Analysis of 663,000 Patient Visits:  Does Point-of-Care Documentation Result in Lower Patient Outcomes?

We’ve all heard both sides of this discussion:

  • Therapists need to document at point of care, during the patient encounter. Real-time documentation enables the therapist to stay on track through the day and leave work on time

Versus

  • Spending time, “hands on the computer” instead of “hands on the patient” is wrong. We didn’t go to PT school to be “keyboard jockeys.”  Treatment is the only thing that improves progression – as such, we need to maximize our treatment time with the patient – and document later

At times, opinions on the above can get heated.  We often hear the rationale that “supporting the proven science and evidence that surrounds physical therapy is our paramount, common goal.”  And that means maximizing patient outcomes – regardless of the impact on documentation time.

Embedded in the discussion that “we need to support the proven science and evidence” lies the answer.

Putting emotion and opinion aside, it’s very simple:  Evidence can prove whether or not point-of-care documentation results in lower patient outcomes.

To answer that question, Systems 4PT has completed a landmark research project, conducting an evidence-based analysis of 776 therapists over the span of 663,000 patient visits.  All therapists involved were documenting on Systems 4PT EMR.  The therapists involved followed their normal approach to treatment and documentation, as they did not know they were being measured.

During this research project, Systems 4PT analysts tracked a variety of data points for each therapist.  For this discussion we will focus solely on our point-of-care documentation research, which identified:

  • Whether each therapist documented daily notes, re-evals, and discharge notes at point of care, and
  • If the therapist did document these notes at point of care, what percentage of documentation was completed during the patient’s visit?

Likewise, Systems 4PT analysts tracked progression for each patient being treated.  Our analysts identified, by patient:

  • The percent of patient progression, based on improvements in functional outcome test scores
  • The number visits required to yield that progression

This research project was a massive logistical and statistical undertaking.  It yielded the evidence necessary to answer the question:  Does point-of-care documentation result in lower patient outcomes?

DETAILED FINDINGS FOR POINT OF CARE (POC) Documentation:

                                                                                  % Patient Progression             # of Visits Required     % of Therapists

100% of patients documented at POC:                                49%                                     14.8                           25%

75 – 99.9% of patients documented at POC:                       53%                                     14.0                           15%

50 – 74.9% of patients documented at POC:                       47%                                     12.2                           6%

25 – 49.9% of patients documented at POC:                       47%                                     15.4                           6%

1 –  24.9% of patients documented at POC:                        46%                                     12.2                           6%

0% of patients documented at POC:                                     53%                                     15.0                          42%

 

Interpretation

It bears noting that all of the 663,000 visits analyzed were documented on Systems 4PT EMR.  The evidence-based conclusions that follow may or may not hold true with other EMR software.  In particular slower, checklist-type approaches to EMR would likely yield different results.

“Hopscotching” around the data:

It’s a black or white issue: Therapists tend to either document at point of care or wait to document later

  • The largest category of therapists (42%) did not document at point of care
  • 25% of therapists documented 100% (everything) during the visit
  • 15% documented 75-99.9% at point of care

Therapists tend not to “dabble” with point-of-care documentation

  • Only 6% of therapists documented 1-24.9% at point of care
  • Only 6% of therapists documented 25-49.9% at point of care
  • Only 6% of therapists documented 50-74.9% at point of care

Note that the lowest functional progression was delivered by therapists who documented a small portion (1-25%) of their notes at point of care (they dabbled)

  • Patient progression was 13.2% lower than best practices, albeit in 18.8% fewer visits

100% point-of-care documentation yielded 7.5% lower patient progression than 0% point-of-care documentation.

  • With 1.3% fewer visits required

Results for therapists who documented 75-99.9% of their notes at point of care, bear a second look

  • These therapists’ patients enjoyed equally high functional progression as the patients of therapists who documented nothing at point of care
  • And therapists who documented 75-99.9% at point of care achieved these top-ranked outcomes in 6.7% fewer visits vs. therapists who waited until after the patient visit to document

CONCLUSION AND RECOMMENDATIONS

  • We live in a world of science and evidence.   It is appropriate that therapists are fair to themselves and apply this same evidence-based thinking to how they document (and how late they work)

Stay Flexible

  • If conditions don’t warrant point-of-care documentation, focus on the patient and document later
  • Therapists who documented every character during the patient encounter yielded 7.5% lower patient progression vs. those who documented nothing during the patient visit
  • The evidence suggests that religiously documenting 100% of the

Don’t Dabble

  • The evidence suggests that therapists who “invest in point-of-care documentation training” and who “dedicate to documenting at point of care” are more successful than therapists “who document a little” at point of care.
  • 18% of therapists documented 1-74.9% of their notes at point of care. This group of therapists delivered the lowest progression of patient function – 12% lower than best practices.
    • To a trained, point-of-care expert, these findings make sense:
      • Point-of-care documentation doesn’t “just happen” as an option or as a spur of the moment choice.
      • Successful point-of-care documentation requires discipline: Hardware accessibility, documentation style, and time management techniques are each unique and very intentional vs. a random, dabbling approach.

The Perfect Balance

  • Therapists who documented most of their notes (75-99.9%) with the patient at point of care:
  • Delivered the highest progression of functional deficits
    • Tied for first place with therapists who documented nothing at point of care.
  • In 6.7% fewer visits vs. therapists who documented 0% at point of care
  • And no doubt, therapists who documented 75-99.9% at point of care:
    • Went home earlier than those who documented everything later.
    • Spent less time catching up on notes at home versus therapists who documented 0% at point of care

This statistical analysis proves that, there is no problem, there is no shame, and there is no downside to dedicating to point-of-care documentation.   As stated, this requires “the right EMR” as well as “the right hardware and techniques.”  But, there is an obvious and significant upside:  Therapists who document at the point of care are able to leave work on time, or earlier than therapists who wait to document after the patient visit.

Be fair to yourself.  Set the goal to master point-of-care documentation.  You will both maximize patient outcomes and take your life back!