Kevin Svoboda, PT, and Connie Ziccarelli

Using an electronic health record solution, Kevin Svoboda, PT, and Connie Ziccarelli review in real time key practice metrics that impact the clinic’s performance.

This is part 2 of a series that chronicles the process of implementing an integrated electronic health record system (EHR) in a single office of a multi-practice regional network of physical therapy practices. Part 1 of this article documented the selection process of an integrated EHR system and appeared in the August/September 2011 issue of Rehab Management.

During the second quarter of 2011, our practice completed its clinical initiative to interview a multitude of electronic health record program vendors, with the goal of selecting an EHR system that would unify administrative and clinical recordkeeping, and satisfy the practice’s internal and external communications needs. Prior to bringing the new EHR online, these functions all were conducted using separate systems built on technology from previous eras. The successful implementation of the new EHR validated a long-held belief of the clinic leadership: for an EHR to perform optimally, a solid foundation of practice management systems and technical knowledge must be in place—even before the product evaluation process begins. For practices that have not established a smooth-running conventional system, the process of adopting an EHR will quickly expose and amplify weaknesses in these areas, and potentially add significant cost and time to the successful adoption of an EHR.

The clinical information systems in our own practice were constructed on a sound foundation prior to implementation of the EHR, which enabled the EHR to take those systems to a higher level of efficiency. As a result, the anticipated advantages of the electronic system began to emerge throughout the clinic in the form of enhanced documentation compliance and improved communication with key parties—including therapists, referral sources, patients, and payors. In the period following implementation, two essential building blocks were identified that helped build success into the fully integrated system. The first was having solid systems and knowledge in place at the clinic level, and the second was equipping staff with a firm grasp of technology concepts and building their comfort in using those concepts.


The solid footing of systems and knowledge in place prior to the implementation proved to be perhaps the most critical element of support for the practice’s transition to an integrated EHR. Those systems included a process for documenting medical necessity, skilled care, and functional deficits, as well as the ability and discipline to submit claims according to the expectations and rules of each payor. Had these systems not been solidly in place as part of the practice’s original infrastructure, the ability to successfully integrate the EHR system would have been hampered by confusion and a loss of productivity. Any practice has the ability to implement an EHR without that foundation, but doing so in most cases would expose the weaknesses in those areas, possibly resulting in loss of revenue and possible loss of staff.

Postinstallation assess-ment also revealed another key contributor to the successful implementation of the integrated EHR, which was that the EHR would continually be assessed as a tool or vehicle to enhance clinical efficiencies and outcomes, ultimately improving cash flow. Remaining focused on these critical benefits the EHR was expected to provide was continually stressed to the staff prior to and during the implementation by the EHR selection committee. The EHR was ultimately considered comparable in value to the practice as a new employee—an “employee” with great potential if enough time were invested to help that employee grow and develop.

Members of the clinic staff began to comprehend that converting to an EHR system did not have to mean practicing in a different way; rather, the conversion simply offered a new way to record information. With this understood, the clinical staff took ownership of the idea that success or failure of the transition was a matter of choice of attitude.


Once the EHR was selected, clinical staff learned numerous best practices for transitioning their work from the previous system to the new system, making their use of the new system more effective. This included devoting time where necessary for some staff members to learn how to overcome the system’s learning curve. In the experience of this particular clinic—which may be typical of any clinical setting—many users of the system displayed multiple levels of experience and comfort with technology. To foster an effective level of proficiency among all staff that would use the system, the practice’s leadership team launched an initiative to support the implementation of the EHR. The initiative consisted of an open-communication approach that focused on three key components. The goal of the first component was to ensure a strong comfort level with the use of computer technology. This was facilitated through discussion with the system’s users. The second component worked to clarify how the EHR module would integrate into the practice’s current systems and was accomplished through staff meetings. The goal of the third component was to troubleshoot any areas of concern among team members and was facilitated through open group discussions. Through this assessment, more emphasis on training and skill development was placed on members of the team whose skill levels were not adequate.

To enhance the skills of all team members and encourage them to embrace the new system, the clinic conducted extensive training. Support teams were created to ensure all staff members had a network of colleagues to whom they could turn for help or to ask questions. Hands-on training with the vendor’s training team also helped to bridge knowledge gaps and provide insight to users who felt uncertain about how the system was designed to function. If our EHR committee felt any staff members were not receiving enough training or did not fully understand training concepts, then more training time was negotiated with the vendor.

Staff members throughout the clinic were coached to cultivate a positive attitude about learning, and a mind-set was championed for each team member to dedicate time to become familiar with the EHR in their daily work routine. Firm drop dates and go live dates for implementing various components of the system were established and provided a sense of priority and urgency to the transition.


Now that an electronic health record solution has been in place in the clinic setting for two quarters, the practice is seeing numerous measurable results. One of the most significant results is that the practice is achieving Medicare compliance with less effort. This is due in part to the strength of administrative and clinical practice systems already in place, but also because the EHR helps ensure compliance through documentation. Clinicians also report they are finding it easier to communicate with key parties such as physicians, patients, and payors by using the integrated communication tools provided by the EHR.

Therapists also report that the new system makes it easier for them to record more essential components of documentation. For example, since the documentation is not limited by space, it is easier to fit key words into the documentation that justifies medical necessity and skilled care. Therapists also find that the ability to compare previous measurements and data from the initial evaluation or previous visits is available with just a few key strokes, as opposed to searching the patient’s chart and then having to rewrite, retype, or redictate those measurements. These two examples alone help to justify the skill of services the therapist is providing and help with recording services that were likely previously provided, but possibly not always captured on a charge ticket. Therapists also are noticing that they are finding it less laborious to accurately calculate their time spent with a patient, since the EHR aids in calculating this for each date of service, which of course helps with accurate billing.

Other important benefits also have materialized as a result of successful implementation of the integrated EHR. The practice now uses and generates less paper in the course of doing business and enjoys the convenience of having one central place in which to store information. The paperless nature of an EHR also has led to shortened billing cycles and less variance due to digital input of information. This has made it easier to be aware of collection levels and also provides a quick glance into the financial health of the practice.

Since multiple users can access the system simultaneously, productivity at all stages of the documentation and claim process has been enhanced. Access to patient charts is only a click away, and members of the clinical staff communicate quickly using the electronic platform, which has led to a streamlined communication pattern and helped ensure compliance with privacy laws. Overall, perhaps the biggest benefit is that the integrated EHR system manages many of the day-to-day tasks of maintaining the practice. This leaves the human capital element of the practice free to be more productive and efficient in other areas, improving the bottom line as the practice moves forward.

Kevin Svoboda, PT, is the Clinical Growth & Development Director of Rehab Management Solutions. An actively practicing physical therapist, Svoboda has more than 12 years of experience owning, operating, and directing private practice physical therapy clinics. He also is the Membership Chair of APTA’s Occupational Health Special Interest Group. He can be reached at .

Connie Ziccarelli is the Principal and Chief Operations Officer of Rehab Management Solutions. She has more than 25 years of health care management experience specializing in the physical and occupational therapy disciplines. Ziccarelli specializes in reimbursement strategies that affect therapists in private practice. Her expertise ranges from CPT coding to documentation strategies and corporate compliance. She also is a member of the Private Practice Section Administrator’s Council and past member of the PPS Annual Program Work Group Committee. She can be reached at .