Having the opportunity to voice their needs and concerns to IT consultants has yielded an electronic medical record (EMR) system at Tallahassee Memorial Rehabilitation Center (TMRC), Tallahassee, Fla, that meets those needs to a “T.” Sheree L. Porter, MS, CCC-SLP, rehab program manager at TMRC and Neuro Rehabilitation, Tallahassee, discusses the gestation of the system and the fruits of multidisciplinary collaboration.
Judy O’Rourke Please provide an overview of the documentation systems you use to streamline operations.
Sheree L. Porter Because we are a large hospital, we are fortunate at Tallahassee Memorial HealthCare (TMH) to have an internal IT department that was able to build a system to meet the needs of our rehab unit for a successful transition to the EMR. A team of consultants from the IT department was assigned to our project at Tallahassee Memorial Rehabilitation Center specifically to meet the directive of transitioning our rehab department documentation to the EMR. At TMH, we use a system that our therapy team is well experienced at navigating. With the help of our IT department, we were able to explore the system and capitalize on the options that enabled us to make a successful transition to the EMR.
JO What do you expect from your software documentation programs?
SP Over a period of several months, the consultants met with our TMRC therapy teams in groups to individually identify the expectations of each of the disciplines—ie, speech therapy, occupational therapy, and physical therapy. This allowed our therapists to dictate the model that would best meet the needs of each group.
JO Have the features dovetailed into and streamlined your operations in terms of documentation?
SP Our decision to make a slow transition was deliberate—to allow the opportunity to identify possible glitches along the way. We started with our inpatient operations first. The outpatient department is presently transitioning. Because our colleagues in the TMH acute care therapy department had performed online documentation in the system for several years, we were able to use some of that documentation as a template for building a system for TMRC. Being part of a large continuum of care proved to be advantageous in that we did not need to totally reinvent the wheel.
JO How many patients do you see each month?
SP Both inpatient and outpatient units at TMRC realize high volumes. TMRC admits and discharges approximately 80 to 90 patients per month. The average length of stay is 15 days with over 90% of our patients returning home. Because a majority of our patients are postsurgical (ie, elective joint replacements), the length of stay at TMRC may be as minimal as 3 days, resulting in more frequent documentation time as patients come and go. The outpatient Neuro Rehab unit, which is housed at TMRC, schedules approximately 1,000 patient visits per month. We have a combined total of approximately 40 in the therapy teams across the two units. This includes full-time as well as flex and floating therapists.
JO Was the transition abrupt or gradual?
SP While we have not yet made a complete transition to the EMR, most of our areas have successfully made the jump. The gradual shift to the EMR has allowed us to work out kinks and identify areas that have helped as each group has transitioned. The inpatient OT team was the first to go live.
JO OTs softened the learning curve for those who followed?
SP When it was time for the speech therapy team to transition, we had learned from the OT experience that it was somewhat defeating to create an online evaluation only to make a paper copy to put into the physical chart for the physician to sign. By alerting the IT team to our need, they were able to create a system wherein our therapists can now send the evaluation and other documents requiring sign-off to the MD for electronic signature. Not only has this streamlined our process, but it has resulted in increased productivity, a reduction in potential citations, increased effective communication, and increased physician and clinician satisfaction. Our therapists have entered their own charges electronically into the system for many years at TMRC. The IT consultants were able to tie our existing charging system into a check and balance with our new online documentation. Directly installed into our documentation system are filters to ensure our billed timed units and charges align.
JO Does the system streamline interdisciplinary transactions?
SP The transition of the therapy documentation at TMRC to the EMR has resulted in a domino effect of positive outcomes within our unit, as well as across the continuum at TMH and beyond. The medical director at TMRC embraces the option to electronically sign-off on rehab documentation. Additionally, the case management department and discharge planners have reported significant improvement in their ability to access the information they need to successfully navigate a patient’s care during their inpatient stay as well as at discharge. And the benefit the interdisciplinary team appreciates most is the ability to access a patient’s chart—including their rehab status—even if the patient and physical chart are unavailable, ie, in radiology, dialysis, or just not accessible at the moment. For example, during a family meeting, our social worker can pull up a patient’s progress and provide an up-to-date report. The only identified drawback at present is the inability to send documentation to all physicians for electronic signatures. Those consulting physicians not in our system still rely upon the physical chart. Our therapy team must be vigilant to ensure paper copies are available in the physical chart in that scenario. Our IT department is aware of the need, and they’re working on that detail.
JO Are some staff members still wary of embracing change?
SP The system has been easy to adopt—mostly because our therapists have had ownership in the project from its inception, and it has been beneficial to have prior expertise with the system. Along with the consultants from the IT department, the therapy team has built the system to our own specifications. The information included was developed personally by our therapy team to best meet the needs of our documentation standards as well as third-party payor guidelines and regulations. Even the technologically timid therapists have embraced the new system, once the benefit of streamlining documentation time was realized. The therapists have also been pleased with the user-friendly performance of the system. We felt it was important for our primary staff to bond with the process before we expected our flex therapists to acclimate to the new system. We wanted to transition methodically to the EMR for both units to minimize disruption in smooth clinical flow as therapists learned a new system. This plan has served us well, and has also resulted in no negative effect on patient flow or productivity. We have been able to effectively educate the interdisciplinary team as we have stepped our way through the process. We have received only positive feedback from the interdisciplinary team.
JO What are the fiscal/manhour benefits of using documentation programs, and has the system proven to be an overall cost-saving measure?
SP Despite the fact that we have had to put more computers into the fiscal budget, the transition to EMR at TMRC has been financially prudent. Of course, the obvious savings is in the reduction of paper—trees are definitely being saved. Second, productivity is positively affected, not just within the rehab department but across the continuum. This is due to the fact that the information is so readily accessible. Moreover, our copiers have almost ceased to break down at TMRC. In fact, a new system of copiers has been installed across the TMH continuum. These copiers are workhorses that augment the EMR transition by performing multiple duties, including scanning documents and sending directly to a desktop. The speech therapists enjoy this option for creating “homework” assignments for their patients. An additional cost-saving measure of online documentation is the reduction of printing forms. Performing documentation online frees the therapists up to plan for therapy sessions, meet with patients and their families, and research therapy techniques. Although the transition to the EMR gives the impression that so much is nonpersonal and electronic, the reality is it has resulted in creating more time for the therapists to spend one-on-one with their patients. In the end, online documentation results in a win-win situation for patients, therapists, and the interdisciplinary team.
JO How has the system impacted Tallahassee Memorial’s operations overall?
SP Because TMH is a large hospital, the EMR promotes an effective communication system within the continuum of care. As we receive patients into TMRC, we are able to access the patient’s information in the system from the minute they were admitted—from the emergency center to the ICU, to radiology, to the surgical floor, to our unit. Now our information is available to the next level of care within the TMH system, whether it is home health care, ortho outpatient, or if the patient is readmitted to TMH. We are able to access notes of case managers, consulting physicians, and nursing. We know when the patient has been identified as a fall or aspiration risk. We can access infection control alerts. As we have transitioned to the EMR for the therapy departments at TMRC, our input is also available within the larger system for anyone working with the patient within the TMH system.
Judy O’Rourke is the associate editor of Rehab Management. She can be contacted at .