Choose Wisely


How to choose an electronic medical record and practice management system that is right for your practice.

By Scott C. Spradling

It’s a moment every administrator meets with equal parts joy and angst: The boss comes in and says, “Okay, let’s get an electronic medical record (EMR) and practice management (PM) system.” Your joy over the prospect of streamlining the practice by eliminating waste and reducing costs is soon overshadowed by the thought of sifting through hundreds of available products to find a system that is the best fit for you and your therapists. Where to begin?

The purchase of an EMR and PM system can be classified into three main categories; Platform, Functionality, and Cost.

First, let’s look at platform. In today’s market, two main platforms exist: server-based or Internet/cloud-based. A server-based product is one in which the actual software lives within your in-house system, most likely on a primary server, to which all of your machines access through your internal network. Typically, this set up will require more attention to hardware and operating system maintenance and upgrades, and also upgrades from the vendor to keep up with technology changes to operating systems. Only those machines connected to your primary server will be able to access your system. On the other hand, it lessens your dependence on the Internet for most of its use.

An Internet/cloud-based product requires only a connection to the Internet to have dedicated access to your company’s “database” via a hyperlink. Your access is controlled by a user name and password. This reduces the requirements on your own hardware and also provides greater mobility and access. Another advantage is the ability to access the program wherever you are so that therapists and administrative personnel can work from home (or on the go). However, one must be aware of possible HIPAA violations. A strong protocol for the protection of PHI must be in place.

A downside of an Internet/cloud-based product is that if you lose your Internet connection, you lose your access. So, you must always have a back-up protocol that aligns with your Internet provider’s capabilities.


This leads us to our second category, functionality. Before considering any product, you must understand the entire patient experience, from the first phone call to the last payment. How do they register? How do they schedule? How does the therapist document and report his or her work? How do you bill, collect money, manage accounts receivable, monitor productivity, and report metrics? Once you have answers to these questions, you can design the product demonstrations to best serve you. Product salespeople will want to show you everything their system can do, but what you really want to know is what it cannot do. How will using this product affect how you function daily? Is it user-friendly? How many clicks does it take to get from point A to point B? Understanding your staff’s knowledge and comfort level with technology will also be helpful and allow you to gauge the level of training required for implementation.

Documentation is a constantly evolving beast in the world of physical therapy, and the requirements necessary to support the use of skilled interventions and medical necessity are only getting stricter. One also has to take into account Medicare guidelines for quality reporting, functional limitations, and therapy caps, along with ICD-10. A sound product will take these into consideration and have mechanisms for monitoring and maintaining these guidelines and regulations. During the product demonstration, review the reports and identify the variety of reports that can be generated. Does the product tell your story the way you want it to? Be wary of vendors that claim everything is customizable. More often than not, there are still limitations on what you can customize. A good, quality product will be able to produce a complete and informative patient report and treatment note, with more detail than you may be accustomed, along with making the monitoring of documentation compliance much easier.

Lastly in the area of functionality, you must look at the components of the product. Is it sold as an “all inclusive” package or is it a “modular” package? How many different places do you have to log in or open up? Does information flow in one direction only or does it sync up regardless of where you are in the program? Does the program have any third-party vendors with whom you also need to connect to or contract?

This brings us to the last category of cost. Costs include both implementation cost and ongoing/maintenance cost. How much will the product cost you to launch? Do you have to buy new hardware or upgrade operating systems? Is there an implementation fee or set up fee? Is free training offered and if so, how many hours? If not, what tools are available for training?

Next, you need to consider how much it will cost you to maintain this product moving forward. Server-based products will include one-time software costs and frequently an annual technical support fee and the cost of any software updates. An Internet/cloud-based program typically functions on a subscription basis. These range from a “per visit price” to “monthly subscription fee” and “monthly user fee.” There is no formula to determine which is better or more cost-efficient. Which one suits your company’s profile and budget? A per-visit price model simply means paying a monthly price per company/location or per active user. Find out if there are any limits on users or discounts for large numbers of users. Regardless of which model you choose, you should break down costs to a per-visit fee to help determine the product that gives you the best value.

Ask for references from the vendors so that you can speak to actual like-minded product end-users. Whichever product you chose, make sure you “test it till it breaks” and protect yourself with an “out clause” if it fails to meet your expectations. Lastly, make sure you allow yourself plenty of implementation time and roll out the product in phases over the course of three to six months. New product implementations rarely deliver instant rewards; allow time to master the learning curve. If you have done it well, you will see the benefits soon enough.

Scott C. Spradling is a member of the PPS Administrators Council and a certified administrator since 2011. He is the administrator of Movement Systems Physical Therapy in Seattle, Washington, and can be reached at

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