22- FOXcast PT: Creating Great EHR

Jimmy: This is FOXcast PT. A podcast for clinicians made by clinicians. It’s brought to you by FOX Rehabilitation. Find out more at foxrehab.org.

Welcome to FOXcast PT. I’m your host, Jimmy McKay, and joining me today is my colleague at FOX Rehabilitation, Rachel Read.

Rachel: Hi, thanks for having me.

Jimmy: Welcome to the show – finally we get you on. So you have a couple of different roles –and I find that the longer I’ve been, or the longer you’ve been, in therapy or healthcare, you realize that nobody really ever just does one thing.

Here at FOX, we say you wear multiple hats. And, that can be in any amount of degrees, whether you’re also a mentor or you’re also working on development.

And, yours is a little bit different and unique. And, as a therapist, I like the fact that there are people like you out there because you’ll make some of the processes in our profession a little bit easier.

So talk a little bit about outside of just being an occupational therapist. What else you do?

Rachel: So my role here at Fox as I’m the EHR clinical director. And it’s kind of a novel role and that I have my hand and you know the clinical hand in our EHR system so we set it up based off of clinicians recommendations that are out in the field taken in mind you know any Medicare updates regulations rules and try to make it as streamlined in as efficient as possible knowing that we’re the ones also out there documenting it. So we we live and breathe it too. It gives us some skin in the game to make it efficient and what it needs do.

Not just put it not just set it up and be done with it and walk away. Right. Because I’ve worked in clinics before where if it’s a large enough clinic they have an I.T. person who kind of manages that. And then as a clinician I know hey you know be easier will be very very helpful if you move this here or can we do it differently? And a lot of times you were left to either do it on your own on your own time. If there was an update you were responsible for that completely that was completely on you. And if your therapist working at a place that’s you know decently busy or you’ve got a loaded schedule. Man, you know changing or manipulating that EHR that’s on the list. But it’s way down the list of things I’m able to get to see. It’s cool that you have that role and you’re not strictly from one side or the other you’re from a user’s perspective.

Rachel: Yeah it definitely makes me to have a little bit more investment in the role. I know what the pains are of documentation and being out on the field especially in this Practice where you’re traveling from patient to patient. So you don’t always have an internet connection and you kind of have to make do what you have also to just as a house calls model the documentation here is rigorous because we’re under Medicare Part B so we try to take all of that into account and make it the best product that we can give out to the clinicians. And it’s interesting because our lead software engineer is a physical therapist. So she codes of everything that we do in our EHR system. So she also knows what it is that is to be expected and she will give pushback and recommendations on her end as well.

Jimmy: It’s great really getting up a therapist’s perspective and when you can speak those those languages fluently together stuff gets done.

Rachel: Yeah it really is quite interesting. Like I would never see myself as doing this. I started with the practice ten years ago as a student went through the mentor program have had various roles in the Kuwait team and kind of gravitated to this and this is something I would never have thought I would have done now.

Jimmy: You mentioned gravity were you pulled in that direction. Was it something that was open and you were suggested. Or how did it work?

Rachel: When we transition to our EHR system I was working in the QA department as a coordinator for OT service and its quality assurance system quality assurance. Yes. During that time we were rolling out our HHR system and I was working with the director of the EHR and really getting it off the ground. And I just was so drawn to it and I really thought it was a great opportunity. And as we transition. And we you know we went and traveled to all of the states that were in and did go live trainings and beta testing and we kind of did the whole gamut.

Jimmy: Kick the tires.

Rachel: Yeah yeah we kick the tires. After that he actually decided to go and teach and go into academia. So it left this opportunity for this role to be open a very fluid process that I just absorbed the role because I was so hands on in the whole phase of our training and implementation.

Jimmy: So what are the things since you’re treating occupational therapist and you work with an EHR what are the things in electronic health records that you look for to decide if it’s a good one or not or if it’s working well or not or what are the things you really pay attention to and hone in on?

Rachel: So one of the things I always say is the amount of clicks something takes. And so the least amount of clicks that I can get to the end goal of our documentation the better. And you know I’m the known Click counter.

Jimmy: So you’re actually legitimately count how long it’ll take to get from this to Z. Wow that’s great.

The goal is for the documentation to be efficient. And so I want it to be seamless and I just keep in mind you know if the developers come up with a solution and I’m like that takes too long too much of a process like it needs to be more direct.

You’re OTeeing it I mean saying this is this is how it is but I bet you I could I could do this better so give me give this over here and I’ll give it back to you when I’m done with. Yeah yeah definitely. So clicks are are definitely a pain point because we’re there as therapists because of a human being. There is this electronic health record that needs to be there. Your goal is to make it work for you and not you working for the EHR.

Right. Making sure that the information we can extract outcomes for it so that we can further our practice and to say this is the value of OT PT SLP. So That we make sure that that information is there as well.

Jimmy: And we could have several episodes about what happens in the extractable data and I bet you we will get into that because across the board payment and you know for some reason that’s a bad word or were looked down on in healthcare but it will be based eventually. That’s all they’re saying on outcomes. So if we can prove it and how do you prove it. Well you know you can write a really great pitch you could say with a smile or data. Right. So that’s what you’re looking for so clicks data. What would a third thing be that you look for when you’re thinking hey we put myself in the therapist shoes with this EHR.

Rachel: That it kind of guides their clinical decision making and that we’re using evidence to support it. So we are continually updating the system based off the latest evidence that’s out there. If there’s any new FOMs functional outcome measures to use for for testing. We will add those and will we change any normative values as we know research comes along. We set up evidence base exercise protocols for the system to kind of guide the clinicians and what they should be doing for their clients out there.

Jimmy: That’s great. The fact that you’re updating those with new evidence we love to use that evidence based practice everywhere. We know from actual evidence that people will hold on to a belief structure throughout their career unless it’s presented to them in a couple of different ways. The fact that you’re putting that literally in the program that they enter their health information with their client that’s great.

Rachel: Yeah. One of the biggest issues with evidence based practice is just that knowledge translation you can learn it and read as many articles. But are you actually putting into practice. Is slapping you in the face in your H.R. system. Here’s the latest on treatments for Parkinson’s disease. It’s right there. And so it’s guiding you to pick the latest and the greatest.

Jimmy: If you tell your kids to clean their room once it’s probably not going to get done. Right so we know as human beings frequency is going to be one of the big factors that decides whether or not you adopt something new or learn something new. I love the fact you’re able to do that with an electronic health record. That’s great. All right. So we have a tradition on the show. It’s called Your FOXtale. So why do you work with older adults?

Rachel: I love the older adults here but I really gravitated to that culture that was at Fox. And so I think the older adults was definitely an incentive for me and I’d love to actually work with this population. But as a new grad coming out of school and I was looking at different places to work and the culture here was great as a new grad coming out of school. I was had the same out of respect as a clinician who’s been here 10 years and they value the clinicians that were here so I really gravitated to Fox for that reason. And then just really enjoyed the population. Once she got here with Sue’s fun population to work with. Ten years later.

Jimmy: Yeah that’s a great milestone. I mean I think a lot of times especially now is people are moving from location to location from setting to setting up trying to find that fit for them. The fact that 10 years that is a big deal especially nowadays. All right Rachel appreciate you coming on the show.

Rachel: Thank you.

Jimmy: Thanks for listening to FOXcast PT, a clinically excellent podcast. It’s brought to you by FOX Rehabilitation. Listen to other episodes or read articles and position papers at foxrehab.org.