The Case for Specialized Software: Why Your Hospital EHR Hinders Patient Care and Increases Risk

If you Google “hospital EHR,” you’ll initially receive an overwhelming number of search results for the EHR systems themselves—essentially, advertisements and promotions for their software. Wade through those results, though, and you’ll uncover a wealth of articles in which hospital practitioners complain about their technology and how it negatively impacts patient care. Search “private practice EHR,” and you’ll encounter the same thing. And these complaints are, by and large, voiced by physicians—the people for whom these systems are generally made.

And if physicians aren’t happy with their own systems, you can bet that specialty providers are beyond frustrated. After all, they typically document far differently than their physician counterparts—and that’s especially true for outpatient rehab providers. As a result, they’re simply not using the systems like they’re supposed to. Instead:

They’re documenting on paper.

In fact, many outpatient rehab therapy providers are shunning their hospital’s overarching EHR, instead opting to document on paper. “More than 70 percent of hospital outpatient therapists still handwrite their documentation on paper forms,” reports this Becker’s Hospital Review article. And that spells trouble: “Rehab departments are coming under increasing scrutiny by Medicare Recovery Audit Contractors,” because beyond “human error, manual documentation can also cause errors due to outdated forms.” In addition to increasing errors, the continued use of paper documentation impedes the advancement of healthcare IT and the large-scale improvement of patient care. And that’s because for optimal care coordination, each patient's complete healthcare record must be readily available and accessible to all members of his or her care team—the true purpose and ultimate goal of implementing EHR and EMR systems in the first place.

Or, they’re using your EHR poorly.

Hospitals that require their outpatient therapists to use their general EHR system don’t significantly reduce error rates, either. That’s because rehab therapists’ documentation needs are majorly different than those of their physician counterparts. Plus, therapists’ documentation requirements and compliance standards are incredibly intense. “Therapy patients typically receive treatment for several weeks and up to a couple months at a time,” explains the Becker’s article. And every visit requires documentation, with certain visits (i.e., those occurring at defined intervals) requiring more extensive documentation. Layer outcomes reporting on top of all that, and whether they document on paper or use a system ill-suited to their needs, therapists increase their risk of error and monumentally zap their productivity—both of which compromise the quality of patient care they are able to provide.

Think about it: How can a practitioner truly focus on providing the highest-quality care and optimal patient experiences when he or she is distracted by sub-par technology? Then there’s the effect on overall staff morale—which patients easily pick up on. No one wants his or her care provider to be frustrated, let alone upset. Furthermore, patient experience is directly linked to how a patient perceives the quality of care received. Thus, it’s imperative that:

1. patient visits go smoothly (i.e., without technological hiccups), and
2. the practitioner appears capable (i.e., the technology enhances, rather than hinders, the visit).  

Rehab therapists are also subject to several Medicare reporting regulations—like functional limitation reporting and the therapy cap—that do not apply to physicians. Thus, EHR systems designed mainly for physicians typically don’t account for these regulations—let alone provide a mechanism for notifying therapy practitioners of, and allowing them to fulfill, such requirements. Unfortunately, that’s not an excuse for Medicare, and failing to satisfy regulatory requirements can result in audits and denied payments—two things hospitals work tirelessly to avoid.

Plus, they're not tracking outcomes in a meaningful way.

Thanks to sweeping healthcare reform, alternative payment initiatives as the CJR model, and newly minted research on the value of outpatient therapy during the post-hospital discharge period, outpatient rehab therapy has never been more important to hospitals—particularly with regards to promoting patient safety, expediting inpatient discharges, and reducing unplanned readmissions. However, reporting and tracking patient outcomes is crucial to achieving all of these objectives. And for rehab therapists, it is best practice to perform outcome measures during specific parts of a patient visit; in fact, outcomes reporting is built into the therapist’s ideal documentation model. As Dr. Heidi Jannenga explains in this Becker’s article, “providers must be able to report [outcomes] in a way that aligns with their individual treatment workflows—and then share that information in a way that preserves the integrity and meaning of the data. Otherwise, details crucial to a patient's case could be lost in translation from one specialist to the next—thus detracting from the benefits of collecting quality data in the first place.”

But by and large, outpatient rehab therapy providers in hospital systems are either sloppily documenting on paper or struggling through the hospital’s EHR software. And both situations are destined to hurt the organization, and more importantly, the patient. So, what’s a hospital exec to do? You’ve most likely guessed the answer (it is in the title, after all):

Hospitals must implement a PT-Specific software for their outpatient therapy clinics.

“Implementing electronic documentation programs for rehab can solve many of these challenges. These systems are most useful when they interface with hospitals' system-wide electronic medical records and when the program is tailored for therapists,” explains this Becker’s article. And Dr. Jannenga agrees: “providers have started to migrate to specialty-specific EMRs—particularly ones with quality data-collection capabilities—that account for the documentation and compliance needs of their individual areas of practices.”

So, it’s imperative hospitals equip their outpatient therapy teams with a software specifically designed for that area of practice. Beyond that, though, the software should:

• Integrate with the hospital’s EHR system.
• Provide outcomes tracking with tests that are understood and used by the healthcare community at large. After all, what’s the point of collecting of outcomes data if it’s only applicable to a single specialty?
• Be web-based, so it’s accessible on any technology device and useable anywhere in the facility. Web-based platforms also foster interoperability.
• Allow rehab therapy providers to create customizable templates and flow-sheets. This increases productivity and ensures greater adherence to documentation standards.
• Account for all rehab-related compliance regulations.
• Provide extensive training and onboarding as well as implementation services. This ensures adoption across the entire outpatient facility.
• Have a proven track record for improving patient care through technology.

Bottom line: Forcing specialty providers—especially providers like rehab therapists, whose documentation workflow and regulatory demands vastly differ from physicians’—to use generic EHR systems increases risk, decreases productivity, and negatively affects patient care. And more often than not, those specialty providers are reverting to paper documentation, which only intensifies these problems.

There’s an easy solution, though, and that’s integrating hospital EHR systems with specialty-specific EMR software. It’s an affordable route that empowers specialty practitioners to document—and treat—like they’re meant to. And best of all, it equips them with the technology necessary to provide better patient care, achieve better results, and drive greater returns for their organizations.