The physical therapy profession is at a crossroads. In the face of falling reimbursement rates and time-consuming documentation requirements, today's health care demands that we do more with less.
Most therapists already work long weeks-adding patients without compromising quality of care or increasing fees can be an impossible task. To grow our income, we must become more efficient with our time. But how?
The solution is technology. Technology has driven efficiencies and time savings into every business sector; physical therapy is next. With ubiquitous smart phone use by our patients and inexpensive, Internet-enabled tablet computers for our therapists, an ecosystem exists to drive major efficiencies in our treatment of care.
The adoption of electronic medical records (EMR) kicked off the first wave of technology in the clinic. The next wave will drive the greatest efficiencies-technologies that enable patients and therapists to connect and communicate throughout the rehabilitation process. In a recent article, Alex Krist, MD, noted that patients seek the ease of electronic access to their health information, but health care has been slow to develop information tools for patients.
Electronic medical records are in the early phases of deployment across clinics nationwide. In other areas of medicine, the government offers federal incentives for EMR deployments as part of the HITECH Act of 2010. Physical therapy clinics are not eligible for these government incentives. However, EMRs offer many clear benefits and clinics are looking to adopt. A well-designed system can lead to better utilization of resources, track best practices, improve efficiency of services and reduce duplication, thereby allowing better use of our time with patients.
Physical therapy EMRs have moved away from the traditional client server models with expensive hardware and software installations, as well as routine upgrades and scheduled maintenance. "Cloud computing" is the new model for EMRs. These EMRs are provided as a web-based service-you don't have to purchase a server, upload a program or even back up your information. In addition, your EMR system can be accessible from any computer or smart phone that has browser capabilities. Since medical records are stored in the "cloud," they are easily accessible to other health care providers involved in that patient's care (permissions required as per HIPAA guidelines).
Many EMRs now offer additional services such as emailing and e-faxing PDF-converted documentation directly to insurance companies and physicians. Processes are thereby streamlined, and lag times for receiving reimbursement, medical errors and redundancy are significantly reduced. In the small- and mid-size business sectors, cloud computing is becoming mainstream as "the way" information is utilized and accessed.
Most physical therapists spend little to no time behind a desk and even less time on the phone. And yet, patients need a way to access our expertise or ask questions regarding their course of treatment. Many physical therapists resort to email as a form of communication with their patients; however this is not a recommended or secure method of communicating personal health information. It can also be a slippery slope in setting professional boundaries with certain patients. How can we best let patients capitalize on our clinical expertise without letting it affect our clinical efficiency or invade our personal space?
The answer is simple: through a secure, HIPAA-compliant electronic communications system. This tool needs to be password-protected and encoded so that hackers cannot access patients' personal health information.
The other advantage of such a messaging system is the ability to keep track and record conversations. Patients feel they are getting better service and quality of care when they have a method to contact their therapist. The Beryl Institute conducted a recent study on a hospital-based system that enabled patients to interact with health care professionals using in-room monitors. The interactive monitors helped boost patient satisfaction with educational materials by 42 percent and lifted overall satisfaction scores by least 10 percent. "Rather than an amenity, interactive technology is emerging as a critical partner in the health care experience," the organization stated.
SMS and Email Alerts
No shows and late cancellations of scheduled visits plague physical therapy practices. Poor patient attendance results in lost revenues and poor patient outcomes. Practices traditionally employ rudimentary strategies to reduce missed appointments including reminder calls and hefty cancellation fees.
Unfortunately, these solutions require additional administrative time and effort and can create poor relations between patients and administrative staff. In other areas of health care, it is already common to use SMS and email alerts to notify patients of future appointments. Ideally, SMS text and/or email alerts for physical therapists would be integrated into a clinic's scheduling system; automatically alerting patients to upcoming appointments or schedule changes.
The potential impact of these alerts can extend to reminding patients to complete their home exercise programs, or giving therapists updates on symptomatic responses to new treatment regimens. Our patients are tech-savvy and already communicate with their banks, airlines, professional services and others over their mobile devices.
Soon they will begin to expect mobile conveniences from their physical therapist. In addition to the considerable cost-saving benefits, automated communication can also serve to increase patient attendance and participation in their rehabilitation regimen, and thereby improve patient/therapist interaction as well as patient outcomes.
Video Exercise Software
Gone are the days of reading a paperback novel, writing a letter on paper or going to a bank teller to deposit a check. We are living in the digital age where everything is at the tip of your fingers and at the tip of your fingers is your Blackberry or iPhone.
The most revolutionary of these digital communication formats happens to be video. Thankfully, electronic devices can now stream full-motion HD video and that has opened up an entirely brilliant way to communicate with patients. Patients should be able to access their rehabilitation program as videos in an attractive and interactive web environment. It is now not only possible, but relatively easy to enable patients to do their home exercise program on the go: whether at the office, gym, on a business trip or in their own home and be confident that they are doing it correctly. The industry standard will soon be video-based home exercise programs.
Video-based exercises can serve to improve exercise performance, retention, motivation and confidence for the patient and at the same time, make physical therapy sessions more efficient and productive.
Compliance Tracking Tools
Ask any physical therapists their greatest challenge to positive patient outcomes and the most common answer will be "poor patient compliance." What can we as clinicians do to ensure our patients are in fact doing their home exercise programs?
In the past five years, there have been significant developments in remote monitoring and compliance tracking in all areas of health care. Every health care professional has his own prescription for health that he needs to be able to monitor. For physicians it might be medication; for nutritionists, a special diet. For physical therapists, it is exercise. Compliance tracking can be beneficial in many ways.
First, it allows patients to be active participants in their care, engaging them in their physical therapy process and holding them accountable for their outcomes. It also serves to improve motivation by knowing their health care practitioner is monitoring them, even while they are not physically in the clinic.
This motivation in itself increases patient confidence in performing exercise and improves exercise performance. A recent study published in JAMA showed that obese patients who were given a structured behavioral treatment program with online weekly contact and individualized feedback had better weight loss compared with those who were just provided with links to educational websites. The researchers used the Internet and email to monitor patients' compliance and engage in personal communications, concluding that these appeared to be viable methods for delivery of structured behavioral programs and resulted in enhanced outcomes over the control group.
There are a multitude of benefits to the use of social media sites like Twitter and Facebook. Not only do these sites help clinics connect with patients and peers, they also offer a great way to educate patients on who we are and what we do. Social media websites are an excellent source of new information and make it easy to keep abreast of the latest evidence and trends in physical therapy, with very minimal effort required. Social media is starting to become a standard for businesses to connect with their consumers and for professionals to connect with other professionals. Physical therapists will benefit by joining this powerful and networked community.
Going Mobile: There's an App for That
Physical rehabilitation starts in the clinic and continues at home, in the office, at the gym-and mobile technology is the perfect solution for this multi-location experience. Why then has the PT industry not embraced this exciting opportunity? Shouldn't we capitalize on the prevalence of Internet connectivity and smart phone use to stay connected to our patients? Wouldn't a patient's mobile device be the perfect rehab aid?
The iPad has quickly transformed the way business is conducted in the media, entertainment and education sectors. But what about health care? There are a number of tangible benefits to using a tablet computer for documentation. It is much faster to enter notes in real time and the small, flat screen is less obtrusive than a laptop, which can create a physical and potentially emotional barrier between patient and therapist.
Some of the shortcomings of the tablet computers on the market include fragility of the device if dropped, sanitary considerations and the short battery life. With the advent of next-generation tablet computers coming onto the market (the Motorola Xoom, iPad 2, Point of View Mobil, HP touchpad and the Samsung Galaxy to name a few), we can be hopeful that we'll see improvements in this mode of computing that will make tablets a viable option in the health care sector. Hopefully we will also see some therapy-specific applications on
We need to unite as a profession to develop systems that improve clinical quality and outcomes, while creating better health care system efficiencies. At the heart of these systems is a dedication to health care data accuracy and comprehensiveness, as well as an appreciation that this brings an advanced set of clinically relevant health care solutions. These evidence-based resources allow us to strengthen our existing treatment plans and raise the standard of care. We have to start now, without delay, and bring technology into the clinic.
Bronwyn Spira is founder and president of a web-based comprehensive patient management solution for physical therapists. She owns a private practice in New York City where she treats orthopedic and sports-injured patients. Tejal Ramaiya is a physical therapist in New Jersey.