Teaching Defensive Documentation in a DPT Program

by Tiffany Enache, PT, DPT, Assistant Professor and Director of Clinical Education

Documentation is an important part of the daily life of a physical therapist, and APTA presents high standards in their Defensible Documentation resources (1) and also in the Guide to Physical Therapist Practice (2).  These both serve as very useful resources when designing learning experiences related to documentation in a Doctor of Physical Therapy (DPT) curriculum.  There are many challenges in teaching physical therapy documentation in a DPT curriculum, one of which is the variety of templates that exist throughout differing clinical settings, both in written template format and in electronic format.  Students in our DPT program expressed confusion when each faculty member introduced a new documentation template for their specialty setting, and the students similarly struggled to produce high-quality documentation in the clinical setting during their internships.  Our DPT faculty therefore sought to create a template that could be utilized across all physical therapy settings: from outpatient orthopedics to neurologic to pediatric to acute care.  The faculty standardized the way that we teach such aspects as goal writing and narrative assessments, and encouraged our students to be descriptive in the ways that they write about current level of function, motor control, and functional mobility.  With one consistent framework for teaching documentation, our students grew in skills and articulation, and documentation shifted from a curricular weakness to a curricular strength.

The final remaining challenge was to utilize an Electronic Health Record (EHR) system to teach documentation.  Even though our students were demonstrating significant improvements in their documentation skills, the way that we were teaching documentation, as one student stated, “needed updating”.  In the search for an EHR that would meet our needs, there were several features we were looking for: 1) a template that was intuitive enough for both novice learners and faculty; 2) a template that included sufficient breadth to cover all physical therapy settings; 3) a template that encompassed the high standards presented by APTA; 4) an interface that would pass university internet security review; 5) an interface that would be compatible with the academic learning environment; and 6) a company that would be willing to price their product fairly, considering that it would not be used to generate revenue.

The DPT academic faculty excluded many EHR systems due to price, a common finding being that there was either no price model available for a usage that did not involve billing, or the base price significantly exceeded the budget of the department and would therefore increase the financial burden on the students.  The next triage of exclusion related to the template design.  Now that our students were finally understanding documentation standards, we felt it critical that we not lower our standards in order to embrace the EHR world.  We became increasingly frustrated as we reviewed templates that either lacked high standards, did too much of the work for the student (thereby decreasing their clinical reasoning), or were not usable across different physical therapy settings (many EHRs are built for the outpatient adult orthopedic population).  We struggled to find an EHR company that was willing to customize a template for us, especially considering our financial constraints.

Our solution was bestPT by Billing Dynamix.  From the very first conversation, their sales team was willing to listen to our needs and offered to create a template that met all of our requirements at a fair price.  Even though they had never before offered their EHR for use in the academic setting, they saw the value not only in this collaboration, but also the value in educating future professionals in the field.  We currently use Billing Dynamix for various classroom activities.  For example, students early in the program will enter data into the EHR as their professor conducts a patient examination in front of the class.  This is an excellent introductory learning activity because the instructor can then use the EHR to write up his/her initial evaluation, then spend class time explaining their choice in wording, the location of particular content, and how a narrative assessment, goals, and treatment plan are constructed.  Intermediate and advanced students in the program use the EHR during simulated patient encounters, and are graded on their documentation content and structure.  Future hopes for this EHR include use at the program’s pro bono clinic.  We have been able to construct our EHR templates to give just enough prompting to provide guidance to novice learners, yet not so much prompting such that students would lose the opportunity for development of clinical reasoning and professional language.

Thank you, Billing Dynamix, for this collaboration.  You are helping to elevate the standards for future DPT professionals!  I look forward to a longstanding relationship with your company.

Tiffany, PT, DPT

(1) http://www.apta.org/Documentation/DefensibleDocumentation/
(2) http://guidetoptpractice.apta.org/