TelePT: Inform Thyself

Sunset over a sheltered Bay Area

Day 65,000 of Shelter in Place (a.k.a 8),

There has been a heck of a lot of info flying around the airwaves as PT’s rapidly prepare themselves to be full on telehealth providers. I wanted to link to some resources:



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.


1. Shinkman, R. 2011. Americans want more online access to physicians, FierceHealthIT,‐want‐more‐online‐access‐physicians/2011‐03‐07.

2. Terry, K. 2011. Patient portal use becoming an inevitability, ForceHealthIT,‐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,, or

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.


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

2. Koploy, M. 2011. HHS Data Tells the True Story of HIPAA Violations in the Cloud,‐violations‐arent‐in‐the‐cloud‐1062011/#ixzz1TYEUKe4G.

3. Simmons, j. 2011. Can ‘clouds’ protect patient data from security breaches?, FierceEMR,‐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, or

Manage the Evidence Like a Pro

The problem. You are trying to stay current with the literature because that’s a great way to ensure quality treatment of your patients OR your a student in a physical therapy school that has a strong evidence based practice curriculum AND you end up having a hard drive littered with PDFs, like this:

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The solution. Papers2 by software developer mekentosj. This app makes it dead simple to organize your PDFs. Think of it as iTunes for PDFs, where instead of double clicking a track to listen, you double click to open the PDF in your favorite PDF viewer. You can search for articles quickly, email them to a colleague, even takes notes, all within the app. There are so many neat features I just had to put together a brief screencast demo, which you can view below:

Managing Physical Therapy Articles Like a Pro from Mike Pascoe on Vimeo.

In this 5 minute screencast, I show off some of the key features of Papers2. This video is directed toward those with a physical therapy background.

Papers2 can be downloaded here:

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,, or

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”

Best of Tech 2010…PT Edition


If you read as many blogs as I do (see Google Reader later in this post) you probably noticed many of them put together an end of the year review of what tools made a big impact throughout the year. I thought it would be a good exercise for physical therapists to see what devices/services exist out there and to consider the benefits of integrating them into your workflow. Maybe they can help you in 2011?

Let’s get started.

1. iPad

iPad was unveiled by Steve Jobs on January 27, 2010. Since then, it has become the most popular tablet device on the market and hundreds of applications are developed every month for use on the device, many that can be useful in a physical therapy clinic. In place of discussing iPad in the PT clinic in this post, I refer you to a post on this very blog, from Dec 20, 2010.

It will be interesting to see what happens with the iPad with the much anticipated release of the 2nd generation, rumored to occur Feb/Mar of 2011. Perhaps we’ll even see some sweet demos a “technopalooza” at the Combined Sections Meeting this month week.

2. The “Cloud”

I’m not talking about cumulonimbus here. I’m referring to the storage of information on a remote server, thereby making it accessible across many devices and to many users. It seems that the days of storing data on hard drives within your device are numbered – AWESOME COMMON CRAFT VIDEO HERE. Some cloud-based services that really gained traction in 2010 include Dropbox, Springpad, Google Docs, and Google Reader. Mike Reinold has an excellent post over on his blog about the applicability of these services in a professional setting.

Dropbox came in handy this past month at Colorado Manipalooza (Jan 22), when the instructor Paul Mintken shared with us all of the videos demonstrating the manipultion techniques that were covered. Although I cannot perform these techniques myself, I can imagine a clinician pulling out their smart phone (they all have one right?) launching the dropbox app, and reviewing a technique prior to meeting with a patient.

An area ripe for the enhancements of cloud-based service is the management of Electronic Medical Records (EMR). Bronwyn and Tejal have covered this in detail in a post on My Physcial Therapy Space.

So, you think you are already “in the cloud”? Take the nifty quiz put together by who else, Google.

3. Google

I say it all the time, everything Google touches turns to gold. My professional and personal endeavors have been made much easier by leveraging all the tools Google has to offer. Here’s a short list of reasons why you need to get a Google account, right now:

  • Gmail – have a pesky email quota on your work/school account? Forward your email to Gmail, archive all your messages and never worry about that quota 95% warning again
  • Google Docs – working on an in-service presentation with co-workers? Collaborate on a shared document to combine your efforts.
  • Google Reader – staying current with PT research. I get so many questions about Google Reader that I actually put together a screencast to show off how effective this tool can be. I consistently find out about the best research either weeks ahead of my peers do or I get notified on articles published on topics in Journals they might not have on their radar screen. Have a look at the screencast here:
  • Gcal – a really handy way to edit your schedule on a variety of computers and from your smart phone.

4. Video

If a picture is worth a thousand words, than a video is worth…..more. It’s getting easier to produce good quality videos with portable HD camcorders apps like iMovie and it’s gotten way easier to share those videos on the web with platforms like YouTube and vimeo. There have been so many good examples of the use of video in physical therapy in 2010.

For the 3rd year, Evidence in Motion put on their Elevator Pitch Contest. This contest required entrants to convey the selected message in a 30 second video. Maybe if you’re on the faculty of a PT Program you could encourage your students to participate in 2011. After all, the more competition, the better the videos will become. You can view the Second, and Third Place videos here. First place video here:

Although not a new technology, we’ve seen the embedding of lecture video become more common place in PT. This makes the presenters message reach more ears than just those in the lecture hall. Like this popular lecture from Dr. Timothy Flynn.

Lastly, to lighten to mood, we saw a series of videos from the students at Pacific University taking popular songs and giving them a PT twist:

5. Social Media

I’m not that compelled to review all the hundreds of social networks out there, those posts are a dime a dozen. And a lot of the biggest networks have been around prior to 2010. What I would like to emphasize is how these tools can be used to network, using the upcoming Combined Sections Meeting as an example:

  • Twitter – this tool is all about what is happening here and now. Check out the hashtag #CSM2011 to see what people are saying about the meeting. I was able to “participate” in conversations happening at #CSM2010 even though I could not be there in person. Also keep track of people attending #CSM2011 by following this curated list of twitter accounts attending the meeting (let me know if you want to be added to the list).
  • Plancast – another way to share your plans to attend certain events, like the meeting as a whole, or even any specific events at the meeting.
  • LinkedIn – meet someone neat at #CSM2011? Connect with them after the meeting using LinkedIn.

I you were expecting something to be on this list and it wasn’t there, please let me know in the comments below (that’s a big part of social media).

Smart phone “use” by physicians. What do the numbers really mean?

A recent article entitled “Why industry surveys on physician adoption of smart phones could be overestimating reality”at iMedicalApps [Mobile Medical App Reviews & Commentary – A publication by medical professionals] explored what recent market research really means…

It has been cited in market research that 72% to 94% of physicians are using smart phones in clinical practice (Questions: How are they using them? And, how often?).  Josh Herigon, MPH  a second year medical student and blogger at Number Needed to Treat comments:

“Although these studies show a high degree of smartphone adoption among physicians, these results should be interpreted cautiously. These firms provide few details on how they actually conducted these studies. A major hurdle to conducting such research is sampling bias. This can occur in survey research when researchers get a low response rate (i.e.—researchers approach a large number of individuals to fill out a survey but few actually fill it out).”

A little bird told me that a PTJ internal study revealed that no more than 50% of the physical therapists they sampled used smart phones. And, while the percentage of professionals who have and use smart phones is interesting data, I think there is a bigger question to consider. How many physicians, physical therapists, and other healthcare providers who own smart phones are using them routinely and effectively in clinical practice?

Owning a smart phone and leveraging its capabilities during clinical practice are two vastly different things. I am an avid smart phone owner and user, but to be honest, I rarely use my phone in clinical practice. I actually use it most while practicing within the in-patient hospital setting to look up medications, abbreviations, surgeries, and specific diagnoses. But, that is only when I am not near, or logged into, a computer. Admittedly, in the outpatient setting I grossly underuse the capabilities of my phone.

Why are we still giving out paper copies of exercises and patient education? I believe the opportunities for leveraging this technology for clinical support, aiding in clinical decision making, and pt. education are infinite. In my opinion, routine use could actually markedly increase efficiency and quality of care especially in physical therapy. Patient’s use and love their smart phone, so why aren’t we interfacing with them using technology? [Yes, I understand the potential HIPPA considerations and that is not the point of this post]

  • Patient education
  • Home exercise programs: Pictures, videos, directions
  • Pictures and videos of patient performance (motor control, motor learning, and feedback)
  • Documentation
  • Scheduling

Do you think it would be possible to run a private practice and physical therapy LLC strictly from a smart phone. If not, why not? Paper is messy and overated anyway…

Do you have a smart phone? If so, how are you using your smart phone in clinical practice? Do you use specific applications? Any ideas for how we can better utilize this technology as we move forward?

Considering making the switch to a smart phone? Check out this article targeted towards medical professionals: iPhone, Blackberry, or Android?

Did you forget what I told you?

via Markle.orgI stumbled across this interesting little bit from the Markle Survey on Health in a Networked Life. It concerns perceptions of communication gaps between patients and physicians. Simply put, doctors think patients forget things they tell them and patients think doctors forget things about them.

While both situations are probably true, the gap in the perceptions is something to take note of. Underlying this gap is the question of responsibility of ownership of health data. The survey reported that nearly half of patients feel their “main doctor” should be responsible for owning their data, but 2 in 5 consumer and physician groups felt that patients should have the ultimate responsibility for owning their data . Check out their slideshow. (Note the 27% response rate from a small convenience sample of physicians.)

In the world of physical therapy, no one really knows much about how data is stored and what perceptions exist about ownership of data, or even if patients think physical therapists likewise forget things about them at the same rate that they perceive physicians do. We simply have not asked those questions. That point aside, rehabilitation professionals would do well to consider the concept of data ownership. Perhaps engaging in initiatives like “The Blue Button” would be a great place to start. Physical therapists: does your paper-based documentation system have a blue button? Does your EHR?