Data Management

Documentation Software Roundtable

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Industry leaders offer insight into the key elements that shape documentation software and its ability to streamline practices.

Rehab Management recently hosted an exclusive roundtable panel featuring industry insiders who provided key insights into a wide range of topics in the documentation software arena. These topics included the ability to access documentation software via mobile platforms, the benefits and considerations behind cloud-based documentation, along with the impact of documentation software on compliance and billing.

Taking part in the discussion were: Nelson Aviles, PT, TherAssist Software; Andrea Cassese, director of PTOS Software, Patterson Medical, Ricky Gomez, director of sales and marketing, Planetrehab; Jerry Henderson, PT, founder of Clinicient; Shawn Hewitt, OTR/L, product manager of Rehab Solutions, MediServe, A Mediware Company; Heidi Jannenga, PT, MPT, ATC/L, WebPT co-founder and COO; Jason Keele, CEO, 1st Providers Choice; Steve Mackie, CEO of OptimaHCS; David McMullan, PT, vice president, product management, SourceMedical; Dan Morrill, PT, MPT, president of Hands on Technology; Amy Orr, vice president sales, ClinicSource Therapy Practice Management Software; Steve Presement, president, Practice Perfect EMR + Management Software; and Gerry Stone, PT, MEd, president and founder of The Rehab Documentation Company (ReDoc).

Rehab Management (RM): How does documentation software reduce operating costs and improve the quality of treatment? Does it streamline work when more than one therapist at a practice works on the same patient?

Nelson Aviles: When you have a complete Electronic Medical Record, you have access to the entire patient history. As a result, everything anyone has done is immediately available. Quality of treatment is improved because all the PT’s information, objective measures, interventions, positioning, etc, are readily available. This eliminates the need to awkwardly ask or find out what the patient has been doing or how they are progressing. For therapists who share patients, that type of information is invaluable. You can make rapid decisions about how to progress the patient and feel confident your recommendations for future visits will be honored.

Andrea Cassese: In terms of cost reduction, there are hard costs like reduction in printing paper forms, reduced file space, and any transcription costs. Cost savings are also realized in the form of improved processes and time savings in the single entry of patient data. It also saves time and improves patient care when multiple therapists work with the same patient—everyone sees and utilizes the same data.

Ricky Gomez: Efficiency and productivity are increased when using documentation software. And although those benefits are hard to quantify, it should lead to better patient care because the therapist has more time to devote to the patient. Documentation software that is consistent so all therapists are used to working with the interface makes it much easier for one therapist to pick up where another left off.

Jerry Henderson: A well-designed single system for documentation, scheduling, charge capture, claims processing, and business reporting gives everyone on the team information they need to complete their job. For example, the person scheduling a patient should be instantly alerted if there is a problem with the patient’s insurance authorization or if attempting to schedule the patient with a therapist who is not credentialed with the patient’s insurance. The therapist should know when the patient needs a new plan of care or if the visit requires an update of Functional Limitation Reporting measures. Charge capture should work off of the therapist’s documentation to ensure the visit is billed the maximum amount allowed.

Shawn Hewitt: Yes, most certainly work is streamlined. When used correctly, our software and documentation can bring a level of efficiency to the workflow that improves the quality of information, improves the timing of information, and can drive compliance required in the documentation/charge capture. These elements reduce and/or better utilize resources and effort that typically might be very time-consuming and manual. More importantly, when a user has timely and useful information about the patient, more informed and quality care can be provided.

Heidi Jannenga: According to a Power DMS infographic titled “The EMR Effect,” it costs $8 a year to maintain one paper chart and only $2 to maintain an electronic one. In terms of streamlining workflow, documentation software ensures that all medical records are complete, legible, and transferable so every therapist in a clinic can understand a patient’s full medical record—as can prescribing physicians. Communication tools within the software also allow therapists to speak with one another across locations in real time, resulting in improved collaboration and patient outcomes.

Jason Keele: It reduces time therapists spend doing initial evaluations, re-evaluations, discharge summaries, daily visit notes, and flow sheets. Documentation software allows the treating provider, treating therapist, and supervising therapist to work in conjunction with one another on the patient’s daily visit note.

Steve Mackie: Documentation software improves data accuracy by facilitating point of service documentation, which lessens the risk for error while entering patient data after the treatment has occurred. It improves efficiency by increasing the available number of billable hours, as time originally used to document can be used to treat more patients. It also allows for an easier, more time-friendly work day, which results in greater satisfaction among therapists.

David McMullan: Improved efficiency and accurate data are primary mechanisms documentation software use to reduce operating costs and improve the quality of data. The therapist has immediate access to patient data and patient response to treatment, versus having to search through paper records and charts. Also, all information is legible and presented in an easy-to-read format. This assists the therapist in effective, real-time clinical decision-making. [Documentation software] makes it much easier to collaborate with colleagues working on the same patient.

Dan Morrill: Administrative costs such as chart printing, auditing, and faxing can be reduced by EMR software. While all clinics operate in the same general manner, they all have unique workflow tendencies that make them different. It is vital to understand how a clinic operates both on the clinical side and the business side, and to find the best software to complement. Most EMR systems have unique logins, which solves the “who did what with whom” dilemma.

Amy Orr: Increased productivity via a reduction in paperwork and higher level of organization. Specifically, this is accomplished via utilizing an EMR’s therapy report templates, integrated scheduling and billing, and the presence of all patient records in one secure, easily accessible system.

Steve Presement: The reduction of operating costs all comes down to being efficient, using time to generate revenue. If the time taken to properly and effectively document can be reduced, it gives the therapist more time to spend treating clients and potentially generating new business. Therapists sharing patients have much easier access to information and potentially a much more robust look into each case without having to find a paper file and thumb through it to find specific information.

Gerry Stone: The reduction in cost can be calculated at various levels. The flow of clinical information through the episode of care decreases the time it takes to do quality and compliant documentation. Costly denials and appeals are minimized. Quality of treatment is improved, and best practices emerge from outcomes that are easier to collect, aggregate, and analyze with clinical software. Documentation software with protected permissions allows easy and secure access to other therapists involved with the patient’s treatment.

RM: How important is it for documentation software to be enabled on mobile platforms such as tablets or smart phones?

Aviles: Extremely. We have become accustomed to instant access. For many therapists, mobility is a way of life, and desk and/or laptops are now seen as clunky and not very ergonomic. To be able to safely and securely access and document while on the go—inside or outside the clinic—is a need all therapists share. For many, it is a necessity; for others, a convenience.

Cassese: Extremely important as mobile technology becomes more prevalent in the clinic setting as well as for access outside of the clinic.

Gomez: Inputting treatment information while treating a patient can be helpful in making a therapist more productive, but if the therapist is not careful, it could actually decrease productivity and patient care. The therapist could be so focused on entering information that their attention is not on the patient. Also, because screens are much smaller on a smartphone, it is often more difficult to enter information on them.

Henderson: Mobile platforms are very useful for viewing schedules on the fly and for entering routine information in daily notes and progress evaluations. Most therapists will prefer a keyboard or use of voice recognition technology for more complex tasks. The ability to use a smart phone or iPad to view a schedule from anywhere is a very nice benefit for a busy therapist.

Hewitt: In today’s tech world, it is very important to be able to use the software in any platform that supports efficiency and better access to the information. This goal should allow the clinician to have the information they need to improve the interaction with patients.

Jannenga: Today’s therapists are no longer satisfied with being shackled to a desk (or a desktop), stuck late at the office because they can’t work on sensitive, HIPAA-regulated documentation at home. They expect to be able to securely access patient information—and thus work—anytime, anywhere, on any Internet-enabled device, regardless of its operating system (eg, Windows, iOS, Android). Flexibility improves productivity, engagement, and thus profitability.

Keele: It is very important. Our software allows the therapist to simply dictate or talk into their smart phone and do daily visit notes in addition to seeing and managing their daily patient schedule. The therapist can do notes from anywhere with the use of an iPad, Android tablet, or Windows-based tablet.

Mackie: It is extremely important. Documentation software enabled on mobile platforms allows therapists to complete documentation while delivering care at the point of service, which promotes efficiency. It facilitates compliance by allowing therapists to meet physician orders and clinical practice guidelines, and improve communication.

McMullan: While it sounds great to be able to document on a smart phone, it really is not practical to create quality clinical assessments and evidence on a device that has a 3- to 4-inch screen. It is important that the software can run on mobile platforms for both mobility and decreased device cost. I would recommend the minimum screen size of any device be at least 8 inches for optimal ease of use.

Morrill: To answer this question, it is important to understand why a user needs mobile devices or smart phone access. Designing software to work on tablets and phones is not that difficult. What is difficult is securing data on these devices to safeguard protected health information (PHI). Phones are lost, computers are stolen, employees change jobs, etc. More risks increase the chance for data breach, which can be catastrophic.

Orr: Mobility has become increasingly important in the health care industry as more providers perform data entry at the point of care. Furthermore as we see more back office operations performed off-site or while telecommuting, users may expect to use their personal laptops to perform billing operations.

Presement: Smart phones may be too small to be practical for such an application, but having a tablet between the clinician and the patient is less intrusive than a full computer or large laptop. Tablets are highly portable and can be easily moved. However, proper computers and laptops offer a far more usable keyboard and larger screens, which may make the actual entry of clinical information quicker and more efficient. It’s really up to the individual clinician.

Stone: Point-of-care documentation is the most efficient way to utilize documentation software. However, you need a device that is large enough, but not too heavy to do work properly. A tablet-size device would be perfect, but a smart phone would be too small and clumsy.

RM: What are the most significant effects physical therapy documentation software can have on compliance and billing?

Aviles: Therapists will tell you they have enough to do without considering all the rules and regulations regarding documentation, compliance, and billing. EMRs can alleviate these burdens without limiting their decision-making. For example, our software allows a therapist to use the functional test of their choice and then assign the approved G-code. We can calculate the time spent on any intervention and then calculate the billing to be sure there are at least 8 minutes for every unit.

Cassese: If your documentation software is integrated with your billing software, you can realize significant reduction in errors and also speed up the billing process as a whole. When using electronic templates, it is easier to build in requirements/reminders to improve compliance with insurance and regulatory requirements.

Gomez: Treatment documentation should justify (or support) the charges. And documentation should be consistent and uniform throughout a therapy company. The owner/manager of a therapy company should be able to control the documentation so all treatment notes are consistent. The software a therapy company uses should be able to provide these features.

Henderson: A well-designed documentation system will guide the therapist and require documentation elements to ensure compliance. It will allow the user to accurately capture charges automatically based on the procedures documented on the visit note while taking into account any billing rules for the patient’s insurance. Having one system for documentation and a separate system for billing not only can increase audit-risk, but is far less efficient and prone to billing errors.

Hewitt: The effect is that the documentation must drive compliance while supporting charge capture. Software and documentation should be developed to balance efficiency and compliance. Therapists must be quick but at the same time are being asked to document more compliancy rules to ensure reimbursement/payment. Our software is set up to drive compliance and capture specific regulatory elements to support charge capture selected.

Jannenga: The most significant effect that physical therapy documentation software can have on compliance and billing is helping users get paid. In terms of compliance, documentation software—specifically, an agile, cloud-based system—can quickly implement tools and features to help its users stay up to date on the latest in documentation regulations well before such requirements become mandatory.
Keele: The use of a template forces compliance documentation in addition to the procedure codes, G-codes, and modifiers automatically flowing into billing for review by the biller.

Mackie: Documentation software forces data content compliance, based on Local Coverage Determinations (LCDs), payor guidelines, and clinical practice guidelines. It also ensures daily documentation is completed for the services billed. With the changing regulatory environment, it is important to have a flexible system so that adjustments can be made quickly, as opposed to manual or paper systems.

McMullan: Clinical documentation software should not only assist with compliance and billing but should dramatically improve compliance and billing accuracy. Even before the therapist closes the note or documentation for a visit, the software should alert and/or guide the user to ensure they have captured and reported everything required for the visit or encounter. Paper-driven documentation not tied to charges or billing is a recipe for disaster. One of the best risk mitigation tools a clinic or practice has is a clinical documentation software solution.

Morrill: Defining workflow and helping clinicians with “reminders” or established guidelines will always help in our never-ending battle to define medical necessity for skilled physical therapy services. Good EMR systems should be proactive in mistake management and offer suggestions or audit tools to reduce compliance errors. It also needs to start on the clinical side; great documentation has always been the best way to defend billing procedures.

Orr: It will increase productivity and ensure accurate accounting/billing. Look for a software product that will save the provider’s time, and allow them to focus more on providing quality services while also electronically processing claims and increasing cash flow efficiency.

Presement: Electronic documentation can help make sure “things match up.” Do the notes justify the charges? Do the charges/units make sense given the appointment time length? Mechanically, is everything being presented on the daily note: signatures, NPI #s, qualifications, all in the right place? Are durations being reported, proper identification, etc? Are the correct modifiers being used? Are you using a Fee Code not allowed by a certain Payor? Have you exceeded funding limits? Are you reporting your Functional Limitation Reporting and PQRS scored when and how you should? All of these items can be monitored and handled by good documentation software.

Stone: Accuracy. Documen-tation software assures that charges submitted on the claim are exactly what the therapist documented in the progress note. The software should contain the latest terminology and specific CMS and Joint Commission required elements for the various reports throughout the episode of care. The software should contain point-of-care billing alerts for the following: over- or under-billing; use of appropriate modifiers; upcoming due dates for reauthorizations, progress reports, and recertifications.

RM: How important is it for documentation software to work with other software systems, or information systems?

Aviles: No software should be an island. Interfacing with hospitals is a must since they can be the primary repository of data for a practice. For others, making a move to one complete EMR can be a shock, and rather than upset the apple cart, it makes a transition smoother if our software can interface with their existing billing in some way until they decide having in-house billing suits their needs.

Cassese: You can realize more benefits in terms of cost savings, streamlined processes, and reporting if your documentation is integrated with your billing and scheduling software.

Gomez: It varies depending on the features the software provides. If the software is strictly for documentation, then the user would want it to interface with billing and scheduling software. But a turnkey system would provide all the components needed to operate a practice.

Henderson: Documentation software should not be a separate system. “Integrated” often means the documentation system exports charges and demographic data to a third-party billing system. If considering a system that is “integrated” with a billing system, ask how data exported from one system to another stays in sync. For example, what happens if the therapist revises documentation that affects billing? Or what if the billing department finds a typo in the patient’s name and corrects it in the billing system?

Hewitt: It is very difficult in today’s health care landscape to have systems that do not talk to one another. Big box systems claim they can do it all but it has been proven that best-of-breed systems have more targeted focus to fill the gaps of the big box system. Both big box and best-of-breed must talk to another to provide the best overall management of clinical information.

Jannenga: The purpose of widespread documentation software adoption is to improve the quality of health care across the board. To do that, we all need to be working toward complete interoperability. The industry as a whole is not there yet—but we’re working on it. In the meantime, documentation software should at least communicate with other systems that make a user’s life easier, such as scheduling, billing, and compliance tools.

Keele: It is very important, our software is CCHIT (Certification Commission for Health Information Technology) and ONC (Office of the National Coordinator for Health Information Technology) certified. The use of a fully certified product allows for the referring provider to share information from their software program to the therapy office. It automatically fills patient demographics and subjective information of the visit note.

Mackie: Integration is extremely important for overall operations, as well as for the patient, as it helps to reduce the risk of medical errors, increase communication, plan discharges, and provide more comprehensive care planning.

McMullan: It is critically important the clinical documentation software interface or integrate with other software or information systems. The rapid growth of Accountable Care Organizations (ACOs) and Health Information Exchanges (HIEs) will make it almost mandatory that your documentation software has the ability to easily share patient and health care data across the continuity of care spectrum.

Morrill: If the goal is to improve health care in the United States, then it is vital we find a way for systems to connect patient care records with the providers treating them for common issues. Better health care will only come from providers and patients being “involved” in care and not simply having all their records in one place.

Orr: Depends. If associated with a hospital, it’s important. The other side of the coin is does the software address all the needs of the clinic (ie, would it need to integrate with another product for some reason to complete the requirements needed for business operations)? If not, then there is no need for integration by the software product.

Presement: Having one system enables cross-checking of notes to charges, and charges to scheduling. With the addition of the new Medicare G-Codes an all-in-one package has become crucial, since scheduling and number of visits now define when testing needs to be performed and reported. Not having integration will result in extra work and errors.

Stone: Interoperability will become paramount, especially in the rehab industry and the advent of Accountable Care Organizations. All documentation software systems used in settings where PT, OT, and SLP services are delivered will eventually have to communicate with a variety of other larger and more global systems.

RM: What considerations about hardware should be made before a practice purchases or upgrades documentation software? (i.e., ease of use, customer support, ability to interface with other hardware/software?) For server-based systems, are new hardware purchases an unavoidable part a new software purchase?

Aviles: TherAssist advises clients to go about hardware purchases conservatively. For example, if a clinic owner thinks all staff should be on iPads, pilot one or two first to see how it impacts workflow. Then see if it makes a significantly positive impact to justify a large-scale purchase. When you have a server-based solution, hardware changes are part of the territory and should be thought of in regards to which components are in need of immediate replacement/upgrade and how that can impact users that connect to said device. Also keep in mind that hardware requires software; will that also need to replaced/upgraded? It also requires a longer view when you manage your own network. You should also work to identify what network pieces need replacing or upgrading in near and long-term future.

Cassese: Hardware requirements would vary with the software being used and also the size of the practice. Whether the system is server or cloud-based, the practice will need to look at their current hardware and evaluate what needs to be updated or replaced prior to moving to a new system. The practice will likely need to determine whether to invest in tablets or laptops to enable electronic documentation.

Gomez: The main consideration is if the software will operate/is compatible with the hardware being purchased. Any server-based software should run on the latest operating system and should have backwards compatibility to previous operating systems. Also, the optimal scenario is to allows users to purchase their own workstations.

Henderson: Any vendor should be able to give you the minimum system requirements and recommendations on preferred hardware.

Therapists, front desk staff, managers, and billing professionals all have different needs. In general, based on cost and other needs, we recommend standard PC workstations for administrators and front office staff that do not need a mobile device. And, of course, we always recommend a mobile device of some sort for therapists.

When deciding on mobile devices for therapists, there are many options to consider. You will need to ask yourself several questions: Is it the only device the therapists will have? How much will they use other productivity software, like Microsoft Office? Will they need to store many files on the machine, or can they access them online consistently? Would the therapist prefer to work on a keyboard or a touch screen for data entry?

Hewitt: This discussion can go many ways depending on whom you are (IT vs. end user). MediLinks has always seen success in organizations that offers a good balance of what is needed to run the software (minimal specifications) and is user friendly/easy to use. If you have hardware that is difficult to use, manage and support then the consumer of that hardware will most likely be dis-satisfied. This dissatisfaction often is projected at the actual software solution. If not managed correctly, this could have real negative impact on software adoption. Anytime purchasing or upgrading software there should be due diligence to understanding the minimal specification, as well as how easy it is to use, implement, train and support the use of any hardware.

Jannenga: When it comes to documentation software, the right cloud-based solution shouldn’t require any accessory hardware. All a user should need is a web browser—such as Internet Explorer, Mozilla FireFox, or Google Chrome—and an Internet connection on any device he or she already has and is comfortable with (Mac, PC, desktop, laptop, tablet, smartphone). However, additional products and features—like WebPT’s eDoc scanning system—may require additional hardware considerations, like a specific type of scanner. To that end, it’s always a great idea to ask plenty of questions up-front about new devices, including whether the software documentation vendor will be able to help troubleshoot the device if necessary. In WebPT’s case, the answer is always yes.

Server-based EMRs, on the other hand, often require a hefty capital investment upfront to purchase the hardware necessary to get started (i.e., servers and additional IT staff to man those servers) and to update or replace said hardware as it ages.

Keele: Many factors should be considered when purchasing hardware. First the decision of whether the therapy office will deploy a server-based or web-based system needs to be addressed. The office is then in a better position to make a decision on the hardware that is best-suited for the software.[For server-based systems, are new hardware purchases an unavoidable part a new software purchase?] Yes unless current system meets the hardware requirements of the software.

Mackie: Ease of use, customer support and the ability to interface with other hardware/software are all important considerations. In addition, portability/mobility, maintenance and connected/disconnected use capabilities should also be considered.

Morrill: Inventory is a great place to start, what do you have and how well does it run? Most hardware today has a limited life span, very few laptops and tablets are “upgradable”, meaning they are at their best out of the box. Therefore we recommend going to local computer stores to get your hands on tablets and laptops to see what would help productivity. Understanding the typical computer has a 2-4 year life span will go a long way in planning budgets and helping choose new technology. If you have a server, plan on some IT support especially if you are hosting your own email server or running your website from it. We develop our software to run on the latest operating systems that are currently being supported by the manufacturers. It is very rare that a company has to replace their computers to run our software. Our motto is to use the technology you have and replace when that device becomes obsolete or no longer functions.

Orr: There are a myriad of operating systems currently in use from Windows XP, Windows 8 64 bit, Mac osX, iPad iOS6 and Android to name a few. All of which users expect their software to support. “In the cloud” browser based systems such as ClinicSource provide this cross platform compatibility users have come to expect.

Presement: Any hardware requirements should be verified with the software vendor before any purchases are made, they could be very specific in some cases, and some vendors even insist that you use their hardware. There is a very good chance that new hardware will not have to be purchased to accommodate a new software system, mainly since any computer system purchased in the last few years will probably have great, unused capacity.

Stone: The first thing would be to determine the pros and cons of hosting the system yourself (see question #6). If the vendor offers both, ask for the specific differences in customer support, interface capabilities and hardware requirements. If your facility already has a good IT infrastructure, you may not need any additional or only a nominal hardware upgrade.

RM: How does cloud computing affect the ease of use of documentation software? What are significant advantages/disadvantages to cloud-based documentation?

Aviles: When your software is remotely managed it can eliminate the need to replace and manage component software and hardware as well as significantly reducing the need to provide security and backups (which the vendor will do). It makes accessing the software across multiple types of devices easy and fast to implement and really gives your practice enterprise scale solutions and extremely low costs. So, when a therapist pops up with the latest tablet, the burden shifts to the vendor and not the clinic to get that device connected. On the whole, it allows you to focus on your business and not be distracted by IT or network issues. Your only real concern is getting Internet access.

Cassese: The fact that a documentation system is cloud-based does not necessarily mean it is easier to use. Ease of use is determined by how well the software enhances or follows the therapist’s workflow, how intuitive it is to build your notes and enter data, and how well it integrates with your other software.

Gomez: Cloud computing should not have an effect on the ease of use of documentation software. The software should operate the same way whether it is cloud based or server based.

The major advantage cloud based software has is mobility. The user can access their data from any computer that has Internet access. The disadvantage is if the user does not have Internet access, then they cannot access their data.

Henderson: Cloud based computing makes everything easier for the user. As long as there is a reliable broad-band internet connection, all of the heavy lifting is done by servers that are administered by vendors with top IT professionals. Data security, system redundancy, required backups, HIPAA requirements, and system and technology upgrades are all handed by the vendor.

The only disadvantage is the need for a persistent internet connection. If you are considering a cloud based system, your practice is based in an area with business quality internet options and you should make sure that the vendor can assist you easily if your internet service is interrupted.

Hewitt: Advantages: It certainly takes some burden of off the IT footprint to purchase, manage and support a more involved hardware set up. It also allows the end user to access information wherever they have an Internet connection. Disadvantages: It does require constant access to the Internet to be able to interact with the information and cloud-based system. Cloud-based systems also add a level of complexity around control of data and applications that must be considered.

Jannenga: Cloud computing greatly improves the ease of documentation software, and there are many advantages to using a cloud-based system. First off, cloud-based EMRs are simple and user-friendly. After you sign up, they require just a brief training session or webinar, and then you can easily navigate the application from anywhere, anytime, on any web-enabled device.

Secondly, cloud-based applications are scalable, flexible, and constantly updated, which amounts to less work for you and your staff. Less administrative work means more time to treat, and that’s ultimately what every business tool should help you achieve. Plus, because cloud-based systems can update on the fly, users always have the latest and greatest in compliance tools and features built right in.

Thirdly, cloud-based software offers unmatched data protection because most cloud-based environments are linked to very large data centers with state-of-the-art security systems in place. WebPT, for example, uses IO Data Center, a Tier Ill-Certified facility that provides data infrastructure to the world’s largest enterprises, governments, and service providers—fellow clients include Amazon, eBay, Salesforce, PayPal, Honeywell, and the Department of Homeland Security. As a Tier Ill facility, IO offers multiple layers of access control, including a defensible perimeter, video surveillance, and round-the-clock security guards.

In terms of disadvantages, the only risk in using a cloud-based system is choosing the wrong one. Users should ask potential vendors how they handle onboarding, updates, and security. They also should know how frequently the system goes down. To give you an idea of what to look for, WebPT has a 99% uptime rate. It’s also wise to look for a vendor that doesn’t rope customers into lengthy contracts—after all, users should be able to take their data and leave anytime they want. Plus, with this arrangement, the company will consistently work to re-win customers’ business during every interaction–and that means the system will keep getting better and better for everyone.

Keele: Cloud software makes it particularly easier to use documentation software in a multiple location situation. Web based software can be accessed anywhere with an Internet connection [and is a significant advantage]. The only disadvantage of cloud-based documentation is if the Internet goes down in which case a secondary connection is recommended.

Mackie: With cloud computing, data is being saved to the cloud, versus the device, so the advantage is that it can be accessed from anywhere. However, the disadvantage is that an Internet connection is required for data access, which can limit mobility. Thus, it is important to purchase software that has the capability to run in a disconnected state.

McMullan: Cloud computing has had a big impact on the ease of use of documentation software. This is due to the real-time access of patient data and the flexibility to access the documentation software from any device with internet capability. This has also lead to software documentation vendors improving workflow and navigation on new mobile devices. We have seen a dramatic increase in our own cloud-based solution, Therapy OnDemand, due to richness of the product coupled with its ease of use.

The most significant advantages of cloud-based documentation are accessibility, flexibility, cost savings, security, disaster recovery, backups, and automatic upgrades. We provide all of these core cloud-based benefits with Therapy OnDemand today. The primary disadvantages are the dependency on Internet connectivity and perceived lack of control over the data. These disadvantages are quickly falling by the wayside with high availability and low cost Internet connectivity and overall consumer acceptance with cloud-based solutions in general.

Morrill: The major advantages to cloud computing is on the IT side. Although on-site network configuration and computers are required, it is less expensive than setting up and maintaining servers and back-up solutions. Cloud offers the advantage of accessing much more powerful servers that offer more protection and redundancy than a typical small business server. Other advantages are automatic backups, data recovery, and the ability to use the system from more remote locations.

The major disadvantage is that an active Internet connection is needed. If the Internet is down, the system is down. The other major disadvantage is that the data is not physically at your facility. If a vendor goes out of business or decides to unplug a server, it may be very difficult to gain access to that data without legal action. In the meantime you may have no access to your patient’s records. Our advice is to know your vendors financial health and history before deciding on a product.

Orr: We have seen cloud computing move from a somewhat feared technology to an accepted and proven technology. The idea of having a server on premises requiring skilled IT staff, worrying about backups, security, office connectivity, etc. can be overwhelming for many practice owners. By leveraging cloud based systems, such as ClinicSource, practice owners can avoid these hassles. Therapist find that it is very easy to use as they can access their program from anywhere and anytime using their desktop computers and or iPads.

Presement: The only two benefits that cloud computing offers are ease of implementation, meaning that no software needs to be installed, and you don’t have to worry about performing data backups. The downsides are substantial and often are glossed over by web-based software vendors. Cloud-based systems tend to operate more slowly since everything is done via the Internet and if your Internet is ever down, you are down. However, the major issue surrounding cloud-based systems is the ownership of your data. Each clinician is ultimately responsible for their clients’ records, yet faith is being put into organizations completely beyond the therapists’ control that could shutter their doors at any moment. They have the data, the clinician doesn’t. And what happens if you leave these web-based software vendors? You are sent your raw data on a memory stick, no more access to the program with which you created these notes—good luck recreating any meaningful documentation.

Stone: Cloud computing will not be easier than having the application hosted on a local server for the end-user therapist. Cloud computing is also less secure in protecting Patient Health Information, so careful consideration must be taken at this time. However, software vendors should be able to deploy their applications either way, especially for the smaller clinics. Do your homework to find the best solution for your clinical and technical needs. RM

Brittan West is associate editor for Rehab Management. For more information, contact


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