The Controversy of Cloud Based Rehabilitation Therapy Documentation

Cloud-based medical systems are so common, yet rehab therapists are still hesitant to adopt this system.

Of the 204,000 Physical Therapists, 113,000 Occupational Therapist, and 134,000 Speech & Language Therapist, more use paper charts to capture therapy notes than use electronic medical records. But when it comes to billing, the case is exactly the opposite. The cause of this paradox can be explained by Payer mandates regarding electronic billing. Getting paid is a top priority, so when Medicare, Medicaid, and BCBS dictate electronic claims, electronic billing software becomes more or less mission critical.

Many physical rehabilitation therapists however still view electronic documentation of patient treatment as an optional agenda that can be deferred, or something that’s too overwhelming.  The notion that recording therapy notes using software and comes at a high price which keeps many therapist from realizing the benefits of a fully automated practice.

But as per Medical Economics, the annual cost of maintaining a paper chart is $16 per year in comparison to an electronic chart which is estimated at $2 per chart.  Additionally, the increased complexity of payer documentation requirements, ever shrinking reimbursements, and rising cost pressure across the board, require greater efficiency in the documentation process that can mean the difference between practice failure or success.

Patient therapy documentation software comes in two flavors:

1. Server based systems that are housed on location at the practice. Server-based solutions are still the most prevalent, but that’s changing due to their many drawbacks, such as high purchase price and overall cost of upkeep, which include network maintenance and annual software updates.
2. Web-based applications that are securely hosted on the ‘cloud’.

With the advent of large-scale adoption of cloud-based software, the cost of software acquisition is dramatically decreasing.  Healthcare is a highly regulated industry and having patient data stored on the web is a concern of everyone, but the risk can be mitigated by finding a technology partner who offers HIPAA and OMNIBUS compliant data hosting and who adopts industry standard best practices to protect and safeguard patient data.

For instance, few therapists know that PHI stored on a PC or on a server at the office typically meet only 17 of the HIPAA technical requirements, but properly maintained cloud solutions automatically meet 37 of the requirements.

The OMNIBUS rule within HIPAA in particular, mandates specific rules defining the governance of physical and logical access, backup, and secure transmission to ensure strict PHI data security. The complex issue of data-security is best met by engaging a technology partner who is an expert at it.

Following are some of the key factors to keep in mind when considering a Cloud-based software:

• All PHI data access must have a complete audit trial.
• Data must be stored for at least 7 years. Purging data should be avoided at all costs. There are a number of extremely affordable ways to store PHI data in a HIPAA compliant fashion.
• Access to PHI must be restricted to clinical professionals who have signed the required Business Associate Agreement. Access of employees no longer with the practice must be terminated.
• The best web-based systems have security settings that enable practice managers to restrict user access at a granular level for each user. This should be a key considerations when choosing a rehabilitation therapy software.
• Most importantly, web-based software should have fewer windows to navigate through to complete a chart.  An intuitive interface that is easy to navigate will ensure that your documentation time is not at the cost of patient care.
• Fail-safe redundancy and automatic incremental and daily backups are a huge advantage of web-based systems. Anyone who has lost precious patient data due to a server crash will vouch for the immense value of automated and redundant system backups.

In Healthcare IT, more and more emphasis is being placed on web-based systems as most of the largest corporations have already made the shift to ‘the cloud’, to take advantage of simplicity, greater access to data, better security compliance, and tremendous cost savings.
As a small business, a Physical Therapy practice can also benefit by moving away from the traditional server-based model to the new era of Cloud Computing: You don’t have to be an IT expert to use web based software, it is generally accessible anywhere there is internet access, and it has the extra advantage of being easy to get out of if you don’t like the application or find that it doesn’t meet your specific circumstance.

Although therapists are not included the American Recovery and Reinvestment Act which provides incentive to help eligible physicians adopt electronic records by 2015, the adoption of therapy software in the near future is going to become a necessity for PT’s in particular to remain competitive. The APTA vision for 2020 mandates ‘Doctors of Physical Therapy’ for all therapy services.