The Practice of the Future Is Now

EMR is more than documentation.

By Dan Alloway

Ask any therapist, “How do you feel about the changes in health care? Are you excited about the future?” After a grimacing stare, they will launch into an often repeated rant about government getting in the way of patient care and “the good old days” when we spent our time treating. “This is not what I signed up for! This is not why I became a therapist!”

While these perspectives are an appropriate reaction to the first generation of electronic medical records (EMR) and health care reform, they are not an accurate description of future generations—or better yet what is available right now.

In the outpatient rehabilitation “practice of the future,” patients will arrive to a calm, welcoming environment. Unlike the overworked, stressed-by-new-rules front desk employee of today, future EMR systems will be aware of payer rules and of changing government requirements. In fact, the EMR will communicate with each patient’s payer electronically, complying with each oppressive requirement. Data will be digitized, substantially reducing the need to scan most documents.

The patient (who books their airplane tickets online, banks online, and shops from Amazon and eBay online) will check in with an automated system that remembers their medical history, emergency contacts, and other details.

The role of the front desk operator will be entirely different in the practice of the future. Since technology will automate most of the “grunt work,” the front desk operator will have the time to focus on patients. The new role of the front desk operator will be practice ambassador. Their focus will be on the patient, with the goal of maximizing their experience in the practice.

While the therapist will edit details and supplement notes, therapist EMRs will be largely automated. Second generation EMRs will employ artificial intelligence to analyze evidence from the patient, both from within the practice and from a nationwide database. This verbiage will be built on the fly, based on the patient’s diagnoses, risk factors, severity, treatment plan, and a host of other factors.

Therapists will be scientists, analyzing nationwide outcome data to identify the treatment plans for the given diagnoses and risk factors that are proven to yield the highest patient outcomes. The analyses will be automated. Think of it as if Google searched, “The top three or four nationwide treatment plans for sciatica for obese 60 to 65 year olds who smoke.” The therapist will analyze a palette of the treatment plans, proven to be most effective and then will apply their clinical judgment and select a course of action. As a result of her/his decision, evidence-based, defensive documentation will be automated, providing statistical proof that the chosen plan of care will restore the identified functional deficits for the specified set of risk factors.

This evidence-based analysis will be one of the most exciting elements in the practice of the future. While this patent pending technology will revolutionize every discipline in health care, automated evidence-based analysis was conceived, developed and first utilized in outpatient rehabilitation.

How patient outcomes are measured and utilized will be turned on its head in the practice of the future. Unlike today, where outcome registries are typically oriented toward the number of patient visits, sometimes including progression, automated evidence-based analyses will emphasize progression. While this technology will identify that treatment plan “A” yields 35 percent progression in eight visits, the practice of the future will also be aware that treatment plan “B” yields 65 percent progression in 12 visits and treatment plan “C” yields 82 percent progression, but requires 16 visits.

This complete paradigm shift in outcomes will be good for the patient (82 percent progression verses 35 percent), good for the practice (16 visits verses 8), statistically validates that outpatient rehabilitation is the most effective, lowest cost medical alternative and it holds the payer accountable to the fact that the patient is paying for insurance to restore their functional deficits, not to minimize their number of visits.

In the practice of the future, every patient will be part of the therapist’s scientific quest to constantly improve patient outcomes. Therapists will be free to apply their clinical judgment and alter the statistically superior treatment plans, based on experience. For the first time in their careers, therapists will see the impact that specific changes in treatment have on patient outcomes. As a result of this “constant improvement” environment, outpatient rehabilitation will enjoy a revolution in patient outcome improvement that will bolster our positioning and importance, amidst other sectors of health care.

In the practice of the future, therapists will finally live in the world of evidence and science that they were trained to use, but never had time to research.

The billing department will be automated. Intelligent, payer-cognizant software will create clean claims and submit them electronically.

In the practice of the future, collections will largely be a battle between integrated EMR billing software and the payer’s computers. Outpatient rehabilitation specific billing software, integrated in the same database with scheduling and documentation will win against the payers’ computers thousands of times every day. The pace of analysis, change, and adjustments are untenable for any human and will not be attainable using a multidiscipline billing software.

Is “The Practice of the Future” an inspired vision? Is it a “longshot” dream? How real is all of this?

Here’s an overview of what is currently available:

• Automated check in process that relieves front desk staff of their “grunt work”
• Second Generation EMR that analyzes evidence and recommends complete sentences and paragraphs detailing: functional deficits, G-codes, including defensive documentation, functional goals, clinical rationale and more
• Evidence-based defense, that recommends the treatment plans that are proven to yield the highest outcomes for a given diagnosis and risk factors (the analogy was, “Think of it as if Google searched, “The top 3 or 4 nationwide treatment plans for sciatica for obese 60 to 65 year olds who smoke.”) Accompanied by technology that automates defensive documentation and statistical proof that the chosen plan of care will restore the identified functional deficit.
• Numerous patent applications have been filed. These technologies are patent pending
• Alpha testing is underway today
• Automated billing department, including workers comp and motor vehicle claims submitted with attachments, touch free
• Collections being largely a battle between the EMR system’s computer and the payer’s computer, with outpatient rehab-specific software that wins against payers computers thousands of times per day.

Welcome to the future!

Dan Alloway is vice president of development at Systems4PT. He can be reached at DCA@Systems4PT.com.