Continuing Education -
Choosing a Physical or Occupational Therapy EMR Product.

Key Points to Consider When Choosing a Physical or Occupational Therapy Electronic Medical Record System.

continuing education, physical therapy, occupational therapy -
  • Know up front that the time frame the company gives you to complete the project is underestimated
  • Some of the major costs you need to plan for (that will never be discussed leading up to the purchase) is the true time in labor you will experience when building, launching, and, of course, trouble shooting and solving issues and bugs after the launch.
    • The cost of paying the “superuser” staff to train others, build, and problem solve
    • The cost of the manager, who will now spend 1 hour a day dealing with EMR issues.
    • The loss of productivity from launch to achievement of normal productivity (if you get there)
      • Think about doubling schedule time slots - initial eval blocks of 90 min. for each therapist at launch x 4 weeks
      • Initial eval blocks at 60 min. x an additional 4 weeks (if you typically allow less time)
      • Overtime (if applicable, therapist anger if salaried) due to error correction, learning, mistakes, inability to enter data while actually tending to the patient for customer service.
  • If you use if for outpatient therapy, demand to see the exercise/treatment flow sheet and see it being used on realistic patient data from visit to visit (not a quick demo where everything works out great)
    • What happens when you want different column headings for Peds / Neuro / Ortho, can you have different column headings on your flow sheet?
    • Can you put in the sequence of the exercises/ treatments performed?
    • Can each therapist build their own treatments so they aren’t remaking the same exercise flowsheet everytime they see a similar diagnosis?
    • How are you going to document total procedure time and total treatment time?  Some may force you to time each exercise versus having a group of exercises and providing a total time for all the listed exercises. 
  • Think it through in all aspects of patient care delivery from start to finish.  Make the EMR company answer/ show you how all aspects will look/work.
    • How are co-signatures handled? Can a PTA or COTA complete charges or can that only be done once the supervising therapist co-signs the note?  How will that be handled if the PTA/COTA is the only therapist at the end of the day?
    • If the front desk staff want to leave a message for the treating therapist to see on the patients next visit how is that done?  Most of the time by a sticky note on their desk!  Welcome to non-treating therapist designed EMR.
    • If charges are tied to documentation (which makes for an efficient system), how do you document on a patient that comes in ill, treatment is cancelled, but you still need to document on the patient?  Most systems expect a charge if you document on the patient.
    • What if you want to print out a daily list of patient appointments for therapists (I know that defeats the purpose of going electronic, but many clinics may want to do this at first) can that be done?  Don’t assume it can, have them show you.
    • Keep in mind that you will want to be looking at the patient and treating him/her as a customer, not staring at the computer screen 90% of the time.  This is very difficult to accomplish initially, but something to keep in mind.  If you have a confusing flowsheet or hard to find data input area, it will require staring at the computer more for simple documentation.  Customer satisfaction will drop if therapists spend more time looking at the computer than the patient.  Do practice evals/treatments with the systems being considered if possible and take note of the difficulty in looking/talking at/to the patient.
  • Find out the true meaning of customizable!
    • Most programs will have a canned documentation system that can be “customized” based on your preferences, but at what cost.  The system may be slick if you use it “out of the box” but if it is customized there may be much more complexity to getting it to work and you may be on your own once you head down that path.  Not to mention this is a built in excuse for everything that goes wrong with the software from that point on.
    • Drill down with customization.  Sure you can change the columns on the flow sheet to have whatever headings you want, but once it is utilized, if it changes does it corrupt all previous documentation on the flow sheet (past visits)?
  • Analysis tools
    • The power of having all the stats you want at your finger tips will surely be touted.  What stats and what do they look like?  Think about what information you will want to see in advance and have them show an example report to deliver that.  For example, if you want to see how many visits, no-shows, and cancels occurred on a particular day – can you get that by running a simple report?  You should be able to.  How many units did each therapist produce on a given day?  Request to see realistic, usable information not what the salesperson has prepared to show you.
    • If the system offers “customized” reports, have them make one that you come up with (again, not something prepared in advance).  What does it look like?  Does it dump all the data in a hard to read, poorly formatted Excel spreadsheet that carries over into 5 pages and is virtually unreadable, and certainly unprintable, without 10 minutes of editing?  It’s out there.   

Many clinics are moving to electronic medical records and there is no doubt the systems are improving.  The cost is significant and the savings minimal, but hopefully well worth it in the long run.  A smart clinic owner or manager will take the time to ask and see detailed aspects of the programs being considered.  You will always see the strong points of each program, the salesperson will see to that, but you may miss some big flaws if you don’t look close.  EMR will be a challenge for any clinic, but getting the best one that fits your priorities, can save you some big headaches down the road.


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