Practical tips for making the most of practice-management software.

It is a good dilemma to have: A physical therapy practice busy enough to open additional offices has to hustle to maintain the personal attention and diligent record-keeping that made it a success. While it may be the result of prosperity, it is still a serious issue for a growing number of practices.

When taking a closer look, scheduling tends to top the list of considerations. Coordinating between multiple locations—each with its own front-office staff and team of therapists—can prove to be a Herculean effort for the administrators who are keeping tabs on everything.

“We had a PT billing program, and we wanted to be able to retrieve data much easier, as well as be able to do our scheduling more efficiently,” says Andy Ward, co-owner of Redbud Physical Therapy Inc in Tulsa, Okla. Ward and his partners—David Wycoff and Terry Smith—oversee seven clinics throughout the northeast Oklahoma region, all within about 45 minutes of Tulsa. “As we were expanding practices, administratively we wanted to be able to sit in one location and see what was happening at the other locations without having to fax scheduling sheets back and forth.”

The solution came in the form of a companywide practice-management software program implemented at Redbud almost 5 years ago. Not only did it make it possible for management to monitor schedules, but it enabled both phone traffic and the entire schedule to be handled from a remote location should a front-office staffer at one location be out of the office for the day.

At the time the practice-management solution was installed, four locations were involved; and while networked, the old system did not provide its users with the ability to coordinate online efficiently.

In addition to making off-site scheduling a possibility, the new practice-management software brought with it an extensive amount of additional functionality. One such benefit was intraoffice messaging, in which therapists can perform online consultations with one another instantly.

“If I’m seeing a pediatric patient and I have a question, I can e-mail my pediatric specialist through the system about the problem I’m having, and he can get back with me in real time,” Ward says.

Putting Technology to Work
Compiling reports can be a frustrating, time-intensive process for practice administrators who, most likely, would rather be helping a patient than pushing paper. A comprehensive practice-management solution can help with that as well.

“It gives us the ability to create more reports than we utilize,” says Ward, who uses the system to assemble data on everything from tracking physicians and referral patterns; to staying on top of which insurers the practice corresponds with, what types of diagnoses they are treating most, and how many visits per diagnosis per patient. The system can even provide very specific time lines. “I can tell you—relatively quickly by looking at some of the reports—what it takes for us to get a torn rotator cuff back to functioning; we definitely get all of the information we need to run an effective practice.”

The resident number cruncher also appreciates the “all-as-one” environment the software creates.

“Our accountant absolutely loves the new program, because he can run all the reports and get all of the information he needs through the administrative system without having to go back through billing,” Ward says. “We can do our billing, our documentation, and our scheduling all from the same software; and not every solution that we looked at could do that.”

The extensive reporting capabilities have also helped Redbud’s therapists provide patients with better service. For instance, Medicare patients often have a maximum number of sessions that are covered. A report on Redbud’s practice-management software can be run to indicate where patients are in relation to that cap—numbers that are difficult to tally manually.

“We run that at least once a week at each individual clinic, so if we see a patient is getting close to the cap, we let him know where he is at so he can decide whether or not he wants to continue treatment,” Ward says. “That’s been very nice for our patients.”

Finding the Best Fit
Bringing all administrative functions onto the same management program was one thing the team at Redbud actively sought when shopping for the best solution. They considered a variety of products before they decided to work with their current vendor.

“The thing we really liked was that we could modify it so we would be able to maintain the way our reports looked,” Ward says. Because existing evaluations had been designed to accommodate the preferences of both physicians and therapists, it was important to Ward and his partners that the format not be altered. “Using this program, our templates stayed the same with regard to initial valuation, progress notes, discharge summaries—everything that goes to the doctor’s office remained unchanged.”

This was possible in part due to the software’s ability to oblige template customization. Being able to modify existing forms or create news on demand was essential for the clinic, which is a general orthopedic and neuro practice with subspecialties of aquatics, pediatrics, and hand, as well as occupational-specific functional-capacity evaluations.

“We were able to use the software to build the evaluations the way we wanted them to look,” Ward says, and gives the example of a therapist hired recently. In a few hours, she was able to design an evaluation form that reflected her preferences, incorporate it into the system, and put it to immediate use. “Regardless of what type of practice—whether it is exercise-based, manual-based, or maybe a high-velocity manipulation practice—whatever the case may be, you can build your system around the therapists, so it’s not only good for the administrative staff, but it’s good for the clinicians.”

Less Work for Busy Therapists
Having a system that coordinates with therapists’ preferred workflow is the best bet for obtaining their buy-in. The 18 therapists working for the various Redbud locations have seen substantial benefits from the electronic documentation aspect of the system. Instead of dictating or hand-writing notes, each of the PTs, PTAs, and occupational therapists type their notes directly into the evaluation form.

And because of the system’s ability to provide quick access to previous documents, it is no longer necessary to create every evaluation from scratch. Over the course of a patient’s treatment, many of the details for each session remain the same. Ward believes the ideal practice-management system eliminates some of the redundancy in recording these types of daily notes.

“One of the nice things about this system is you don’t have to continually rewrite everything that you’ve done, but you can modify it as you need to, which has been a remarkable time-saver,” Ward says. Therapists treating a patient can pull up the notes from his or her previous visit and use the existing information to populate the new evaluation form. “If you want to change it—different reps and sets or whatever it was that the patient did this time—it is all there, and it’s very easily modified.”

Each therapist is also able to create customized exercise templates, which he or she can store online for future use.

“They can put in their own exercise techniques, and those are then stored in the system so they can always go to their program and simply pick out the exercises that they want their patients to do that day,” Ward explains.

All exercises are stored in a central database accessible by all therapists, creating a valuable online resource for professionals to share their favorite techniques.

“If I’m watching another therapist do an exercise program with the patient and I really like a specific exercise, they can show me what it is,” Ward says. “The next time I think it might be a good exercise for one of my patients, I can go to that specific therapist’s exercises and take that program out.”

Getting Online
Available service and support was also a vital consideration when comparing different software solutions. Ward strongly encourages practices to make sure the vendor is able—and willing—to provide the level of service required to make the program a success for everyone.

“I was very impressed with the level of tech support we’ve received,” says Ward, who notes that ongoing support is essential, especially during the initial transition to the new software. In addition to several days of on-site training sessions, the vendor provided telephone support when needed. “They also have some very good Internet-based instruction that is ideal for updates, and about every 18 months we bring somebody in to provide an update. It costs money, but we always learn something new.”

Once a vendor and product have been selected, a phased-in approach is the most common way to bring multiple locations online with the new system. Ward recommends consulting with the company’s representatives on the best method of implementation and then following their advice.

“They will tell you what they think is the best way to phase it in, and that is the best way to do it,” Ward says, admitting to repudiating his vendor’s advice to install the billing portion of the software first, then add scheduling, and finally bring patient documentation online. “I was impatient as a therapist, because we needed something to expedite getting our notes done, so I wanted to do the patient documentation first; but it didn’t work as well for us. I recommend you go with how they tell you to do it.”

Whatever challenges there may have been, Ward and his team at Redbud are satisfied with the results.

“Going to any electronic documentation system is difficult,” he says. “But if you told me today I was going to have to go back to handwriting or to dictation, I’d be rather disappointed.”

They also realized a relatively rapid return on their initial investment.

“When we were four clinics and doing dictation, the software was expensive to purchase, but it basically paid for itself in less than 2 years,” Ward says. “We no longer need a full-time transcriptionist, and it also did expedite our turnaround time on our evaluation process.”

Change is Never Easy
No matter how great the benefit in the end, the sizeable changes an electronic approach brings means the transition is usually not painless. In addition to changing well-ingrained habits, less tech-savvy staffers are sometimes resistant to the new method of operation.

Ward suggests enlisting the support of therapists who are eager to adopt the new system to help keep everyone engaged and enthusiastic about the progress.

“People who have grown up with computers take to this rather quickly, and you really want to keep them on your side,” Ward says. One of Redbud’s more analytical therapists invested quite a bit of time figuring out how to make the system work really well for him. He then went on to share his approach with everybody else. “Just be patient, and offer as much assistance as you can as the owner or as the director.”

An Ideal Fit
Ultimately the best software program is the one that best fits the needs of the practice. Keeping this in mind when comparing vendors is key, according to Ward.

“Make sure it does what you want. Look for something that is high quality but is going to be pliable,” he says. “We didn’t want something that would force us to change the way we did business and make us work for it; we did just the opposite and found something that works for us.”

Dana Hinesly is a contributing writer for Physical Therapy Products.