Electronic Medical Records in Outpatient Rehabilitation Kristine Terrio PT, Concord Hospital
Multiple Systems. Multiple Inefficiencies.
Concord Hospital is a 240-bed acute care facility with six outpatient physical and occupational therapy sites in New Hampshire. Our staff includes 35 physical therapists and 4 occupational therapists.
Around 2005, we began searching for an Electronic Medical Record to replace our scheduling, insurance authorization and documentation systems. We were utilizing an electronic scheduling system and an internally developed database that managed insurance authorization and charting for progress notes only. Documentation was inefficient as we used a combination of dictation and paper notes. We also struggled with managing each insurance company's authorization rules and ever-changing requirements (including Medicare compliance, CCI edits, coverage of services, pre-certification requirements, etc.).
The Search
When evaluating new EMR systems, my management team was very critical. They knew what tortured them most and what they ultimately wanted the new system to do. Given our experience developing them internally, we fully expected difficulties in finding one that met all our needs. Ultimately, we wanted a vendor that would partner with us. One that would allow us to influence the development of the product to be flexible with changing industry requirements. We were also looking for a vendor that would allow us to develop reporting tools that met our daily needs.
Additional requirements included a:
-
Flexible scheduling system to meet the needs of a busy, multi-site outpatient setting. This includes simple scheduling, the ability to block off times for evaluations and specialty services, quickly creating multiple appointments for patients, and producing productivity reports.
-
Insurance Authorization system to identify each insurance requirement, notify therapists when they're running out of visits or time for authorizations, identify when CCI edits are needed, identify interventions that are not ‘covered services’ by an individual insurance plan and send reminders when Medicare progress notes are due.
-
Clinical Documentation that is flexible and has tools for a wide scope of clinical diagnoses for both PT and OT.
-
Charging that is supported by clinical documentation and assures compliance for Medicare and other insurance rules.
-
Electronic transfer of clinical reports to other EMR systems.
-
Electronic charging into our billing system.
-
Ability to scan into the product for paperless documentation.
The Partnership with Cedaron
Cedaron’s APTA CONNECT product was our choice for best meeting our current and future needs. Their partnership with the APTA was key for us when choosing a vendor. We understood and valued the influence the APTA had over the development of the product. Also key for us was that Cedaron’s engineers were committed to continued development to help us meet the challenges of the regulatory environment and our need for efficiencies. Cedaron is committed to understanding our issues, our practice environment and to developing solutions.
A Smooth Transition
The success of implementing the new system was highly dependent on staff adoption. It brought tremendous change to our daily operations. To make it as smooth as possible, we had a core group of the leadership team working closely with Cedaron to shape our application, while keeping their respective teams informed of progress. We also trained clinical staff early and allowed them to use our TEST environment to learn documentation on actual patients. This allowed staff exposure to the product and helped shape our further development and training.
During the first year after implementation I meet with staff to get feedback on our transition, they all spoke positively about our supportive transition process and say they would never want to go back to our old world of multiple systems and paper documentation... even my staff who are challenged with technology.
More Time With Patients... Not Paper
Concord went live with CONNECT in January 2009. We transitioned from our multiple systems that did not communicate with each other into one system that manages our scheduling, insurance management, documentation and charging. We have interfaces with our registrations system, our billing system and for electronic communication with our referring physician’s EMR as well as an electronic interface to our permanent record repository with McKesson Horizon We no longer have medical record cabinets as we discharged our last paper record about six months after going live.
At their fingertips, my therapists, support staff and management team have access to schedules, clinical care notes and authorization information. CONNECT also calculates the visits used and notifies the therapist when they are running out of insurance authorization. It reminds them when they have a Medicare progress note due and tells them whether a particular intervention is a covered benefit for an insurance plan.
The Result
Concord Hospital now has a fully operational outpatient medical record system in place in all our sites. We eliminated all paper charts, our previous scheduling system and our separate database system for insurance authorization. Our hospital uses Centricity as the EMR for all of our providers (family practice and specialties). We are able to securely receive our referrals from these practices and can electronically send our Rehab Reports directly to the EMR.
As insurance requirements continue to change and challenge us, we have fully integrated systems that allow us to modify our ‘insurance rules’ and are immediately compliant with the new requirements. Our partnership with Cedaron has provided us an end product that meets our needs today and will continue to meet our needs as healthcare changes in the future.