My Electronic Medical Record (EMR) Wish List

Converting-to-Electronic-Medical-Records-300x300Many of you may be surprised that while I love and recommend technology to improve efficiency for cash pay practices, I still use paper notes in my practice.  I have a manila folder for each patient. I use the type with two metal tabs at the top of each side. Left side for treatment notes, Right side for patient history forms, objective measures and any reports or medication lists the patient brings with them. I have a 2 drawer file cabinet for my current patients and at the end of each year I take out the files of patients who I have not seen in 3 or more months and put them in a file box in my closet.

Since I opened my practice I have strongly considered the use of an electronic medical record system multiple times. There are web based and server based versions, and I prefer the web based versions.  I’m not going to list the exact companies here or call anyone out, however I do want to share my concerns and decision making process.

The 1st huge barrier and main reason I did not go down this path right away, when I was staring my practice, was the start up cost of $2,025 and $495/month or 8% of collections. Wow!  A deal breaker for a small, low overhead, cash based practice.  This was in 2008 and the Electronic Medical Record (or EMR) landscape has changed, and I believe this company has since updated their pricing structure and there are many more EMR systems at very competitive prices.

On the other end of the scale I played around with Practice Fusion a few years ago which is a Free and Ad supported web based system. It looked nice and for being free was pretty awesome. At the time there was no “physical therapy” template, which would have been very time consuming to create my own.

My #CashPT EMR wish list:

  1. Simple, low cost and/or high value pricing structure
  2. Dedicated Mobile App to schedule patients & access records on the go
  3. Integration with Gmail & Google Calendar even with Dropbox, Evernote and other web based platforms
  4. Dedicated iPad and Android Tablet App that allows for customization of all patient intake questionnaires, objective measures and consent forms
  5. Zero need for any paper to be used in patient contact
  6. Easy to use and simple web based platform for documentation
  7. The feeling that this is saving me time, money and energy


Of course I have my Pros and Cons list, and the Cons still win for me and my practice.

EMR Pros:
1) The biggest pro for me would be the ability to log into a website and complete my patients notes from home, after my kids are asleep or any other time when I am away from my office

2) No storage space required for older patients notes

3) Ease of sending patient documents and notes. This is a minor pro, because with a low volume practice I receive a request for patient notes 4-5 times a year, however it would be as easy as a click of a button rather than pulling the files waiting for the fax or copy machine. No envelopes to buy or trip to the post office for a particularly large file.

4) Coolness and Subscribing to technology.

EMR Cons:
1) ) Mobile office: Can not schedule patients on the go. Almost all EMR suites use a scheduling calendar, and I have not yet found a company that has a dedicated Android or iPhone app which would allow one easy access to the schedule for on the go scheduling of patients.

I am not always in my office sitting at my desk and do not have an assistant answering my phone, but I am very frequently available to take phone calls. I want to be able to answer the phone and schedule a patient right when they call, while I’m at work, shopping at Costco or grilling some steaks.  I lost a patient a few years ago when I was not able to schedule her immediately and the very next day upgraded to a smartphone.

2) Who is going to upload all of the paper documents that are still generated with a patient visit? Me?

I currently have each patient fill out a 4 page patient history, consent forms, no-show/cancellation policy and objective measures. I do not have time to sit around and wait for my computer and scanner to crunch the images. An easy solution would be to take a picture with a smartphone or iPad and have it convert automatically to a pdf and attach it directly to the patient file.  Better yet, the iPad would have the forms and objective measures programmed in so the patient can use the tablet to enter all the information.  The best solution would be customizable forms using an iPad or Android tablet for intake.

3) The cost. Most start at $49.95 and go up from there depending on the amount of therapists or users and add on services. Other add-ons include extra storage space for uploaded files, ability to send a fax with the click of a button, billing, text message reminders, etc…

How can one justify the cost if using an EMR if it takes more of my time and does not pay for itself by reducing my cost to collect? I can’t, yet.

Also, my wife is a massage therapist and teaches private yoga. We are co-owners in our practice and I need to know her schedule and she needs access too. There would be an additional cost to have her as another therapist or user in most EMR systems, and she does not need as detailed of a SOAP note as I do. Her massage therapy SOAP notes are 10 visits for 1 piece of paper, 5 to a side.  Easy.

Other considerations: For those people with a traditional insurance based practice, electronic verification of patients benefits is a must. When I first looked into EMR 6 years ago, this was not available and someone (ie: me) was going to still have to spend time on the phone with each patients insurance provider verifying their coverage. Yuck! I don’t have an office staff to do this and calling insurance providers and running their gauntlet is exactly why I don’t participate in their networks or “take insurance.”

For these reasons, as well as the fact that my practice model is a low volume model,  I still use paper documentation and you can too.  It takes me only moments to complete the forms I use, and a minimal amount of time and money to print them from my computer.   My forms and templates are available for you to download and customize in The CashPT Toolkit.

What’s on your EMR wish list?

About The Author

Aaron LeBauer

Aaron LeBauer PT, DPT, LMBT started a 100% cash based physical therapy practice right after graduation. He's on a mission to save 100 million people from unnecessary surgery & enjoys helping passionate therapists build successful businesses without relying on insurance.

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  • Justin Feldman

    Reply Reply January 15, 2014

    Great post! I too played around with the EMR options out there and I wasn’t very impressed. I will say that a practice I worked in prior to opening my own had on integrated EMR system with a scheduling system as well, and I actually really didn’t like the integration. Sure it was easy to click on your schedule and write a note, but if the EMR system went down (which they all do, and that is technology for you), then you loose your ability to see your schedule and write notes. I currently use genbook for online scheduling they have an iPhone web app that I can use on my phone and patients can schedule directly from my website. I love that since I don’t have a receptionist it cuts down on phone calls to schedule or change an appointment and I always have access to the schedule.
    I would highly recommend keeping the schedule and EMR independent, just in case!

  • Aaron LeBauer

    Reply Reply January 16, 2014

    Thanks for your comment and sharing your experience.

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