"Physical therapy is not a subspecialty of the medical profession and physical therapists are not medical doctors; we are a separate profession that provides a unique service that physicians are unable and untrained to provide."

Letter to the AMA from the APTA, Dec 2009

Monday, July 18, 2011

Demystifying Health Information Technology (EMR/EHR/PHR - What does it all mean?)

As health care professionals adopt information technology within their organizations, a new language has emerged around these activities.
For physical therapists, these terms can be confusing - for example what is the difference between an Electronic Health Record (EHR), an Electronic Medical Record (EMR) and a Personal Health Record (PHR)? How do provisions for Meaningful Use outlined within The American Recovery and Reinvestment Act of 2009 impact physical therapists? Let's start by describing the various types of electronic documentation and their differences.

An Electronic Medical Record (EMR) is an electronic record of health-related information on an individual that can be created, gathered, managed, and consulted by authorized clinicians and staff within one health care organization.

An Electronic Health Record(EHR) is an electronic record of health-related information on an individual that conforms to nationally recognized interoperability standards and that can be managed by authorized clinicians and staff across multiple health care organizations. It allows integration across multiple settings, provides tools that support clinical decision-making and provides access to electronic data by multiple authorized users.

A Personal Health Record(PHR) is an electronic record of health-related information that can be drawn from multiple sources, where the information it contains is under the management and control of the individual (patient).

The EHR is the primary focus of our government as it attempts to leverage technology to reduce health care costs and business inefficiencies.

According to the Committee on Data Standards for Patient Safety, technology based efficiencies will enhance quality, safety and expediency in health care delivery processes. The core functions of an EHR, according to this Committee, include electronic communication and connectivity, longitudinal collection of personal health information and patient support.

Further, the Institute of Medicine (IOM) stipulates that EHR systems must support the delivery of personal health care services, including care delivery, care management, care support processes, and administrative processes (e.g., billing or scheduling). The IOM suggests as individuals engage more actively in management of their own health, they too become important users of electronic health information.

EMRs and EHRs are tools for providers while PHRs are the means to engage patients in their personal health and well-being. The key difference between an EMR and an EHR is interoperability -- an EHR is used to exchange information across multiple users, an EMR does not.

Although the federally mandated Meaningful Use reimbursement plan is not applicable to physical therapists, multiple benefits can be extrapolated from adopting an EHR including improvements in:
  • Documentation efficiency and accuracy
  • Overall operational efficiency
  • Communication (amongst health care professionals as well as between patient and therapist)
  • Data accuracy and analysis
  • Clinical decision-making
  • Research and outcomes management
  • Coordination of care
  • Reimbursement efficiency

Accordingly, changes are being made in Health Insurance Portability and Accountability Act (HIPAA) regulations to accommodate the use of technology in health care.

As a response, the American Physical Therapy Association (APTA) has recently launched a multi-phase initiative to assist physical therapists with the implementation process -- from decision-making to training and preparation, through the final stages of incorporating electronic systems into clinics (the APTA does endorse products, they just provide guidance on selecting the right solution for your clinic).

When implemented properly, the adoption of electronic documentation has the potential to transform clinical practice for both therapists and patients.

The question remains- have therapists begun to adopt health IT into their practices?

The APTA along with the Health Policy and Administrative Technology Special Interest Group recently conducted a survey measuring EHR/EMR adoption among physical therapists. The results indicate that 28% of those surveyed have fully adopted an EHR/EMR in their practice. Of these respondents, 13% reported they were extremely satisfied and 50.8% were somewhat satisfied. 22.6% of physical therapists surveyed are in the implementation phase of introducing an electronic system.

Given the vast investment by multiple public and private agencies to provide guidelines for health care professionals to embrace EHRs, the significance of technology adoption is clear.

The goal is to continually provide clear and concise information that will hopefully make it easier for the clinician to transition to the world of HIT.

Bronwyn Spira, PT, and Mark Fields, PhD, MPH co-authored this post.

Bronwyn Spira is Founder and President of Force Therapeutics, a web-based comprehensive patient management solution for physical therapists. Also ForceTherapeutics/Facebook and ForceTherapeutics/Twitter .

She owns a private practice in New York City where she treats orthopedic and sports injured patients.

Mark Fields PhD, MPH is a Digital Marketing Associate for Force Therapeutics.

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Tim Richardson, PT owns a private practice at Medical Arts Rehabilitation, Inc in Palmetto, Florida. The clinic website is at MedicalArtsRehab.com.

Bulletproof Expert Systems: Clinical Decision Support for Physical Therapists in the Outpatient Setting is a manager's workbook with stories, checklists, charts, graphs, tables, and templates describing how you can use paper-based or computerized tools to improve your clinic's Medicare compliance, process adherence and patient outcomes.

Tim has implemented a computerized Clinical Decision Support (CDS) system in his clinic since 2006 that serves as a Reminder, Alerting, Prompting and Predicting CDS using evidence-based tests and measures.

Tim can be reached at
TimRichPT@BulletproofPT.com .

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