
• Total ongoing: $18,000/year

Net first-year savings: $131,000 - $68,000 - $18,000 = $45,000 Year 2+ ongoing savings: $131,000 - $18,000 = $113,000/year

3-year TCO comparison:

• Commercial EHR: $393,000
• Custom EHR: $122,000 (development + 3 years maintenance)
• Total 3-year savings: $271,000

Training Time: 2 hours vs. 40 hours

Commercial EHR onboarding:

• Initial training: 40 hours/employee
• Annual refresher training: 8 hours/employee
• New feature training: 4 hours/employee/year
• Total first year: 52 hours × 22 staff = 1,144 hours

Custom EHR onboarding:

• Initial training: 2 hours/employee
• Annual refresher: Not needed (intuitive system)
• New feature training: 30 minutes/year
• Total first year: 2.5 hours × 22 staff = 55 hours

Training time saved: 1,089 hours/year = $41,382 in labor cost savings

Patient Throughput: +18% Increase

Before: 3,200 procedures/year (62/week average)

After: 3,776 procedures/year (73/week average)

Same staff, same facility, same hours—18% more capacity unlocked by eliminating administrative friction.

Revenue impact: 576 additional procedures × $2,400 average revenue = $1,382,400 additional annual revenue

Qualitative Improvements

Staff Satisfaction

Post-implementation survey results:

• 94% of staff rated custom EHR as "easy to use"
• 88% said it "significantly reduced stress"
• 100% of nurses preferred custom EHR over commercial system
• Zero turnover in first 12 months (vs. 2 nurses quit previous year citing EHR frustration)

Surgeon Feedback

Dr. Anderson: "I can complete my operative notes in the time it takes to walk from OR to the lounge. The old system required me to stay an extra hour after my last case. Now I'm home for dinner."

Patient Experience

• Pre-op wait time: Reduced from 45 minutes to 28 minutes
• Total facility time: Reduced by 22 minutes average
• Patient satisfaction scores: Increased from 4.2/5 to 4.7/5
• Common feedback: "Staff seemed less rushed and more attentive"

Operational Flexibility

The custom system enabled rapid adaptation:

• New procedure types: Added in 1 day (vs. 3-month vendor timeline with commercial EHR)
• Insurance changes: Updated billing codes in hours, not months
• Reporting updates: Custom analytics created on-demand
• Workflow tweaks: Modified screens based on staff feedback within days

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Client Testimonial

Extended Feedback:

"The commercial EHR vendors kept telling us we needed to 'adapt our workflows to the software.' That's backwards. The software should adapt to proven clinical workflows, not the other way around.

Throdl spent three weeks just watching how we actually work—not how some hospital administrator thinks we should work. They built software around our reality, not some theoretical ideal.

The difference is night and day:

Speed: Tasks that took 15 clicks now take 2. Documentation that took 8 minutes now takes 2. We're not fighting the software anymore.

Simplicity: New staff learn the system in a single afternoon. No thick manuals, no weeks of training, no constant reference to help documentation.

Focus: The interface shows exactly what we need for ambulatory surgery—nothing more. No scrolling through irrelevant hospital modules to find the one feature we actually use.

Cost: We're saving over $100,000 a year in software costs alone. That's funded our entire quality improvement program.

Flexibility: When COVID-19 hit and we needed to add telehealth pre-op assessments, Throdl built it in 5 days. With our old vendor, we'd still be waiting for the feature request to be reviewed.

The best part? My surgeons actually like using it. That's never happened with healthcare software before."

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Why It Worked: Custom vs. Commercial Software

The Commercial Software Trap

Enterprise healthcare software vendors optimize for:

• Feature breadth: Selling to many customer types (hospitals, clinics, ASCs, nursing homes)
• Maximum price: Charging based on "comprehensive features" whether used or not
• Vendor lock-in: Making switching costs high through complexity and data silos
• Lowest common denominator: One-size-fits-all design that fits nobody perfectly

This creates bloated, expensive, complex systems that technically do everything but excel at nothing.

The Custom Software Advantage

Purpose-built systems optimize for:

• Workflow efficiency: Designed around actual user tasks, not theoretical features
• Minimum viable complexity: Only essential features that deliver value
• User experience: Fast, intuitive interfaces requiring minimal training
• Adaptability: Rapid iteration based on real usage and feedback

This creates lean, focused tools that solve specific problems exceptionally well.

When Custom Software Makes Sense

Custom development is the right choice when:

1. Workflow specificity: Your processes are unique and don't fit standard software
2. Feature bloat: Commercial solutions include 70%+ features you'll never use
3. Cost-benefit: Annual software costs exceed custom development amortized over 3-5 years
4. Integration needs: Connecting disparate systems requires custom APIs anyway
5. Competitive advantage: Operational efficiency is a strategic differentiator

For Summit, all five factors applied—making custom development the obvious choice.

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Lessons for Healthcare Organizations

1. Question the "Industry Standard" Software

Just because everyone uses certain software doesn't mean it's optimal for your organization. Hospital-focused EHRs are categorically wrong for ambulatory surgery centers, urgent care clinics, and other focused healthcare settings.

Ask:

• What percentage of features do we actually use?
• How much time do we spend working around the software?
• What would software designed specifically for our workflows look like?

2. Calculate True Total Cost of Ownership

Software costs extend far beyond licensing fees:

• Training time: Hours × staff × hourly rate × annual turnover
• Lost productivity: Extra clicks × tasks per day × labor cost
• IT support: Dedicated staff or consultant hours
• Upgrade fees: Mandatory version updates and new modules
• Opportunity cost: Could staff serve more patients with better tools?

For Summit, the commercial EHR's true cost was $131,000/year, not the $84,000 license fee.

3. Value Simplicity Over Features

More features ≠ better software. Complexity creates:

• Longer training requirements
• Higher error rates
• Staff frustration and turnover
• Slower task completion
• Poor user adoption

The best software includes only features that deliver value to actual users.

4. Prioritize User Experience

Clinical staff are the users, not IT administrators or executives. Software should be designed around:

• How clinicians actually work (not how administrators want them to work)
• Minimizing clicks and keystrokes
• Displaying only relevant information
• Enabling common tasks quickly
• Gracefully handling exceptions

Summit's custom EHR achieved 94% user satisfaction because it was built for the people using it daily.

5. Consider Custom Development

Custom software development has become dramatically more accessible:

• Modern frameworks: React, Node.js enable rapid development
• Cloud infrastructure: HIPAA-compliant hosting readily available
• Developer talent: Experienced healthcare software developers available
• Lower costs: Custom development often cheaper than enterprise software over 3-5 years

Organizations spending $50K+/year on commercial software should evaluate custom alternatives.

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Technical Architecture (For IT Leaders)

System Components

Frontend Application:

• React 18 with TypeScript for type safety
• Responsive design (desktop, tablet, mobile)
• Offline-capable for network interruptions
• Real-time updates using WebSockets

Backend API:

• Node.js/Express RESTful API
• JWT authentication with role-based access control
• HIPAA audit logging for all data access
• Automated backups (hourly incremental, daily full)

Database:

• PostgreSQL 14 with encrypted storage
• Patient data encrypted at rest and in transit
• Full-text search for rapid record retrieval
• Automated data retention policies (7-year compliance)

Infrastructure:

• HIPAA-compliant AWS cloud hosting
• 99.9% uptime SLA with automatic failover
• DDoS protection and WAF security
• Automated security patching

Integrations:

• HL7/FHIR APIs for lab/imaging systems
• X12 EDI for insurance claim submission
• REST APIs for billing software integration
• Webhook notifications for appointment systems

Security & Compliance

HIPAA Compliance:

• Business Associate Agreement (BAA) with hosting provider
• End-to-end encryption (TLS 1.3, AES-256)
• Access controls (role-based, least privilege)
• Audit logging (all PHI access tracked)
• Breach notification procedures
• Annual security risk assessments

Data Protection:

• Encrypted backups stored in separate region
• Point-in-time recovery (30-day window)
• Disaster recovery plan (4-hour RPO, 8-hour RTO)
• Annual penetration testing
• Vulnerability scanning and patching

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Next Steps & Future Enhancements

With the core EHR operational, Summit and Throdl are exploring additional capabilities:

Planned Enhancements (Months 3-12)

Patient Portal:

• Online pre-registration
• Consent form completion before arrival
• Post-op instruction access
• Secure messaging with care team

Telehealth Integration:

• Virtual pre-op assessments
• Post-op follow-up video calls
• Remote patient monitoring

Advanced Analytics:

• Surgeon efficiency benchmarking
• Supply cost optimization
• Patient satisfaction trend analysis
• Procedure outcome tracking

Supply Chain Integration:

• Automated implant ordering based on scheduled procedures
• Inventory management with usage alerts
• Vendor pricing comparison

Mobile App for Surgeons:

• Schedule viewing and updates
• Quick access to patient records
• Voice-recorded operative notes
• Push notifications for urgent matters

Strategic Expansion

Summit is considering licensing their custom EHR to other ambulatory surgery centers:

• ASC Network: 8 surgery centers have inquired about using Summit's system
• White-label offering: Throdl could offer customized versions to similar facilities
• Shared development: Multiple centers funding feature development
• Industry impact: Potential to disrupt bloated commercial EHR market

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Conclusion: Purpose-Built Beats One-Size-Fits-All

Summit Surgical Center's experience demonstrates a fundamental truth about enterprise software: generic solutions optimized for everyone serve no one particularly well.

By investing in purpose-built custom software, Summit achieved:

• 62% reduction in administrative time per patient
• $113,000/year ongoing savings in software costs
• 18% increase in patient throughput with existing staff
• 2-hour training vs. 40 hours with commercial EHR
• 94% staff satisfaction with the new system

The custom EHR paid for itself in less than 12 months and will deliver over $270,000 in savings over three years.

Key Takeaways

For Healthcare Leaders:

• Challenge assumptions about "industry standard" software
• Calculate true total cost of ownership (including hidden costs)
• Prioritize user experience and operational efficiency
• Consider custom development for unique workflows

For Technology Decision-Makers:

• Simpler, focused solutions often outperform feature-bloated alternatives
• Modern development frameworks make custom software accessible
• User-centered design drives adoption and ROI
• Purpose-built tools create competitive operational advantages

For Software Buyers in Any Industry:

• More features ≠ better software
• Workflow fit matters more than feature checklists
• Training time and productivity losses are real costs
• Custom development is often cheaper than enterprise software over 3-5 years

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Get Started with Custom Software Development

If your organization is struggling with bloated commercial software that doesn't fit your workflows, Throdl can help. We specialize in building lean, purpose-built applications that solve specific problems exceptionally well.

Free consultation to evaluate whether custom development makes sense for your organization.

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