Dystopic Times Call for Logical Measures

Why you need to change EMR systems.

By Heidi Jannenga, PT, DPT, ATC/L

According to Robocop, Back to the Future 2, and The 6th Day, the year 2015 was supposed to feature cyborg police officers, hoverboards, and successful human cloning. Disappointingly, many of us in the health care industry instead began this year with a strong desire to turn our backs on technology—and throw our computers out the window. Why? Well, the majority of our industry has switched from paper charting to electronic medical record (EMR) documentation, and while we certainly are not living in a Robocop-esque dystopian society, many of our EMRs make us feel like we are. Fear not, my fellow physical therapists. There is no reason for you to stay stuck in time with a lemon of an EMR. Believe it or not, there actually are great EMR systems out there—and there is nothing fictitious about them. IF your practice is on the brink of an EMR apocalypse, it is crucial that you switch systems before it is too late and look for a new solution.

4 Signs You Have an Apocalyptic EMR

1. It is designed for physicians.
While they share a doctoral title and a love of caring for people, physical therapists and physicians certainly do not share the same documentation needs. If your EMR is designed for a medical doctor instead of a physical therapist, you are probably having a heck of a time developing Band-Aid fixes and workarounds to ensure you can complete your documentation compliantly, and thus, get paid. Productivity dramatically affects bottom lines, and nothing zaps productivity like a system that does not jibe with your specialty and workflow. Plain and simple, as a physical therapist, you deserve an EMR that’s tailored to your needs. Just think: functional limitation reporting, eight-minute rule monitoring, and therapy cap tracking all built into your documentation software. Add in a design that matches the physical therapy workflow, and you have got major time saved and headaches eliminated.

2. It is server-based
If your EMR runs on a server, you are shelling out way more money and time than you should be. Not only do you have to worry about securing your patients’ protected health information (PHI), but you are also responsible for updating the system to ensure it is equipped with the latest compliance features—if your server-based EMR vendor upgrades its technology at all. Who has got time for that?

Alternatively, a web-based EMR enables you to securely access your documentation anywhere you have an Internet connection. And because most web-based EMR vendors store all their data with top-tier security firms, you can be sure your patients’ PHI is safe. As if that were not enough, you will also gain the benefit of never having to perform a manual upgrade again. Instead, your EMR vendor will automatically update the system for you, so you will always have the latest technological advancements and relevant compliance features at your fingertips. That means you will never miss out on potential incentive payments or suffer devastating fee schedule adjustments and denied claims.

From a more straightforward cost-savings perspective, web-based EMR systems require significantly lower capital investment—and subsequent financial commitment—than traditional, server-based systems. With online solutions, you do not have to purchase and install expensive equipment. And with no physical hardware in your building, there is 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 initial switch to your current EMR from paper records was tough, and you are 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 practice for implementation, with additional fees for support and maintenance.

While you cannot recover the expenditures you have already made, you can save significantly going forward. With 8,000 baby boomers a day turning 65 over the next 18 years¹ (AARP 2014), your practice is likely to expand in the future—and the more you grow, the more leverage you get for the dollars spent on implementing a web-based system.

3. It costs an arm and a leg—and a chart.
Your EMR should increase your cash flow, not deplete it. So, if you are using a system that charges you per chart or per visit, where is your incentive to grow? The more patients you add, the more you are paying your software vendor. That does not sound right. The good thing is, there is another payment model available. I recommend pinpointing an EMR solution that offers you a monthly, membership-style payment structure. That way your technology can adjust with—rather than cap—your growth. Look for a solution that does not lock you into long-term contracts or hold your data hostage. That way, you will never again feel stuck with an EMR that is not right for you.

4. It does not include free training and support.
If you are paying extra for support and training—or worse yet, there is no one available to answer your calls—your EMR is definitely bad for business. Sure, your system should be intuitive and easy to use, but good training should be a given and support should always be available just in case you need it. The last thing you want is to have an urgent question and either not be able to reach someone or have to shell out your hard-earned dollars just so you can get back to work. Instead, opt for an EMR vendor that prides itself on providing exceptional customer support and training—for free.

Debunking Making-the-Switch Myths

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 reported in a 2011 blog post titled “Top 5 worst EMR myths,” “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.” When shopping around for a new EMR system, look for one that has a straightforward, flexible, and well-documented training and implementation plan. Ultimately, no practice-wide change comes without a period of workforce adjustment. In the long run, though, you will recover any losses you incur due to transitional hiccups (see the next myth). Furthermore, if you are considering retiring, selling, or changing hands at your practice, switching to EMR sets your clinic up for future success and an easier transition.

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 feature low month-to-month charges 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.

Web-based EMRs can be expensive, too. However, the key is to look for truly web-based software (not web-enabled, which requires you to download a software platform that then connects to the Internet). True web-based EMRs charge per user, whereas web-enabled systems usually charge per chart or employ a pricing structure similar to those of their server-based forbearers (which typically involve contracts, upfront expenses, maintenance fees, and the like). You are probably focused on growing your business, but that is tough to do in a per-chart pricing structure that forces you to pay more money for every patient you add. Your EMR should work for you and your business, not the other way around.

Speaking of business blessings, not burdens: In many cases, clinics have to keep dedicated IT teams on staff just to keep all the bulky server hardware humming along. And if all that complicated equipment ever goes on the fritz, fixing it could set you back thousands of dollars—not to mention hours of lost time.

Now, you may be thinking that you can just drop your EMR and switch back to paper. I mean, paper is more cost-effective than EMR, right? That’s another myth. (Just think of how quickly the costs of copying, transporting, and storing paper records add up.) Check out these myth-busting stats from SouthTech Systems (2014):

• One four-drawer file cabinet holds 15K-20K pages, costs $25,000 to fill, and costs $2,000 per year to maintain.
• The U.S. spends $25 to $35 billion annually on filing, storing, and retrieving paper.
• It costs $20 to file a document and $120 to track down a misfiled document.²

Still not convinced? According to Medical Economics, it costs about $8 per year to maintain a single paper record, compared to $2 to maintain a single electronic record.³ 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 will save in labor costs and free up more time to see patients—a double dose of increased efficiency.

One final reason why you should not revert back to paper or stick with server-based systems is compliance. Server-based systems require you to handle all the upgrades yourself, and because those upgrades are cumbersome and occur irregularly, there is a good chance that at one point or another, you will be using an out-of-date system. And with compliance regulations in a near-constant state of change, an out-of-date EMR puts your practice at risk. The same goes for paper charting. The onus is on you—and only you—to ensure strict adherence to all regulations. (Do you have time for that?) If your documentation is not up to snuff, you could face penalties, fees, or rejected claims—not to mention any consequences that might happen as the result of an audit.

Sci-fi movies rarely depict utopian futures. But real life—especially in your physical therapy practice—should not follow the plot of a blockbuster film. Do not let your EMR drag your practice down by dystopic proportions. Trade up, and give your practice the happily—and easily—ever after it deserves.

Heidi Jannenga, PT, DPT, ATC/L, is the founder and chief operating officer of WebPT. Heidi leads the product strategy and oversees the WebPT brand vision. She co-founded WebPT after recognizing the need for a more sophisticated industry-specific EMR platform and has guided the company through exponential growth, while garnering national recognition. Heidi brings with her more than 15 years of experience as a physical therapist and multi-clinic site director as well as a passion for health care innovation, entrepreneurship, and leadership. An active member of the sports and private practice sections of the APTA, Heidi advocates for independent small businesses, speaks as a subject matter expert at industry conferences and events, and participates in local and national technology, entrepreneurship, and women-in-leadership seminars. Heidi is a mentor to physical therapy students and local entrepreneurs and leverages her platform to promote the importance of diversity, company culture, and overall business acumen for private practice physical therapy clinics. Heidi was a collegiate basketball player at the University of California, Davis, and remains a life-long fan of the Aggies. She graduated with a bachelor of science in biological sciences and exercise physiology and went on to earn her MPT at the Institute of Physical Therapy in St. Augustine, Florida. In 2014, she completed Evidence in Motion’s post-professional DPT program. When she’s not enjoying time with her daughter Ava, Heidi is perfecting her Spanish, practicing yoga, or hiking one of her favorite Phoenix trails. She can be reached at hjannenga@webpt.com.

REFERENCES

1. Baby Boomers Turning 65 – AARP. (2011). http://www.aarp.org/personal-growth/transitions/boomers_65/ Accessed March 2015.

2. SouthTech Systems™. (2015). from http://www.southtechsystems.com/gogreen.php Accessed March 2015.

3. Advance HR Functions with Document Management. (2014, June 19). http://www.paycom.com/blog/?p=1704#.VQh6O47F9Og Accessed March 2015.

4. Corporate Governance. (2014). Retrieved March 17, 2015, from http://www.haystac.com/corporate-governance/ Accessed March 2015.

5. Medical Economics, December 1997. Accessed March 2015.