EMR For The Enterprise

A Guide For Rehab Therapists
by Erica Cohen

You've got a lot on your plate—multiple clinics, dozens of employees, and hundreds of patients. Add a constant barrage of new rules and regulations—Health Insurance Portability and Accountability Act (HIPAA), Physician Quality Reporting Systems (PQRS), functional limitation reporting (FLR)—and it's enough to make your head spin.

With so many things to worry about, who has time to deal with unruly stacks of paper? As the director of a large rehab therapy practice, you're probably already familiar with the countless advantages—reduced costs, increased efficiency, fewer headaches—of ditching paper documentation in favor of an electronic medical records system. Perhaps you already have one in place.

In this day and age, the value of EMR is pretty clear—not only as it relates to your business's bottom line, but also as it relates to the quality of care delivered to your patients. Even the federal government has jumped on the EMR bandwagon with the HITECH Act, which requires all physicians and hospitals to adopt an EMR system for patient data by 2014.


Thanks to a constant stream of changing regulations, EMR systems also are becoming increasingly attractive to owners and managers of healthcare practices in a variety of specialties, including rehab therapy.

The thing is, not all EMR systems are created equally. Many do not take into account the workflow or treatment style of rehab therapists, and the server-based options of yesteryear are already well on their way to becoming obsolete. In fact, systems that were on the cutting-edge ten years ago are basically dinosaurs today. Why? Two words: the cloud.

The reality is that business in the modern world is inextricably tied to Internet capability. In a largepractice setting, everyone—patients, employees, referring physicians—benefits from working in the cloud. Soon, they will come to expect it.

In this whitepaper, we'll show you why upgrading to a cloud-based EMR system is the perfect way to streamline operations in your large rehab therapy practice and why the transition away from your current system will not be nearly as painful—or as costly—as you might think.

The thing is, not all EMR systems are created equally.

Why EMR In General?

Expectation

As a major player in the rehab therapy space, it's important for you to keep pace with evolving technology and maintain a reputation of extreme professionalism. EMR has long been touted as the way of the future, but it's fast becoming the way of the present. How do we know? Take a look at the following figures, courtesy of medicalrecords.com:

  • » About $19.2 billion of the $787 billion American Recovery and Reinvestment Act (ARRA) signed by President Obama in 2009 took the form of an electronic medical records stimulus. Why? Streamlining patient care and providing long-term savings in the health field is of supreme interest to the US Government as it continues to reform the nation's healthcare system.
  • » An estimated 57% of office-based physicians in 2011 and 87% of hospitals in 2012 had EMR systems in place.
  • » The 2009 Health Information Technology for Economic and Clinical Health (HITECH) Act requires that all physicians use electronic medical records by 2014, and it's important that other professionals in the healthcare industry keep pace with this transition.

Your credibility with referring physicians is of the utmost importance. With stats like these, it's easy to see why implementing an EMR in your rehab therapy practice would strengthen your rapport with doctors, thus generating new referrals to grow your business. Many EMR systems feature the added convenience of instant reports to update referring physicians on their patients' treatment. With WebPT, you can customize these reports based on the preferences of each individual physician.

And speaking of customization—EMR systems make it easy for businesses to create and distribute documents that are consistent in their organization and appearance. This is important in a large practice setting because it creates a uniform brand identity across all clinics.

Your credibility with referring physicians is of the utmost importance.

Cost Savings

Practices that use EMR systems not only save in storage, printing, and paper costs, but they also cut labor costs associated with transcription, receive payment more quickly, and create opportunities to see even more patients.

Billing already is electronic, but you can't really maximize your billing capacity if charges are left out due to human error. Completing your documentation within an EMR system that has integrated billing ensures the capture of all charges and reimbursement of all claims.

According to an analysis of primary care settings published by nyehealth.org, the average estimated net benefit of using EMR instead of paper-based records over a five-year period was $86,400 per provider (2002 dollars). Decreased billing errors and improvement in charge capture made up 30% of that savings. The same study found that transcription costs were reduced by 28% with a projected 2% improvement in billing capture. The expert panel involved in this study estimated that computerizing the charge sheet could decrease errors by 78%.

Some additional facts to consider (compiled from above sources and this MediServe article):

  • » An electronic chart costs $2 per year to maintain, whereas a paper chart costs $8 per year to maintain.
  • » Integrated, automated billing can increase charges by as much as 10-20%. For a large, high-revenue practice, that translates to tens—possibly even hundreds—of thousands of dollars a year in additional revenue.
  • » EMR scheduling features such as automated appointment reminders—which WebPT offers at no additional cost—significantly reduce the number of cancellations and no-shows. This is huge given that private practice facilities currently average a 13-18% no-show and cancellation rate.
  • » The net return on investment in EMR almost certainly will grow as time passes.

Accountability

With the decrease in reimbursements and the increase of regulations, the rehab therapy industry needs defensible documentation now more than ever. One of the reasons the government is pushing EMR in the healthcare industry is that government agencies, healthcare organizations, and insurance carriers can monitor electronic records for compliance much more easily than paper records.

The PQRS and functional limitation reporting requirements that CMS recently implemented provide a perfect example of regulations that would be much more difficult to satisfy in the absence of an automated system. And failure to adhere to such regulations could result in claim denial—meaning you don't get paid.

Luckily, though, most EMR systems feature built-in alerts and reminders to ensure that your documentation is complete, accurate, and compliant. In essence, EMR acts as your quality control. With the weight of compliance off your shoulders, you can focus your attention on what really matters—treating your patients.

EMR solutions also improve accountability by preventing the deletion of notes—a big no-no in the realm of documentation. If you are ever audited, you'll be glad your EMR empowered you to create an addendum.

Efficiency

In the absence of an electronic scheduling system, human resource management in a large practice setting becomes a nightmare. An EMR system with front-office capabilities makes it easy to manage the schedules of multiple therapists. Plus, with EMR you lose no time searching for paper charts when a patient comes in and filing them away once the patient has left.

Also, keeping all your patient data in an easy-toaccess, easy-to-transfer format opens up the door for participation in rehab therapy research efforts. Using data stored in EMR systems, researchers can easily build databases, study patient outcomes, and crosscheck complex information. For example, the Mayo Clinic and IBM collaborated to strengthen the link between research and the practice of medicine. The goal of this partnership is to discover new ways of harnessing patient data to improve diagnoses, create better computer models of diseases, and change the way patients and physicians interact and access information.

Additionally, the reporting features included in many EMR systems allow you to check the pulse of each clinic for things like productivity, number and source of referrals, and billing totals. This enables you to see what each clinic is doing right—and which areas still need work. It also can come in handy as you develop your strategy for marketing and reaching out to referring physicians.


Why Cloud-Based EMR In Particular?

Lower Cost

Earlier in this whitepaper, we established that implementing an EMR system saves money. If you're still a slave to pen and paper, you're probably giving some serious consideration to installing an EMR system in your clinic. And if you've already made the switch from paper to digital documentation, you're probably enjoying the benefits of lower costs.

But if the EMR system you implemented is serverbased rather than cloud-based, you might not be saving as much money as you could be. Webbased EMR systems require significantly lower capital investment—and subsequent financial commitment—than traditional, server-based solutions. When you set up shop in the cloud, you don't have to purchase and install expensive equipment. And with no physical hardware in your building, there's no need to power it, maintain it, secure it, and replace it once it reaches its shelf life.

You might hesitate to overhaul your system yet again. Making the switch from paper records was tough, and you're reluctant to put your staff through another big transition. But keep in mind that this change will definitely pay off—and quickly. With virtually no initial setup costs—no hardware and no need for dedicated space to house said hardware—the payback period is significantly shorter. Vendors of server-based systems, on the other hand, typically charge around $30,000 per doctor for implementation with additional fees for support and maintenance.

While you can't recover the expenditures you've already made, you can save significantly going forward. As an enterprise-level practice, you are likely to expand in the future, and the more you grow, the more leverage you get for the dollars spent on implementing a cloud system. Adding users to your account is simple, and if your system uses a monthly, per-user pricing structure—like WebPT's—instead of a per-chart structure, you won't have to worry about ever-increasing costs as your clinic grows. Furthermore, the cost of IT support staff alone makes the switch to a cloudbased solution worthwhile. Typically, web-based EMR systems automatically include tech support, which means that when you have a question or if something goes wrong, help is just a phone call away.

But keep in mind that this change will definitely pay off—and quickly.

Better Data Management

You've got a lot of clinics, which means you've got a lot of data to store. That can be a huge problem with a server-based system, where space is limited and your storage unit—i.e., hardware—is immobile. If you want to open a new location, you have to install a whole new set of expensive equipment. Why spend tens of thousands of dollars when you don't have to?

With the cloud, space is infinite. Many systems even allow you the ability to upload external data. WebPT, for example, does not have a cap on the amount of data its Members can upload to the system. And with advancements in Internet technology, speeds are generally fast enough to handle data-intensive content, whether it's images, video, or just pure text.

Unlimited data capacity also means your practice's growth is not tied to acquiring additional hardware as it's easy to add a new clinic and new employees to a cloud-based system. And speaking of data, you're probably concerned about the security of your patient records. The cloud has your back in that area, too; most cloud-based environments are linked to very large data centers with state-of-the-art security systems in place. Plus, you don't have to worry about physically locking up your server and policing access to it.

Compliance

With all of the new rules and regulations—PQRS and functional limitation reporting are two big ones right now (and there are bound to be more in the future)—you can't afford not to be compliant. Luckily, web-based applications make compliance a breeze. These applications are "living" systems— that is, they continually update to reflect changes in policy. For example, a recent update to the WebPT application added all of the necessary components to ensure compliance with Medicare's new functional limitation reporting requirements.

Plus, cloud-based systems continually change and evolve to serve the needs of their users. Talk about valuing customer input. Furthermore, upgrades are painless and require virtually no effort on your end. Upgrades to server-based programs, on the other hand, are much more complicated and time-intensive. There's also a great deal of risk associated with relying on outdated equipment. If something goes awry, there might not be anyone immediately available—and with the necessary knowledge and materials—to resolve the issue.

Accessibility

When it comes to convenience, nothing compares to the cloud. Therapists can easily access a cloud-based system from almost any web-enabled device without having to deal with virtual private networks (VPNs) or remote desktops, both of which are very prone to technical issues. Most cloud-based applications—the top-tier ones, anyway—experience very little downtime and provide instant support in the event of downtime.

Additionally, these systems often integrate with other emerging technologies, something server-based systems typically cannot do. Plus, cloudbased systems foster interoperability. For example, in the future, reimbursements—especially from Medicare and Medicaid—likely will require more, and higher quality, electronic data submissions from providers. And the healthcare industry as a whole will expect all of this data to easily transmit back and forth.


Cloud-based EMR solutions also offer unmatched portability—one of the main focal points of HIPAA. In these systems, patient records aren't tied to a specific location. This is great in an enterprise setting in which a patient might visit multiple locations. A web-based EMR application with internal messaging capabilities allows therapists in different clinics to communicate with each other directly within the system. Therapists with expertise in certain areas can easily lend their knowledge to colleagues, and those seeking advice don't have to waste time tracking down a certain therapist. This allows you to maximize the talent of your employees and thus improve efficiency, increase your bottom line, and above all, provide the highest possible quality of care for your patients.

On the subject of talent, remember—rehab therapists are in high demand. According to the US Bureau of Labor Statistics, employment of physical therapists is expected to grow by 39% from 2010 to 2020, which means top professionals in the field have a lot of job options to choose from. Offering an intuitive, convenient, modern, therapyspecific solution for documentation is a huge selling point for practices looking to attract top talent. Rehab therapists want a program that is tailored to their specific needs and allows them the flexibility to work where and when they desire. That flexibility leads to higher efficiency, smoother workflow, better employee morale, and superior quality of treatment for patients.

Patients also benefit directly from web-based EMR systems. It's easy for therapists to send out home exercise plans—including instructions, illustrations, and videos—thereby increasing the chances that patients will comply with the prescribed plans.

Community

The benefits of a web-based, rehab therapyspecific EMR system don't end once you've signed out for the day. Case in point: In addition to WebPT's constant effort to improve the application based on user suggestions, we've also invested considerable resources into building a community for our Members.

We have become a trusted resource for all things rehab therapy, providing industry information and news in the form of blogs, webinars, and slideshows. But that's not all. We've also negotiated an awesome deal on continuing education units (CEUs) through MedBridge, which allows our Members to take advantage of preferred pricing on online CEU courses taught by the world's top instructors.

We've also maximized the collective buying power of our Members with the launch of our new WebPT Marketplace. Through this ecommerce site— accessible directly from the WebPT application— our Members can purchase their favorite therapy supplies at deeply discounted prices. This is especially lucrative for large practices with multiple clinics; the more you buy, the more you save!

Patients also benefit directly from web-based EMR systems.

Debunking Common Fears

So, you're leaning toward switching to a webbased EMR solution. But you still have a few lingering concerns that you must address before you can fully embrace the cloud in all of its accessible, compliant, cost-effective glory. Here's a roundup of common fears and the truth that will help alleviate them:

Security

The Fear: Distrust of Internet security is still prevalent among those in the healthcare industry—with good reason. Healthcare providers are charged with protecting a lot of sensitive Protected Health Information (PHI), like patient names, insurance IDs, diagnoses, Social Security Numbers, medications, billing information, and medical history.

It's easy to see why they're so nervous. According to HIT Consultant Media, Data breaches cost the US healthcare industry nearly $7 billion annually. Approximately 94% of healthcare organizations have suffered at least one data breach during the past two years with 45% reporting more than five breaches in the past two years. Nearly 20 million patient records have been compromised in the past two years. The cost of responding to breaches averages $2.4 million.

Furthermore, the repercussions of privacy violations are harsh, to say the least. HIPAA rules extend the burden of security and privacy requirements to business associates, contractors, and subcontractors (e.g., billing companies) that perform services on behalf of a provider. The penalty for non-compliance has increased to a staggering $1.5 million per violation.

The Reality: With so much at stake, data security should be one of your top priorities. You've probably heard a lot of talk about Internet "hackers" and such. Maybe you've even experienced it firsthand with a personal email or social media account. That's why it's so important to shop around and take a close look at the security features associated with any web-based EMR system you're considering. For example, IO Data Centers—a Tier III-Certified facility that provides data infrastructure to the world's largest enterprises, governments, and service providers— houses WebPT's servers. Fellow IO clients include Amazon, eBay, Salesforce, Facebook, PayPal, Honeywell, and the Department of Homeland Security. As a Tier III facility, IO offers multiple layers of access control, including a defensible perimeter, video surveillance, and round-theclock security guards.

Even so, many providers are nervous about relying on a system that exists outside the walls of their practice. The ability to see the physical location of the data gives some providers an added sense of security and control. In reality, there is much less risk associated with housing data in the cloud. Think about it: if your information is located exclusively in onsite storage, you risk losing it all to disaster, accident, or even theft. These "what-if" emergency scenarios simply do not apply to data storage in the cloud. WebPT currently holds 37 million patient records in its servers, and not a single one has been lost—ever.


Credibility

The Fear: If your practice has an electronic records system in place that works well enough, making the switch to cloud-based technology might seem like not only a waste of time and money, but also a gamble in the trust department. The company that manufactured your current system has probably been around for a long time, and that makes it seem more credible. You're busy, and you're overwhelmed by the prospect of carefully researching all of your options. And even if you find a system you like, you'll probably be reluctant to commit to something new and different.

The Reality: Even large server-based EMRs are starting to explore—or have even started offering— cloud-based alternatives. Why? Because they understand that the entire healthcare industry is moving in that direction. What does that mean? It means servers inevitably will become obsolete. Furthermore, longevity in the EMR market does not necessarily translate to credibility. It's important to consider user ratings of any system before you commit to it; a quick Google search can provide customer reviews on your current EMR. Are they really holding up to your standards?

Control

The Fear: Many providers are nervous about relying on a system that exists outside the walls of their practice. They are afraid that if something goes wrong, they will be completely helpless to correct the situation. What if the system goes down? What if the connection speed is slow? What if the data you enter into the system gets lost? What if you need hard copies of your records?

The Reality: System-wide downtime in a webbased 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. Internet speeds today are more than fast enough for your web-based EMR needs. Remember, server-based systems also require Internet connections that are affected by lag and latency during peak Internet-use hours.

Although there is a certain degree of comfort that comes with having all of your data under your own roof, keep in mind that with that small bit of control comes all the responsibility of protecting it, updating it, backing it up, and staying compliant with all patient privacy regulations.

As for data loss—any cloud-based EMR system worth its salt backs up its data consistently and reliably so lost data is never an issue. For example, WebPT backs up all system data every 60 seconds. That way, no data is lost in the event of a sudden system outage. And you maintain complete ownership of your records. If you ever need a hard copy of your data, all you have to do is ask. You'll receive it in an encrypted format, and we'll still keep a backup record of it for ten years.

Productivity

The Fear: Large practices have a lot at stake, and transitioning to a new system puts a big strain on workflow, efficiency, and overall company morale. You might worry that the opportunity cost of staff time dedicated to training in, and adjusting to, a new system is not worth the benefits.

The Reality: If you're having trouble seeing past the short term, consider this: WebPT routinely gets new clinics up and running in one day. Although new Members typically learn the software in a virtual meeting environment, 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. No practice-wide change comes without a period of workforce adjustment; but trust us—in the long run, you'll recover any losses you incur due to transitional hiccups.

With the decrease in reimbursements, the increase of regulations, and the overall competitive nature of the profession, you need tools to help you be better in business while staying compliant and crafting clean, detailed, and goal-oriented SOAP notes. Isn't it time you elevated your practice? Isn't it time you implemented a web-based EMR to help you achieve greatness?

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