By Frank Long, Editorial Director, Physical Therapy Products

The business of healthcare seems to live increasingly in the cloud, but for clinic infrastructure, as in life, there are practices that make a difference between living—and living well. In this special Q&A, Physical Therapy Products interviews executives from several of the leading providers of cloud-based software systems that clinics use to manage, bill, and document. We share their responses to help guide questions crucial for getting the most from cloud-based technology. Their insights help answer questions about whether a cloud-based system is the right choice, and what the considerations should be for data stored in the cloud if a breakup occurs between clinic and provider.

Executives who participated in this interview are: Dirk Wierbicky, vice president of business development, BMS Practice Solutions; Jeremy Cader, vice president of product innovation and engineering, Clinicient; Shawn Hewitt, rehab product manager, Mediware; Sharif Zeid, business director, MWTherapy by MerlinWave; Brian Shivler, vice president, ReDoc Market Segment Sales, Net Health; Steven Presement, president, Practice Perfect EMR; Terrence Sims, president, chief operating officer, Raintree Systems; Daniel Morrill, chief executive officer, TheraOffice by Hands On Technology; and Heidi Jannenga, president, WebPT.

What buzzwords or trends should managers know about cloud-based IT systems for the PT clinic?

Dirk Wierbicky: They should be thinking about cloud-based systems making it easier to access and archive data; and provide effective communication and passing of information across disparate systems. For example, access to patient data and outcomes across the continuum of care. They also enable providers to negotiate value-based agreements with payors, and allow healthcare providers to be more mobile. A cloud-based system can lower IT costs and be a more efficient means for data storage. It also provides a vehicle to accommodate telemedicine.

Jeremy Cader: Blockchain (an immutable chain of custody for data) and FHIR (a new standard for interoperability) are two buzzwords managers should become familiar with. Some important trends include: tablet centric design, responsive UI, Value Based Care, Alternate Payment Models, Interoperability, Outcomes, and Patient Engagement. Ease-of-use for therapist documentation and full compliance support are some other important topics. Mobile/tablet-friendly interfaces that support multiple devices is a hot area as more tablets are used in offices to enhance productivity.

Shawn Hewitt: Our goal in offering cloud/web-based solutions are around mobility and device flexibility (access from anywhere on any device). Cloud/web-based solutions typically offer a better user experience and use of up-to-date interaction with the software. We also want the solution to be easy to implement and install (IT light), meaning there are no heavy needs for an organization to support technical hardware. At the end of the day, the focus is to have easy-to-use and easy-to-access tools to take the right action on the right patient at the right time.

Sharif Zeid: PT clinics should be looking for fully cloud-based systems with no required server or software installations. The provider should include backups, and HIPAA compliance is a must.

Brian Shivler: As far as buzzwords are concerned: minimal hardware required; no server maintenance fees; efficient implementation; seamless and timely software updates; no downtime during business hours for upgrades; secure, anywhere access on computer or tablet; built-in encryption; backup and recovery.

Steven Presement: The “cloud” is a very generic and often misunderstood term. Typically, information stored in the “cloud” can be accessed from anywhere. Even if your patient information is stored within the walls of your clinic, your clinic could actually be considered “the cloud” if you can get into your data from outside the facility—basically creating your own personal and secure, unshared storage space.

Terrence Sims: One of the most important things with cloud-based EMR and PM systems is that the system is “fully integrated.” This means that all Scheduling, Clinical, Billing and Reporting data is contained within the same system/database. This ensures data integrity across your entire organization—ie, Administrative, Clinical, and Billing departments are working from the same data set; which is important when it comes to billing. When your billing data leaves your software and goes into another system to bill insurance, it sets up the potential for mistakes, data loss, and incorrect billing. It also reduces Admin visibility when there is a problem or a rejection.

Daniel Morrill: HIPAA-compliant, CMS-compliant, patient engagement, fully integrated.

Heidi Jannenga: Cloud-based IT systems that are not only designed for physical therapists, but also work to enable seamless information transfer (ie, interoperability) will be immensely helpful for providers, payors, and patients alike. These types of systems have the potential to produce meaningful data at every level—showing everything from how well a healthcare system as a whole is faring, to the manner in which a single patient is responding to a specific physical therapy treatment. And there’s a huge opportunity for healthcare professionals to use that data to inform decisions that will impact us all.

What benchmarks can managers look at to gauge whether a PT clinic is getting the most from its cloud-based software?

Dirk Wierbicky: Is the system ever down? If so, at what level of frequency? What device options (PC, iPad, phone, android, Apple, etc) can I deploy to access the software?

Jeremy Cader: Therapist productivity—Is the software waiting on the therapist or the therapist waiting on the software? Accounts Receivables trend from billing perspective and therapist productivity reporting will give you a good idea if you are getting the most out of your cloud-based software.

Shawn Hewitt: The benchmarks and metrics utilized to optimize use of the software should show a manager how the clinic, therapist, and/or patient are staying compliant with industry and regulatory requirements. The software should make it clear on the collection of outcome measures to show improvement and to demonstrate value for the care being provided. The software should use checks and balances metrics to ensure the therapist/clinic is following CMS or other payor billing and documentation rules. These metrics serve to protect revenue and even provide opportunities to gain revenue. Then there is efficiency.

Often hard to measure, but the software should help show productivity metrics, scheduling efficiency and capacity, time of documentation, time of referral to first visit, and/or time of payment processing. The cloud/web-based software should offer easy transparency in tracking metrics that support a clinics CORE Compliance, Outcomes, Revenue, and Efficiency.

Sharif Zeid: Clinics should be looking at receivables, payments, documentation efficiency, and feedback from staff to ensure they’re getting the most.

Brian Shivler: System availability and accessibility; system speed, performance and downtime; system security; hardware costs; IT resource and service costs.

Steven Presement: When data can be accessed from your cloud, it opens up a world of possibilities for practice management and EMR software. Instead of just allowing clinic staff to access information, all of a sudden the ability for patients to book their own appointments, complete their registration forms, and view their accounts online should exist, giving potential patients instant gratification and freeing up clinic admin staff time. Patient access is a major potential benefit of having your data stored on the cloud.

Terrence Sims: The benchmarks to gauge the effectiveness of a cloud-based system will vary based on what is important to the practice. However, whatever benchmarks are set, the practice should easily be able to meet or exceed those benchmarks. This is because cloud-based systems, if implemented correctly, should increase efficiency, reduce errors, and streamline people-based processes.

Daniel Morrill: Vital indicators to measure whether or not you are fully taking advantage of your current EMR situation include average time-to-completion for documentation based on varying degrees (evaluations, daily notes, etc), revenue cycle management trends such as outstanding AR tracking, and the amount of automation that the EMR carries out for its users. One of the primary objectives an EMR should fulfill is saving its users endless amounts of time by eliminating tedious, unnecessary manual steps. If your current EMR does not accomplish that, it’s time for a change.

Heidi Jannenga: The right PT-specific, cloud-based software should enable PT clinics to ensure defensible documentation in the case of an audit as well as optimize their workflow and maximize their reimbursements—through features such as intuitive scheduling, automated appointment reminders, integrated billing, and outcomes tracking with measures that are relevant to the entire healthcare community. The system should also analyze clinic data and present it in the form of meaningful, impactful, and intuitive reports (aka, business intelligence). That way, managers will be able to monitor increases in staff productivity, decreases in cancellations and no-shows, and increases in referrals—among other things.


What distinguishes your cloud-based software solution for PT clinics?

Dirk Wierbicky: Access anywhere, use anywhere. Users are able to access the applications and get their work done from virtually any remote location with assurances of security for all data. Also, software updates on demand. Application vendors are now able to push updates and enhancements to users with the frequency required to support the business needs.

Jeremy Cader: Our Clinicient INSIGHT platform is a complete end-to-end solution for all PT clinics. It is an all-in-one system which gives a 360-degree view of the entire PT business starting from Patient Engagement to Claims Submission and Status for Cash Collection from Payors. Our rich clinical content for PT business is a unique library of topics and templates which can be customized to meet the needs of each PT clinic.

Shawn Hewitt: Mediware’s years of dedication and experience in working in the rehab market has allowed us to be more than just a vendor. We are partners with all of the clients that use our software to make sure that together we offer software and services that set clinics up to provide a true quality patient care experience. Our experienced and dedicated clinical staff work hard to offer value such as: configurability over conformity; manage margin through effective schedule management; efficient practice management through workflows, content, and features that guide proper and timely patient management; revenue protection by efficiently capturing charges and applying checks and balances for following billing rules (CCI, FLR, Time/Unit, KX, etc); reduces the time spent on compliance management by offering automated prompts and notifications; native web application that provides mobility.

Sharif Zeid: MWTherapy works to be at the forefront of the PT Cloud-based software market by offering a fully integrated experience with scheduling, documentation, and billing all living and working in harmony.

Brian Shivler: ReDoc powered by xfit offers complete packages that include scheduling, clinical documentation, reporting, integration with external systems, as well as internal billing or billing services. And we have several additional features designed to meet the specific needs of therapy clinics such as a home exercise program, appointment reminders, FOTO integration, electronic faxing, and more.

Steven Presement: Practice Perfect distinguishes itself in two key areas. First, clinics benefit from having their data accessible via the cloud while still keeping their info within the walls of their clinic, which we feel is safer than having their data on a server sharing with other clinics. Second, Practice Perfect does offer a patient portal where clients can book their own appointments and complete all the requisite paperwork before even attending the clinic.

Terrence Sims: Raintree Systems is a fully integrated EMR & PM system designed specifically for PT clinics of all sizes. One of the things that distinguish Raintree is that it is completely scalable to any practice size. Often clinics, as they grow, also will outgrow their software. This is because their software is designed for a specific type/size of practice. However, as they grow and their business increases in complexity, their software just can’t keep up. Raintree’s unique structure allows practices to grow without ever needing to worry about outgrowing their EMR & PM software.

Daniel Morrill: Several things: the highest, most adaptable level of system-wide customization; the most efficient documentation process on the market that allows for 5- to 6-minute evaluations and 1- to 2-minute daily notes; a fully integrated faxing system that was built in-house. Not only does it support outbound communications, but it also supports direct inbound receiving as well. An extremely extensive reporting application that gives owners the ability to take complete control of their practice. With 180 vastly unique, preloaded reports as well as over 2,000 custom reports already created, TheraOffice provides clients with all of the tools needed to measure positive growth and assure a successful business model.

Heidi Jannenga: As a true SaaS business—with a month-to-month payment model—WebPT works hard to prove our value to our members every day. To meet—and exceed—our members’ expectations, we offer top-notch how-to guides, extensive knowledge bases, and an at-the-ready, expert support staff. Plus, we’ve worked hard to make WebPT simple, user-friendly, easily scalable, and flexible. We roll out constant updates to improve the user experience and ensure compliance, and offer integrated products, such as billing and outcomes tracking to help our members optimize their workflow, maximize their reimbursements, and objectively demonstrate their value.

For clinics thinking about switching cloud-based software providers, what concerns should they have about being able to continue to access their data and application, once they leave their current provider?

Dirk Wierbicky: Providers should ensure that their cloud-based practice management system vendors contractually allow them access to their data after termination of their agreement, and also provide an option for receiving their data on a searchable DVD or similar media.

Jeremy Cader: They shouldn’t. The clinic should own the data in any contract they enter. A termination clause in the contract defines how and when a clinic will receive their data as part of a termination. Clinics need to clearly understand what happens to the clinical data after termination.

Shawn Hewitt: From a technical standpoint, the clinic should ask about options to migrate patient data, request the ability to continue access to the previous software’s application and database, and have the ability to access any key reports. There should also be discussions on a straight cut over to the new system or a transition of all new patients on the new system with a phase-out of older patients (this often depends on the initial systems capabilities to pass data). From a clinical standpoint, the clinic should ask about “documentation transfer templates” that will help update the newer system with Plan of Care counts and/or time frame management for FLR and progress reporting.

Sharif Zeid: Clinics should ask what the protocol is and if there are any long-term contracts. Contracts, especially 1 year or longer, can be very detrimental to a practice if the system isn’t working out.

Brian Shivler: Getting a copy of their data, integrating data from previous systems into new systems and what format that data is in, accessing data and information in the previous system after they’ve left the provider, copy/backup of medical records (either electronic or paper).

Steven Presement: This is actually a major concern. It’s especially a problem if EMR vendors are vague about what you can and cannot access post-termination, or provide a disk full of raw data that is completely unusable should you be audited, financially or clinically, down the road. A user should be very clear with their potential EMR provider and ask, “Can I access my data in the exact same manner if I am no longer your client?” The big problem here is that most EMR users don’t ask this question until it’s too late.

Terrence Sims: The first thing they should do is inquire with their current provider about how they will access their data. The data belongs to the clinic, so the software provider is required to allow them to get a data file. However, the process is different for every software provider, and there may be costs associated with obtaining the data. Since there are HIPAA requirements around maintaining patient records, the clinic should have a plan for archiving those files—either in hard copy form, importing into their new software, or maintaining a license with their old software vendor so they can access their records.

Daniel Morrill: Once a close-out with TheraOffice is official, all of the patient data within that respective database will be sent securely to the owner of the clinic in question in a fully encrypted, HIPAA-compliant manner. This data includes all of the provider notes as well as a wide variety of additional patient-specific reports that detail information such as treatment history, financial summaries, etc.

Heidi Jannenga: While providers may have to manually transfer their clinics’ information into a format they can upload into their new system (ideally, before they terminate their contract), the new system vendor should be able to help. Ultimately, PTs should adopt a system that safely secures their data on their behalf and enables them to take it with them anytime they please. PTP