PTO 86 | PromptEMR

 

There is constant chatter about "which EMR is the best", "what ERM do you use --- and do you like it?", and "what EMR should I use?" No PT-specific EMR has all the answers, and every EMR has pros and cons that make it seem like they're all equally average and stuck 5-10 years behind current technology. PromptEMR shows us that there are new EMRs in development that, built on better platforms, can become the ideal EMRs we desire. Based on their patient-based perspective, PromptEMR was initially built to provide better communication with patients during their therapy episodes. Since then, it is striving to bring the rest of the business cycle and PT clinic employee tasks into the ‘20s, making everyday tasks and reports easy to perform and access. In this episode, the co-founders join Nathan Shields to share their stories.

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Disrupting The EMR Industry - The Co-Founders Of PromptEMR With Michael Dwyer And Adam Baliatico

I'm talking about EMRs. Most notably, we're talking to the cofounders of a new EMR out there called Prompt EMR. I'm interested in talking to them because they're doing things differently with a different perspective and I'm hoping that they can be disruptive to the EMR space. I've interviewed Heidi Jannenga of WebPT and Jerry Henderson of Clinicient. I've used their products in the past and I've been happy with them, but there's always something missing. If you worked with different EMRs, some EMRs would be good at some things. Some EMRs will be better at different things, but you never are truly happy with your whole EMR system across the board.

That's the ideal scene to get to. Hopefully, these guys at Prompt EMR can be those people. I'm excited to hear about the time and energy they've taken to develop practice management reports to improve the patient experience and the systems that they've developed to stay in touch with patients in-between visits and post-discharge. All those things can be super valuable and add to your marketing efforts. I'm excited to bring them on and talk about what they're doing, what they're seeing, and how they're maneuvering so that they can be the best EMR system out there for physical therapy owners. Let's get to the interview.

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I've got the Co-Founders of Prompt EMR Practice Management. I've got Mike Dwyer, Co-Founder, and Director of Sales and Adam Baliatico, Co-Founder and Director of Operations who are joining me. I'm excited to bring on a group that is newer coming into the EMR space for physical therapy and trying to be disruptive. Do things a little bit differently so that the EMRs that we have in physical therapy truly can be something that can be a benefit to all the owners out there. Not in terms of documentation, billing, some of the basics, but even more than that. That's why I thought it'd be cool to have the co-founders on and talk about Prompt EMR and what they’re trying to do to disrupt things. Thanks, Mike and Adam, for coming on. I appreciate it.

Thanks for the opportunity.

Mike, maybe you can share with us a little bit about the germination of Prompt EMR. What brought it about? What got you into this space?

I started this in 2017 and it came from being a good patient. Over my four years of college, I had multiple injuries, most notably a SLAP tear and then external compartment syndrome on both of my legs. At that stage in my life, I track every aspect of my life. I still do this in my sleep, my diet, my exercise, everything. One thing I couldn't do at the time was to track how it's progressing in therapy. When you're in therapy for about 2.5 years, it's draining. You're there because something's wrong and you're trying to get to your level of function. As a patient, it's tough. I was trying to create a product that essentially would tell a patient where they stood in therapy and then when they would be expected to get to where they were supposed to be beforehand. What we found with that product early on was that it was nice to have things, but it wasn't essential. The big problem we had with that was if it wasn't connected with an EMR, it was useless because as a provider, you have limited time. Documenting one system and documenting another would never happen.

That was a critical point for the company because it led us to a bigger problem. Given that we weren't able to integrate, we noticed that there were already too many pieces of software in a clinic. There were 2 to 5 generally in each setting that we were in. It wasn't the most fun years of our lives, but Adam and I spent roughly eight months as a fly on the wall in clinics to make sure that the juice was worth the squeeze. We decided it was and we tackled the big overarching problem of combining all of the software required in the clinic into one spot. That’s a long-winded answer but it should give you an idea.

PTO 86 | PromptEMR
PromptEMR: A lot of the patient experience defaults more to the front desk managing the intake.

 

That's great because you're coming at it from a different perspective. You're not a physical therapist who's saying, "This is what I would prefer to have and this is what I need." You're looking at it from a patient perspective, which is different. What might keep patients engage or even retain them and make them part of the journey when it comes to developing in the EMR. That's a different perspective. 

It is also the way we structured the platform, most of these other systems can't display data to the patient. Where trying to make it similar to that original idea, to be able to have someone in tune with their care. Also, on the flip side, healthcare providers get as much information as they need. For example, going out there and take ahead of time going right to the eval and being able to book online. There are a lot of angles for the patient that was actively taking it as well.

It makes it an easier experience and a better patient experience altogether. 

It's also something that's expected. For me, it was something I didn't have in therapy. Let's say class pass or something where you're booking online to get into your thing. It was something that I didn't see in therapy at the time and something I wanted to have. We went all-in on that.

It seems like many of the software EMRs that are out there live about 5 to 10 years behind the times. You would think and even patients came into our clinic like, "Why do I have to fill this out all again? Is there some way we can make this easier?” It would even be super nice if you're able to schedule online because you're able to do that with many other software programs. It would be nice and anxious to see how it goes with you to incorporate all that and put it all into one EMR. That makes the patients’ experience much better and easier.

One of the things that we noticed during that research phase was a lot of the software was built by the therapist and the focus was on the therapist. A lot of the patient experience falls more to the front desk, managing the intake, scheduling, and things like that. Since the software was built by the therapist for the therapist, they were focused on the therapist’s experience. A lot of them ignored the other users within a clinic. That was coming at this as an outsider and as a patient and not a physical therapist or a biller or the owner of a clinic. We took a unique approach that we wanted to build our software for every user in the clinic and also the patients. We were focused on optimizing each user's experience in software from patient to front desk.

Can you tell me a little bit about maybe what you’re doing to keep patients engage via the software? Are there any examples you can share?

Even though the patient engagement aspect of what got us into it, we had to do a lot of the other things first, like facilitating good patients’ engagement. We started with normal patient reminders and things like that. In the coming weeks or months, we'll be launching a home exercise program that's built right from the therapist flow sheet. They'll also be able to engage and track the progress. Patients will be able to tell the therapist while they're doing their home exercise program, “This hurts. I skipped this because my knee was sore.” Engaging in the home exercise program. Another area of friction for patients has always been having to call and pay your statement instead of being able to input your credit card information. Through our process, the patient's going to be able to pay their invoices without any friction. Little things like that seemed minor but improved the overall patient experience. The bigger vision is to use the data of their recovery to display progress to patients and let them visualize that recovery like Mike's original idea back in 2017.

Disrupting the EMR industry and bringing it into the 2020's Click To Tweet

You're saying that patients from home make comments about the exercises that they're doing at home to the therapist prior to or in-between visits? 

That's an enhancement to our home exercise platform that we'll be launching soon.

Do you also envision having something that can retain patients even post-discharge, whether that's email reminders or whatnot? You can use Infusionsoft but that's way above our heads as a physical therapist. I’m speaking for myself. Do you have some visions for having email marketing programs for customer retention? 

To delve back on your point with the flow sheet. Once the patient is out discharged, being able to give them a plan, it's a big thing going forward with all these cuts coming in to diversify the clinic and having potential revenue screens that you didn't already think of. That's the way to do it because, through our system, you can template out exercises in the future, send it to the patient and still see how they're progressing outside of the clinic.

On the email marketing side, we're having some discussions with some of our clinics and we’re starting to work through the specs. It's a priority of ours to be able to engage with not just your active patients but also the patients that have left the clinic in a simple way. We don't want to give 500 different features to the therapist and owners who are going to use it for free. We're trying to figure out the core features in email marketing. Being able to engage with those patients is a priority of ours going forward.

We're talking to owners. They're going to have to deal with what the physical therapists or providers that are on their team have to deal with it. A lot of that seems to be what you guys do about ensuring fast documentation times, whether that's setting up templates and also how you deal with compliance. How do you attack something like that?

Our big thing during the research phase was to figure out exactly the workflow. We came to the conclusion that documenting in SOAP format doesn't make any sense. For insurance purposes, we have to report to SOAP. For documenting it wasn't following the same train of thought that the therapist goes through. For example, you're taking a pain measurement and then you're hoping to different tabs to generate that thought pattern. You're going to the assessment tab and the plan tab to finish it out. For us, we centralized everything on one screen. Also, a big thing we worked with our early clinics and billers, was building click-based documentation with compliant language. Our main use cases are on a tablet and the therapists as they're going through, they're tapping. They're not dealing with a bunch of pre-texts. Our main goal with documentation is to finish it either in session or before the therapist leaves. When I started this and I was talking to therapists, almost every single person said that was the worst part of their job. It was also something they were doing after hours. They didn't necessarily have to be. It was the software that required it. That was the bulk of our research. Adam, do you want to maybe touch on a little bit more of the compliance end?

We've worked with a lot of billers and people that have a lot of experience in dealing with audits and things like that. We make sure that all the items that need to be documented on eval, plan of care, or your normal follow-up visits are all there. Even things like making sure our electronic flow sheet that it's easy for the therapist to say which CPT code each exercise is associated with and then automatically populating that into their notes so they don't have to type it all out. Little things like that to make it easier to document compliantly. It was a big focus of ours early on to help the therapist document in a compliant way but also keep it easy so they can get their notes done fast on the same day. Many of our clinics are not finishing their notes on the same day, but since it's a seamless flow into the billing, a lot of our clinics are submitting their claims on the same day as the date of service with their documentation done as well.

You do have a built-in billing software program.

That's all built-in, all in one billing and documentation.

In my episode with Rick Gawenda, both of us shared a discouragement amongst the EMRs that are out there in their capabilities to generate quick malleable practice management reports for the small practice owner. We want to see the skilled units or CPT codes that are being built out by the provider but also in a clinic average. We want to see who's completing their full plans of care. How many times per week each patient is coming and is it the appropriate amount? What is the average furlough of the clinic? Things like that that you're not able to get a lot of from EMRs. It sounds like you’re looking at each aspect. You are also considering what you can do to provide those types of practice management reports. 

We were an end-to-end solution. We're not an EMR that relies on a third-party billing software to do the billing. We're not a third-party billing software that relies on an EMR that passes the data. Also, because we’re capturing the whole patient's experience. By the time they book an appointment and they pay their final bill, we're able to generate a ton of reports in an easy to understand way with a complete data set. A system that doesn't do the end-to-end, they're going to have a hard time generating reports on tracking the entire plan of care. Making sure each therapist is billing out the right units and things like that. It all flows in one architecture. It’s an all-in-one platform that allows us to generate robust, easy to understand reports and we're unlimited on what we can do in reports. It's something we talk to our current owners about all the time, “Here are the reports we have. What else would you like to see?” Since we have all of the data, we're able to overtime generate all of the reports that owners find useful.

It's also not inundating an owner with reports. They need to be able to look at their dashboard and make decisions quickly. If you have over 100 reports, that's impossible. We spent a ton of time talking to owners, "What matters to you?" and then putting it all within one eyesight so you can make decisions immediately versus having to generate a bunch of reports and finish your thought.

If you're capable of doing it, if you can at some point, take some of those stats and graph them for us over a period of time, that would be great too.

A big objective for us will be trending statistics. We have all the data as a statistic. The goal for us in reports 2.0 will be trending statistics. Let's look at this compare to this month or last year. Let's look at the last six months or the last twelve weeks. It’s being able to get all that trending data so you can predict where your practice is going, instead of viewing a snapshot of where it is.

That gets me excited. Also, why I was excited about bringing you on because many of my coaching clients, I talk about certain reports that they need to generate. Either they need to finagle their current EMRs or they have to start tracking those statistics manually on a separate Excel spreadsheet that either they do or their front desk person is doing. As I'm talking about these reports on statistics, I want them to track because they're vitally important to increase their cashflow and their profit margin. I can feel like, "It's one more thing that I've got to do." To find an EMR that can provide those reports would be much easier to the benefit of the owner as well. One of the things I'm excited about talking to you is you're thinking somewhere in the future you might have a CRM as it pertains to marketing efforts.

The CRM side, our more core focus will probably be marketing to your existing and past patients first. Incorporating a lot of like helping you run Google Ads. We'll also potentially integrate with one of the existing CRMs because CRM is a massive product. We’ll be able to market to your existing patients and past patients that are in the system. We’re coming up with ways to help the clinics grow their marketing efforts as a whole or through potential partnerships or integrations with CRMs and things like that.

Some of the reports that I saw even had broken down some of the physician referrals and who sent you, how many patients, and how that generated such income based on the referrals that those physicians sent. That breakdown is hugely valuable if you're setting up a marketing strategy campaign.

We've also added the ability to taking the patient to say where they found you. For example, you're spending a bunch of money on Facebook Ads. It's a good way to be able to track similar to how we do the referring position of what that means dollar-wise once that patient is in the clinic.

That’s valuable because the statistics show that physician furloughs are significantly decreasing over time. Whether that’s because they're saying, "Go to any physical therapist around you or you’re going to stay on my network,” or whatever it is. Nowadays, it was different a few years ago. You have to do some social media marketing. You have to market directly to consumers. You've got to be able to track your efforts in those realms. That data is huge. 

We're big on doubling down on what's working, getting rid of what's not. That's going to be able to help the owner to say what matters and what to leverage.

Are there any big exciting projects you’re working on?

There are some huge undertakings. We launched version 2.0. We'll be rolling out version 3.0 of the platform, which will include the most robust internal communications, as I've seen on the market, Scheduling 2.0, Documentation 2.0, some upgrades to hap, patient intake upgrades. Also, the patient's ability to pay their invoices without any contact with the clinic. There's going to be some massive updates that will culminate in version 3.0 of the product. It's massive improvements.

What are your greater visions beyond 2020?

A big piece of what we started this on was agile development. What that means for people that are not aware of it. We take feedback and implement it quickly. Our biggest focus is on talking to our users. What do they need? How can we make it better? Our ability to listen and act quickly is unique in this space. We're updating this every two weeks.

It sounds like your customer service response time is quick.

We don't off-source any customer service. It's a core competency of what we do. Built into the software is live chat support. If you submit a request, you're getting a response within 1 or 2 minutes. If we can't solve the issue through chat or through one of our pre-written help articles, we have this feature called smart help. Depending on what page you're on the platform. We can see that and we recommend articles that are likely to help you while you're on that page. If an article or the chat can't get it done, every one of our users has our cell phone numbers, our support numbers, and then we're happy to hop on the phone and work through solving a problem. If a user needs an additional 5-minute, 10-minute training session to remind them of the optimal workflow for doing something, we hop on with people. We are willing to do and have follow-up training to make sure at the end of the day that everyone's using the software in the most efficient way so that ultimately, the clinic operates in the most efficient way possible.

What have you found has been the biggest uphill struggle in getting this going from the get-go, Mike?

I would say convincing people that the new guys are better. It's something we deal with, but it's something we're open to showing. We always do demos that we always offer to people who are using the platform. The big piece that scares people and there has been a challenge is the fear of switching. If someone has switched in the past, it generally goes poorly for the most. For the past years, we're trying to make it a little less badly. We try to get all the data into the platform, get everyone trained and comfortable prior to going live. We're getting much better at it and it's going to be something we're going to always be tweaking to make it easier because from an owner standpoint, that is probably the biggest hurdle.

We're lucky in that regard that one of our senior engineers has many years of experience migrating data and taking sources of data from one system and putting them into another, whereas a lot of EMRs and other systems hand you a blank slate. We're able to transfer over in some cases, all of your patient demographics, case information, insurance info, all of the PDFs of your past notes, visits, no-shows. Depending on the system, we can maybe even bring in a history of all the claims you've submitted. Because we have a good data migration team, you're not tasked with the burden of bringing over all your data by yourself. With all the training we do for our clients when they start, it’s smoothening out that transition process. You're still switching the entire way you run your business. We've been able to make it as easy as it can be. Generally, by week 2 or week 3 for our clinics, they're operating in a way more efficient level than they were prior. Maybe there's a week of some back and forth of getting things moving out. It's not this big long extended process.

Engaging with not just active patients but also that have left the clinic should be a priority. Click To Tweet

What makes you capable of doing all these things that the bigger companies can't do? What makes you more nimble and flexible?

We’ve built this from scratch. Some of these companies, you're dealing with legacy databases and to adjust it, fix it per se is a lot easier. It's a lot harder than saying it. Our ability of what we built it in, our frameworks have allowed us to be able to be nimble and adjust the platform quickly.

Our engineering team made sure we built it in a language and a system that is easy to upgrade and improve. We also actively seek out our customer's feedback and input because ultimately, we're building software for them, not the other way around. If we can't build it to satisfy all of their needs, then we're missing out on something. We recognize that. We seek out our customer's feedback and engage with them. Take their feedback and value it much higher than our thoughts. Our user experience team can take their feedback on what they would like to see or what they're used to and come up with solutions that are even better than what the users were hoping for and improve their efficiencies and beyond what they expected it could be.

I'm excited about having a new guy on the block, someone who’s a little bit more flexible, nimble and capable of creating more than what's out there. Is there anything else you wanted to add regarding Prompt EMR?

One other point we didn't add is their ability to integrate easily. Having companies that have existing workloads that they're trying to bridge together, we're able to do that. Another good piece of what we do to get people to spin the water to see what's different is we do a trial environment for 30 to 45 days. A clinic that can recreate all their workflows before deciding to switch over to our system. From your standpoint, it's a huge switch. You're changing your whole workflow. It's going from say G Suite to Outlook and changing everything up. We get that it's a big switch and we try to walk everyone through it to make the most informed decision on their end.

 If someone wants to try you out, how would they get in touch with you?

Our website Prompt EMR and then we generally do a 10 to 15-minute demo quickly to let people see at a high level what's different about it. From there, most people will go to the trial site. There's no risk to it. You're not locked into anything. You can play with that.

If anyone wanted to reach out to one of you individually, how would they do that? Who should they contact?

I do the demos and then my email is Mike@PromptEMR.com. Someone could always go onto the site and book a demo directly from PromptEMR.com.

They can also call (888) 855-2107 that is our direct line. The other thing I'd like to mention is that for us, we're launching version 3.0. That’s three versions of the product in a few months. The sky is the limit for us and where we're going to go from here in terms of improving the efficiencies and optimizing for every user in the clinic, from the patient to the front desk, to the biller, to the therapist and the owners. Our core focus is improving the efficiencies of every single user and we're not going to lose that focus, delivering tremendous customer experience and customer service. That will be at the core of what we do as we grow and as we continue to move the platform forward and hopefully help improve the efficiencies of the entire industry and the outcomes of patients.

PTO 86 | PromptEMR
PromptEMR: The CRM side’s core will be marketing to your existing and past patients first.

 

I'm excited because we hit on it during the episode that you are coming at it from a different perspective. It's easy to understand what the physical therapists and what the owners know or want to know and want to have in an EMR system. It's cool that you're coming out of it from, "What can we do to engage the patient more?" Maybe not even during visits but in-between visits after their plan of care has ended. That's the highlight of something that would set you apart for sure.

It's the patient and the ability to go especially in private practice outpatient. You could go wherever you want. There are ways to differentiate yourself, especially to our platform to keep it more sticky for that patient.

One of the things I realized we didn't even touch on was the billing side. When we got into this, one of our first partners was a billing company and seeing some of the things they had to do on a day-to-day basis that was antiquated like printing out, going into the EMR and getting the notes and then stuffing all of those manually into an envelope and mailing it out to people or faxing it. We've been on the billing side, get rid of a lot of the archaic processes. You don't have to print anything and mail it. You don't have to print anything and fax it. Everything's in one system. It's electronic and human-less as possible in a lot of those things. There's no reason any more to have to go through and look at all your Medicare claims and make sure the GP modifiers there. On the billing side, we didn't touch on much, but we've solved a lot of the archaic processes that delay the cashflow coming into the door of our clinics.

You would expect that in 2020. Many of our EMRs are 5 to 10 years behind. They're not doing any of that stuff.

What got us excited 18 or 20 months ago, we were sitting in our billing partner's office. She had a mountain of paper stacked on her desk. We asked her what it was. She said, "It's all the stuff I have to mail and fax.” When you see an opportunity like that with all the bills and the existing ways to avoid that problem, that was an exciting moment for us way back when we knew there was massive room for improvement in the efficiency.

We were already in at that point with that. We put all our chips in after that.

The big piece that scares people is the fear of switching. Click To Tweet

That gets me excited that you were able to be flexible and mobile enough and pivot to make significant differences in not just the patient experience, but also the experience of the billers, and making their lives easier and better than what they're used to for the past twenty years. It's exciting to talk to a company that focused on that experience all around. Thank you, guys, for coming on. I appreciate you taking the time. I know you're busy doing demos and whatnot across the country. I wish you the best. I know your focus is to disrupt the industry a little bit. I hope you were able to do it. I wish you the best. 

Thanks for this. It was great to be able to tell our story and walk through everything with you. It's great.

Thanks for having us, Nathan.

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About Michael Dwyer And Adam Baliatico

PTO 86 | PromptEMRAdam Baliatico - With a background in Equity Research at Canaccord Genuity Group and owner/operator of Boston College 247 Sports, Adam has a unique background of managing large teams on different tracks. At Prompt, Adam serves as Director of Operations and is a co-founder. Adam oversees Product Development and Customer Support. As product development lead, Adam focuses on incorporating customer feedback into unique solutions that improve clinic efficiency from end-to-end.

 

PTO 86 | PromptEMRMichael Dwyer - Michael’s lengthy history as a physical therapy patient led to the founding of Prompt Therapy Solutions. As an industry outsider with a background in finance, he came to notice many inefficiencies and redundant workflows within the physical therapy clinics he attended. Mike then assembled a team of software engineers, user experience gurus, and billing experts to create a seamlessly integrated solution for the physical therapy industry. He now leads Prompt’s sales team and guides the companies with long term strategic initiatives.

 

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