Wanted: Practice software
I haven’t made the leap to practice software yet, and I’m quite motivated to get there. There are many impressive features available from over a dozen vendors, but there are some features I’m still waiting to be integrated.
By Don Quinn Dillon
In this article I provide “top 12” features I’d gladly pay for, preceded by software conventions I’d rather see withdrawn. For a perspective from some of the software developers, see my article, “Charting in the Electronic Age,” on the Massage Therapy Canada blog.
Missing the mark
Featureless text boxes. Although text boxes offer great flexibility for a variety of entries idiosyncratic to the practitioner, typing notes without common, prepopulated choices takes longer and lags in efficiency compared to hand-written short-hand notes.
Fancy graphics that don’t transpose pre/post intervention information well. Anatomical graphics are great, but simply tagging findings without showing how findings change post-intervention have little pragmatic application. A graphics interface should demonstrate pre- and post-findings, or allow the program to transpose graphical symbols into the comprehensive written notes.
Prepopulated choices are modality/methodology-focused (as opposed to observation and outcomes focused). There are a myriad of proprietary methods and modalities. Rather than listing these, feature should focus instead on prepopulating observations and outcomes that are commonly understood and applied by RMTs (examples: postural assessment, range-of-motion, muscle test, palpation, numeric pain scale, neurologic/orthopedic tests, pain indices like Oswestry or Vernon-Mior). This would save a great deal of time in recording a session.
Treatments that are not sequenced, with loose association. Some treatment templates (including the sample available from the College of Massage Therapists of Ontario website) create efficiency through checkbox options for symptoms, body areas, techniques applied and outcomes. However, this method confuses which checked options go with which. For example, if trigger points, tension, tenderness and temperature/inflammation are checked, then neck, shoulders, thighs and legs are checked, then hydrotherapy, mobilization, massage therapy and stretching are also checked, and then reduced tension, reduced stress and reduced pain are checked. Which symptoms go with which body areas that go with which techniques and then with which outcomes? While efficient, this method is not descriptive and without a sequential account of intervention. It would be impossible five years hence to reproduce or even describe the treatment of that day without a better correlation between these variables.
Missed opportunity to draw a logical conclusion (professional opinion). Diagnosis in many provinces is a controlled act and a gatekeeper health discipline privilege/responsibility. However, the massage therapist must still draw a logical conclusion – a professional opinion – based on case history taken, objective observations and assessment. If check boxes, drop down menu and field entries are available but do not focus on a conclusion, they will fail to bring home a comprehensive picture.
Inability to add more images or documents to a file. Practitioners need to apprend additional content to a file – scanned copies of gatekeeper practitioner prescription notes, radiological reports, or captured images or videos of the patient’s posture and range-of-motion. Any software that purports comprehensive, secure records should have this feature.
Adaptive. An online fillable intake template that captures essential information and adapts to the more complex case history by prompting further questions. If the patient shares information that trips a yellow (precaution) or red flag (preclusion), the software expands the case history template and prompts further specific questions to gain a more comprehensive picture. This feature could be beneficial to multiple disciplines working together under one roof, where common essential information is captured and additional specialized questions (example: a naturopath wanting more dietary information) are prompted based on the practitioners involved.
Meaningful. Prompt the recording of observation and outcome parameters common and informative to massage therapists: postural assessment, range-of-motion, muscle testing, palpation findings, numeric pain scale, orthopedic/neurologic tests and pain questionnaires (e.g. Oswestry, DASH, Vernon-Mior).
Intuitive. Based on input, the software prompts additional questions or recommends outcome measures. Increased efficiencies are found when the software prepopulates the assessment (post-treatment) section of the SOAP format with the same variables entered in the objective section, saving time in having to enter the correlating variables again.
Applicable. Practitioners can record observations and measure outcomes in all sectors they find work: spa, rehab, private practice, multi-disciplinary, human performance/athletics, and workplace wellness/mobile massage.
Alert. A primary reason for taking a case history is to mitigate the risk of doing harm. I want software that keeps the precautions and preclusions (yellow and red flags) to care prominently visible so if I haven’t seen this patient for over a year, I’m quickly reminded of the risks in applying certain methods or modalities.
Analytical. I want to sort and review patient demographics, conditions treated, outcomes achieved, number of new patients, frequency of visits, referral sources, outstanding balances, dollars spent per patient and my earnings per week, month and year.
Engaging. Help me deepen the relationship with my marketplace by providing me templates for marketing materials, integration with social media, incorporate appointment booking and reminders, interface with my website and automate follow-up surveys soliciting service feedback and measuring response to care.
Informative. Offer useful graphic interface that provides essential anatomy, physiology and pain pattern information while integrating effectively any markings on the graph into the comprehensive session note.
Imagine this: you click the muscle on a screen and are shown origin/insertion, innervation, myofascial trigger point patterns, muscle and other applicable tests. Perhaps a possible integration with apps like Trigger Points from Real Bodywork or Anatomy from Visible Body, coupled with a medical/pharmaceutical dictionary would be ideal.
Efficient. Group muscles (e.g. spine extensors, scapulae retractors, ankle flexors) for general assessment, with opportunity to qualify a particular muscle if desired. Provide access to drop-down menus to easily click and record gradients of the “4 Ts” common to massage therapy assessment: muscle tension, tenderness, texture and temperature. This information is then transposed from the graphic to the comprehensive note for review. Ensure that symptoms, areas worked, techniques/modalities applied and outcomes achieved are inextricably linked in the treatment sequence.
Portable. Include basic aspects adaptive to mobile apps and for practitioners working with multiple contracts and locations. Ensure the treatment record can be stored separate from the client/patient contact/demographic information so if a practitioner leaves a practice, they can retain their session notes without violating non-solicitation/non-competition contract obligations.
Supportive. Provide me with cutting edge tutorials to understand the marketplace and how to position my practice within it. Cultivate a community I can join and ask questions or provide mentoring to other practitioners in developing their practices.
Compliant. The software must protect my records and secure them from cyber threats, while remaining compliant with regulatory, privacy and other government agencies. Incorporate mandatory must-fill-in fields required to save the record and ensure I’ve captured all necessary information.