Many therapists are grappling with the transition to electronic medical records (or EMRs, also known as electronic health records or EHRs). In July, we revealed a few tips from PTPN members on how to shop for EMR and billing software. This month, Stevyn Voyles, COO and vice president of Progressive Physical Therapy (a PTPN member with four locations in Southern California), and Andrea Cassese, director of PTOS Software for Patterson Medical (a Preferred Vendor for PTPN), give readers some advice when preparing to integrate such software into their practices.
Before we begin, Stevyn, what type of EMR system do you use?
SV: After being a testing site for four different EMR systems and trying out at least 10, we considered ourselves pretty knowledgeable about what a system should do, what it shouldn’t and what we wanted. Needless to say, we are a demanding group. Our goal was to find a system that would help us chart faster, be more complete (that is, compliance-driven), and integrate with billing.
Most of the open architecture systems relied on too much open data entry for our taste. We decided against them because regulations are ever-changing, and we don’t want our PTs to be caught short just because they forgot to dot an “i” or cross a “t.” That’s why we focused on compliance-driven software that used drop-down menus to help PTs choose the right codes for billing, PQRS, etc. There’s still data entry and the ability to free-type, but less room for error.
The program we decided on is an ASP access program, software that is accessed via the internet. Though we have the ability to bring the program in-house and host a server for ourselves, a web-based solution works well for us because we have four different clinic locations.
What kind of training was necessary in order to understand the software?
SV: Training started with online webinars, video tutorials and handouts. We also had on-site training, so we had a trainer in each of our clinics for the week we went live. The training schedule was as follows:
- Day 1: Training on each segment of charting.
- Day 2: More intensive for the therapists, i.e., how to do an evaluation, progress report and discharge.
- Day 3: Going live! It was the first day that we starting charting on the new system. On the vendor’s recommendation, we only used the system with each new patient seen. All other patients were done using the old system and their billing was entered manually.
- Days 4 and 5: We continued to use the new system while the trainer observed, scheduling two new patients for each therapist per day.
AC: PTOS offers several different types of training similar to what Stevyn experienced. We hold free webinars throughout the year addressing different topics and product features, and we have a large FAQ library that contains audio and video resources, as well as text responses. Finding out the training resources of any vendor you are considering is key.
How do PTs in your clinic use the software — laptops, tablets, etc.? Do they continue to use paper charts while treating patients, or is everything electronic?
SV: We started with desktops and progressed to laptops. Our software can be used to document on a mobile phone (although not recommended due to the size of the screen) or an iPad, but we only have a couple of PTs trying this.
The hardest part is getting physical therapists used to the idea that charting while treating the patient is both the preferred method and the most efficient. While some PTs don’t think this is fair to the patient because it takes a little time away from their interactions, I believe they will come around one day. Change takes time, and you really can’t speed the process.
How long does it take to convert your existing files to electronic ones?
AC: This really depends on the size of the clinic and how they want to handle transition. Most clinics will start fresh in a new system. They will need to determine how many documents they need to scan or enter into the new system and what is critical/non-critical.
SV: Each of our offices is progressing to the same point of paper-free charting, but we are not there yet and it has been 19 months. It does help that our system is able to scan documents into the patient’s records, like referrals, outside reports, etc. We could probably let go of the paper chart, because the cloud is fairly reliable, and our staff understands the software more and more every day, but everyone is not on the same page or timeframe. I do believe it’s in our near future. Just give us another six months.
However, we still question whether we should get rid of all our paper. We could shred all of the patient charts, but if the internet went down, we’d be in trouble. While all of our files are secured on an off-site server in a HIPAA-compliant facility, quick access is not an option when your internet is down. And we still print things like the daily schedule and patient flow charts, just to be safe.
Stevyn, what would you do differently, knowing what you know now?
SV: I think you have to assume that change is difficult for everyone and that this is not an easy process. Since our group has looked at so many programs, we wanted something that would be easy and perfect, but quite honestly, there isn’t such a program. We have been really hard on the program we chose: We knew what we wanted, we knew what was out there, and we knew what a program should be, but we couldn’t write the program. We want to be able to identify issues and have them corrected immediately, and that’s not possible.
So instead, our goal is to become experts on our software. My people now want to hear from others using the system. They want to know what other users are doing to use the system more efficiently: What are the shortcuts? What aspects are we not utilizing — or not using correctly? I think we’re getting there, slowly but surely.
What are the biggest lessons you learned? The biggest surprises?
SV: The amount of time it took to get up and running. I think our PTs expected it to take some time to get used to the learning curve. But with more detailed software comes more training and more shortcuts, leading to the need for more help! Have you ever heard the expression, “You don’t know what you don’t know, until you know it?” That’s this process, to a T.
Another issue is that PTs have been trained to treat, not to be expert typists or computer gurus or wordsmiths. So you have to start with knowing what you have to say, where you have to say it, and how you are going to have to bill it. If we had a do-over, I’d ask for more training from a physical therapist, one that currently uses the system, earlier in the process.
Is there anything else PTs should know before they start the process?
SV: I don’t think there’s any way to anticipate every possible challenge. That said, one thing you can do is think about your staff’s previous experience and knowledge. Be realistic and give lots of training. If you have any therapists that are not computer savvy, start there and get them up to speed. This is a new world and it’s not going away.
AC: Agreed. If they aren’t used to using electronic forms or entering data into a computer, be sure to allow enough time for getting used to the system. You may want to consider starting small until you are used to the system, or having a “super user” — someone who is trained first and can then help others get up to speed.
A special thanks to our contributors:
 |
Stevyn Voyles is the COO and Vice President of Progressive Physical Therapy, a PTPN member with four locations in Southern California. She has been with Progressive PT for more than 20 years and has been working in health administration since 1984. |
 |
Andrea Cassese is the Director of PTOS Software for Patterson Medical, a Preferred Vendor for PTPN. |
