The Paperless Trail

Electronic medical records (EMR) are the wave of the future for the rehab industry. And while EMRs have been around for more than a decade, smaller facilities and clinics are just now beginning to realize the positive effect they can have on their practice. Hospitals started the trend of transferring from a paper office to paperless files, and for good reason. According to Amy Mullican, RN-BSN, an EMR specialist at Vanderbilt Medical Group, Nashville, Tenn, accessibility is the biggest benefit to using such software.

“It allows for better holistic care for patients just because specialties and then primary care areas can see more clearly what’s going on,” she says. “It helps with communication and accessing patient information.”

Mullican says Vanderbilt uses a homegrown application called StarPanel to meet its needs, and the person who developed the system is still on staff. The program has an outpatient order entry system, electronic prescription writer, several documentation tools, and all patient medical records.

“The benefit of having somebody here that does development is that they know the system so well they can make changes,” she says. “We have a great on-site resource and a whole development team that goes along with this so we don’t have to call somebody from outside to help manage problems. It’s also helped us cater this system to our specific university hospital needs. Because it’s a teaching institution, it demands a little bit more support than, say, a nonteaching institution.”

The Montgomery County Public Schools Infants and Toddlers Program in Maryland is in the middle of transitioning to paperless records, says Ginny Paleg, an NDT certified pediatric physical therapist. “We started a year ago taking computers into [patients’] homes and we would be writing our notes in the homes so we could leave a copy with the family,” she says. “And now we’re going to electronic everything; even the daily notes will be written on the computer.”

The biggest advantage Paleg sees with going paperless is making therapists more consistent as well as more accountable.

“I think it’s really going to improve the system,” she says. “You can read the handwriting, which is a big one. When you write the report, you’ve already got the bulk of it done so you can just cut and paste. It is going to help therapists be more cognizant of using evidence-based practices, and increase the consistency between therapists.”

Of going electronic, Paleg says she believes it will save a lot of money. Forms that used to be ordered in triplicate are now just a click of a mouse away.

“We don’t have to store all those forms, and we don’t have to order all those forms, which can be expensive,” she says.

THE TRANSITION PHASE

Lauren Robertson, MPT, cofounder of Wild Iris Medical Education, Comptche, Calif, agrees that going paperless can be less expensive monetarily, but expensive in other ways.

“There are a lot of things that you end up replacing electronically that did perfectly well in files for 100 years,” she says. “For every paper that you put into a file cabinet, that system has to be replicated on the computer.”

Mullican says the transition period can be challenging, as facilities move their paper files to electronic copies in a process called scanning. Files are scanned into the computer, but with the system at Vanderbilt documents can still be accessed as paper files.

For the system at Montgomery County Public Schools, Paleg says paper files had to be converted into an electronic form, such as a PDF. Instead of manually filling out the information, therapists can just go online, fill out the form, and send it electronically to the database.

“It’s not really complicated,” she says. “It’s really the exact same system we were using before, it’s just now all done electronically instead of a hard copy.”

Cherilyn G. Murer, JD, CRA, CEO, and founder of the Murer Group, a legal-based health care management consulting firm in Joliet, Ill, says the transition period can be difficult, but once completed can be a much easier system than a paper office.

“It’s an easier system in terms of protection of information once the systems are all in place and people have experience with it and all of the safety mechanisms such as scanning issues and passwords,” she says. “It’s very time-consuming and very cumbersome to enter all the data and to be able to set the templates for electronic medical records.”

PRIVACY AND HIPAA COMPLIANCE

When transitioning from paper to cyberspace, Murer suggests facilities use common sense. She acknowledges that everyone is aware of HIPAA and the necessity for privacy; however, research and literature show that significant technology breaches are an ongoing problem.

“The Government Accountability Office (GAO) back in September 2005 reported that 40% of health insurance contractors and state Medicare and Medicaid offices experienced data breaches within the last 2 years,” she says.

Murer says that the final rule on HIPAA enforcement became effective in March 2006, and suggests that facilities go back and review all of their processes to assure that they are in timely compliance with the comprehensive rules. In addition, one practical problem facilities need to be aware of is human nature.

Facilities need to be conscious of the information they are passing on, especially when e-mails are utilized relative to personal health information with data being transferred about patients internally over unencrypted networks.

“It’s an attention to detail where no error is accepted in terms of security and compliance,” she says.

Murer also recommends that an audit relative to security risks on any updated software be completed annually.

“[Facilities] have to assure that they’ve gone through the training,” she says, “that the security officer is up to date on all new developments, and that they’re monitoring viruses.”

THE BIG PICTURE

Once the processes are in place and once the system is learned, Mullican says that, in the big picture, the system will be less time-consuming than the paper method.

“It’s much less time-consuming because you don’t have somebody sending a request to a medical records department to retrieve a paper chart, having it delivered to the clinic, getting it catalogued where the physician wants to see it, and then the physician retrieves it and looks through it,” she says. “You can sort documents within the patient record in the [EMR] system, so if you wanted to see only discharge summaries you could pull up the summaries on a patient rather than flipping through 3 years’ worth of documentation to find one piece of information.”

One of the factors helping to facilitate the transfer to a paperless office is the pressure to be compatible with the facilities sending out referrals. Brand-new facilities will immediately be paperless because of the way they are set up, whereas older facilities will have to transfer.

“If you’re serving a medical staff on an outpatient basis or as a specialty hospital that relates or depends on referrals from a major hospital referral system and if that system is on EMR, then you really do have the pressures to be compatible with the health system that is sending your referrals,” Murer says. “Once the physicians are used to this and once the staff is used to this, then it seems archaic to go back to a paper system. The pressures on a specialty hospital or an outpatient facility are that they must enhance that continuum of care and they must be compatible with their primary referral sources.”

THE LEARNING PROCESS

Another concern for facilities transferring to a paperless office is backlash against change. With facilities rapidly embracing new technology comes a new learning process for some who have been in the field for years.

“There are people who are not comfortable using the technology, especially people who don’t know how to problem solve when things go wrong,” says Paleg.

Murer says that it is human nature to resist change.

“I’ve seen a lot of passive aggressive behavior,” she says. “In the past the electronic dimension was so focused on your support staff and your ancillary services, and now it’s going to the heart. Now it’s going to be physicians, your legal departments, and all of your departments that relate to this. So now you’re dealing with human nature as well as a corporate policy to move forward.”

Morgan Saffari is associate editor of  Rehab Management.

INDUSTRY INSIDERS OFFER PAPER-FREE CONNECTION

With a plethora of vendors to choose a paperless system from, a facility looking to make the change to electronic medical records can spend a lot of time searching for the right program that fits their needs. The following companies and their products are just a taste of what a facility may be looking for to make a smooth transition. Clinicient, Portland, Ore, offers Clinicient Insight. All of the information is available in a centralized database for easy retrieval, reproduction, and updating. Clinicient software includes a task alert system, built-in reminders to take care of the details that ensure physical therapists get paid. Clinicient electronic charge tickets eliminate the need to re-enter data, which allows clinic staff to spend their time on the tasks that matter, and reduces the mistakes that inevitably occur when data is re-entered. EON Systems Inc, Clearwater, Fla, offers The Practice Solution™ and Documentor™, both designed not only to automate many of the tasks of an office, but also to follow the basic office traffic flow by eliminating the need for double entry of patient charges, payments, etc. “Gone are the days of manually tracking things such as patient deductibles, insurance fee schedules, maximum visits, missed appointments, and other things that are easily forgotten or overlooked, that can be costly to the clinic in staff time or lost patients,” says Derek Greenwood, CEO. “Basically, we help them to determine which area of their practice is most adversely affecting them or their bottom line.” Hands On Technology Inc, Hinsdale, Ill, offers TheraOffice (documentation, scheduling, patient accounting, and enterprise management) and TheraWriter.PT (documentation and scheduling). Both products are designed with adaptive and customizable interfaces to take advantage of new mobile devices like Ultra Mobile PCs, PDAs, tablet PCs, and lighter laptop computers. By doing so, clinicians can efficiently document while treating the patient. “Unique to TheraOffice is an auto task engine that automatically scans patients and creates tasks for front desk staff or clinicians,” says Daniel J. Morrill, PT, MPT, president of Hands On Technology Inc. “Tasks such as prescription reminders, patients who haven’t returned for therapy, and insurance caps can be set per patient.” HealthLink Technologies, Concord, Ontario, offers InTouch Practice Management Software. This “all-in-one” software package allows users to track receivables, referral trends, and patients who stop attending treatment or have used up their benefits, in addition to billing, scheduling, reporting, and documentation. “InTouch automates many processes being performed by hand, giving clinic staff more time to treat patients and generate new referrals,” says Jeff Ryzner, director of sales and marketing. “Our clients are very happy with the functionality of our software, the high level of customer support that they receive, and our ‘low impact’ subscription-based pricing in which users pay one low monthly fee without any form of long-term commitment.” MEDadept, St John, Ind, offers three modifiable practice performance solutions: encompass™, a comprehensive financial performance solution; etrieve™, integrated reimbursement performance solution; and escribe™, an EMR and clinical performance solution. The company helps its clients improve their profitability by providing innovative and affordable practice management solutions, including revenue cycle management services, practice performance and EMR software, and financial and practice development strategies and services. “MEDadept’s groundbreaking point-of-care, handheld, wireless documentation and clinical performance system—IPED (Integrated Protocol Electronic Documentation)—provides instant access to all patient data and incorporates extremely easy-to-use clinical decision support and voice recognition technology allowing therapists to bill, schedule, and complete customized notes, reports, and home exercise programs quickly and easily,” says Amy DeRosa, vice president of client services. Medical Information Management Systems LLC (MIMS), Waukesha, Wis, offers the Rehab Toolkit™, a single program encompassing scheduling, documentation, and billing needs. “A productive employee must be able to eliminate repetitive steps in their workday,” says Steve Gottfried, director of sales and marketing. “Our program eliminates wasteful re-entry of a patient’s data and reduces mistakes—for example, proper coding and accuracy. Therapists love it because they can access any patient’s chart within seconds and communicate better with their patients.” Presagia Corp, Montreal, offers the Presagia Enterprise for Rehabilitation Providers. This program helps centralize records and the associated patient administration in a secure system to avoid duplicating work. It also provides users with real-time access to information. All of the information is stored digitally in a single database. The information can be entered into forms or used for analytical reporting to assess organizational processes and outcomes. Presagia Enterprise can be tailored to meet a practice’s data capture and workflow needs. The Rehab Documentation Company, Nashville, Tenn, offers ReDoc Software. According to the company’s founder and president, Gerry Stone, more than 75% of all treating therapists are still handwriting or dictating their documentation. Problems inherent with this include not being assured of CMS and JCAHO compliance, and possibly not maximizing reimbursement. “ReDoc software has an integrated scheduling program and interfaces with the majority of billing applications in the market,” Stone says. “Rehab clinics will not have to change the way they do billing, plus there will no longer be any discrepancy between what the therapists stated they did in their progress/treatment notes and what the clinic is billing.” Source Medical Solutions Inc, Birmingham, Ala, offers TherapySource™, which the company says accomplishes 11 critical objectives: ease of use; comprehensive data collection; improved documentation; data integrity; better clinical decision-making; decreased operating costs; increased charge capture; reduction in billing errors and defects; decreased days accountable receivable; maximization of reimbursement for clinically appropriate care provided; and increased compliance. “These applications will create a more complete medical record and will prevent clinicians from ‘miscoding’ or ‘under-coding’ treatment procedures for reimbursement,” says John Wilkes, director, product management—therapy. SpectraSoft, Tempe, Ariz, offers the PT Suite, which contains AppointmentsPRO, DocuPRO, and Streamline rehab billing. The company focuses on five key areas to streamline office workflow. First, DocuPRO creates a virtual folder for every case to eliminate the need for traditional paper. Second, the PT Suite creates a closed loop throughout the office to make sure each task is completed, from appointments to billing. Third, each program is integrated in addition to being able to share data with other software solutions. Fourth, PT Suite runs automatically behind the scenes performing repetitive chores, such as appointment reminder calls. Finally, the scheduling systems looks and acts like an appointment book and the documentation system looks like a note. —MS