Don't Spend Big Bucks on a New EMR... until you read this!

This new article, published in Advance for Physical Therapists April 3rd, 2012, shows you the future of Electronic Medical Records (EMR) in physical therapists' clinics.

We cover EVERYTHING physical therapists want in a new, electronic documentation and billing system.

In the article we discuss the following:

• Physical therapists documentation
• Productivity and profitability
• SOAP notes
• Medicare Audits
• Personal Health Records (PHR)
• Electronic Health Records (EHR)
• Mobile or handheld computing
• Psychosocial factors
• Quality metrics

BEFORE you spend lots of money on a new computer system or new software you should READ THIS FIRST!

Federal Agency Chief Rebuts Findings That Show EHR May Lead to Increased Diagnostic Imaging

Just one day after the Health Affairs article that showed an association between physicians' Electronic Health Record (EHR) use and increased ordering of diagnostic imaging the chief of the Office of the National Coordinator for Health Information Technology (ONC HIT), Dr. Farzad Mostashari has writen a scathing piece in the Health IT Buzz blog blasting the author's conclusions as "far beyond the scope of their research".

Dr. Mostashari points out the following:

• The Original Study Was Not About EHRs At All, Much Less Their “Meaningful Use”
• The Original Study Falls Prey to the Classic Fallacy of Using Association to Suggest Causality
• The Original Study Did Not Consider the Appropriateness of Imaging Tests
• Reducing Test Orders Is Not the Way that Health IT Is Meant to Reduce Costs

Essentially, Dr. Mostashari is serving as a government mouthpiece trying to poke holes in a study that questions the effectiveness of the 2009 American Recovery and Reinvestment Act (ARRA) that provides $25.8 billion in stimulus funding, much of to physicians and hospitals who purchase Electronic Health Records.

Dr. Ray, one of the commenters to Dr. Mostashari's blog post points out that the burden of proof is on the government to show that EHRs actually work to bring down costs.

And, quoting the original authors:

"History urges caution in assuming that advances in medical technology will result in cost savings. In fact, the opposite is more often the case."

Medical imaging costs will most likely rise as physicians gain increased access to image-viewing features of EHRs.

And, as I originally pointed out, critical pathways for high-cost conditions treated by physical therapists will become increasingly popular, driven by payers frustrated by soaring medical imaging costs.

What say you?

Electronic Health Records May INCREASE Uitilization of Diagnostic Imaging

Contrary to the notion that Electronic Health Records (EHR) will lower spending a new study in the March Health Affairs found a 40% to 70% INCREASE in ordering of second x-ray or CAT scan. EHRs are supposed to lower health care spending by improving physician access to a patient's medical history and diagnostic test results.

Read the Health Affairs article here.

A "convenience effect" may be the mechanism by which EMRs lead to increased imaging.

Physicians have the ability to review results much more quickly and without having to track them down from an imaging facility.

"The effect may be to provide subtle encouragement to physicians to order more imaging studies".

Referring to better access to results with computerization, lead author Danny McCormick, MD says,

"As with many other things, if you make things easier to do, people will do them more often."

You can also read this summary article from Fierce Healthcare.

One implication for physical therapists might be an increased need for critical pathways like the Starbucks/Virginia Mason model from 2006 or the Intel/Cigna model from 2011 in order to contain the overutilization of diagnostic imaging.

Physical Therapy Apps

The physical therapy application marketplace is growing.

The iPhone is just the first mobile platform where consumer apps really exploded.

But, the iPhone provides some lessons about where app developers and medical device innovators are heading within the physical therapy space.

According to Office of National Coordinator of Health Indormation Technology (ONC HIT) staff member Jacob Reider, MD all new medical apps need these features:

• Functional (it does what it is claimed to do)
• Reliable (it works consistently)
• Usable (it works in a way that is consistent with the user’s expectations)
• Meaningful (it does something important or valuable)
• Pleasurable (it is enjoyable to use)

The ONC HIT website takes Dr. Reider's message a step further:

"...the iPhone, for instance, uses a software platform with a published interface. This interface needs the ability to have both core components and applications (apps).

On the iPhone, core components include cameras, geolocation, networking capabilities, etc. The platform functionally separates the core components from the apps, and the apps are substitutable.

For instance, a consumer can download a calendar reminder system, reject it, and easily replace it with a new one.

Substitutability is the capability of a system to replace one application with another of similar functionality. As we define it, substitutability requires that the purchaser of an application can replace one application with another without being technically expert, without requiring re-engineering of other applications they are using, and without having to seek assistance from any of the vendors of previously or currently installed applications.

This allows developers to rapidly create a large marketplace of apps for consumers to choose from.
 
A HIT environment characterized by substitutable apps constructed around shared core components would drive down healthcare technology costs, support standards evolution, accommodate difference in care workflow, foster competition in the market, and accelerate innovation. 

Competition on quality, cost, and usability would become fierce. 

With the cost of switching kept low, a physician using an electronic health record (EHR), a CIO running a hospital system, or a patient using a personally controlled health record (PHR) would all be empowered to readily discard an under-performing app and install a better one."

New Electronic Health Records Toolkit available from the APTA

An Electronic Health Records (EHR) adoption toolkit is now available at the American Physical Therapy Association (APTA) website. Member log-in is required.

The site is divided into four parts for ease of assimilation. As described on the website:

1. Decision - why there is a push to adopt EHR and an introduction to the issues that impact physical therapists' practice.
2. Preparation - What you need for successful adoption of an EHR system. Also, what is an EHR? How does an EHR fit in your current environment and workflow.
3. Selection - What are the available types of EHR software and hardware?
4. Implementation - A smooth transition when adopting an EHR requires an organized approach and clear communication with your facility's staff.

According to the APTA:

"Although PTs are not yet required or incentivized to adopt EHR systems for such initiatives as Medicare's Meaningful Use Program, which in 2015 will penalize eligible providers that do not meet the requirements for "meaningful use," physicians and facilities that are included in the program will expect the PTs with whom they share patients use compatible EHR systems."

In other words, physical therapists are not yet invited to the party but we need to get dressed like we're going anyways :)

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.