Kenji Carp, P.T., O.C.S., A.T.C., opened his own physical therapy practice Cooperative Performance & Rehabilitation in Eugene, Ore. in June 2010. His practice is 70 percent orthopedics patients and 30 percent vestibular patients. Carp has grown his practice from one therapist and one billing manager to four therapists and three front desk administrators in a relatively brief time with the help of WebPT (Phoenix, Ariz.), practice management/electronic medical record (EMR) software, and Apple’s iPad. Carp spoke with HCIAssociate Editor Jennifer Prestigiacomo about the efficiencies that have resulted from integrating an EHR and a tablet into his practice’s workflow.Healthcare Informatics: When did you implement an EMR in your practice?Kenji Carp: Recently, I opened my own my own private practice, and when you do that there’s always concerns with carrying over the quality—can you keep the referrals and those lines of communication? I think [my EMR] has been a big part of that clinically and in growing our business. We really thought that that was a big part of our due diligence. I went the previous year to the American Physical Therapy Association Combined Sections Meeting and looked at a lot of varieties for electronic medical records. I think there’s a lot of them out there that are a rehash of different medical [products]. You can tell the designers of [WebPT] have given thought to people in my situation, who want to grow a practice. There are a lot of powerful tools that help us track referrals and track how we’re doing on productivity and cancellation and no-show rates. I think it’s a great tool for all my staff therapists to document correctly and give quality care. It’s also a great tool for private practices like ours that have to be cognizant of the bottom line and business success and what return we get on the different vendors we invest in.We’ve also taken on a sublessor as a client [Willamette Hand Therapy, Eugene, Oreg.], who pays us to do scheduling, office management, and billing for them. That’s a source of revenue for our business. They deal with hands, which are also a nice synergy for us; and we’re able to offer them a value-added service. A lot of businesses are looking for turnkey revenue, where you’ve invested in a system, and you have another way to generate a revenue stream. It’s easy because these are just things we already have going.Our EMR has the ability to really translate what we want our clinicians doing with evidenced-based practice into the way that they’re charting and thinking about patients. A good example is we want all our therapists to use standardized outcomes measures, not just on their Medicare patients, but all their patients. Those are integrated in WebPT; it’s almost hard for staff therapists not to do that because they come up within the charting automatically. We treat a lot of patients with orthopedic and vestibular problems, and they have balance issues; so one of the outcomes measures that a lot of therapists use is the dynamic gate index (DGI). With WebPT, when I’m doing an evaluation, I can click one little tab on my iPad that says “outcomes measures,” and it pulls up all the available things I can use to document that progress. I can just enter a raw score, and I can come back later and see an outcomes measure, either an evaluation to document where they’re at and the functional limitation and the risk for falls. And hopefully four to six weeks later when I’ve trained them, I can document the improvement they’ve made. Just having that integrated so easily within the documentation suite, means that automatically my people are using a good measure to quantify the risk for falls. The nice thing is instead of having 30 staff meetings about compliance and haranguing people to use these measures; it’s just easy in WebPT because they come up as options.
Kenji CarpHCI: So, you use the iPad for documentation. Can you tell me about that process?Carp: What we really love about [our system] is you can access it from any platform. What we really love about the iPad is its tablet size. We can be right in the room with the patient. I’ve found patients really like the iPad because you can be entering [information], but you don’t have to look down as much as you do on the laptop, so you can still have those nonverbal communications with the patient. I think they like seeing that we’re being accurate and entering as they speak. And it’s so easily pulls up that I can jump back and forth between the WebPT, and then go to a picture of that injury for anatomy education. That is a nice thing about the iPad, versus non-Web-based documentation systems—I’m not tethered to a wall. I can jump back and forth. It also works really great on a Mac or PC. There’s sometimes when I have a really long narrative note, and I can pull it up on my iMac. It’s nice to know that I can pull this up anywhere, and it looks the same everywhere I’m at, since it’s Web-based.HCI: What was training like for PTs in your practice on these technologies?Carp: We’re building and revamping our Web site, so I just had an IT person go over training with a staff member yesterday, and the nicest way to put it, he just wasn’t that optimal. However, every time we’ve worked with WebPT, it’s been really nice. They have a cool thing where they take over your computer, and if there’s a question, you can ask it at your pace. They’ve been very flexible. I have a student from University of Montana in clinic, and we can have the WebPT people set up a time with him before he ever hit Eugene. He’s already worked with them, and he’s shows up at our clinic and already has training. The system is pretty intuitive. What I found for our staff is there wasn’t much of a learning curve.HCI: What efficiencies has this information system created in your practice?Carp: The ability to fax straight to digital is great. We’ve all had the situation where the doctor wants to know if the patient can get back to play basketball. They have us do functional testing in the clinic to see if the patient’s knee is going to hold up for that. The game is that Monday at 4:30 p.m., and before would have turned into a whole megillah—getting to your desktop, writing up your report, getting it in the chart, and having your staff stat fax it to the doctor, who then has to carbon a copy to the school’s athletic trainer. Or, I’m on my screen in my EHR, and it digitally faxes to the fax number we have entered into our list of referrals, and I tell the doc to check the fax in five minutes. Oh and by the way, while I’m on there, I can just add the number of the trainer and fax that. Not only is the accuracy of the documentation that much better, it’s really PT-friendly; and you’re literally improving the speed of communication.Sometimes all the requirements they heap on us with documentation, I think sometimes clinicians feel like it’s a requirement, and we’ve lost track of that this is supposed to be a form of communication to other clinicians or a record of what happened. And this really feels that it’s put it back in your hands. It’s useable communication because you can get it there pretty quickly.I managed a practice for six years for my previous employer before I opened this one in June. So, I’ve got a pretty good line on the expenses that it takes to operate an outpatient clinic. We spend 75 percent less on our pen and paper office supply cost because of going digital. A good example is the faxing that I just went over eliminates the whole process of pen and ink. If I look at my invoices from Office Depot, paper, pens, and printer cartridges are the most expensive things you order, and a lot of that just goes away. Another thing that goes away is your front desk administrative staff man hours, in which they take the note, fax it, dial the number, resend it if it didn’t go through; and while that was happening they missed a call on a new referral— all that goes away. Also, we used to rent storage space for old charts— all that goes away, and the costs that go with that. We still have a shredder service that comes for some of the few hard copies we get, but the volume went [dramatically] down.HCI: What do clinicians need to know before installing a clinical information system in their practice?Carp: I think for clinicians it takes discipline; you need to change your protocol. We’ve gone to iPads in the rooms, and you should be entering as much data in right as you’re collecting it. So, if they can get out of the room and have a percentage of their note already done, that’s our goal for clinicians. They might still pull up the EMR from any platform they want and finish up the note and make it pretty. One of our therapists really likes the preview feature. She likes to pull it up and make sure it looks good in the format that is going to go out to the doctor.I think it would be a good thing for your readers to know though, if you’re going to go with a [clinical information] system, you have to see that as a strength and really change your SOP [standard operating procedure] for that. I see this as a force to change my practice. It makes it easier for clinicians to give quality care. The service that we deliver to our patients is still done by hand, but I think this system creates an environment that makes this easier to do with more quality. All the research that they’re [WebPT] using to pick which tests and measures they put in helps for the simple fact, if you have a therapist struggling with the concept of writing good functional goals and understanding how they should be using that to shape their plan for the patient. This system makes it easy for them to shift into that. It’s a good way to have your staff always keep themselves honest of if they are giving a good service to their patient.