The Software Bamboozle No One in the PT Industry is Talking About

Nowadays, shopping for business software is a lot like shopping for a car. You do a lot of online research; you ask friends and coworkers for their recommendations; and you take some test drives. One thing—besides the price tag—that can ruin the whole experience? You pulling out of the lot with your shiny, new investment—and an uneasy inkling that maybe, just maybe, you got the wool pulled over your eyes.

Of course, when you buy a car and you get that feeling, you talk to folks about it. The same can’t be said for the PT industry, though. Certain software have been duping us for many years now—and yet, we remain silent. That stops today. There are three ways physical therapy software vendors have been bamboozling their prospective customers. Let’s take a closer look.

The Web-Enabled Smoke and Mirrors

True web-based EMR systems store data within secure data centers; nothing is downloaded, installed, or stored on any customers’ computers. Customers then access that data via web browsers (e.g., Google Chrome, Mozilla Firefox, or Internet Explorer) using any device connected to the Internet. Essentially, this is how you use a web-based EMR system:

  1. You visit the website of the EMR system.
  2. You log in.
  3. You conduct your business directly through your secure login on the website.
  4. When you’re finished, you log off.

Web-enabled EMRs, on the other hand, require you to download and install a software platform that then connects to the Internet. As this article explains, “…you still have to install software on your computer, and your computer still does all the processing. However, at certain intervals, the software will connect to the Internet to sync your account and data to the cloud.” This means that like server-based systems, web-enabled ones only allow users to access the program on the computer to which it’s installed. Furthermore, every time there’s an update or upgrade, you’ve got to download and install more stuff. You also must deal with all the security drawbacks of server-based systems (i.e., storing data on local servers and managing all the hardware yourself). Plus, as the above-cited article states, “…your EMR and its data does not update online in real time,” and that’s problematic if you have multiple clinics or different therapists accessing records simultaneously. Individuals could access or alter outdated information, or accidentally save over others’ work.

In addition to coming with all of these significant drawbacks, these EMRs also usually charge per chart or employ pricing structures similar to those of their server-based forebearers, which typically involve upfront expenses, maintenance fees, and the like.

In short, web-enabled systems don’t satisfy the demands of a growing business because they’re ineffective at scaling. Vendors of these systems know that, and that’s why they never just come right out and say they’re web-enabled. Instead, they either a.) don’t specify what type of platform they are, or b.) say they’re “cloud-based” and hope that you—the customer—are none the wiser. Don’t fall for the old smoke-and-mirrors trick. After all, if a company isn’t truthful about its platform functionality, what else are they hiding?

Ask your current EMR or—if you’re shopping around—any systems on your “yes” list the following questions:

  1. Do I need to download or install anything? (With a true web-based system, you shouldn’t have to.)
  2. Does the system need to sync with the Internet periodically to update my online data? (A true web-based EMR is always functioning—and saving your data—in real time.)
  3. Will I need to store any data locally? (With a true web-based EMR, you don’t need to store any data on your computer.)
  4. When it’s time to document, how do I open the EMR? (With web-enabled software, you’ll open the program on your computer, and it’ll connect to the web. With a truly web-based system, you’ll visit a website to log in.)

The “Free” EMR Gimmick

In the world of PT, clinics typically rely on two types of software: electronic medical record systems, which handle documentation and scheduling, and revenue cycle management (RCM), which handles accounts payable and receivable. As this blog post explains, “Sometimes, you’ll see vendors advertising an ‘all-in-one’ solution, which implies the EMR and RCM live within one system…Other vendors will tout an ‘integrated solution,’ which is basically a fancy term for an EMR or RCM system that integrates with other softwares.” For an in-depth discussion of each setup’s pros and cons, I recommend this article.

One major reason to avoid the all-in-one system, though, is its fee model. Often, the vendor will offer the EMR portion of its software for free in order to gain your business. Then, you simply pay for the RCM. But watch the pricing on this “deal”; sometimes, vendors will charge high percentages per reimbursement for billing, which means the more money you make, the greater your vendor’s cut. Your billing software should take the smallest percentage possible, and the money you’d save with a “free” EMR definitely doesn’t make up for an overcharging RCM.

Before committing to any software, make sure you ask about its pricing structure and how it adjusts for your business’s growth. Then, compare it with other systems’ pricing to gauge whether the giveaways really make for a better deal.

The Per-Patient Pricing Hustle

Software costs money. But every system charges its customers in a different way and at a different rate. It’s imperative that you understand your EMR vendor’s pricing structure, because some systems charge per patient visit or chart. And that’s detrimental to your practice’s cash flow. Here’s why: The more patients you generate, the more visits you’ll have or the more charts you’ll create. That means you pay more as your business grows. In other words, you’re punished for being more successful.

Your EMR should work for you and your business, not the other way around. So, instead, look for an EMR solution with a per-user pricing model. Also, investigate whether the company sets different rates for different user types. Finally, look for a system with a cancel-anytime subscription model. This ensures you know what you’re paying for from the get-go—no surprise fees or rate hikes. That’s the kind of EMR system that works for scale.

 

Now that I’ve essentially shown you the “EMRFAX,” you’re in the driver’s seat—and you shouldn’t have any uneasy feelings or buyer’s remorse as you drive your physical therapy software off the lot. Be well-informed when you shop for EMR, RCM, and practice management platforms; trust your gut; and ask not only a lot of questions, but the right questions. You might not be able to out-sell a salesperson, but you can certainly outsmart ’em.


Avoid These Common EMR Pitfalls

You’re shopping around for an electronic medical record (EMR) solution for your physical therapy practice, and boy, are there a lot of options. You’re trying to make up your mind, but you need to be absolutely sure. After all, implementing an EMR is a big commitment, one that will dramatically affect your clinic’s workflow. The last thing you need is a nagging feeling that this major change won’t absolutely be for the better. To prevent any inkling of buyer’s remorse, be sure to avoid these common pitfalls during the EMR selection process:

Cost-per-chart or per-visit pricing

The EMR solution you choose should help your clinic’s cash flow—not deplete it. So, select one that offers a cost-per-user payment structure rather than a cost-per-visit or cost-per-chart plan. You want your visits to increase as you grow your business; you shouldn’t have to pay more to your EMR as a result. Plus, the minimum monthly payment for per-char or per-visit structures typically far exceeds the price of a cost-per-user (membership-style) system.

And while we’re on the topic of cost, web-based solutions far outshine server-based ones because most server-based EMR systems come with a hefty capital investment upfront, especially if they require expensive hardware.

Limited accessibility

As a therapist, you’re busy—constantly on the move. Make sure your EMR can move with you. Look for a solution that is truly web-based (not web-enabled), so you can access it from anywhere and at anytime. And while you’re at it, make sure you can access your web-based EMR from any web-enabled device (i.e., Macs, PCs, iPads, and tablets). Also, ensure the web-based EMR you choose is browser-neutral, which means that no matter what browser (e.g., Safari, Google Chrome, Mozilla Firefox, or Internet Explorer) or version of that browser (e.g., IE7 vs. IE9) you use to access the Internet, the application will work.

One-size-fits-all system

You want an EMR tailored to your practice and profession, so avoid generalist EMRs. How? If you see the words physician, doctor’s office, hospital, or skilled nursing anywhere on the EMR’s homepage, scratch that vendor off your list. Instead, look for an EMR that is specifically for physical or rehab therapy. If you have a different therapy specialty, such as speech-language, occupational, pelvic health, or pediatrics, be sure to find out whether the EMR has modules that support your specialty.

Meaningful Use certification

As a healthcare professional, you’ve most likely heard of Meaningful Use. As as part of the American Recovery and Reinvestment Act (ARRA), the federal government is offering financial incentives to ‘eligible professionals’ who use electronic health records in their practices. According to this blog post, though, there’s a big caveat: “To qualify for the incentive, these practitioners had to implement a certified electronic health record—that is, one that ‘offers the necessary technological capability, functionality, and security to help them meet the meaningful use criteria.’” However, just because an EMR is Meaningful Use-certified does not mean it’ll suit your practice. The federal government is doling out quite substantial incentives (up to $44,000 through the Medicare incentive program and up to $63,750 through the Medicaid incentive program), so you can imagine plenty of companies are eager to take advantage of the certification.

But here’s the real kicker: as a physical therapist, you are not considered an “eligible professional” for Meaningful Use. Therefore, you cannot earn the incentive for using a Meaningful Use-certified EMR. Furthermore, these vendors tailor their EMR systems to those who are considered “eligible professionals,” like physicians, hospitals, and critical-access hospitals, so if you choose one of these systems, you’re automatically falling into the previous trap—using an EMR that’s not designed for you.

No support necessary

As I stated at the beginning of this post, selecting an EMR is a big decision. So, it shouldn’t be like buying a sack of potatoes—no instructions, no training, no follow-up—just you and your newly bought potatoes, hanging out in your kitchen. Rather, there should absolutely be instructions, training, and follow-up. If an EMR is touting that it’s so easy to use that there’s no training necessary, then that’s an EMR you should avoid, because it’s either a.) not easy but they don’t have the money to offer you training, b.) incredibly rudimentary, or c.) quite tricky and training is an “add-on” that they’ll price gouge you for later.

All that said, there are some EMRs that are more intuitive and easier to learn than others. You want one of those EMRs, but you also want that EMR to provide free in-depth training and free unlimited support.

These pitfalls are common, but your practice needn’t succumb to them. Be mindful of these traps as you shop. Want more assistance? Here is a list of questions to ask EMR vendors.


Four Web-Based EMR Myths Exposed

Spend enough time scrolling through Facebook, perusing magazine headlines in the grocery store checkout line, or catching snippets of daytime television in the waiting room, and you’re bound to get a healthy dose of gossip. Typically, we assume that the grapevine babble stops with Miley Cyrus just being Miley or politicians getting caught doing smarmy things. In reality, though, rumors swirl everywhere—even within the healthcare industry. Take web-based EMR for example. Do you know the myths from the truth?

Myth: The Internet’s not secure enough to keep my important data safe.

Truth: With so much at stake, data security should be one of your top priorities—but don’t write off the Internet just yet. As Power Your Practice points out, web-based EMR systems “store data in high-level storage centers with bank-level security and a minimum of 128-bit encryption methods, per HIPAA’s standards.” Consider WebPT: We store data at IO Data Center, a Tier III-Certified facility that provides multiple layers of access control, including a defensible perimeter, video surveillance, and round-the­-clock security guards.

Paper storage certainly doesn’t offer that, but what about server-based EMRs? Well, if it’s under your desk or in a room in your office, I bet not. And that means you—and your patients—could be at risk. Just think about what could happen in a natural disaster. If your data is stored offsite, in the cloud, with multiple failsafes and backups, it will remain safe and secure. You’ll be able to get back to work as soon as you’re ready—exactly where you left off. What about theft? Whereas IO has 24/7/forever guard protection, your clinic probably doesn’t. WebPT currently holds 27 million patient records in the the cloud, and we’ve never lost a single one.

I could prattle on for several more paragraphs about how any web-based EMR worth its salt is far more secure than the server-based systems of yesteryear. Instead, I’ll refer you to this super awesome blog post I wrote about the security and compliance of web-based vs. server-based software.

Myth: Cloud-based systems go down—a lot.

Truth: System-wide downtime in a web­-based EMR should be a very rare occurrence. WebPT, for example, boasts over 99% uptime. Downtime for site maintenance is scheduled ahead of time during low-use hours, and Members always receive plenty of advance notice. There’s a lot of chatter out there about the threat of downtime with web-based applications, but oftentimes such problems are actually the result of issues with individual Internet providers. In that case, you can easily prevent outages with the installation of a backup Internet solution, such as a mobile hotspot device. Lastly, Internet speeds today are more than fast enough for your web-based EMR needs. (And remember, server-based or web-enabled systems often require Internet connections, too.)

Myth: Learning a new system is just too hard.

Truth: Contrary to popular belief, you can teach old (or change-resistant) practitioners new tricks. As Healthcare IT News reports, “although there is an initial learning curve during the EMR adoption process, an easy-to-use EMR can significantly improve workflows once [it’s] fully implemented.” We here at WebPT, for example, we routinely get new clinics up and running (with training) in a matter of days. Most new Members learn our application in a virtual meeting environment; however, we do offer onsite training as well, which might be convenient if you have a lot of employees who all need to learn the new system at once. Ultimately, no practice-wide change comes without a period of workforce adjustment. In the long run, though, you’ll recover any losses you incur due to transitional hiccups (see the next myth). Furthermore, if you’re considering retiring, selling, or changing hands at your practice, switching to EMR sets your clinic up for future success and an easier transition, says Healthcare IT News.

Myth: Switching to web-based EMR is expensive.

Truth: Some EMRs are expensive—and that goes for both server- and cloud-based systems. However, the best web-based EMRs cost merely a fraction of what server-based systems charge. Why? Because web-based options typically charge low month-to-month costs and require neither a contract nor a hefty upfront investment. Server-based systems, on the other hand, typically require a lot of upfront costs, including hardware purchases or upgrades and software installation. There are also recurring costs to consider, such as hiring new employees, conducting training, and replacing, repairing, or adding to your hardware.

I know I mentioned that web-based EMRs can be expensive, too. The key is to look for truly web-based (not web-enabled) software. True web-based EMRs charge per user, whereas web-enabled either employ the pricing structures of their server-based forebearers (contracts, hefty upfront investments, maintenance fees, etc.) or employ cost-per-chart pricing. You’re probably focused on growing your business, but that’s tough to do in a per-chart pricing structure where you pay more money for every patient you add. In my book, your EMR should work for you and your business, not the other way around.

Now, you may be thinking that paper is more cost-effective than EMR. That’s another myth. (Just think how quickly the costs of copying, transporting, and storing paper records add up.) Check out these myth-busting stats from DSSI:

  • One four-drawer file cabinet holds 15K-20K of pages, costs $25,000 to fill, and costs $2,000 per year to maintain.
  • The US spends $25-35 billion annually on filing, storing, and retrieving paper.
  • It costs $20 to file a document and $120 to track down a misfiled document (if you can find it).

Still not convinced? According to this article, it costs about $8 per year to maintain a paper record, compared to $2 to maintain an electronic record. Multiply that by hundreds of patients, and the case for EMR becomes pretty clear. Plus, with no need to spend precious minutes digging around for patient files, you’ll save in labor costs and free up more time to see patients—a double dose of increased efficiency.


Now that we’ve busted these web-based EMR myths, we can return to guessing which celebrities are now dating. In all seriousness, though, it’s important that private practice PTs wade through the hearsay, so they can make educated decisions about the tools they use. After all, decreases in reimbursements, increases in regulatory changes, and intensifying competition definitely aren’t rumors, and neither is this: Web-based EMRs can sincerely help you not only be better in business, but also stay compliant and craft clean, detailed, and defensible documentation.


Web-Based vs. Web-Enabled: The Tale of Two EMRs

So much of what we do nowadays, we can accomplish online—from tax preparation and banking to movie watching and shopping. It’s no wonder that so many electronic medical record (EMR) systems—tools that allow medical providers to digitally document, schedule, and bill—are accessible online, too. Of course, these EMRs aren’t all the same. Most do not take into account the workflow or treatment style specific to physical therapy. Beyond that, some aren’t even truly “online.” That’s right, there are server-based EMRs out there masquerading as web-based applications by calling themselves “web-enabled.” Don’t be fooled; here’s why you should skip the tricksters and go for the real deal:

True Web-Based

In a cloud- or web-based system, the EMR stores your clinic’s data—which can include anything from patient records to appointment schedules—within secure data centers. You can then access that data online using any web-enabled device with an Internet connection. You don’t store your data on internal hardware (e.g., the computers at your practice). Instead, you access your EMR—and all of the information it contains—via your web browser (e.g., Google Chrome, Mozilla Firefox, or Internet Explorer). With that kind of flexibility, you can document, schedule, and bill from anywhere, at any time. And many web-based EMRs charge month-by-month and do not have contracts—making them a very affordable option.

Server-Based

In contrast, server-based systems require your practice to store all its data as well as the EMR software itself. This means you need a server, corresponding hardware, and quite possibly an IT person or staff simply to maintain everything. It also means that you can only access the EMR from the computers on which it’s installed. To offset the costs associated with producing and supporting such expensive equipment and software, server-based companies use long-term contracts to ensure returns on their investments. Frequently, they also tack on maintenance and support charges, which ups the upfront expense and long-term cost burden on your end.

Web-Enabled

In an attempt to compete with the web-based EMRs hitting the market, many server-based systems have developed “web-enabled” versions. With these pseudo-cloud options, you still have to install software on your computer, and your computer still does all the processing. However, at certain intervals, the software will connect to the Internet to sync your account and data to the cloud. So even though your access is a bit more flexible, your EMR and its data does not update online in real time. Furthermore, such software may require you to manually sync the software with the web. Not only is this process tedious and time-consuming, but also your practice will still need the aforementioned hardware, servers, and IT staff.

Why You Want the Real Deal

At the end of the day, web-enabled EMRs are basically just as clunky as their server-based predecessors as they often require additional hardware, servers, and IT resources. Talk about cumbersome. Plus, business in the modern world is inextricably tied to Internet capability. Workers in every sector—health care included—have come to expect the convenience of anytime, anywhere access to their files. And they want all that data in real time. Web-enabled simply can’t provide that.

Furthermore, if you have multiple clinics or different therapists accessing records simultaneously, you run the risk of individuals accessing or altering data that’s not current. When the EMR connects to the Internet to sync, someone’s entries might replace someone else’s work depending on timestamps. I hate when someone accidentally saves over work I’m doing in a shared file, and I’m just writing blog articles. Imagine if it were a patient’s record! Another drawback of web-enabled: you must download and install web-enabled software, meaning it resides only on the computer to which it’s installed and you can only access it from that computer. Talk about chained to your office. 

When you go with web-enabled rather than true web-based, you also must deal with the security drawbacks of server-based systems. Storing data on local servers, like the computer under your front desk, is just about as secure as keeping your money under a mattress; there’s no failsafe. True web-based systems, on the other hand, provide top-notch security features like unique password-protected access, bank-level security encryption, and automatic data backups. And the best web-based EMR vendors keep your data in a secure, defensible facility with 24/7 surveillance.

Because web-based EMRs undergo regular updates, they can easily integrate new compliance measures as they’re introduced. Built-in alerts ensure you always document completely, correctly, and defensibly.

Another reason to go web-based: the trust factor. Server-based EMR systems never manage your data. You do, because the data is stored locally, like on that server under your desk. So, when server-based systems switch to web-enabled, they’re essentially entering uncharted territory. That’s an issue. It takes a particular skillset to not only develop an application, but securely and compliantly manage the data associated with it. You want to go with the people who are the experts and have been managing data all along. Patient medical records are too important to trust with the inexperienced.

Lastly, true web-based EMRs are more cost-effective over the lifetime of the service than web-enabled EMRs because they feature low, month-to-month, per user costs. Web-enabled EMRs either offer the pricing structures of their server-based forebearers (contracts, hefty upfront investments, maintenance fees, etc.) or employ cost-per-chart pricing. You’re focused on growing your business, but that’s tough to do in a per-chart pricing structure where you pay more money for every patient that you add. In my book, your EMR should work for you and your business, not the other way around.

How to Avoid Getting Tricked by Web-Enabled

The value of EMR is pretty clear—as it relates not only to your business’s bottom line, but also to the quality of care delivered to your patients. Now it’s imperative that you choose a true web-based system by asking the following questions:

  1. Do I need to download anything? (With a true web-based system, you don’t need to download anything.)
  2. Do I need to install anything? (With a true web-based system, you don’t need to install anything.)
  3. Does your EMR need to sync with the Internet occasionally to update my online data? (A true web-based EMR is always functioning in real time.)
  4. Will I need to store any data locally? (With a true web-based EMR, you needn’t store any data on your computer.)
  5. When it’s time to document, how do I open the EMR? (You access a true web-based EMR simply by opening your web browser, going to the service’s website, and logging in.)

Your documentation is important. It’s how you demonstrate your expertise and value; it’s also how you prove that the services you provide are beneficial and necessary. That’s why you should choose an EMR worthy of you and the great work that you do. For that reason, go with a physical therapy-specific, cost-per-month, web-based EMR. It’s secure, mobile, and compliant; it’s quick to adapt and update; and it’s super easy to use. Most importantly, it is what it says it is. If an EMR vendor isn’t truthful about how its product actually operates, what else is the company hiding? Your EMR should be a reliable, honest business partner, dedicated to helping you achieve greatness in practice. Don’t settle for an EMR that provides you with anything less.


Compliance and Security: Cloud-Based vs. Server

HIPAA Compliance: Why Cloud-Based EMR is Your Security Champ

At this point, I think it is safe to say that sensitive data—such as patient records—is more secure in digital storage (i.e., electronic medical records) than it is in filing cabinets (i.e., paper charts). Software Advice’s analysis on the US Department of Health and Human Services (HHS) 2011 HIPAA security violation report supports this observation. But data security—and therefore HIPAA compliance—isn’t as cut-and-dried as computer-versus-filing cabinet. In fact, paper isn’t even a contender in this discussion. When it comes to patient data and security in today’s medical landscape, the two duking it out are both digital—and cloud-based has run away with the title.

Cloud. Server. What’s the Difference?

In a cloud- or web-based system, the EMR stores your clinic’s data—which can include everything from patient records to schedules—within data centers. You can then access that data via the web. All you need is a web-enabled device with an Internet connection. In short, you don’t store your data on internal servers (e.g., the computers at your practice), and you access the EMR and everything that goes along with it through your web browser (e.g., Google Chrome, Mozilla Firefox, or Internet Explorer).

In contrast, server-based EMR systems require your practice to store all its data as well as the EMR software itself. This means you’d need a server, corresponding hardware, and an IT person or staff simply to maintain everything.

Why the Emphasis on Security?

The Health Insurance Portability and Accountability Act (HIPAA) is a beast, especially with the newly introduced Final Omnibus Rule. HIPAA decrees that all healthcare providers, insurers, and their business associates may only collect, share, or use a patient’s protected health information (PHI) via the act’s approved methods and only for the explicit purpose of furthering patient care. To put it succinctly: if you violate HIPAA, you—and your practice—are in a world of hurt. Thus, data security is paramount.

How is Cloud-Based More Secure?

As this ServerWatch article explains, cloud-based software providers built their systems from scratch with the web in mind. Thus, they have “security best practices planned for and built into the system from the ground up. This includes everything from the core cloud computing software platform to the processes that are put in place and the monitoring systems used to control them.” How does that translate to you, the user? As I mentioned above, cloud-based EMR systems use data centers to house all their—and thus, your—data. To ensure HIPAA compliance, these data centers must possess bank-level security and supreme encryption methods that render data unreadable—even if hackers somehow get to it.

Server-based EMR systems, on the other hand, often leave data unencrypted. Furthermore, your data is only as secure as the room housing those servers, which means in the unfortunate event of a robbery, fire, or natural disaster, your data is in peril. You’re also at risk for a HIPAA violation. Data centers, however, securely back up data to multiple locations, so in the event of a natural disaster or fire, your data is still safe. Data centers also protect from physical breaches, too. Take web-based physical therapy EMR, WebPT, for example. WebPT houses all its data at the HIPAA-compliant IO Data Center in Phoenix, which has digital video surveillance, biometric screening, round-the-clock guards, and a defensible perimeter.

ServerWatch points out that “One of the biggest security problems for many organizations is the insider threat—the risk that an employee with access to sensitive systems will use his [or her] access privileges to compromise security.” There is also the chance that the server-based software and the computer it’s housed on lack the security protocols necessary to truly ensure HIPAA compliance. Cloud-based EMR systems take all this off the table, though. Most systems provide unique user IDs and passwords for each user (think: therapists, assistants, front office staff), which allows your clinic’s admin or director to control access to your patients’ private information. To use WebPT as an example again, they use 256-bit SSL encryption for customer interfaces. And as a recipient of the TRUSTe Certified Privacy badge, WebPT employs strict password guidelines for customers to ensure login security.

And that’s how cloud-based EMR systems best server-based software when it comes to security and HIPAA compliance. Bottom line: Make sure you’re using an EMR system, and make sure that system is cloud-based. Of course, not all cloud-based EMR systems are created equal, so it’s crucial that you vet potential vendors. Here is a list of questions you can ask. Already using a cloud-based EMR system? Ask them the same questions to ensure they’re up to snuff. And I recommend addressing the security of your data sooner rather than later. After all, HIPAA compliance is definitely not something for the back burner, and cloud-based technology isn’t going anywhere. It’s more than the future; it’s the present. Even the CIA is moving all its data to the cloud—and they’re the CIA.