Physical Therapy Patient Engagement

Physical Therapy Patient Engagement | Exciting Digital Possibilities

Physical therapy clearly requires commitment to the plan of care as it is typically conducted over several visits. It should come as no surprise that dropouts are frequent with completion rates as low as 45% per published academic research. A well-structured program of patient engagement should help lift plan of care completion rates.

Many paths to patient engagement

There are several channels available to engage with patients and get them more involved in their plan of care. These could kick in before patients come to the clinic, during the care program, or after discharge. The Patient Portal would come in high on the list. While securely storing patient information, the portal would provide patients with convenient access to the clinic?s services as a virtual extension of the practice. Online bill pay, appointment scheduling and reminders, and accessing clinical outcomes, to name a few. Home exercise programs would be another key component of the clinical treatment plan by engaging patients in the exercises assigned to complete at home. But at the top of the charts would probably be direct two-way communication with patients. This is therapist centered patient engagement about their care with questions and updates appropriately delivered via email and/or SMS/MMS messages. The idea would be to provide patients with the reassurance that they are personally connected to their therapist at all times by increasing the number of digital touchpoints.

Nothing to beat direct communication

Direct two-way communication would call for a digital communication platform (web/mobile) to be implemented that is tightly integrated with the EMR. The system would be based on secure messaging technology that is built into the EMR. One would be able to set up clinics and add users among other administrative functions though some of this information could also flow in from the EMR. Here is a quick synopsis of what this would look like:

• The communication process would begin with an opt-in message that could go out along with the patient portal invite, this could also increase chances of the patient arriving for their evaluation. There could be several other messages from the therapist that get pre-defined in the system.
• Essentially, patients would get enrolled into messaging plans that are triggered by automated messages sent to the patient from their therapist at pre-defined intervals throughout the therapy program and after completion.
• This would provide the patient with secure, constant access to their therapist during therapy and after getting discharged.

For example, this could be a simple message to just check in on how the patient is doing. It would appear to be a personal and interactive message coming from the therapist but is actually an automated message from the system. If the patient were to respond to the message then the therapist would get a notification and would prompt a personal response to be sent by the therapist via the platform. The automated messages would use pre-formatted templates with tokens for personalizing content for example based on which therapist is assigned to the patient in the system. It would all be powered by flexible communication plans that could be configured in the platform:

• These communication plans could be set up separately for each therapy discipline (PT, OT, Speech, Chiropractic etc.) or combined across specialties.
• They could be executed either at the patient level or at the case level. Setting up messages at the patient case level may be preferable to avoid message overload.
• Patients could be seen for multiple disciplines in the clinic on the same day and we may not want that to lead to multiple messages being sent out if the several appointments are all part of the same case.
• Additionally, a guardian plan would help communicate with minors with messages getting routed to the parent/guardian.

The two-way communication would also help after patient discharge through a ?reactivation? message to check on how the patient is doing. It could be programmed to go out at regular intervals after discharge. It is possible that the patient?s problem may have recurred after discharge or something new may have come up. The ?reactivation? message could motivate the patient to seek guidance and prompt direct access where the patient comes back to the clinic without going to their physician for a referral. Engagement doesn?t need to stop when patient is no longer in the clinic. Indeed, it will likely play a much bigger role after discharge as the patient is no longer being seen by the clinic.

Staying clear of missteps in communication

Management reports would provide additional data and insight on patient engagement for example the average amount of time it takes a therapist to reply to a patient and flag any outliers or concerns for further investigation. Some additional considerations to avoid issues:

• It would be a good idea to avoid messages being sent out on treatment days, certainly not doing treatment hours. You wouldn?t want the patient to receive a message from the therapist while with the therapist! All such issues could be easily preempted in the messaging platform by setting a calendar for when messages go out.
• Malpractice and liability would be another key consideration. Patients and therapists should not have access to each other?s personal cellphone numbers and/or email addresses. We would want to avoid any communication between a therapist and patient going on that is not monitored. This would protect the patient, the therapist, and the practice while limiting liability and exposure to external communications.

Surveys to get a full picture Another important component of patient engagement would be surveys. Implementing surveys and messages in the same platform would be helpful. Surveys would provide total feedback on the care process and patient experience including aspects like the ease of calling into the clinic and getting convenient parking. Such surveys could include during-program surveys and post-discharge feedback surveys that provide an array of metrics like the Net Promoter Score. It would be possible to design custom survey questions to elicit information the clinic may otherwise not have received from the patient. Administering a survey on the day of discharge before patients leave the clinic would help achieve higher survey completion rates. Surveys should preferably be sent by the therapist to prevent the wrong templates being used for example a discharge survey being sent to an active patient. Survey feedback could be used in reputation management, in marketing, and to fix internal process issues. Today?s technologies for digital patient to therapist communication present new, exciting possibilities. Making full use of these technologies would likely raise plan of care completion rates via the increased engagement and commitment that the communication engenders. Patients would always welcome the opportunity to stay connected to their clinician. EMR and messaging platforms should easily make that possible.