Technology in PT Practice

1. WVPTA PT After Hours Technology in PT Practice

2. Technology in PT Practice At the end of this session, participants will be able to: • Identify the electronic resources available to practicing clinicians to improve access to evidence regarding PT practice. • Report the function of APTA’s Open Door Portal • Identify the location and purpose of the APTA Legislative Action Center

3. Technology in PT Practice • Identify the benefits to patient care from using current evidence in practice. • Define tele-rehabiliation • Identify the equipment necessary to create a tele-rehabilitation site within a clinical setting. • List the benefits of tele-rehabilitation to the consumers of health care in WV, specifically in rural areas.

4. Technology – What is it good for? • Efficiency in practice logistics • Scheduling • Billing • Documentation • Providing resources for clinical decision making • Patient educational tools • Assuring regulatory compliance • Productivity/budgetary/outcomes reporting

5. Technology – there’s an app for that! • iOrtho • OMT – spine and extremities • iMuscle • WebMD • Medscape • Radiology • Pharmacology • Skyscape • ICD9/10 codes • And the list goes on and on and on………

6. Technology – so what’s out there for practice management? Practice Management Software • APTA Connect • Rehab Optima • Physical Therapy Advantage • Clinic Source • ReDoc

7. Technology – how can it help my patient care? • Evidence • I don’t know where to get to it. • I don’t have time for look for it. • I don’t know how to ask for it. • I don’t know how to evaluate it. • I don’t know what it means to my patient.

8. APTA1 Open Door Hooked on Evidence PTJ and section journals PT Now Move Forward Internet Too many to list! Facebook Twitter PT Think Tank http://ptthinktank.com Physiopedia Technology – where to find evidence.

9. Technology • Open Door - http://www.apta.org/OpenDoor • Portal that provides access to multiple databases and full text articles to APTA members. • ProQuest • Medline • CINAHL • Cochrane • SportDiscus

10. Technology • Hooked on Evidence - http://www.hookedonevidence.org/reviewstation.cfm?CFID=90895431&CFTOKEN=43781805

11. Technology • Journal of Physical Therapy - http://ptjournal.apta.org/ • full text articles • Podcasts • Videos

12. Technology • PT Now – Clinician portal – • http://www.apta.org/PTNow • Robust Google-type search • Clinical summaries • Examination tools and multimedia resources • Quick route to clinical practice guidelines, best practice recommendations, outcomes data, systematic reviews, and policy statements • News for clinical practice • Drug updates • Discussion forums targeted to clinical topics • Customizable clinical collections for sharing with patients and colleagues

13. Technology • Move Forward – Consumer Portal • http://www.moveforwardpt.com/Default.aspx • Consumer portal with information regarding diagnoses, physical therapy intervention • Consumer videos • Interactive body • Symptoms and conditions • Find a PT • Todays PT

14. Technology – how does it help advocacy • APTA Legislative Action Center • Federal Advocacy • State Advocacy • Take Action

15. Technology – Federal Advocacy • Health Care Reform • Provides summary of PPACA related to PT profession • Legislative Issues • http://www.apta.org/FederalIssues • What APTA is addressing on Capitol Hill regarding PT practice nationwide • News and Updates – PTeam newsletter • Policy Resources

16. Technology – State Advocacy • Justin Elliott – Director • Angela Chasteen – Assistant Director • Current issues • State legislative issue tracking • Grants for advocacy work

17. Technology – Take Action • So why do I need to know this? And, what do I do with this information? • http://app3.vocusgr.com/WebPublish/controller.aspx?SiteName=APTA&Definition=Home&XSL=Home&SV_Section=Home

18. Telehealth • USDHHR definition: • Use of electronic information and telecommunications technologies to support long-distance clinical healthcare, patient and professional health-related education, public health and health administration.

19. Telehealth • Telemedicine 2 • Use of technologies to assist in delivering healthcare services such as patient care and monitoring. • Telerehabilitation2 • Remote delivery of rehabilitation and home care services. • Assessment, monitoring, prevention, intervention, supervision, education, consultation, counseling • PT, OT, SLP, audiologists, physiatrists, nurses, bioengineers, AT experts, teachers, psychologists, dieticians.

20. Telemedicine • History2 • 1880s – after the invention of the telephone • US Government • VA utilization 1957 – telemental health with other projects to follow • Now it is system wide throughout the VA • Recent past – most research activity in telehealth surrounds rural medicine • 1997 telehealth business – 6.8 million • 1998 telehealth business – 13.8 million

21. Telerehabilitation • Benefits3 • Increases access to care/ speed of diagnosis • Increased quality of care • Increased access to specialized services • Cost- effective • Decreased travel time for patient/practitioner • More time for practitioner to see more patients with less travel time • Patient and practitioner satisfaction • Comparable outcomes to face to face • Practitioner education/mentorship

22. Telerehabilitation • Lets talk dollars and ‘sense’! • Very little quality economic analyses of this method of delivery • Cusack4 study results • Factors affecting results – cost of face to face visit vs cost of telehealth visit, success of telehealth visit • Vo5 study results – UTMD • Univ. of TN – Telehealth Network

23. Telerehabilitation - technologies • Pramuka6 • Text based • Audio based • Video based • Virtual reality • Web based • Wireless • Integrated

24. Telerehabilitation • What equipment might I need? • Don’t ask me!!!!! But, seriously folks…. • Conferencing telephone • Internet access – broadband – high speed • Smart phone • Videoconferencing equipment • Monitoring equipment • Check out the Mountaineers • http://www.hsc.wvu.edu/its/MDTV

25. Telerehabilitation - technologies • So, what’s right for me? • Consider: • Data type to be transmitted • Clinic’s budget • Application purpose/patient characteristics • Technical support structure • Skills of client and clinician – both tech and rehab skill • Ease of installation

26. Telerehabilitation • Barriers • Lack of professional competency standards • Degree of physical contact • Patient cognition • Availability of resources for interventions • Reimbursement models do not support TR • Liability clarifications • Quality of tech devices • Licensure clarification • HIPPA • Lack of literature to base policy change on

27. Telerehabilitation • Policy issues to be addressed2 • Licensure • Consistent clinical standards • Privacy and access to PHI • Reimbursement standards across state lines • Reimbursement period! For telehealth services • Liability and accountability • International rules on clinical consultations

28. Telerehabilitation – w/c seating7 • Purpose • Subjects • Telerehab – 10 • Out of region face to face – 10 • In region face to face – 10 • Results • Consistent satisfaction and goal achievement among groups • Telerehab group assessed sooner

29. Telerehabilitation – Care giver burden8 • Purpose • Subjects • 11 caregivers of elderly clients diagnosed with Parkinson’s Disease • Results • Time saved • Work time saved • Cost savings

30. Telerehabilitation – Vocational Rehab3 • Increased access to services regardless of geography • Vocational assessment • Employment preparation • Seeking and obtaining employment • Maintaining employment (job coaching) • Monitoring and follow up

31. Telerehabilitation – Post TKA pilot study9 • Purpose • Subjects • 5 subjects (3 men and 2 women) • Results • Clinical outcomes improved • Levels of satisfaction were high for both

32. Telerehabilitation – You tube10 • Type in rehabilitation and what do you get? • 88,200 results • Type in physical therapy and what do you get? • 67,900 results • Posted by? • Accuracy? • Appropriateness?

33. Telerehabilitation – You Tube • So, what do I do with it? • As of 2009, 68% of American households had computers with internet access • Create Private Channels - Post videos specifically for your patients as homework to supplement your care • Parental controls to limit access • Use audio via telephone during simultaneous viewing of the video

34. Telerehabilitation - EI • “…telerehabilitation is a feasible service delivery model that has the potential to improve access and reduce the costs associated with delivery of early intervention services in rural communities”.11 • “…telehealth services are not meant to replace face-to-face services, but when in-person services are not feasible, they provide a viable alternative”.11

35. Telerehabilitation – EI12 • Kentucky Telehealth Network • 100 telehealth sites • MDTV has 35 in the state, 1 in MD and 7 international • Purpose • TR as alternative deliver model for EI services in KY • Subjects • 2 families in rural KY receiving OT x 12 weeks • Results

36. References 1. American Physical Therapy Association. www.apta.org 2. Seelman KD, Hartman LM. Telerehabilitation: policy issues and research tools. Intl J Telerehab. 2008;37-48. 3. Schmeler MR, Schein RM, McCue M, Betz K. Telerehabilitation clinical and vocational applications for assistive technology: research, opportunities and challenges. Intl J Telerehab. 2008(fall):12-24. 4. Cusack CM, et al. The value proposition in the widespread use of telehealth. J Telemed Telecare. 2008;14(4):167-68. • Vo AH. The telehealth promise: better health care and cost savings for the 21st centruy. Retrived October 18, 2011 from http://ehealthvirginia.org/downloads/20080529/UTMB%20Telemedicine%20White%20Paper%2019May2008.pdf. • Pramuka M, van Roosmalen L. Telerehabilitation technologies: accessibility and usability. Intl J Telerehab. 2008;1(1): 25-36.

37. References 7. Barlow IG, Liu L, Sekulic A. Wheelchair seating assessment and intervnetion: a comparison between telerehabilitation and face to face service. Intl J Telerehab. 2009;1(1):17-27. 8. Tindall LR, Huebner RA. The impact of an application of telerehabilitation technology on caregiver burder. Intl J Telerehab. 2009;1(1): 3-7. 9. Tousignant M, Boissy P, Corriveau H, Moffet H, Cabana F. In-home telerehabilitation for post-knee arthroplasty: a pilot study. Intl J Telerehab. 2009;1(1):9-16. 10. Manasco HM, Barone N, Brown A. A role for YouTube in telerehabilitation. Intl J Telerehab. 2010;2(2): 15-18. 11. Cason J. Telerehabilitation: an adjunct service delivery model for early intervention services. Intl J Telerehab. 2011;3(1): 19-29. 12. Cason J. A pilot telerehabilitation program: delivering early intervention services to rural families. Intl J Telerehab. 2009;1(1): 29-37. 13. American Telemedicine Association