Anthony: What brought me was actually Dr. Fox. And that sounds pretty simple, but it was at a time when I was in an outpatient clinic, sports med. I was treating a specific patient that I remember very very well who I believed was getting better, you know. And I remember talking to her along the course of her treatment and saying, "You know, Mary you're doing great. Look at all your objective measures -- nice, pristine outpatient clinical environment," and she looked at me and she said, "Son, I think you're great but I'm not any better." So it is like that real pivotal moment for me where I had someone sort of call out my clinical ability to help her. Right at the same time, someone was saying, "Boy, this guy, Dr. Fox, he's onto the something. Tim Fox: You have to meet him. I think he's..." Yeah, so I did. I sat down with him and I had Mary in my head because I was dealing with: how do you fix her? how to help her? I totally didn't see your home environment. I totally missed the boat on everything that she was telling me. And we sat down at the diner together, and Tim throws about three articles in front of me. Literally within the first minute of conversation, three articles from the PT Journal. One of them was about subjective reports of pain and disability in older adults, and that that is the primary sort of guide to making sure that you're actually impacting change. It just like stopped me in my tracks. Robyn: Back when I started with FOX, I was the eighth clinician hired to work with Dr. Fox and the practice. That was back in 2002. Travis: Many people remember their first day. It was my orientation day with the practice, with FOX Rehab. And we were in an office in Cherry Hill and I remember walking and you walk down the steps into the basement of this relatively small office. And now here we are in our current home office, also in Cherry Hill, but you could probably fit about 20 of the previous offices into our current home office. Robyn: Dr. Fox gave me a pile of charts about 20 charts high, handed them to me, and we went through all the paperwork, learned how to do it, but he said, "Now, get on the road." Anthony: So what you had to do was proactively call some voicemail box that you were set up for you at the practice. You would call in and you would listen to whatever voice messages were there. You might get a new patient. That's how you know. Now you would get the name of the patient and address and the phone number so you can hopefully connect and contact that patient on the move and get them scheduled and going. Robyn: At that time of the practice, we were going wherever the patients were. And you know, we didn't have the opportunity to have tighter areas, treating areas and focused areas. We went we went where we needed to go. Anthony: The big thick, you know, schedulers. Some people still actually carry them because if they can't get away from them, right? I'm electronic now, finally, but a huge scheduler booklet like you would see in an outpatient clinic. Robyn: I would always go to 7-Eleven and every time I had a patient in a new county and I'd buy the county map and open up the map, find the address, find the square in the box where it was, and then try to figure out the roads I knew to get there. There was no Waze, right? Like, I had to figure that out if there was like a school bus or an accident or something, I'd have to know my back ways around. Anthony: But often even if you scheduled them, you wanted to kind of try to route yourself to swing back to your house which is where your fax machine was which had the face sheet on it. Robyn: And of course, the proverbial fax machine: So I would get home every evening and see what patients Dr. Fox sent to me that day and where I was driving the next. Anthony: So that becomes almost this visceral thing in your life. "Op, the fax line is going off. I either have another patient or something's something's up." Right? So you had to wait for it to download hopefully the paper was in the fax machine because you don't have an office staff of people helping to maintain these things. It's just you maintaining this fax with a majority of communication that occurred between home office in the field. So, it's really crazy when you step back to think just how non-automated our lives were. Travis: I remember back when we first started doing documentation. It was all on paper. So each patient you would see, you'd get out of your piece of paper documentation: a soft chart, right, with all of the documentation right there in it. You'd write down all things with a patient. And then at the end of the week, you had to get your paper documentation, all of your file folders, separate each of the different pieces of paper because some piece of information had to go to a senior living community. Robyn: One went to the chart. One went to compliance. One went to our records. And then one would stay in my soft chart. So I would be running around with charts. Travis: I mean since 2008, in the last 10 years, we've dealt with Medicare caps and sequestration and NPPR, PQRS, and a lot of different types of audit and appeal and systems of denial. This organization has continued to grow its regulatory and appeals and departments in order to respond to the known evolution of the way the regulatory environment is going to happen. Anthony: It's the same care. It's the same deliverable. It's the same really good therapists completely focused on clinical excellence, engaging in older adult in their home who is in tremendous need of something that they never had access to before. That's the same. Robyn: So when I became a regional director, I went crazy and I got a BlackBerry. That was my first smartphone. Anthony: So I remember when I got my first... it was a BlackBerry -- Loved it. I thought it would make the world a lot easier. And in many ways it did. But over the coming years, I certainly came to reflect on the complications that create. It creates changes in... One thing I could say is: even as a clinician within this practice was, my cell phone would call with patients in the evening sometimes. And that hasn't changed. I know all of our clinical teams still deal with patients and family members after hours and durable medical equipment providers. But now, it was so much easier to access me that learning to start to draw some lines in your own personal life and balance, work/life balance, was so critical. Robyn: So looking back over the last 20 years with the practice and 16 years specifically for me, I mean gosh, we've come a long way. We've gone from a 2-3-4-5-clinician professional private practice to a professional private practice of -- we're going to be 1,600, 1,800 before you know it. Travis: When I started back in 2008, we had maybe a handful of certified geriatric practitioners. GCS-level folks and no BCGs meaning board certifications in gerontology which is the OT equivalent. Now here we are 10 years later with 75 GCSs and 7 BCGs. Robyn: I look at some of the things that we're rolling out now like Hot Sync to be able to work offline and to constantly not have to be hooked up to Wi-Fi to be able to get your documentation done effectively and efficiently. Anthony: Well jeez, and I think about where the practice is today versus where it was you know when I started 15 years ago. And back then, like we were discussing, manila folders, blue and black pens, a voicemail box, a phone that could call on a limited plan but couldn't text couldn't e-mail. It couldn't access a browser. To today where everything is automated. All of your documentation is in an electronic health record, not a four-page carbon copy. You press a button when you receive a face sheet, and it can link you to a map. You don't need to deal with a paper map in your car. I mean wow have we taken some tremendous steps. But, I still think there is this gap of where we want to go. And I know I speak for others when I say this in that there's an opportunity for us to even further deliver clinical care, taking some more of the administrative component off of it if we can just get the automation around the experience to the point where: A clinician who comes into our practice, that that process becomes as simple as getting an iPhone or an Apple iPad or something like that and very intuitively you can do 80 percent of what you need to do on that device within a matter of days. And for some clinician who's looking at FOX Rehab and coming into our practice and being able to start here and figure this job out from that perspective makes their experience so much better makes our practice an even an even more optimal place for our profession to practice, right? So if we can if we can get that done where 80 percent of the work that goes into being able to deliver good clinical care is so efficient, then we've accomplished something good. And I know the colleagues of mine are all clinically focused on trying to make sure how do we deliver that care and take some of that additional work and burdensomeness off of both new employees coming into the practice but also those who've practiced for this for so long who remember the manila folders who are now into RainTree and the applications that start to map out where their patients are. Boy, what a gift that would be for them for the future for their work-life balance as well. So, I think that's what I look ahead towards.