The rapid evolution of technology is enabling patients to become more involved in their rehabilitation and even continue their therapy outside of the clinic. This technology includes patient-focused features incorporated into practice management software to help practices increase their ability to deliver services to patients and manage the information generated during the episode of care. In this roundtable discussion, manufacturers of practice management software discuss how the incorporation of these tools help continue to keep their software competitive in this technological environment. They also discuss the role of these patient-focused features in the patient experience, and how well they have delivered on their promise to engage the patient. Further discussion covers the importance of these features to clinics in the future, as well as the development of software apps and the provision of non-emergency transportation to help reduce no-shows.
Participating in this Q&A are: David McMullan, senior vice president of customer operations, Casamba; Holly Taylor, Vice President and GM, Keet Health, a Clinicient company; Sharif Zeid, business director, MWTherapy; Doug Cundiff, Vice President, ReDoc 360 Professional Services, Net Health; Steven Presement, president, Practice Perfect EMR + Management Software; Kathryn Rigda, director of product management, Raintree-; Daniel Morrill, PT, DPT, CEO/president, TheraOffice; and Heidi Jannenga, PT, DPT, ATC/L, president/co-founder, WebPT.
Q. What are the top two or three features or functions added to your software in the last few years that have helped keep it competitive? Are any of those features patient-facing?
A. David McMullan, Casamba: We have added the following key features to our software over the past year: customized clinical documentation templates; e-faxing and secure direct messaging; and EMR integration with several patient engagement platforms and tools. The ability to provide EMR integration with patient engagement tools/platforms allows our customers to provide high-touch solutions for patients that help drive patient retention and compliance; increased communication with patients between encounters; patient feedback and education; and timely patient payments.
A. Holly Taylor, Clinicient: Clinicient acquired patient engagement platform Keet Health to accelerate our ability to deliver patient-facing solutions. In addition to adding industry-leading patient engagement tools, Clinicient released the initial version of its InsightGO software—a new browser-based, device-flexible charting tool that allows therapists to view their schedules and complete documentation in any setting.
A. Sharif Zeid, MWTherapy: MWTherapy is constantly adding new features, and updates/upgrades are free to clients. The icing on the cake is that we take care of updates during off-hours, so clients don’t have to take any action to receive updates. We’ve released features that touch every corner of our system from scheduling, to EMR, to billing, to reporting. Some popular features include outcomes reporting, our communications module, HEP tools, comprehensive patient source reporting, email/text-based reminders, and more. Truth be told, a lot of the features we’ve added wouldn’t be things we could explain in 100 words or less, but they are the things that clients ask us for in their feedback. The additions are tools that make day-to-day operations smooth for clinicians, billers, and front-desk staff. We are 100% committed to implementing as much client feedback as possible.
A. Doug Cundiff, Net Health: In our view, “being competitive” means enabling the providers who use ReDoc® to get the best results for their patients. Seamless integrations like FOTO’s predictive analytics for risk-adjusted outcomes planning and benchmarking or the BioEx video-based home exercise program library that makes patients’ between-visit work as easy as possible are just two examples of features that drive realistic plans of care and improved communication/expectations setting in the provider-patient relationship. Keeping the therapist patient-facing, instead of bogged down in complex documentation or accessing a bunch of unrelated apps, is surely pivotal to the overall care experience.
A. Steven Presement, Practice Perfect EMR: Patient engagement seems to be the driving force behind the majority of the changes made recently to Practice Perfect. From the ability of clients to register themselves online and complete their intake paperwork before even attending the clinic, to booking their appointments online and even to two-way texting with their clinic or therapists, patient self-serve, on their own terms, on their own time, seems to becoming a reason for the patient to pick a provider.
A. Kathryn Rigda, Raintree: In addition to the normal feature and functionality upgrades Raintree continually does, much of the work we have been doing is with deep software integrations with key partners to extend abilities of Raintree with regards to very specific functionality. Raintree has added functionality around BI & Analytics, Integrated CC Processing, Integrated SMS Texting, Advanced RCM Tools and Patient Engagement.
A. Daniel Morrill, TheraOffice: Regulations and time-preserving functions are the focus of our software development. The reimbursement squeeze has been on therapy for quite a few years. Clinics now rely on creative ways to create clinical and business success. One way is for practices to be ultra-efficient and productive while keeping fixed and variable expenses under control. There are two standout features in TheraOffice that help clinics achieve this. First is a customizable dashboard that allows different screen configurations based on role and function. For example, having access to one screen that determines if a payment should have arrived based on insurance history. The second is billing recommendations based directly on the treatments performed. TheraOffice will even tell you how close you are to billing another unit of service for a particular treatment. Linking treatments to billing will result in fewer audit risks and improvement in per-visit billables. Why not get fair payment for the fantastic care we provide?
A. Heidi Jannenga, WebPT: 1) Constant Compliance Updates. Although this isn’t necessarily exciting, we’re constantly creating functionality to ensure our members meet payor rules—thus helping them get every dollar they deserve—with minimal interruption to their clinical workflows. While this isn’t explicitly patient-facing, it does help providers avoid insurance issues that could lead to awkward conversations with patients. 2) Enhanced Home Exercise Program. Our enhanced home exercise program contains thousands of exercises—with more content being added regularly. Therapists can quickly create a plan, and patients can access it through not only a handout, but also a smartphone app or virtually any Internet-enabled device. 3) Patient Relationship Management (PRM). Our PRM platform helps providers engage and retain current patients—and gain new ones.
Q. In your view of the rehab industry, what role have software-based patient engagement tools played in the patient experience? Are they delivering on the “patient engagement” promise?
A. David McMullan, Casamba: The primary role of patient engagement is to enable the patient to have an active role in the healthcare and their healthcare decisions. Patients who are actively engaged as decision-makers in their care tend to be healthier and have better outcomes. In the rehab industry, patient engagement tools started with home exercise programs and patient education solutions that helped both educate the patient on their condition and assist them with tools to improve outcomes and compliance between their in-office visits with providers. Today, the patient engagement tools available in the rehab industry have evolved to provide patient surveys, feedback mechanisms, NPS scoring, secure messaging with providers, and online patient access to their statements and clinical records. The rehab industry has made great progress toward the “patient engagement” promise over the past 2 years, but we still have a ways to go to catch up with the other healthcare verticals.
A. Holly Taylor, Clinicient: Historically, patient engagement tools in the rehab industry have focused on marketing components, such as delivering NPS surveys to drive positive social reviews and the delivery of home exercise programs. While these functions offer value, we do not believe they are doing enough to actually move the needle in relation to improving either the patient experience or their clinical outcomes. Keet Health believes the value of true patient engagement is aggressively developing solutions to turn patients into partners.
A. Sharif Zeid, MWTherapy: Patient-engagement tools are an interesting and emerging area in healthcare. The best example of a positive change is the advent of home exercise programs that can be shared with patients through a variety of mediums. MWTherapy offers a comprehensive HEP that can really help with patient engagement and follow-through, which leads to better outcomes. MWTherapy’s E-mail/Text reminders keep patients engaged while reducing cancels/no-shows. One last engagement tool is patient statement. A detailed patient statement, as the one offered by MWTherapy, keeps patients informed and make their customer service experience transparent.
A. Doug Cundiff, Net Health: We all get it. Given the industry data around the low volume of patients who complete 75% or more of their plan of care, it’s clear that a strong patient engagement strategy is a must-have for clinics. In my experience as a therapy business leader, I view “patient-engagement” tools more broadly than others might. Let’s start with appointment reminders via a patient’s chosen method of receipt (text message, email, phone). That’s something that good software can automate and is proven to reduce missed visits. It sounds simplistic, but it’s a first step that I’ve guided many rehab therapy facilities through. Getting your patients in the door and giving them an easy way to communicate with the scheduling team to adjust visit times and dates absolutely increases the adherence to their plan of care and will result in more optimal outcomes—plus, the facility realizes a greater portion of the expected billing amount for that patient.
There may be value in therapy clinics developing their own apps, but those apps would be most valuable when they provide the necessary tools and comprehensive information for the patient (ie, ability to access their medical records, ability to schedule their own appointments, ability to access their home exercise programs, and so on). Think of it as a “one stop shop” so that patients don’t need to have multiple different apps on their phones for each of those functions. Health information technology vendors might be best positioned to develop app solution(s) that would consolidate those disparate functions into a single app for the benefit of their patients.
A. Steven Presement, Practice Perfect EMR: I think we’re still in our toddler years here. We have seen new Patient Relationship management tools being put into play, automated texting campaigns, and two-way text communication, patient portals for booking and paying bills, even Home Exercise Software that gamifies rehabilitation, but there is more room to grow here. One of the issues with patient engagement is HIPAA—the more we put online, the more accessible things become, the more the patient “can see,” the more we, and the clinics, are liable to be breaching HIPAA. The benefits must be weighed against the risks here.
A. Kathryn Rigda, Raintree: Patient engagement software tools within the Rehab industry has helped close some of the gaps between therapist & patient, reduce no-shows and in some case provide education to patients about treatments, etc. The challenge on the provider side is having tools that are integrated directly into their core EMR/PM tools that streamline operations. The “promise” of patient engagement is that providers will get closer to patients to improve care, however when providers have to use multiple platforms to engage, schedule, chart and bill it creates new challenges and bottlenecks to office admins and therapists.
A. Daniel Morrill, TheraOffice: I think this question is crucial for clinics to consider when looking at patient engagement strategies. Start with the question: Is patient engagement the best driver for increasing patient visits or is it just another marketing tool in healthcare? Marketing and brand awareness are essential to any size practice, and being able to engage current as well as future clients is a solid platform. The harder part is understanding the ROI. Is it driving our business? Is it increasing our reach? Are we having fewer patients “fall” off the schedule? In our opinion, having a complete marketing program that is objective and measurable is the most critical place to start before adding any tools. One of the most successful practices TheraOffice has ever worked with was a group of clinics that hired dedicated marketing professionals to generate business growth.
A. Heidi Jannenga, WebPT: Patients are changing the way they seek and receive care—and that includes rehab therapy. They are exhibiting consumer-like behaviors, including using reviews in the same way they would before making any product or service purchase. And software has pivoted to help providers meet the demand for more and better reviews. That’s why we now offer a robust PRM platform that not only helps clinics improve patient engagement by delivering the right message, to the right patient, at the right time, but also monitors patient loyalty and automates the review request process. This, in turn, decreases patient dropout, improves current patient loyalty, and increases patient reactivation—thus creating better patient outcomes and driving a better bottom line for the clinic. Talk about a win-win! Additionally, our platform enables patients to access their home exercises programs with virtually any Internet-enabled device or via a smartphone app—in turn increasing patient adherence to their prescribed plans.
Q. How important will software-based patient portals be to therapy clinics moving forward? What do clinics get out of them, and what do patients get out of them?
A. David McMullan, Casamba: Patient portals and smartphone applications will have an important role to both patient and the therapy providers and clinics moving forward. Physical therapy is an elective healthcare service which gives the patient the power of the consumer and choice in their healthcare providers. Patient portals provide an easy and simple way to inform and keep the patient engaged with the provider, which can lead to better outcomes. Improved patient outcomes and patient satisfaction are the two key benefits that both the provider and the patient share in equally. Patient portals create a platform for ongoing communication and engagement between the patient and the provider during the episode of care and after.
A. Holly Taylor, Clinicient: The term “patient portal” typically refers to software that is linked to a provider’s EMR, which can be problematic when a patient is being treated by multiple providers using disparate systems. As an example, a patient requiring joint replacement surgery would likely be in active treatment by a physical therapist, orthopedic surgeon, and primary care provider. In this scenario, the patient would be required to log-in to three separate web-based portals that do not communicate with one another. We believe in changing that paradigm by offering an easily adopted app that is centered around the patient and the disparate providers that care for them.
A. Sharif Zeid, MWTherapy: Patient portals have the ability to offer patients a nice patient-customer experience and clinics a way to streamline certain operations. They will not replace the importance of a good in-clinic experience, including customer service and, of course, treatment. MWTherapy has many tools to help every step of the way. As with most things, security and HIPAA are paramount, and we’ll be working to ensure that our offerings continue to utilize and meet the most rigorous security standards out there.
A. Steven Presement, Practice Perfect EMR: It’s a bit of a double-edged sword. In theory, by patients doing their own “work,” filling out their own forms, paying their bills online, etc, it should reduce the workload of the clinic admin staff. However, it also takes away some of the control of the clinics, especially when it comes to scheduling. The clinic with more online accessibility will ultimately win out over their competition with patients picking the “easiest” option for their health care spending dollar, not always the “best” option. This certainly gives more power to the patient as well, but again, it doesn’t mean they will receive the best care—just the most accessible care. We are living in an era that requires instant gratification with Amazon Prime delivering products same-day. So why not the same for rehab?
A. Kathryn Rigda, Raintree: Patient Portal are becoming increasingly important as patients are more accepting of using them to interact with therapy providers. Clinics can use patient portals to streamline everything from intake to bill-pay. Patients get a single location hub to communicate with their therapy providers and access health documents, pay bills, etc. The challenge comes in creating a portal that is compelling to use and is driven by the data created by the therapy practice’s EMR/PM system in order to help patients communicate with the clinic, understand treatments, costs, outstanding bills, etc.
A. Daniel Morrill, TheraOffice: We believe patient portals can save time and create efficiencies for both clinics and patients. However, they need to offer more than necessary information like demographics and insurance information. Patient portals with advanced functionality, like interoperability, will have a significant impact on the delivery of therapy services and the management of all the data that is being generated during care. Portal interoperability will also improve the data exchange to maybe someday achieve the perfect world of a single mobile patient record controlled by the patient.
A. Heidi Jannenga, WebPT: As discussed above, patients are exhibiting many more consumer-like behaviors. As such, they expect certain functionality to be available outside of their clinic visits, whether that be the ability to access their prescribed exercise plans, manage their bill, or message a therapist. Ultimately, we view this as a part of the PRM continuum. As PRM adoption increases, we expect to see patients achieving better outcomes—and clinics achieving better bottom lines.
Q. Some healthcare organizations have developed their own smartphone apps. Is there value in therapy clinics developing their own apps? What would be the advantages or disadvantages for software manufacturers in the rehab space to be involved in their development?
A. David McMullan, Casamba: As I mentioned in the previous question, patient portals and smartphone applications can go hand in hand. Healthcare organizations and rehab clinics can develop their own smartphone applications, but I do not recommend it. The patient and healthcare consumer do not want a smartphone application or patient portal for every different healthcare provider they see. The patient wants to go to one patient portal or use one smartphone application to access their information and to communicate with their healthcare providers. To deliver real value to the patient and healthcare consumer, the patient portal or smartphone application must be interoperable and allow the patient to pull healthcare data and information into the single application or portal. Software manufacturers in the rehab space are starting to realize that they can’t limit the patient or healthcare consumer to their ecosystem of software customers. We must provide the capabilities and benefits to the patient that go beyond that a single therapy clinic provider can offer or even a single software vendor. The collaboration and interoperability of healthcare information technology for the benefit of the patient can only be achieved by software manufacturers working together based on industry standards.
A. Holly Taylor, Clinicient: Developing your own apps can be very time-consuming and expensive to manage. They would also require ongoing investment to maintain the technology and ensure compliance with federal regulations, which is not a core competency of provider organizations. Partnering with a technology platform like Keet Health that allows you to white-label the application with your clinic branding is much more cost effective.
A. Sharif Zeid, MWTherapy: Smartphone apps are good for patients, assuming it has the right features, as they can manage their care on the go, such as accessing a HEP. Therapy clinics are advised to outsource the app development as they may not have the in-house expertise to develop, deploy, and test such apps. If a practice decides to go down this route, the process should start with clearly defined goals and interviews with patients to define what the app should do and how it should do it. Practices should also take care to watch out for HIPAA requirements and make sure that data will be stored and transmitted securely.
A. Steven Presement, Practice Perfect EMR: Smartphone apps are costly to develop and, while the experience of a smartphone app is generally better than a web application, unless there is a really specific, ongoing need, it may not be required. Usually one uses a smartphone app for something recurring, like travel, going to a movie, booking a restaurant, etc. Physical therapy is usually a blip in someone’s life. By the time they find out that you have a smartphone app, and actually use it, they are probably well into their treatment and it won’t really be required. Again, if it becomes “the norm,” we would certainly investigate further.
A. Kathryn Rigda, Raintree: The value in developing apps is going to be determined by the clinics customer/patient base as well as the needs of that customer/patient base. Unfortunately people are reaching the point where there is an app for everything so one more app to download just becomes noise- especially if it not well designed and highly functional. If however, a clinic has a compelling need within their patient base that cannot be filled by a current app or technology then a well-designed app may be useful to their patients. If a clinic is looking to create their own app, they should inquire with their EMR/PM software manufacturer to see what data is available to them to for the app- (ie. Scheduling, communication tools, bill-pay, etc)
A. Daniel Morrill, TheraOffice: Understanding the key drivers for your business is vital to any decision you make regarding your practice. Developing apps can be expensive and may also challenge the clinic’s resources by detracting from what you do best (providing amazing care). Working directly with a software developer would be a reasonable approach to developing an app, but it needs to be managed carefully. It is essential to be able to measure the upside of developing an app and its impact on your overall business.
A. Heidi Jannenga, WebPT: Software development—specifically, mobile app development—must be well-planned and provide continuous value to the user in order to promote adoption. This research and development is costly and out of reach for many organizations, as regular updates are necessary to ensure up-to-date content and to keep up with ever-changing technology requirements issued by app vendors. We have proven results with our mobile apps—including our Strivehub app, which allows patients to access their home exercise programs, message their therapists, and manage goals. Plus, we’re continually adding functionality and content to meet evolving consumer demands.
Q. More than 100 healthcare organizations are reportedly arranging non-emergency transportation for their patients via UberHealth and Lyft Business to reduce appointment no-shows. How should software manufacturers who serve the rehab space view this development?
A. David McMullan, Casamba: The integration of transportation provided by UberHealth and Lyft Business is an excellent step forward in continuing to provide care and increasing access to patient care that might not have been possible. Software manufacturers should be embracing the opportunity to leverage improved and increased access to transportation for patients. The patient can now go online and find the provider of their choice based on specific criteria, schedule their own appointment, and then order the transportation to get to the provider’s location. Overall, this advancement will lead to more access to healthcare and even potentially more timely access to care. Patient outcomes can improve with more timely access to the care they need when they need it.
A. Holly Taylor, Clinicient: Addressing patient access to care is a fundamental component of health care reform, and we embrace the idea of these technologies lowering the barrier of entry to rehab services.
A. Sharif Zeid, MWTherapy: This is a welcome development as it reduces the cancels and no-shows which translate to more revenues for the clinic. Any push that helps connect patients with high-quality care can only be a good thing. As treatment options expand, so should other services that surround healthcare such as transportation. Practices should exercise caution with respect to liability when it comes to newer technologies like ride-sharing.
A. Doug Cundiff, Net Health: Any programs aimed at supporting patients’ adherence to their scheduled visits are worth a try. My guess is that the hospitals and practices that have adopted UberHealth or Lyft Business probably have data to show that lack of transportation was a leading cause of missed appointments in their region. If that’s the case, it’s smart to build a business practice around reducing this kind of barrier to care. In many geographic areas patients do have a choice of therapy providers, so a facility that offers a service like this is sure to stand out. Caregivers openly trying to reduce any friction that makes care seem less accessible or practical is a winning strategy.
Rehab industry software providers should be encouraged that the network of solutions aimed at creating positive therapy experience is expanding. There will be more expansion to come. But, for a facility that understands they need to create a whole ecosystem to support patient success, these tools are simply part of a job well done. That being the case, it’s likely that many solutions will end up interfacing or being integrated over time—we’ll just have to see which services have the most significant impact. A software provider is simply looking to offer the best workflow possible for all the necessary functions. We’ll see where these developments take us!
A. Steven Presement, Practice Perfect EMR: It’s interesting and admittedly, we don’t know that much about how this all works yet, is their reimbursement, liability, etc. Being able to directly integrate with Uber/Lyft into an EMR would certainly help to streamline processes, both for the actual transportation, reminding the patient about the appointment, and for billing, but we haven’t seen a groundswell yet in physical therapy. That being said, its coming and we’ll need to keep our eyes wide open.
A. Kathryn Rigda, Raintree: Anything that helps patients keep appointments should be seen as a good thing. In the long and short term, this helps patients improve health/recovery and it helps the clinics increase revenue by keeping their schedules full.
A. Daniel Morrill, TheraOffice: As physical therapists, we need to agree that patient access to therapy must be our fundamental collective goal. In this case, utilizing services to improve “physical” access to therapy services is a great idea. Using a third party to provide the service probably reduces risk. However, if an unfortunate incident with the rideshare occurs, it could negatively reflect on our business. As a software company, we built TheraOffice to be adaptable for all clinics, and managing a rideshare program can be done quickly in our scheduling system with non-clinical resources. If ridesharing improves practice metrics, great. If ridesharing increases access for patients, it is indeed a win-win.
A. Heidi Jannenga, WebPT: WebPT has members who are using these services and achieving great results. We currently have phone, text, and email reminders available in our products, and while we are still in a discovery process, we can see incorporating something like this into our products in the future. RM