Electronic medical records (EMR) are the wave of the future for the rehab industry. And while EMRs have been around for more than a decade, smaller facilities and clinics are just now beginning to realize the positive effect they can have on their practice. Hospitals started the trend of transferring from a paper office to paperless files, and for good reason. According to Amy Mullican, RN-BSN, an EMR specialist at Vanderbilt Medical Group, Nashville, Tenn, accessibility is the biggest benefit to using such software.

"It allows for better holistic care for patients just because specialties and then primary care areas can see more clearly what's going on," she says. "It helps with communication and accessing patient information."

Mullican says Vanderbilt uses a homegrown application called StarPanel to meet its needs, and the person who developed the system is still on staff. The program has an outpatient order entry system, electronic prescription writer, several documentation tools, and all patient medical records.

"The benefit of having somebody here that does development is that they know the system so well they can make changes," she says. "We have a great on-site resource and a whole development team that goes along with this so we don't have to call somebody from outside to help manage problems. It's also helped us cater this system to our specific university hospital needs. Because it's a teaching institution, it demands a little bit more support than, say, a nonteaching institution."

The Montgomery County Public Schools Infants and Toddlers Program in Maryland is in the middle of transitioning to paperless records, says Ginny Paleg, an NDT certified pediatric physical therapist. "We started a year ago taking computers into [patients'] homes and we would be writing our notes in the homes so we could leave a copy with the family," she says. "And now we're going to electronic everything; even the daily notes will be written on the computer."

The biggest advantage Paleg sees with going paperless is making therapists more consistent as well as more accountable.

"I think it's really going to improve the system," she says. "You can read the handwriting, which is a big one. When you write the report, you've already got the bulk of it done so you can just cut and paste. It is going to help therapists be more cognizant of using evidence-based practices, and increase the consistency between therapists."

Of going electronic, Paleg says she believes it will save a lot of money. Forms that used to be ordered in triplicate are now just a click of a mouse away.

"We don't have to store all those forms, and we don't have to order all those forms, which can be expensive," she says.

THE TRANSITION PHASE

Lauren Robertson, MPT, cofounder of Wild Iris Medical Education, Comptche, Calif, agrees that going paperless can be less expensive monetarily, but expensive in other ways.

"There are a lot of things that you end up replacing electronically that did perfectly well in files for 100 years," she says. "For every paper that you put into a file cabinet, that system has to be replicated on the computer."

Mullican says the transition period can be challenging, as facilities move their paper files to electronic copies in a process called scanning. Files are scanned into the computer, but with the system at Vanderbilt documents can still be accessed as paper files.

For the system at Montgomery County Public Schools, Paleg says paper files had to be converted into an electronic form, such as a PDF. Instead of manually filling out the information, therapists can just go online, fill out the form, and send it electronically to the database.

"It's not really complicated," she says. "It's really the exact same system we were using before, it's just now all done electronically instead of a hard copy."

Cherilyn G. Murer, JD, CRA, CEO, and founder of the Murer Group, a legal-based health care management consulting firm in Joliet, Ill, says the transition period can be difficult, but once completed can be a much easier system than a paper office.

"It's an easier system in terms of protection of information once the systems are all in place and people have experience with it and all of the safety mechanisms such as scanning issues and passwords," she says. "It's very time-consuming and very cumbersome to enter all the data and to be able to set the templates for electronic medical records."

PRIVACY AND HIPAA COMPLIANCE

When transitioning from paper to cyberspace, Murer suggests facilities use common sense. She acknowledges that everyone is aware of HIPAA and the necessity for privacy; however, research and literature show that significant technology breaches are an ongoing problem.

"The Government Accountability Office (GAO) back in September 2005 reported that 40% of health insurance contractors and state Medicare and Medicaid offices experienced data breaches within the last 2 years," she says.

Murer says that the final rule on HIPAA enforcement became effective in March 2006, and suggests that facilities go back and review all of their processes to assure that they are in timely compliance with the comprehensive rules. In addition, one practical problem facilities need to be aware of is human nature.

Facilities need to be conscious of the information they are passing on, especially when e-mails are utilized relative to personal health information with data being transferred about patients internally over unencrypted networks.

"It's an attention to detail where no error is accepted in terms of security and compliance," she says.

Murer also recommends that an audit relative to security risks on any updated software be completed annually.

"[Facilities] have to assure that they've gone through the training," she says, "that the security officer is up to date on all new developments, and that they're monitoring viruses."

THE BIG PICTURE

Once the processes are in place and once the system is learned, Mullican says that, in the big picture, the system will be less time-consuming than the paper method.

"It's much less time-consuming because you don't have somebody sending a request to a medical records department to retrieve a paper chart, having it delivered to the clinic, getting it catalogued where the physician wants to see it, and then the physician retrieves it and looks through it," she says. "You can sort documents within the patient record in the [EMR] system, so if you wanted to see only discharge summaries you could pull up the summaries on a patient rather than flipping through 3 years' worth of documentation to find one piece of information."

One of the factors helping to facilitate the transfer to a paperless office is the pressure to be compatible with the facilities sending out referrals. Brand-new facilities will immediately be paperless because of the way they are set up, whereas older facilities will have to transfer.

"If you're serving a medical staff on an outpatient basis or as a specialty hospital that relates or depends on referrals from a major hospital referral system and if that system is on EMR, then you really do have the pressures to be compatible with the health system that is sending your referrals," Murer says. "Once the physicians are used to this and once the staff is used to this, then it seems archaic to go back to a paper system. The pressures on a specialty hospital or an outpatient facility are that they must enhance that continuum of care and they must be compatible with their primary referral sources."

THE LEARNING PROCESS

Another concern for facilities transferring to a paperless office is backlash against change. With facilities rapidly embracing new technology comes a new learning process for some who have been in the field for years.

"There are people who are not comfortable using the technology, especially people who don't know how to problem solve when things go wrong," says Paleg.

Murer says that it is human nature to resist change.

"I've seen a lot of passive aggressive behavior," she says. "In the past the electronic dimension was so focused on your support staff and your ancillary services, and now it's going to the heart. Now it's going to be physicians, your legal departments, and all of your departments that relate to this. So now you're dealing with human nature as well as a corporate policy to move forward."

Morgan Saffari is associate editor of  Rehab Management.