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Imagine you’re a physical therapist at the start of a busy day. Your first patient has suffered a devastating leg injury in a car accident and is now trying to recover from surgery. It’s your job to teach him a set of challenging leg exercises over the course of several weeks. Perhaps the next patient is dealing with crippling lower back pain, so you administer several minutes of electrical stimulation treatments. Athird patient comes in with painful arthritis inher hands, so you massage her wrists andshow her how to perform pain-relieving hand movements.

At the end of the day, you’re probably exhausted from such physical work. But it all becomes worth it over the course of the next few weeks, as these patients learn to walk more easily and bend over without pain. Maybe you’ve helped them return to their jobs. Or given them the ability to reach down and pick up a child again. No matter what the story, you’ve no doubt dramatically improved their lives. In fact, yours is quite possibly one of the most rewarding niches in healthcare.

Now picture yourself doing such rewarding work at a huge, crowded urban hospital in today’s supercharged, competitive healthcare environment. You’re judged not only on your skills, but also on how many patients you can treat in one day. And because a colleague is away, you’re even busier than usual. Running from one huge ward of the hospital to another to meet your next appointment, you feel as if you’re trying to reach a different terminal at an airport with only minutes to spare before your next flight departs. Just as you try to take a break, another patient—one of dozens you need to treat today—is wheeled in to see you. If you weren’t already exhausted, you most certainly are now.

As you finally reach the end of such a brutal day, you still face three hours of paperwork, including billing insurance companies and logging patient records. You must also fax requests to ensure you have enough crutches and other rehabilitative equipment for your patients, check to make sure your patients received what they needed, and fill out more billing forms for your assistants.

This scenario is standard fare for big-city healthcare practitioners these days. Labor shortages and an aging population that requires more hospital visits mean physicians and therapists are busier than ever. And because of referrals and the increase in managed-care health plans, therapists also need to fill out many more charts and forms than ever before. In other words, physical therapy can be a genuinely rewarding career, but it almost always comes with a glut ofpaperwork.

Until recently, that burden of paperwork was part of a typical day for Physiotherapist Shamsynar Ani Ismail and the 50 other physical therapists in the Rehabilitative Services department at Changi General Hospital (CGH), located in eastern Singapore. CGH, which serves the healthcare needs of more than 1 million residents, provides a range of rehabilitative services to inpatients and outpatients. To do their jobs, the physiotherapists require up-to-date information about patients and rehabilitation equipment, but that information is difficult to get because the therapists travel almost continuously between wards.

For years, each time Ismail and her colleagues needed to find up-to-date information about a patient’s treatment and medications, they had to sit down at a desk and conduct a time-consuming search of the hospital’s data system. They also had to rely on a paper-intensive process of entering data for billing patient services and ordering equipment such as crutches and walking aids from the hospital’s central store. “Billing and ordering equipment can be quite time-consuming because there are many patients. And the paperwork can be error prone and required constant monitoring,” she says.

Indeed, billing errors and inventory management mistakes were common under the old system, according to Jacqueline Lee, another CGH Therapist. “There was no computerized and systematic way to account for inventory,” she says. As a result, therapists were expected to constantly check inventory requests, billing, and the delivery of crutches and other items to each patient that they saw.

Ismail has to find the time to diagnose and treat 20 to 30 patients with back and neck pain each day. Her job is to teach patients to exercise, help them become more mobile, and administer shortwave therapy treatments. Time that she had to devote to administrative work could be better spent with patients.

Facing this increasingly labor-intensive, time-consuming method of managing patient information, Changi General knew it had to come up with a better, more efficient method. It needed not only to give therapists a better, faster way of accessing patient data, but also to make it simpler for the healthcare specialists to manage equipment inventory. In January 2004, the hospital partnered with an IT consulting firm, Hexaware Technologies, to implement a new patient data system called Rehabilitative Services Management System (RSMS). This system offers data and medical inventory management through a Web-based application that was built in the Microsoft® .NET Framework.

Essentially, RSMS collects inpatient and outpatient data from one of the hospital’s data servers and sends it through an interface component, from which therapists and their assistants can access the data over the Internet. Because RSMS is set up as a smart client application, therapists can also access patient data from their Windows Mobile® powered Pocket PCs. Using these mobile devices, therapists enter billing information as well as information on which patient needs which medication and what services and therapies were prescribed. All data is routed back into the central server.

With RSMS and their mobile devices, CGH therapists and assistants can now view data about patients and therapy equipment inventory in real time, as they move from patient to patient.

RSMS has single-handedly made the jobs of therapists and therapy assistants much easier. RSMS links all inventory and patient data requests to a central computer, which completely eliminates the need for CGH therapists to rely onpaperwork. Therapists who need torequest crutches or walking aids nowonly have to find an available computer and quickly type in a request or use their Pocket PCs to make an equipment request.

And because the system constantly integrates and updates data from various applications—from the external system to RSMS to the Pocket PCs and back—patient and inventory information is always current. In fact, the solution’s messaging component can receive 3,000 patient records in less than two seconds, meaning that a therapist located anywhere in the hospital can find out the most current information on a patient before actually visiting him or her. A quick glance at a Pocket PC, for example, now reveals anything from a patient’s identification number to a list of the specific instructions and treatment that the patient needs. “I can bill a patient with my Pocket PC even if I’m physically away from anactual computer,” says Soh Xin Yi, a Physiotherapist at Changi. As a result, therapists are more productive than ever and more closely involved with rehabilitation patients.

Whereas previously they had to sit at a desktop computer to access data, therapists at Changi can now use their Pocket PCs anytime they need to find up-to-date patient information quickly. For Ismail, it didn’t take long to notice the difference in her day. “This solution has helped me keep tighter control of inventory and allowed me to be more productive,” she says. Now that she has real-time access to patient records and equipment information, she spends much less time searching for data and more time concentrating on patient care.

RSMS has also dramatically reduced the amount of time that therapists and their assistants in the Rehabilitative Services department need to do their jobs. Working in the old system, five to six therapy assistants had to spend many hours a day on completing the billing and auditing of all therapy charges related to patients, according to Tan Hai Yang, a Principal Physiotherapist at CGH who manages therapists and assistants. “Now, two to three therapy assistants only need one to two hours to audit the billing by the therapists,” he says.

The extra time that therapy assistants have now goes to helping therapists with patient care, which means more patients overall can move through the hospital. “With RSMS, therapy assistants are freed from their billing duties and are able to spend much more timein group therapy sessions and rehabilitation classes, for example,” says Yi. “That means more patients are seen within the sametimeframe.” Prior to the installation of RSMS, asmall group of therapists at CGH conducted just one rehabilitation class each day. Since the implementation of RSMS, that number has gone up to three per day, with the number of classes for the future expected to be even higher.

Productivity, management reporting, and operational efficiency have all risen substantially among the physiotherapists at CGH since RSMS was put into place. Therapists can perform their patient billing and inventory management duties much faster, and only have to check their Windows Mobile powered Pocket PCs to get all the updated data they need. “Our staff can do their jobs faster and better, and the department as a whole is more productive,” says Hai Yang.

In addition, ease of use and accuracy have improved dramatically. “When there is a discrepancy in my stock, I now spend less time poring over documentation,” says Lee. “I just need to search in the RSMS solution.” Having a more accurate system also means that therapists can better manage their assistants’ performance. “RSMS allows us to track items sold directly to a patient, and that lets us easily determine which therapists issued the items,” says Lee. “There is definitely more accountability because everything is in the system.”

Likewise, managers in the Rehabilitative Services department can better analyze overall therapist productivity and sales details from the Web-based reports generated by the system’s reporting module. Automated reports on inventory tracking and stocking, in addition to patient visit information, have helped managers optimize operations and increase the department’s efficiency. “RSMS allows me to track each therapist’s productivity,” says Hai Yang. “I can see how many patients a therapist is treating and how much time is spent with each patient. It also allows the therapists themselves to account for their time, account for productivity, and make sure that patients are getting the best care.”

Such productivity analysis tools have also helped improve the productivity of individual therapists at Changi. “We are better able to track an individual patient’s treatment and records,” says Yi. “It’s also easier to plan theschedule and patient lists at the start of myday.”

For the therapists and assistants at Changi, the hectic pace of hospital life continues, particularly now that there are more patients and more data than ever. But a life without paperwork and free from laborious billing processes has certainly made things less stressful. And most important, the specialists in the Rehabilitative Services department can give more of their time to the people who need it the most: the patients who are recovering from strokes or car accidents and who depend on physical therapy to return them to full health. “We’re all able to work much more with the patients, and that’s what this is all about,” says Ismail.