Focus: Point-of-Care Solutions
How are clinicians and practitioners using point-of-care (POC) technologies to improve the quality of healthcare delivery to their patients? The advances in these technologies are providing clinicians with a wide range of diagnostic, monitoring, and therapeutic tools, enabling them to make life-saving decisions on the spot. In this first of a series of special supplements, Healthcare Informatics focuses on POC technologies in action via two case studies.
When Justin Silver, founder of ProFormance Physical Therapy, a privately owned practice based in Skokie, III., implemented electronic health records (EHR), he opted to deploy a solution via handheld devices, thereby increasing patient intimacy and directing the provider to ask the right questions.
Dr. John Fontanetta, who provides emergency medical services in Red Bull Arena in Harrison, N.J., and uses EHR to connect the first-aid room with Clara Maass Medical Center's Emergency Department, describes how this process has expedited the admissions process and medical care for patients who need to be transferred to the hospital.
For physical therapists, getting accurate, real-time patient information is important when mapping out a patient program. It can make a significant difference by dramatically improving patient performance and quality of life. In this interview, Justin Silver, MPT, founder of ProFormance Physical Therapy, in Skokie, III., explains how using a tablet PC for electronic medical records (EMR) has improved the patient experience at his privately owned practice.
Healthcare Informatics: Why did your company decide to adopt a point-of-care (POC) EMR?
Justin Silver: ProFormance is actually a new company that I founded six months ago. Before that, I worked for a larger company for a long time, which was paper-based. When I started ProFormance, I wanted to be on the frontline of where medicine is headed, yet I wanted that same kind of easy flow in practice. A POC EMR allows us to maintain the very close contact with our patients that we always had, but without making patients feel like we are running back and forth for paperwork. Note-taking while you are working right with the patient tends to be more accurate than when it is done after the patient leaves. I wanted a state-of-the-art system where we could also provide good quality of care and patient education, which is becoming increasingly important.
HCI: How does this work when a patient comes in for a physical therapy session?
Silver: The way that EMR works is, you have a lot that is already generated from the front office standpoint. You see some of the medical history, some of the questions are already populated, and there are prompts for gathering relevant clinical information. We are working with tablet PCs so that patients can see that we are documenting their situation accurately while they are describing it to us. The flow is very similar to paper-based documentation, except that EMR is on the spot, helps us work faster, and be more accurate.
We always perform an initial evaluation of every patient we see. On the first date of service, we will get a medical history, then do some testing to see where the patient is, and set up a plan of care. For us, it also came down to wanting to be sure that patient information is secure. At the same time, we get added value by being able to pull up their information when we are with them. For example, I can immediately see the surgeries a patient had, instead of waiting until the file is located. It makes the care more patient-centered and secure. With POC record keeping, we can stay with our traditional workflow, except that everything moves more quickly and efficiently.
HCI: How does the tablet PC expedite your note taking?
Silver: With a tablet PC, we can flip between a slate where we can take notes or use a touch screen, or easily flip it over to a laptop-type keyboard. The Thinkpad slate that we use recognizes my handwriting, and I am really used to working with handwritten notes. It is powerful, updates quickly, and it is much lighter than earlier-generation tablets.
HCI: How do patients feel when they see you holding the Thinkpad?
Silver: So far, it seems like patients see us getting our notes directly from them and they like that. They can interject information that is important to them right when we are there with them. Eventually, we will study outcomes like this more systematically, but the EMR project is only a few months old, and it is still being tweaked. I see it as a work in progress.
HCI: Did you consider using iPads?
Silver: Initially, when we first started looking at systems, we considered using an iPad. iPad is a very sleek, very neat technology. It works very well for certain things and it does work well with Cerner's [Cerner Corporation, Kansas City, Mo.]EMR. The number one thing that you have to consider in selecting an EMR is what works best for your company. What made us switch to a tablet was its stylus and writing program. Handwriting recognition and documentation is very important to us, and we liked the way it felt with a tablet.
HCI: Is there any specific advice you have for practices just starting to look at EMR systems?
Silver: If I had to tell anyone looking at systems what to keep in mind, I would emphasize exercising due diligence. You have to keep focused on what you want to do with the EMR. In every EMR project, there are so many valuable tools. There are all sorts of features, such as past history, a place for old notes, leaving little notes for yourself for continuity of care, alerts, and more. What is important in one setting may not be important in another.
We decided to go with Cerner because it is a well-established company that has been around for awhile. We wanted a certain amount of flexibility. Cerner's technicians and programmers have been accessible for our needs. Also, we wanted a truly mobile EMR. One vendor had a lovely system, but it used a monstrous computer that wasn't practical for our needs. It certainly was not portable. I cannot emphasize enough that you have to do your homework. You might find a cheaper out-of-the-box EMR, but it might not be the most efficient in the long term.
HCI: If you could visualize where ProFormance might be in a year or so relative to an EMR, could you tell me whether you might try to use your records for any meaningful use projects?
Silver: I would really love to do that. I'd like to have patient portals, exercise videos, and I'd like to be able to track some of our case-types, like our ACL repairs, shoulder, and rotator cuff injuries. There is a lot of untapped potential, and I am excited about these possibilities.
Healthcare Informatics 2011 April;28(4):18-20