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FOTO Rehab Outcomes Blog

Clinician Perspective of Technology

What changes as you weave technology into clinical practice? 


Back in the day, I had 3 forms for patients to fill out about their personal/medical history. Patients would sit there and sigh and scribble their responses. We'd mail these out in the event there was a lag in time between their initial contact and their desired appointment date. We'd just hand them the packet if they walked in to set their initial appointment. When they were finished, I'd have myself a little packet of information to squint through, interpret and incorporate into my documentation. I'd spend initial visits engaged in conversation... jotting scribble notes to myself to decipher at a later moment in time. I was totally inefficient.

A couple years ago I undertook the search for an electronic medical record. Unlike many of my colleagues, I wasn't as worried about compliance. The majority of EMR companies are going to help you be in compliance - it's one of the huge reasons an EMR is needed. I had two unique needs: 1) An EMR completely customizable to maintain the brand I had established for many years and 2) an EMR that integrated with FOTO. Losing the power of FOTO and my brand were 2 non-negotiable factors. I'm easy to sell to: I know what I want... I focus first on whether a product meets my needs... and if it doesn't I move on to the next product. I'm not wishy-washy or persuadable when I've researched exactly what I want: I'm on an adventure to find the perfect product to meet my needs. You could say I'm a selfish buyer. Kind of... I just don't like to waste my time or the time of others when it comes to purchases.

I'm one lucky physical therapist when it comes to technology in my clinic. I own the clinic; I make purchase decisions; I am continually delighted with how technology has altered my practice. I haven't incorporated technology in a flippant way either - it takes work and vision to be delighted with how my practice has been altered.

Between FOTO and Hands on Technology's TheraOffice, my clinical practice has substantially changed. The two products integrate with each other. I have a feeling one day full integration will happen. For now, the two products talk to each other with regard to FOTO pulling patient information from TheraOffice into FOTO when adding a new patient in FOTO.

I've chosen to use FOTO not only for functional status, but also to gain thorough intake information from the patient prior to the initial visit. Pen and pencil paperwork is substantially reduced. I'd love to say we use the email feature 100% of the time, but that doesn't happen. I have some patients who do not use computers or want to share their email address because they don't know it or know how to get into it. I'd guess 75% of the time the FOTO intake and status assessments are completed via email. Two things are nice about this: the patient completes the assessments in the comfort of their own home and the flow of patients in and out of the clinic happens without a bottleneck waiting to use the iPad or taking time from my office administrator to work with patients on this task. TheraOffice is key to consistently include FOTO in daily workflow. TheraOffice was built to definitely alert clinicians as to when a progress summary is due. Because TheraOffice has fantastic capability for customization, we can create special appointment types alerting that a status assessment is due. (We have patients complete a FOTO status assessment one visit prior to the progress summary visit.)

Fifteen years ago I used paper and pen outcome measures. That was a great start in my journey in knowing, understanding and using outcomes. The information from those measures is quite limited. Upon completion of the Oswestry Disability Index or the Lower Extremity Functional Scale or the Neck Disability Index or the Disabilities of the Arm, Shoulder and Hand, I had one consistent piece of information: a score.

For the last 3 years I have used FOTO. I truly would never go back to my old way of doing things. First of all, my conversation is flipped! Really and truly flipped. My initial evaluations are quite different. During the subjective portion, I'm already squeaking in treatment. Prior to siting down with a patient, I've taken time to skim through the FOTO report. I know their level of fear... I know a glimpse of their health based on co-morbidities... I know if they've had diagnostic testing AND a hint about their results... I know if their pain fluctuates... I know where their pain resides. I also know if their current function is comparable to others in the system. I know statistically how much they should improve... and in how many visits over how many days this improvement should take. I spend my time verifying... and I spend time delighting them with why they are great candidates for physical therapy and impress all the positiveness I see in the report. I begin treating from a biopsychosocial perspective pretty much immediately. There is no other system or technology out there that allows me to begin treating with a targeted focus upon greeting and shaking a patient's hand.

The FOTO report also impacts my workflow. As I'm skimming the FOTO report, I'm also immediately incorporating information into TheraOffice. Due to years of experience, I can often complete almost the full initial evaluation minus the objective findings based on the FOTO intake report. In the event I am surprised by something found objectively, I can quickly change the data in TheraOffice.

Technology has been really helpful for me. The three biggest changes for me were:

  • More efficient
  • Clinical confidence increased
  • Ability to use patient data to drive clinical decisions
  • Able to begin psychosocial aspect of treatments immediately

In hindsight, I should have incorporated FOTO in my practice a lot sooner. For me, it was a trust issue: does a computer and technology really know more than me? Sadly, my perspective was wrong. What I failed to realize is just how much technology could format information and provide concise data to clinically help me.

Until next time,