Physical therapy practices moving to an EMR system should consider multiple factors to identify the technology that best suits their unique needs and goals.
By Vicki Buchanan, PT
All of the changes in the regulations that have been implemented over the last 4 years have created an environment that is conducive to making the transition to electronic medical records (EMR). EMRs can streamline and coordinate a clinic to improve efficiency for staff when scheduling, documenting, and performing accounting services for the treatments it provides. In the current health care climate, with declining reimbursements and increasing documentation requirements, an EMR must be highly flexible to meet all of a clinic’s needs.
Regional Physical Therapy Inc, Midwest City, Okla, made the transition to EMRs in 2008 in order to coordinate scheduling, documentation, and billing departments. Many aspects of the software were considered before the final purchase decision. This article aims to equip those clinics currently considering the change to EMR with the knowledge to ask the correct questions and reach an informed decision about which software solutions provide the best fit.
Finding a System to Suit Your Needs
When looking for an EMR, the first step should be to assess which needs are specific to a clinic. Decide whether the clinic demands a full-service EMR that performs in three aspects (scheduling, documenting, and billing), or whether only
one of the pieces of an EMR system is needed. If purchasing a system that performs only one of the three aspects, be sure to ask what it will cost later to add additional services.
It is also important to ask about the cost of future upgrades to the current version of the software as they are released. Ask how often upgrades occur, on average, and whether the EMR keeps up with the latest Medicare changes as they occur. For example, in October of this year, the new ICD-10 codes will become mandatory, so a smart question to ask is whether the upgrades will be downloaded at no extra cost. Ideally, free upgrades offer the best value.
Financial Considerations
Cost of the EMR is a great place to begin talking about the conversion process for a clinic. The first question to ask is the cost per user for the system. Most often it is more expensive for more users on the system. It is wise to ask about the cost to add additional users in the future so the EMR can grow with the clinic. Often, the cost for clinicians versus ancillary staff members is different, so think about how many administrative staff users will be needed for an EMR to do scheduling and billing services. In some systems, the cost is different for PTs versus PTAs.
Types of EMR Systems: Weighing the Pros and Cons
Most EMRs will offer a web-based or server-based version. The decision between web-based and server-based versions can have profound implications over time. Both the web and server versions have advantages and disadvantages. Prospective buyers should seek assistance with this decision from a computer specialist who can help them understand whether a system has the capabilities needed for either version. Following is some basic information that will be important to find out for either application chosen.
Web-Based EMRs
Web-based versions have the advantages of not needing to be backed up routinely because the software providers store the practice’s information on a “cloud” of data. The cost for the storage cloud can be expensive, but this type of system offers the security that a clinic’s information is protected from a computer crash that could potentially cause the loss of all information. It also provides a practice the benefit of not having to upgrade the server as often.
Health Insurance Portability and Accountability Act security issues are handled mostly by the software company when a practice is web-based, reducing a practice’s liability in the case of a data breach. With the web-based version, a clinic will need to be sure the upload and download speed that its Internet provider allows is sufficient to allow multiple people to upload information simultaneously.
The upload speed is normally what limits and slows down staff. For example, if a receptionist is attempting to schedule a patient, and at the same time a therapist is trying to type in a note, it can slow down both tasks as the web is trying to store the information on the other end. Additionally, if the Internet goes down on either end, work within the software program will come to a halt.
Server-Based EMRs
The server-based version offers the safety of not having to rely on a functioning Internet connection to complete work. Clinics do not have to worry about the speed of the Internet provider slowing down staff when scheduling, documenting, and billing. However, the server must always be functioning for staff to continue to work, and information on the server must be backed up consistently to assure information that resides on it is not lost.
In the event of a server crash, the only way to restore the information is to have a backup on another hard drive. The costs of having a server and backup system can be significant.
Liability for keeping a server secure from a computer breech is solely on the clinic when using a server-based solution. All policies and procedures must be in place, and the clinic bears responsibility for periodically testing the security of the server.
Additional Factors to Weigh
Ask for a trial use of the software for documentation to see how easy it is to learn and use. Other important things to look for are whether the software is customizable to a practice. Ask if the software is compatible with the portable devices on which it is going to be used, such as laptops, tablets, and smart phones. Be specific about what operating systems it will work with.
If you have a specialty practice, such as a pediatric facility, make sure it meets all the practice’s documentation needs. Look for how easy it is to report the Physician Quality Reporting System (PQRS) and functional G-codes for Medicare. Software should save time with documentation so therapists can spend more time with patients.
Look at the reports that are available to track important data and measures within the practice. The metrics usually employed to assure proper billing and coding should be easily accessible. If you track how many exercise (97110) codes were billed in a given time period, let the software people know that is what you look at and see how easily it is accessed. For your Medicare population, assure you can easily provide functional G-codes and PQRS codes and easily track progress toward goals.
The Transition to Digital
When I chose my practice’s system, we searched for a comprehensive system that would allow scheduling, treating, and accounting to be integrated. I assembled people from all three areas to look at the demo software so that each could bring their expertise to ask questions that would help us with a system to meet all our needs. I have been pleased with the efficiency the EMR system brought to the clinic in terms of completing documentation more timely, the speed with which we can send billing, and the ease of posting payments.
My clinic transitioned to EMR in 2008, and we looked at several options before making our final decision. We eventually chose TheraOffice by Hands On Technology due to its ability to tie all three major needs of scheduling, documenting, and posting payments into one system that coordinated all the activities together. We wanted a system that gave us flexibility in documentation for our therapists, and would update our system as things change in the healthcare world. We made the right choice with TheraOffice. PTP
Vicki Buchanan, PT, is founder and owner of Regional Physical Therapy Inc in Midwest City, Oklahoma. She has multiple outpatient clinics and is an active member of the American Physical Therapy Association and the Oklahoma Physical Therapy Association. For more information, contact [email protected].
