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Alphabet Soup Redux

Credential Soup word cloud

In 2009 at the Annual Meeting and Exposition of the American Physical Therapy Association in Baltimore, MD, the Oxford Debate took up the issue of alphabet soup. The issue debated was, “Are the use of multiple credentials a distraction or an attraction to our profession?” The team in favor of eliminating the excessive use of credentials included, Robert Landel, PT, DPT, OCS, CSCS; Stephen C. F. McDavitt, PT, DPT, FAAOMPT, and Robert H. Rowe, PT, DPT, DMT, MHS, FAAOMPT. A well-credentialed bunch, indeed.

I recall siding with that team, as I have always had an eye toward PR and branding and consider too many credentials as being bad for a brand. Successful branding includes paying attention to your brand’s identity, as Philip Davis points out in this well-crafted blog post. This can be anything from making sure your fonts and colors are the same to making sure you dress according to how you want your brand to be perceived. If fonts and colors are important, a myriad of obscure credentials are most certainly critical as well.

This weekend’s visceral debate on Kyle’s post brought this larger issue to the forefront once again. What do you think about this issue of alphabet soup? Join the #SolvePT discussion tomorrow, hosted by @SnippetPhysTher.

[icon style=”notice”]Update: Check out the summary of the tweet chat on 5/22/12 here. [/icon]

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Happy Mother’s Day: Get Real

[icon style=”notice”]Update: Be patient with the Samahope.org site as they roll out over the next few days… [/icon]

Welcome to PT Think Tank’s new website design and Happy Mother’s Day to all the mom’s out there!

Today, we’re going to jump right in and get real on Mother’s Day. So real, in fact, that we’re going to talk about fistulas. Obstetric fistulas, to be specific. The kind that form mostly in impoverished countries after childbirth, we’re birth trauma causes tissue death and connects parts of the mother’s pelvic anatomy that should never, ever be connected. Women suffering with obstetric fistulae are ostracized by husbands and communities and suffer from infections, poor quality of life, and even death.

According to The Fistula Foundation, the occurence of new obstetric fistulae number about 50,000-100,000 annually, while the global capacity to treat this condition is only around 20,000. While this condition is extremely rare in developed countries, the World Health Organization estimates that between 2 to 3 million mothers in poor countries struggle with it. While the cause of obstetric fistulae are complex,  with as little as $450-$1000, the condition can be effectively repaired surgically.

My very compassionate and talented fried, Michelle Greer let me know about Samahope. Samahope.org is attempting to tackle this problem. This new venture is working to crowd-fund this procedure for women who can’t afford it. In an elegant interplay between philanthropy and technology, Samahope.org allows donors to select the individuals you want to help, donate simply using PayPal, and even track the outcomes for the surgeries they helped fund. Samahope.org is a project of Samasource.org, a non-profit based out of Silicon Valley who is working to reduce poverty through creating jobs via the innovate idea of mircrowork, connecting people with jobs over the internet. Leila Janah, the founder of Samasource, spoke recently at a TED event in Brussels:

[youtube id=”319sQ9s-lyQ#!” width=”550″ height=”300″ align=”center”]

Get involved and for this Mother’s Day, in addition to that nice pot of flowers and brunch we all like to confer upon our maternals, give the gift of life. If you’re feeling a bit quirky, consider browsing through some Weird Gifts to add a delightful twist to the traditional Mother’s Day celebrations. Those who are looking for custom gift options may consider visiting sites like Swagify to see more items.

Samahope.org is beginning their rollout today. In fact, they have but one tweet. It says, “How can you help change a life with only $20? Easy… I just did.“

[button style=”green” link=”http://www.samahope.org/donate.php” target=”_self” align=”left”]Donate Now[/button]

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CSM 2012 Was Thrilling…(and cold!)

Chicago Skyline

Thriller Flash Mob at CSM!

And another bonus video based on the soon-to-be-dead meme, “Sh*T Physios Say”:

http://vimeo.com/36158277

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CSM 2012, Chicago Edition is Here!

Chicago

My hat and gloves are packed, my boots are ready, although my ice walking skills may have gotten rusty having moved away from the northeast now 8 years ago. Regardless, I think I’m ready to dive in and embrace the winter wonder land that is Chicago, that is this year’s APTA Combined Sections Meeting.

PT Think Tank is going to be covering CSM in full force for those of you who can’t attend. Mike Pascoe, Kyle Ridgeway and myself will all be there and ready to tell you about the goings on either here, on Twitter, or however else we might discover. Dr. Pascoe is also planning some exciting live-blogging events from some sessions, so keep your eyes peeled and tune in REAL TIME from Chicago!

I’ll be representing the Orthopaedic Section as the Public Relations committee chair and performing tasks and attending events related to that role, and I’m excited to be presenting a research platform on Saturday afternoon.

Jason Tonley, PT, DPT, OCS, and Marcie Harris-Hayes, PT, DPT, MSCI, OCS, will be delivering a session entitled, “Don’t Forget to Be Hip: Looking at the Role of the Hip in Lumbar Spine Disorders” at 3:30pm Saturday. Part of that session will include several research platforms related to the topic. I’ll present the hip-spine case series I’ve been working on with Cheryl Sparks from Bradley U. and Derek Clewley from Benchmark in Atlanta. Check us out!

Here is our Twitter info: (Check out #CSM2012)

@PTThinkTank

@EricRobertson

@MPascoe

@Dr_Ridge_DPT

And check out, @AAOMPT, as it seems like they’re planning some fun, social gigs.

Also, don’t forget the APTA CSM Mobile App. Get it here. It’s way more convenient than trudging to those programming boards! I’m keeping my fingers crossed to see a little white stuff, but I do have some post-trauma from a failed attempt to get to Boston the last time CSM was held in a draft climate, so if it does snow, perhaps Friday night might be a good time. Can we schedule that?

See you there!

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The Value of a Patient Portal: Increasing Compliance While Reducing Cost

As patients become more and more interested in engaging and communicating with their healthcare providers online, the demand for portal applications will only increase. Patients are looking for innovative ways to access their health information and care providers – what better way than online patient portals?

Portals are healthcare related online applications that allow patients to interact with their healthcare providers through secure websites or integrated electronic medical records (EMRs). These applications can give patients the ability to request prescription refills, make appointments, receive medical reminders, view billing statements, and ask providers questions about ongoing treatment regimens (2). The key is engagement and it’s a growing trend among individuals who expect the most out of their provider‐patient relationships.

In the realm of healthcare, patient portals have revolutionized the way patients manage their treatment and recovery. However, their impact on healthcare providers cannot be understated, especially in the area of physical therapy care. Compliance is a significant challenge when it comes to ensuring proper recovery during the physical rehabilitative process, and physical therapists have a lot to communicate and monitor, from home exercise regimens to post-surgical contraindications and body mechanics. One way that healthcare providers can leverage patient portals to address these issues is by using them to send important messages directly to patients and monitor their compliance both at the clinic and outside of it. By doing so, physical therapists can substantially improve the quality of care they provide, which in turn leads to improved patient outcomes. Additionally, patient portals can help expand the reach of practices, making it possible to provide innovative solutions for patients who may be geographically inaccessible, such as those seeking urgent care Manhattan Beach. The downstream effects of using portals in this way include increased efficiency and productivity and a reduction in administrative overhead costs.

So, you may well ask: is now really the time to integrate this type of technology in my practice? In a recent survey conducted by Intuit Health, 73% of respondents said that they would use an online communication application to pay medical bills, communicate with their physician or physician office, make appointments and view lab results (1). More than 40% said they would consider switching physicians in order to obtain such access. Research such as this makes it clear that patients are eager to adopt such applications and now is the time for providers to get on board.

The use of portal technology is inevitable as patients take control of their health and demand two‐way communication platforms from their providers. As we innovate around ways to increase the quality of care provided to patients, the integration of secure portals should become a mainstay for effective clinical practice.

Resources

1. Shinkman, R. 2011. Americans want more online access to physicians, FierceHealthIT, http://www.fiercehealthit.com/story/americans‐want‐more‐online‐access‐physicians/2011‐03‐07.

2. Terry, K. 2011. Patient portal use becoming an inevitability, ForceHealthIT, http://www.fiercehealthit.com/story/patient‐portal‐use‐becoming‐inevitability/2011‐04‐23.

This guest post was co‐authored by Bronwyn Spira, P.T., President of Force Therapeutics and Mark Anthony Fields, Ph.D., M.P.H, Digital Media Associate of Force Therapeutics. Force Therapeutics is an online suite of solutions tailored for the busy physical therapist. Force Therapeutics can be found at www.forcetherapeutics.com, www.facebook.com/forcetherapeutics, or www.twitter.com/ForceTherEx.

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Avoiding the Breach: Is our patient data really protected?

Electronic health records (EHRs) are the future of the provider‐patient relationship. As the storage, retrieval and sharing of information via EHR accelerates, providers benefit from the most accurate and up‐to‐date information available. The delivery of care is optimized through these systems giving providers the information necessary to make the most effective clinical decisions for their patients.

The issue of patient security is an ongoing concern. Privacy of our medical data is one of the cornerstones of our healthcare system. This code of confidentiality empowers patients to share critical information with providers and, in turn, allows them to make the most appropriate diagnosis and plan of care necessary. In a recent blog entitled Living on a Cloud, we discussed how physical therapists are beginning to embrace ‘cloud computing’ as the new standard for accessing patient information any time and anywhere without having to purchase a server, upload a program or even back up their information. We emphasized that these services must provide Health Insurance Portability and Accountability Act (HIPAA) compliant user logins to ensure patient‐therapist confidentiality and should be SSL encrypted to the level required by CMS guidelines.

So, just as with our financial information we must ask the same questions concerning our patient data: Is this data vulnerable to internet attacks and security breaches? What precautions are providers taking to avoid these issues?

Here are some facts on EHR security. A recent study conducted by the consulting firm, Software Advice, found that security breaches of patient data through internet hacking only account for a small percentage (6%) of HIPAA violations (2, 3). A majority (63%) actually came from physical theft and unauthorized access or disclosure (16%). Of EHR violations, all involved on‐premise violations as opposed to ‘cloud based’ breaches. The author of the study points out that, “HIPAA violations aren’t happening in the cloud, rather, they’re happening in the doctor’s office, hospital IT closets, cars, subways, and homes.” In order to continue the safety of patient data, providers need to take precautions to comply with HIPAA Privacy, Security, and Breach Notification Rules (1). These include:

• Ensuring that any disclosure of patient information comply with HIPAA Privacy Rule

• Ensure the service performs a HIPAA Security Rule risk analysis indentifying potential threats and vulnerabilities to protected health information

• Ensure that service conforms to the HIPAA Breach Notification Rule which requires the reporting of breaches of protected health information

It is clear that EHRs can enhance the quality of patient care and that taking the necessary precautions to protect privacy is a crucial step to ensure that our healthcare system moves closer to a paperless practice model.

Resources

1. Dolan, B. 2011. Mobile Health: How to Comply with HIPAA, mobihealthnews, http://mobihealthnews.com/11272/mobile‐health‐how‐to‐comply‐with‐hipaa/.

2. Koploy, M. 2011. HHS Data Tells the True Story of HIPAA Violations in the Cloud, http://www.softwareadvice.com/articles/medical/hipaa‐violations‐arent‐in‐the‐cloud‐1062011/#ixzz1TYEUKe4G.

3. Simmons, j. 2011. Can ‘clouds’ protect patient data from security breaches?, FierceEMR, http://www.fierceemr.com/story/can‐clouds‐protect‐patient‐data‐security‐breaches/2011‐06‐23.

This guest post was co‐authored by Bronwyn Spira, P.T., President of Force Therapeutics and Mark Anthony Fields, Ph.D., M.P.H. Force Therapeutics can be found at www.forcetherapeutics.com, www.facebook.com/forcetherapeutics, or www.twitter.com/ForceTherEx.

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It’s Not About the Patient

If you have not yet viewed this video from Jack Bert, MD, from which the above screen shot was taken, please check it out now. Brace yourself. At the 8-minute mark, he discusses PT. He gets excited that a physician in SC was able to hire a chiropractor through this contact form and “athletic trainers to do the PT” and bill for it, and ran 60% of the physical therapy business out of town.

Is there not some really big problem with this situation? Does this not border on breaking the law? The unrestricted medical license of physicians allows them to bill for whatever medical service they want. Thus, the athletic trainers can indirectly become physical therapists. As a licensed physical therapist in the state of SC, I wonder why I’m paying a fee for licensure, when the state could simultaneously allow non-licensed individuals to perform the service that I’m trained to provide. Why are consumers not being protected from this action?

In the comments on the site, which by now are littered with offended physical therapists, Jack Bert responds:

“Now that I have thought about this, the discussion on ancillary services really has nothing to do with physician arrogance or greed. It really has to do with what is best for the patient.”

I simply don’t buy it. How is having patients be treated by providers with less training and a different skill-set than PT’s (the athletic trainers) equate to something better for the patient. Yes, physicians do medicine. They do it well. Physical therapists, well we do rehab and do it well. Can’t we both exist together?

He goes on to suggest:

“For ancillary providers, such as physical therapists and chiropractors, to believe that they have the same training and ability to diagnose musculoskeletal pathology as a boarded orthopedist with a minimum of 5 years of post-medical school training, excluding a fellowship, is truly astounding.”

Perhaps Jack Bert is not aware of the body of research that suggests overall, that physicians are not adequately trained in musculoskeletal care either. In fact, I find it astounding that a general practitioner with little specific training on the subject finds themselves capable of diagnosing the specifics of an injured shoulder or neck. I fully agree that Jack Bert, a board certified, fellowship trained, orthopaedic surgeon has very capable musculoskeletal examination skills, but I also feel that his disregard of physical therapists to also have those skills offensive and reflective of an old-school physician mentality whose time has passed. There is research to support my claim. Physical therapists are musculoskeletal experts!

If this was truly about the patient, we would give the patients choices. We would empower them to choose their providers. We would act to reduce limited providers and wait times and work towards an equitable distribution of resources. There’s enough demand for everyone to play together. Comments like those of Jack Bert simply shed light on what these turf battles over physician-owned PT services and direct access restrictions are really about. It certainly isn’t about the patient.

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Mrs. Smith: you have an upcoming PT appointment…

Another guest post from Bronwyn Spira, PT, and Tejal Ramaiya, DPT, CSCS, this one an apt follow-up to my post on Physical Therapist Use of Smart Phones:

One of the most frustrating issues plaguing physical therapy practices has to be no shows and late cancellations of scheduled visits. Poor patient attendance results in lost revenues and poor patient outcomes. Practices traditionally employ rudimentary strategies to counter-balance the impact of missed appointments including reminder calls and charging hefty cancellation fees. Unfortunately, these solutions require additional administrative time and effort and can create poor relations between the patients and administrative staff. There must be a better solution!

The answer may be one that 78% of Americans keep in their pockets or purses: a cell phone. The average American spends 619 minutes per month on their phone and, according to a ComScore study from March 2010: 63% of Americans are using text messaging. The use of SMS or text alerts as patient reminders has been shown to reduce the ‘noshow’ rate by 73% (or 1,837 fewer ‘lost’ visits) according to a recent study for Kaiser Permanente by mobilStorm. Kaiser was able to contain their communication infrastructure costs, while saving $150 per appointment (their no-show cost) which equaled a total cost savings of more than $275,000 at just a single clinic.

Ideally, SMS text and/or email alerts should be integrated into a clinic’s scheduling system; automatically alerting patients to upcoming appointments or schedule changes. And why stop there? The potential impact of these alerts could extend to reminding patients to complete their home exercise programs, or give therapists updates on symptomatic responses to new treatment regimens.

A study conducted by comScore found that daily use of Smartphones to access emails rose by 40 percent in the last quarter of 2010. Laptops and desktops it seems, have become primitive mediums for real-time communication. As our patients become more and more tech-savvy, they will begin to expect these type of mobile conveniences from their service providers. In addition to the considerable cost-saving benefits, automated communication can also serve to improve patient/therapist interaction, increase patient participation in their rehabilitation regimen and thereby improve patient outcomes. Have you considered integrating automated SMS text or email alerts into your clinic?

Bronwyn Spira, PT, and Tejal Ramaiya, DPT, CSCS authored this guest post. They can be found at www.forcetherapeutics.com, www.facebook.com/forcetherapeutics, or www.twitter.com/ForceTherEx.

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Smart Phone Use by Physical Therapists

A Physical Therapist using his cell phone today in clinic.

Houston, we have a problem!

Kyle’s post about smart phone use by physicians had a brief reference to some data attempting to describe smart phone use by PT’s. Well, we did some digging and discovered the real figures. This information is preliminary data obtained when PT Journal surveyed a representative sample of APTA member subscribers and was relayed to me by personal communication from the managing editor. The response rate was limited (~30%) which is why this is preliminary data, but I’m told the demographics of the responders matched the journal’s overall demographics. The numbers are concerning when the respondents were asked, “Do you use a smartphones to access professional content?”

Essentially, more than half (54%) of the respondents from this preliminary survey were not interested in using smart phones to access professional content, thus rendering the phones significantly less smart. We have no idea how many PT’s own smart phones, but to me it this question is more important that how many people own a smart phone. To compare, numbers for physician use of smart phones range from 72% to 80% depending on the survey. Yikes!

Why the disparity between two related professions? I’m just not sure. I am looking forward to more data of this sort. We need to figure this out. I’ll leave you with this quote from Stewart Brand:

“Once a new technology rolls over you, if you’re not part of the steamroller, you’re part of the road”

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Say Hello to Mike Pascoe

As you may have seen from his first post, our second new author is full of energy and really likes sharing! That’s a good combo for this blog. Mike and I have been acquaintances for several years now, albeit in a completely virtual sense. That is, until earlier this year when he took me on a tour of Boulder, CO. We found a coffee shop that could make this and had some real geeky conversation:

Mike is also just beginning a new phase of his career. He’s signed on to a faculty position at the Univeristy of CO, and is instructing Anatomy in the Physical Therapy program. He’ll be attending his first CSM conference this week, so if you see a tall fellow live-blogging and tweeting, run up and welcome him into the field of physical therapy.

About Mike:

Mike Pascoe, PhD recently joined the faculty of the Physical Therapy Program at the University of Colorado Health Sciences Center as a senior instructor of clinical anatomy. He graduated in December 2010 from the University of Colorado Boulder, where he studied age-associated differences in motor unit activity under the direction of Roger Enoka, PhD. He is married to Stephanie Pascoe PT, DPT, OCS, and together they enjoy traveling, snow boarding, and discussing basic research and clinical practice over cups of coffee.