by Doug Rabkin

There has been a great deal in the news regarding digitizing healthcare records. The Affordable Care Act requires medical offices to have electronic medical records (EMR) or face penalties. ASCs are still in the “pen and paper” era. An era that most businesses left in the dust years ago with regards to accreditation record keeping.

Electronic logbooks (ELB) seeks to change all of that. AccreditSoft!, a software company based in Pasadena, Calif., offers an ELB that uses an iPad as the recording device which allows staff to move around the facility entering “logbooks” without the book. The company AccreditSoft! studied dozens of ASCs to understand the workflow used by those centers to maintain their logbooks. Analysis of this information allowed them to mimic that workflow in an electronic format.

Accreditation record keeping has a cost

One of the very first challenges to developing ELB was cost justification. The last thing any ASC needs is another bill each month. After extensive research, and visiting dozens of facilities, researchers uncovered the huge unseen costs associated with current paper forms and logs. The time involved in writing information in the myriad of paper forms was the biggest culprit. The time spent actually writing in the data is quite small, however, the time spent “catching up” from forgetting to write in the logbook over time really adds up. The main mission of accreditation is patient safety. “Catching up” is not in the spirit of patient safety.

ELB eliminates forgotten log entries by reminding staff of unfinished tasks throughout the day ensuring accurate logbooks and eliminating the need to “catch up.” Many small centers hire a consultant to help them pass inspection. A large part of the inspection preparation process, and the actual inspection, involves logbook review. ELB drastically reduces the time required to review log data in preparation for inspection and speeds up the inspection. Having a printed report is preferable to deciphering handwritten logbooks. Reduced time equals reduced costs for both nurses and consultants.


One of the more difficult and time-eating elements of accreditation record keeping found by ELB developers was the myriad of forms that centers use. The log form to record sterilization data, as an example, was different in almost every center visited. Centers that were almost identical, except for different owners, had different forms for the same task. Many of these facilities were entering completely unnecessary data in their forms. It’s like paying taxes. If you pay too little, you’re going to hear about it. If you pay too much, you won’t hear anything. Entering unnecessary data costs time.

Another problem ELB developers uncovered regarding accreditation documentation forms relates to new centers just getting started. Many small, single-doctor facilities are left to troll the Internet looking for forms or, worse, they are creating their own.

ELB takes a huge burden off of these new facilities and the nurses that manage them by having standardized forms for most of the nurses’ responsibilities regarding accreditation documentation. It allows the nurse manager to move on to other important matters for the start-up and not waste time reinventing the wheel.

Every start-up facility interviewed saw extreme anxiety amongst the owner and the manager regarding inspection. The owner has a huge investment riding on the passage of that first inspection. Using electronic logbooks with the standardization of forms and built-in compliance tools, the owner, manager and the surveyor are immediately on the same page.

What happened to that logbook?

Data safety is another very important benefit of digitizing valuable accreditation documentation. Facilities are inspected every three years. That means they have collected three years worth of data and it’s all in a three-ring binder. The larger the facility, the more data and binders it has to keep up with. Is there any other business that keeps its most valuable data in a book or binder on a shelf?

With electronic logbooks, user data is stored on secure and backed up cloud servers. This has two benefits. The first is obvious. The facility’s data is safe … very safe. The second benefit is accessibility. ELB users can access their “books” from anyplace that has an Internet connection. Managers can review data without having to “get the book.” This is especially helpful for managing multiple facilities. Corporate organizations that own large numbers of facilities can review data or get reports on every center and see every form from the home office.


Resistance to change is part of human nature. In the early to mid-1980s, word processors were making their way into the business world. Using a computer to write a letter seemed very cumbersome. People were used to taking a sheet of paper, rolling it up in a typewriter and writing a letter. Simple, right? Now, what about changing that paragraph, spelling errors or making multiple copies to different people? How about those little bottles of whiteout? No doubt there were many complaints about not having a typewriter. No doubt those complainers were soon wondering how they ever managed without their computer.

A nurse working in a small ASC was rushing to get home after a surgery that went two hours late. She decided to finish the logbooks the next morning. We timed it. It took her almost 12 minutes with interruptions to retrieve each logbook and fill it in and she had to remember to do it when she came in the following day. With an iPad and ELB, the time was 96 seconds and she could have updated her books the day of surgery like you’re supposed to. Now, if it really was urgent for her to leave, she could have taken the iPad home and finished the logbooks then.

Bottom Line

Electronic logbooks represent a quantum leap in ASC administration and accreditation compliance. It allows a center to efficiently manage its accreditation requirements and thereby have a significant savings in time and money. It also allows the center to generate meaningful information through extensive reporting. For new facilities, it provides a quick and easy way to get their accreditation documentation in order and feel more confident when that surveyor arrives. No doubt the surveyor feels the same way.

Doug Rabkin is the president and founder of AccreditSoft!. For more information, visit