Technology in PT Practice

WVPTA PT After Hours

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

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.

Technology – What is it good for?

Efficiency in practice logistics Scheduling Billing Documentation

Providing resources for clinical decision making

Patient educational toolsAssuring regulatory complianceProductivity/budgetary/outcomes

reporting

Technology – there’s an app for that!

iOrthoOMT – spine and extremities iMuscleWebMDMedscapeRadiologyPharmacologySkyscape ICD9/10 codesAnd the list goes on and on and

on………

Technology – so what’s out there for practice management?

Practice Management Software APTA Connect Rehab Optima Physical Therapy Advantage Clinic Source ReDoc

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.

Technology – where to find evidence.

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

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

Technology

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

Technology

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

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

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

Technology – how does it help advocacy

APTA Legislative Action Center Federal Advocacy State Advocacy Take Action

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 nationwideNews and Updates – PTeam

newsletterPolicy Resources

Technology – State Advocacy

Justin Elliott – DirectorAngela Chasteen – Assistant Director

Current issues State legislative issue tracking Grants for advocacy work

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

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.

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.

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

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

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

Telerehabilitation - technologies

Pramuka6

Text based Audio based Video based Virtual reality Web based Wireless Integrated

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

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

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

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

Telerehabilitation – w/c seating7

PurposeSubjects

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

Telerehabilitation – Care giver burden8

PurposeSubjects

11 caregivers of elderly clients diagnosed with Parkinson’s Disease

Results Time saved Work time saved Cost savings

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

Telerehabilitation – Post TKA pilot study9

PurposeSubjects

5 subjects (3 men and 2 women)Results

Clinical outcomes improved Levels of satisfaction were high for both

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?

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

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

Telerehabilitation – EI12

Kentucky Telehealth Network 100 telehealth sites▪ MDTV has 35 in the state, 1 in MD and 7

internationalPurpose

TR as alternative deliver model for EI services in KY

Subjects 2 families in rural KY receiving OT x 12

weeksResults

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.

5. 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.

6. Pramuka M, van Roosmalen L. Telerehabilitation technologies: accessibility and usability. Intl J Telerehab. 2008;1(1): 25-36.

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