Web-based and server-based EMR systems are the two options in physical therapy documentation software. Nitin Chhoda discussess the advantages and disadvantages of both options and helps you decide which type of EMR is best for you.
There’s been a lot of confusion and indecision among physical therapists about which type of EMR to implement.
Therapists can choose from a web-based or server-based EMR. Both can be pricy, but practice owners should be aware that there are free EMR physical therapy documentation software programs available.
They’re customizable, created by and for physical therapists, and feature an array of the most highly sought functionalities by clinic owners.
Whether web-based or server-based, physical therapy documentation software purchased from a vendor can be extremely expensive and require exorbitant monthly fees to pay for the vendor’s sophisticated and extensive data center.
Server-Based Versus Web-Based
A server-based system is housed on-site at the clinic. It doesn’t rely upon an Internet connection to access data, but remote access can be limited, necessitating establishment of an expensive WAN network.
A web-based physical therapy documentation system is hosted by a vendor and information can be accessed anywhere in the world where an Internet connection is available.
With a server-based system, therapists have more control of the overall data within the physical therapy documentation system. But with that control comes all the responsibility and cost of updating servers, backing up data, ensuring the security of patient information and remaining in compliance.
The cost of maintaining databases, workstation and networking within the office is also at the discretion of the clinic owner.
A web-based EMR dramatically reduces the cost of set up, maintenance, upgrades and IT support. Physical therapy documentation training is provided and a higher level of security can be achieved.
A high-speed Internet connection will be required for both options, but with a server-based EMR, connectivity is confined to the speed of hospitals, labs and other professionals with which the practice is communicating.
Either physical therapy documentation system can be affected by lag and latency during peak “rush hours” online when students arrive home to visit on Facebook and view YouTube videos.
Customization of forms and documents is an essential feature of any EMR and a server-based system can allow for extensive changes and customization of processes to meet the individual needs of a practice.
Many web-based EMRs type of physical therapy documentation aren’t conducive to changes or customization. They can intrude upon and affect the way therapists operate their clinics, making it imperative to implement an EMR specifically designed for physical therapy practices.
Weighing Your Practice Needs Are Very Important
Both server-based and web-based physical therapy documentation systems encompass a variety of features beneficial to a practice. Clinic owners must weigh the advantages of maintaining control over their EMR with shouldering the entire burden of cost and security.
Those who opt for a web-based EMR enjoy training, enhanced security and anywhere access, but speed can be limited during peak usage hours and by the abilities of connected EMRs. Confusion over the type of EMR to deploy has led many clinic owners to hesitate and delay implementing physical therapy documentation software.
EMRs provide the means to increase the efficiency and profitability of any practice with electronic bill submissions and marketing analytics.
Both types of EMRs also support patient portals that assist clients in scheduling appointments, requesting refills, viewing test results, and completing forms, encouraging clients to take a more active role in their healthcare.
Let’s face it. Healthcare is complicated. Nitin Chhoda explains how a good EMR system can simplify healthcare with simple and efficient data entry, better patient communication between provider and patient, and improved interaction between providers.
In this article, learn how to make scheduling, documentation, billing and even marketing simple and systematized in your practice.
Spiraling costs for clinics and tougher reimbursement standards are two of the most pressing problems facing physical therapy practices.
An integrated medical EMR offers an elegant and efficient solution to provide an enhanced level of patient care, while facilitating collections and reimbursements.
A variety of individual office systems has been available over the years, but software creators and designers have raised the bar with electronic medical records.
The Best Tool
Today’s integrated systems provide a comprehensive array of tools for billing, scheduling, communications and marketing to keep practices profitable and maintain a superior level of patient care.
EMRs are available as web-based software systems that are compatible with a wide array of tablets. Medical EMR software can also be implemented via on-site servers, but require costly hardware and practice owners are responsible for maintaining their own security and remaining HIPAA compliant.
A web-based system is extremely fast and offers computing in the cloud that can be accessed from any venue where an Internet connection is available. The portability of a web-based medical EMR allows therapists to take advantage of new opportunities to increase their stream of revenue.
Clinicians can extend their services into an array of new avenues, from corporate wellness programs, senior facilities, in-home services and even spas. Modern physical therapy treatments and associated services aren’t just for those who require extensive rehabilitation.
EMRs excel as a point of billing and coding, expediting reimbursement claims and allowing funds to be deposited directly into the clinic’s account. They significantly reduce errors and mistakes that result in rejections and denials.
If a claim is questioned, additional information and documentation can be sent electronically, via medical EMR, to insurance providers and clearinghouses in a matter of moments instead of waiting weeks or even months to cycle through the postal system.
A patient portal is an important part of any integrated medical EMR. It provides the means to contact patients by phone, email, and voice and text messaging, and collect insurance information to verify eligibility before the client arrives at the office.
Patient forms can be offered online to eliminate long waits in the office, schedule appointments, post test results and offer pertinent information. A patient portal makes it easy for clients to make secure payments online.
Therapists alleviate pain and improve the quality of life for millions of clients each year and an integrated medical EMR allows clinicians to begin treatment sooner. EMRs enable therapists to access a client’s records to determine previous treatments and their success rate, along with other information pertinent to future services.
EMRs allow patient records to be updated immediately and accessed by multiple healthcare providers for the most current information available. A medical EMR is unparalleled as an advertising and marketing tool. Clinicians can easily ascertain where referrals are originating and identify patients that may self-terminate treatment or pose a financial risk to the clinic.
Marketing efforts can be tracked and monitored, and therapists can locate specific demographics on which to focus for future campaigns. An integrated medical EMR will affect every aspect of a physical therapy practice. A system designed specifically for therapy clinics allows users to customize forms and work smart, not hard.
EMRs are fast, efficient and increase the overall productivity of practices. Clinicians can begin treatment sooner for better patient outcomes, while ensuring a steady cash flow for the practice.
The big day for the ICD-10 transition is just around the corner. Practices should have been using their time to train, install hardware and test their software for compatibility with other entities with which they communicate. However, despite the best laid plans and intentions, clinicians may not be as ready as they think. Software systems are a prime consideration and there are steps that practitioners can take to ensure they’re ready when Oct. 1, 2014 arrives.
There are dozens of EMRs available. They have multiple features, but clinicians are often required to pay extra for access to updates and other items that should be included automatically. Practitioners will want to ensure they have an EMR capable of handling the new codes and that they have the latest version available installed.
EMRs must have sufficient security measures for HIPAA compliance to safeguard patient information. Consult with vendors to verify that the EMR is HIPAA compliant, code upgrades are covered in any contracts, and if training will be included.
A crosswalk offers a means of translating ICD-9 codes to the new ICD-10 version. It’s essential that any software include those crosswalks for translation, especially in the early months of the transition. If the EMR doesn’t support crosswalks, clinicians may need to invest in a program to assist with coding tasks.
General Equivalence Mapping isn’t designed for long-term use, but it does provide a valuable resource. It’s a tool that can be used to assist in locating the correct code options and help staff become more fluent and comfortable with the new code selections.
Until everyone in the practice is familiar with the new coding system, a side-by-side coding feature will prove very helpful. It will reduce staff frustration and help everyone rest easy knowing they’ve entered the correct diagnosis codes.
A system that allows clinicians and staff to incorporate the new coding into their everyday duties will help everyone become familiar with the new codes before the deadline. They can also begin using the new codes prior to the implementation date with entities that are ready.
It’s critical that in-house or contracted billing services are prepared for ICD-10. They must be compliant with the new HIPAA transaction standards for transmitting data electronically. Be prepared for a reduction in productivity, even with superior billers and coders.
Testing should include the ability to submit claims and insurance eligibility. The only way to ensure if a practice’s software is ready for the ICD-10 transition is to conduct exhaustive testing in those areas – then test some more. If any glitches or issues do exist, the more the system is used the more likely they will be to become apparent. It’s also important that inter-office systems can communicate with each other.
The software that transmitted a claim perfectly today has the potential not to work smoothly tomorrow. Continued testing is the only way to ensure that problems are identified and addressed prior to the deadline. If for some reason an issue can’t be fixed by implementation day, be sure to have a contingency plan. Relationships with new vendors may have to be established, so be prepared.
Significant coding changes will take place with implementation, but if the practice’s software can’t communicate successfully with insurance companies and clearinghouses to submit claims, they’re of no use and will cost clinics dearly in revenues. Implementation is more than just a coding change. It affects every department. Ensuring the clinic’s software is working correctly will make the transition easier while maintaining revenue levels.
Almost everyone in the medical profession anticipate a loss of income with the implementation of ICD-10. However, some healthcare management and technology firms have postulated that the switch to ICD-10 will present practitioners with opportunities to increase revenues, as it will be easier to document co-morbidities. They also note that the key to increased revenues depends on greater documentation accuracy, one of the stated goals of ICD-implementation.
The new documentation requirements for ICD-10 have a focus on the specifics. Payers want as many in-depth details as possible for each claim so they can decide if they’ll make the reimbursement or if the financial responsibility can be shifted elsewhere. Clinical documentation is a critical element for clinician reimbursement.
The American Academy of Professional Coders (AAPC) estimates that only 37 percent of current clinician documentation provides enough detail to meet the stringent reporting requirements of ICD-10. Documentation will require more detailed information on topics that include the what, when, where and why of injuries, diseases and conditions.
Typical information about the client’s height, weight and vital signs will remain, but the details of an injury and surrounding circumstances are much more specific. In the previous example of the woman who suffered shoulder pain and headaches after an accident on a cruise ship, the following information will be required under ICD-10 coding.
All external causes that led up to or contributed to the injury;
The exact location of the injury on the patient’s body;
The patient’s actions and activities at the time of the injury and after;
Injury codes require a character extender to identify the type of encounter and if the patient sought medical attention;
Data will be required to identify where the client sought medical treatment, any tests that were conducted and referrals that were made;
The patient’s location when the injury took place or when the symptoms appeared is essential and ICD-10 provides data that narrows the location to a specific room, environment or mode of public transportation, including cruise ships;
Applied specificity is required for any number of accidents and injuries to document the immediate symptoms experienced by the patient at the time of the incident, as well as ongoing symptoms, severity and frequency;
Clinicians must indicate any methods the patient has used for pain relief or to alleviate the problem, from over the counter medications to hot and cold therapies;
Documentation must identify if the pain or symptoms from the injury are chronic or acute;
Any related complications encountered;
The result of hands-on examination and any tests ordered;
A detailed account of the treatment plan, including the symptoms that will be addressed and how.
Complete and detailed documentation is essential for reimbursements and Medicare requires clinicians to maintain records on all of a patient’s health and medical history both past and present. A number of variables must be documented that were not required under ICD-9 code sets.
Clinicians will need to exercise caution to ensure each item is thoroughly documented with the corresponding code. The new documentation requirements have a focus on the immediate complaint and no suspected diagnosis must enter the equation, only what can be clearly determined from the available information.
More codes, greater specificity and increased reporting regulations, combined with coding rules and categorization changes, are all leading to significant increases in documentation time when ICD-10 is fully implemented. It’s estimated that clinicians will experience a 15 percent increase in their documentation time and that’s a conservative number.
Many ICD-10 codes are very similar except for one or two differences, while other codes are only differentiated by which side of the body the problem affects. Searching with a GEM may turn up no results or thousands. Even practitioners who have acquired ICD-10 training and use a computer assisted search tool will face challenges when locating the exact code that’s needed.
Productivity is expected to drop by up to 10 percent due to physician queries from billers/coders. The potential for denials and the need for additional management of claims will affect revenue flows. Very real problems will arise with clinician queries using keywords. The following example outlines a potential patient complaint and the results of a keyword search.
Mrs. Johnson was on vacation aboard a cruise ship and was walking in the gift shop when a vase fell on her right shoulder. She has had pain in the right shoulder since then. At the time that this injury occurred, she did not consult with a healthcare provider; she thought it would just go away on its own. After a few days, the pain seemed to get worse, and she started noticing more trouble reaching up and to the side. Also, ever since the incident, she has been suffering from chronic headaches. The patient complains of severe pain across the insertion of the supraspinatus. Traditional over the counter medications do not relieve the headache or the shoulder pain. Past medical history is unremarkable. She followed up with her primary care physician, who referred her to physical therapy. Patient indicates that no diagnostic tests (i.e – X-rays, MRI) were done so far.
The patient weighs 220 lbs. and is 5 feet 4 inches tall. Her blood pressure is 128/86, pulse rate is 72 and respiratory rate is 16. She has full strength in all muscle groups in the upper extremity with the exception of the right middle deltoids, which are 3+ and right supraspinatus, which is 2+. All deep tendon reflexes in the upper extremity are normal. Range of motion is normal in the upper extremity with the exception of right shoulder external rotation (to 25 deg), abduction (to 130 deg) and flexion (to 135 deg). All of these ranges exhibited pain at end range.
Special tests: Right shoulder (+) Neers, (+) Hawkins-Kennedy, (+) IR lag sign with pain.
Cervical range is restricted to 50% for flexion, extension and side-bend. Tenderness and hypertonicity noted at suboccipital area (right>left).
Exam findings are consistent with rotator cuff strain in the right shoulder. Pain, range of motion restrictions, and weakness in right shoulder, with chronic headaches.
Physical therapy 3 times a week for 4 weeks for treatment of right shoulder pain, with range restrictions and weakness, with symptoms consistent with rotator cuff involvement. Treatment to also address chronic headaches and neck range restrictions, with therapeutic exercises, therapeutic activities, postural exercises, patient education, joint mobilizations/soft tissue mobilizations, home exercise, and modalities as indicted.
A clinician that searches for the keywords cruise ship will find 233 results in two classification sets and a further search for falling object and right shoulder pain each has 500 references in three classification sets. A more specific search for rotator cuff returns 109 results in four classifications. Results increase with a key word search for physical therapy returning more than 500 results across seven classification sets.
Searching by specific codes will display results for multiple categories ranging from nuclear medicine and obstetrics to mental health, substance abuse and poisoning. The typical practice won’t experience many of the situations described in the new ICD-10 coding, but they must still wade through a morass of potential codes to arrive at the desired data.
Navigating the ICD-10 code set will affect every individual within the practice and clinics can’t rely on GEMs and crosswalks indefinitely. Implementation requires that all staff members receive education and clinicians obtain coding training in their specialty. It will help reduce documentation times and the instances of claim denials under the new codes and documentation rules.
A General Equivalency Mapping (GEM) system is available to assist clinicians determine the correct coding options in the ICD-10 system. It’s a necessary and useful tool, but one that has distinct limitations. It provides no substitute for real training. A GEM is a general purpose tool and wasn’t originally developed for coding. It was a means of analyzing data and conducting research and studies.
GEM is a tool that can be used by clinicians to conduct searches and reverse searches to identify the correct ICD-10 codes in their practice. Translations and conversions can be done between either coding system to the other. Translating ICD-9 to ICD-10 is known as forward mapping, while ICD-10 to ICD-9 is called backward mapping. Searches will turn up approximate matches, possible combinations, and potential scenarios from which to choose and search for more data.
There are multiple versions available that have been created by vendors and professional organizations. Versions are available from the Centers for Medicare and Medicaid Services (CMS) and the National Center for Health Statistics (NCHS), along with many vendors of EMR software systems. The ease of use will be determined by multiple variables that include the developer, logic and programming used.
The results that the GEM returns are dependent upon the creating entity. Clinicians will receive entirely different coding options depending upon which GEM they’re using. The sheer volume of codes in ICD-10, combined with those that didn’t exist in the old system, means that a given GEM won’t always return the best matches or choices.
The chance of a one-to-one match is very slim, and in certain circumstances the GEM may offer none at all. All search features aren’t created equal and clinicians may find they have to try multiple search terms before the GEM returns any results at all.
It’s imperative that practitioners remember that GEMs aren’t designed to be an exact converter within a clinical setting and even an “exact match” may only be an approximation. Other coding difficulties may arise when differentiating between an initial encounter and a subsequent encounter. Some ICD-10 codes may not offer lateral solutions, which means practitioners will have to create the data themselves.
The imperfections of GEMs can have a significant impact on revenues for practices, making it imperative that clinicians bill and code at the highest possible level whenever practical and prudent. GEM results may not provide an accurate reflection of the clinician’s intent or care episodes.
Any unmapped codes that are encountered will present additional challenges for overworked practitioners struggling to adapt to a new code set and maintain revenues. Examples that reflect no translation between codes are surgical instruments, cardiovascular devices and autopsy. While the latter two are unlikely to arise in the average practice, it still points out the limitations of a typical GEM.
A GEM is a tool that provides a starting point for clinicians and is no substitute for ICD-10 training and education. The GEM can’t think or factor in the many aspects that practitioners must consider when diagnosing and treating a patient. For that, clinicians must rely on their training and unique experience.