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Implementing an Integrated Electronic Outcomes and Electronic Health Record Process to Create a Foundation for Clinical Practice Improvement

D Deutscher, PT, MSc, is Quality Assurance Coordinator, Physical Therapy Service, Maccabi Healthcare Services, Tel Aviv, Israel. Mr Deutscher's institution mailing address is: 27 Hamered St, Tel Aviv 68125, Israel
DL Hart, PT, PhD, is Director of Consulting and Research, Focus On Therapeutic Outcomes Inc, White Stone, Va
R Dickstein, PT, DSc, is Department Chair, Department of Physical Therapy, Faculty of Social Welfare and Health Sciences, University of Haifa, Mount Carmel, Haifa, Israel
SD Horn, PhD, is Senior Scientist, Institute for Clinical Outcomes Research, Salt Lake City, Utah
M Gutvirtz, PT, MHA, BPt, is Head Director, Physical Therapy Services, Maccabi Healthcare Services

Address all correspondence to Mr Deutscher at: Deutsch_d{at}mac.org.il

Background and Purpose: Improving clinical outcomes requires continuous measurement and interpretation in conjunction with treatment process and patient characteristics. The purposes of this study were: (1) to describe implementation and integration of electronic functional status outcomes into an electronic health record (EHR) for the promotion of clinical practice improvement processes and (2) to examine the effect of ongoing outcomes data collection in a large physical therapy service in relation to patient and clinic burden.

Subjects: Data were examined from 21,523 adult patients (mean age=50.6 years, SD=16.3, range=18–99; 58.9% women, 41.1% men) referred for physical therapist management of neuromusculoskeletal disorders.

Methods: Process and patient characteristic data were entered into the EHR. Outcomes data collected using computerized adaptive testing technology in 11 outpatient clinics were integrated into the EHR. The effect of data collection was assessed by measuring the participation rate, completion rate, and data entry time. Qualitative assessment of the implementation process was conducted.

Results: After 1 year, the average participation rate per clinic was 79.8% (range=52.7%–100%), the average completion rate per clinic was 45.1% (range=19.3%–64.7%), and the average data entry time per patient (minutes:seconds) was 03:37 (SD=02:19). Maximum estimate of average administrative time per patient was 9.6% of overall episode time. Barriers to and facilitators of the implementation process were identified.

Discussion and Conclusion: The results indicate that routine collection of outcome data is realistic in a large public physical therapy service and can be successfully integrated with EHR data to produce a valuable clinical practice improvement platform for service evaluation and outcomes research. Participation and completion rate goals of 90% and 65%, respectively, appear to be feasible.