- Email: [email protected]
Computers in hand therapy practice
Computers in Hand Therapy Practice Theodore I. King, II, PhD, OTR Faculty, Occupational Therapy Program, School of Allied Health Professions, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin
William W. Walsh, BS, OTR/L Director/Owner Hand Therapy of Greensboro Greensboro, North Carolina
s early as 1975, Englishl suggested that computers could be used in therapy clinics both A for administrative as well as therapeutic functions.
Since then, many articles have addressed the specific use of computers clinically. Lehmann et al.2 discussed computerized data management in rehabilitation medicine in general. In physical therapy, Crowe,3 Krebs,4 and Francis 5 explored uses of computers for documentation and assessment. Cromwe1l6 and Spicer et aU discuss computer use in occupational therapy settings. As the technology improves and software becomes more available, the potential for use of computers in the clinic for administrative and clinical purposes is expanding and is recognized by clinicians as they become more familiar with computers.
PURPOSE OF THE STUDY This study was designed to collect and disseminate data related to the current use of computers in hand therapy settings throughout the United States. Questions specific to the use of computers and type of hardware available were addressed to determine current utilization. Anticipating interest among hand therapists for use of computers in documentation, specific portions of the questionnaire addressed current documentation trends. The questionnaire provided inf~rmation on the following questions: 1. What types of centers do hand therapists work in and what is their role/job title? 2. How many hand therapists have access to computers and what types of hardware are they using? 3. What clinic functions are currently computAddress correspondence and reprint requests to Theodore I. King, II, Ph.D., OTR, Occupational Therapy Program, School of Allied Health Professions, University of Wisconsin-Milwaukee, P.O. Box 413, Milwaukee, WI 53201.
ABSTRACT: Survey data were collected from a questionnaire mailed to current members of the American Society of Hand Therapists (n = 359). Information collected included: (1) work setting and job title, (2) types of hardware used, (3) functions currently computerized and desired to be computerized, (4) evaluations used, (5) methods of documenting evaluations/treatment, and (6) frequency of documentation. Questionnaires were returned from 52% of the sample (187). Seventy-five percent of the respondents were using microcomputers in their clinical practice, primarily for billing and word processing purposes. Half of the respondents noted they would like to use computers for documentation purposes within the next 2 years. Seventy-nine percent prepare a treatment note for each patient visit and 65% of the sample reported handwriting their notes. IBM or IBM-compatible hardware was utilized by 55% of the sample.
erized and what functions would the therapists like to have computerized? 4. What types of evaluations are currently being used in hand therapy settings? 5. How often is treatment documented for each client? 6. How are evaluation results and treatment notes currently recorded by hand therapists?
METHODS The study sample consisted of all current members of the American Society of Hand Therapists living in the United States. This provided a sample size of 359 therapists. The questionnaire was designed primarily with a multiple-option/fill-in-the-blank format to expedite completion of the survey and enhance returns. The questionnaires were mailed to the sample along with self-addressed, stamped envelopes. Recipients were requested to complete and return the survey within 4 weeks. Respondents were given the option to include their name and address at the end of the questionnaire if they wished to receive preliminary results of the study.
RESULTS Questionnaires were returned by 187 of the sample group, which represented 52% of the sample. Results were tabulated for each of the sections of the survey to indicate percent of the respondents for each of the categories within each question. As this is a descriptive/survey study rather than experimental or methodological, data/statistical analysis is not appropriate to determine significance and is not included. In some instances the results reflect a response of greater than 100% total due to multiple selections by survey respondents. The results obtained are as follows: July-September 1990
157
Current Work Setting and Job Title by Percent (n = 187)
TABLE 1.
PERCENT WORK SETTING
(%)
Therapist-owned practice Physician-owned practice Hospitallinstitution Freestanding clinic Medical univ. setting Other
36 25 18 9 8
PERCENT (%)
JOB TITLE Owner/director
36
Supervisor/manager Senior therapist
29
Staff therapist Other
11
15 9
4
1. Current Work Setting and Job Title (see Table 1): The majority of the respondents (36%) owned their own practice, whereas the next largest group (25%) worked directly for a physician. Less than 40% of the survey respondents worked in a hospital or institutional setting. The majority (65%) were in a supervisory capacity, and an additional 15% were titled "senior therapist." 2. Computer Hardware Currently Used (Fig. 1): Seventy-five percent of the respondents had access to computers that they were using in the clinic. Fifty-five percent of the respondents noted they were using IBM (or IBM compatibles), 11% were using Apple, and 16% noted they were using other types of hardware. 3. Clinic Functions Computerized or Desired to be Computerized (Table 2): At the time of the survey, 70% of the respondents replied they were currently using computers for billing purposes and the remaining 30% noted they would like to have had their billing com-
55 50
40 35 30 25
25
r--
20
16
15
r--
11
10
r--
5 0 fiGURE 1.
= 187).
158
FUNCTION Billing/reimbursement Correspondence/word processing Baltimore Therapeutic Equipment Scheduling Documentation Inventory management Cybex Treatment procedures Other None
TABLE 3.
CURRENTLY COMPUTER[ZED (%)
WOULD LIKE COMPUTER[ZED (%)
70 51
30 32
18
32
16 12 9 6 3
28 50 42 3 26 7 14
11
16
Evaluations Currently Used by Percent (n 187)
=
EVALUATIONS USED
Grip and pinch strength ROM-isolated joint goniometry Manual muscle test Two-point discrimination Volume-circumferential Volume-water displacement Monofilament sensory test Purdue Pegboard ADL check list/demonstration BTE Work Simulator Tcrtal active & total passive motion Moberg Pick-Up Test Minnesota Rate of Manipulation Jebsen Hand Function Test O'Connor Dexterity Test Valpar Work Sample Series Other
PERCENT (%)
100
98 90 90 86 85 78 70 68 66 63 54 52 48 26 26 21
55
r--
45
PERCENT
TABLE 2. Clinic Functions That Are Currently Computerized or That Therapist Would Like to Have Computerized by Percent (n = 187)
IBM
APPLE
OTHER
NONE
Computer hardware currently used by percent (n
JOURNAL OF HAND THERAPY
puterized. The other major category of current computer use was for correspondence or word processing (51 %). The two areas most highly desired by the respondents to computerize in their clinics within the next 2 years were documentation (50%) and inventory management (42%). 4. Evaluations Used in Hand Therapy (Table 3): One of the multiple-option questions in the survey concerned the use of specific evaluations in hand therapy clinics. The respondents were requested to mark each of the evaluations listed that they currently used. Table 3 is a summation of the evaluations listed on the survey and the percent of respondents for each of the items. 5. Frequency of Documentation (Fig. 2): The therapists were asked how often they were currently documenting results/progress in clients' medical records. Seventy-nine percent of the respondents said they were documenting on every visit, whereas 11 % noted they documented weekly (even if clients were seen more than once a week).
DISCUSSION Every Visit
79%
FIGURE 2.
Frequency of treatment notes by percent (n
187).
6. Method of Recording Documentation (see Figure 3): Therapists were also requested to indicate how they were currently recording their documentation in the medical record. The majority (65%) responded that they were currently handwriting their notes and placing them in the chart. Eighteen percent noted they handwrite notes but have office personnel type them. Only 9% of the respondents said they type some of their own notes. Almost half (49%) of the respondents have the opportunity to dictate notes and have office personnel type them.
The major aim of this study was to determine the current availability/use of computers in hand therapy clinics and how hand therapists would like to increase the use of computers for administrative and treatment purposes. With the current trend toward the use of computers not only at work sites but also at home, it was surprising to find 25% of the clinics surveyed having no access to computer hardware. The proliferation of software for various functions in recent years also suggests that hand therapy clinics with computer access are not using this tool to its greatest potential. This deduction is based on the fact that of all computer functions included in the survey, only two (biIIing and word processing) were used by more than 50% of clinics with computer access. Also, a high number of therapists indicated interest in expanding their current computerization of clinic functions. It is felt that, though the technology and software programs may currently exist, clinicians are not educated well enough in computerization to further develop use in their setting. It is apparent from this study that there is a strong interest among hand therapy specialists for software that would allow them to increase the computerization of their clinical setting. Computer use has become the norm, and greater development of software and communication among clinics is needed to derive the fullest potential of computer use for therapy clinics.
SUMMARY 65
65
,....-
60 55 49
50
r--
45 40
PERCENT
35 30 25 20
r--
10
1. English CB: Computers and occupational therapy. Am J Occup
9 r-
5 0
REFERENCES
18
15
A
B
This study was designed and conducted to gather informatioq about current use of computers in hand therapy clinics. Questions specific to current computer use were included in the survey questionnaire along with questions related to current documentation practices. It was found that the majority of clinics currently use computers and that most would like to expand their use to additional applications. Data were collected regarding current documentation practices as most respondents noted an interest in computer use for this purpose.
C
o
FIGURE 3. Current recording of evaluations and treatments by percent (n = 787). A = handwritten by therapist; B = handwritten by therapist and typed by office personnel; C = typed by therapist; and D = dictated by therapist and transcribed by office personnel.
Ther 29:43-47, 1975. 2. Lehmann JF, Warren CG, Smith W, Larson J: Computerized data management as an aid to clinical decision making in rehabilitation medicine. Arch Phys Med Rehabil65:208 - 209, 1984. 3. Crowe T: Physical therapy documentation: A model for the word processor. Phys Ther 64:1393- 1394, 1984. 4. Krebs DE: Statistical software packages for physical therapists. Phys Ther 65:1243- 1244, 1985. 5. Francis K: Functional assessment using the microcomputer. Phys Ther 68:261-263, 1988. 6. Cromwell F: Computer applications in occupational therapy. Occup Ther Health Care 3:1-208, 1986. 7. Spicer MM, McMillan SL: Computers and occupational therapy. Am J Occup Ther 41 :726-732, 1987.
July-September 1990
159
William W. Walsh, BS, OTR/L Director/Owner Hand Therapy of Greensboro Greensboro, North Carolina
s early as 1975, Englishl suggested that computers could be used in therapy clinics both A for administrative as well as therapeutic functions.
Since then, many articles have addressed the specific use of computers clinically. Lehmann et al.2 discussed computerized data management in rehabilitation medicine in general. In physical therapy, Crowe,3 Krebs,4 and Francis 5 explored uses of computers for documentation and assessment. Cromwe1l6 and Spicer et aU discuss computer use in occupational therapy settings. As the technology improves and software becomes more available, the potential for use of computers in the clinic for administrative and clinical purposes is expanding and is recognized by clinicians as they become more familiar with computers.
PURPOSE OF THE STUDY This study was designed to collect and disseminate data related to the current use of computers in hand therapy settings throughout the United States. Questions specific to the use of computers and type of hardware available were addressed to determine current utilization. Anticipating interest among hand therapists for use of computers in documentation, specific portions of the questionnaire addressed current documentation trends. The questionnaire provided inf~rmation on the following questions: 1. What types of centers do hand therapists work in and what is their role/job title? 2. How many hand therapists have access to computers and what types of hardware are they using? 3. What clinic functions are currently computAddress correspondence and reprint requests to Theodore I. King, II, Ph.D., OTR, Occupational Therapy Program, School of Allied Health Professions, University of Wisconsin-Milwaukee, P.O. Box 413, Milwaukee, WI 53201.
ABSTRACT: Survey data were collected from a questionnaire mailed to current members of the American Society of Hand Therapists (n = 359). Information collected included: (1) work setting and job title, (2) types of hardware used, (3) functions currently computerized and desired to be computerized, (4) evaluations used, (5) methods of documenting evaluations/treatment, and (6) frequency of documentation. Questionnaires were returned from 52% of the sample (187). Seventy-five percent of the respondents were using microcomputers in their clinical practice, primarily for billing and word processing purposes. Half of the respondents noted they would like to use computers for documentation purposes within the next 2 years. Seventy-nine percent prepare a treatment note for each patient visit and 65% of the sample reported handwriting their notes. IBM or IBM-compatible hardware was utilized by 55% of the sample.
erized and what functions would the therapists like to have computerized? 4. What types of evaluations are currently being used in hand therapy settings? 5. How often is treatment documented for each client? 6. How are evaluation results and treatment notes currently recorded by hand therapists?
METHODS The study sample consisted of all current members of the American Society of Hand Therapists living in the United States. This provided a sample size of 359 therapists. The questionnaire was designed primarily with a multiple-option/fill-in-the-blank format to expedite completion of the survey and enhance returns. The questionnaires were mailed to the sample along with self-addressed, stamped envelopes. Recipients were requested to complete and return the survey within 4 weeks. Respondents were given the option to include their name and address at the end of the questionnaire if they wished to receive preliminary results of the study.
RESULTS Questionnaires were returned by 187 of the sample group, which represented 52% of the sample. Results were tabulated for each of the sections of the survey to indicate percent of the respondents for each of the categories within each question. As this is a descriptive/survey study rather than experimental or methodological, data/statistical analysis is not appropriate to determine significance and is not included. In some instances the results reflect a response of greater than 100% total due to multiple selections by survey respondents. The results obtained are as follows: July-September 1990
157
Current Work Setting and Job Title by Percent (n = 187)
TABLE 1.
PERCENT WORK SETTING
(%)
Therapist-owned practice Physician-owned practice Hospitallinstitution Freestanding clinic Medical univ. setting Other
36 25 18 9 8
PERCENT (%)
JOB TITLE Owner/director
36
Supervisor/manager Senior therapist
29
Staff therapist Other
11
15 9
4
1. Current Work Setting and Job Title (see Table 1): The majority of the respondents (36%) owned their own practice, whereas the next largest group (25%) worked directly for a physician. Less than 40% of the survey respondents worked in a hospital or institutional setting. The majority (65%) were in a supervisory capacity, and an additional 15% were titled "senior therapist." 2. Computer Hardware Currently Used (Fig. 1): Seventy-five percent of the respondents had access to computers that they were using in the clinic. Fifty-five percent of the respondents noted they were using IBM (or IBM compatibles), 11% were using Apple, and 16% noted they were using other types of hardware. 3. Clinic Functions Computerized or Desired to be Computerized (Table 2): At the time of the survey, 70% of the respondents replied they were currently using computers for billing purposes and the remaining 30% noted they would like to have had their billing com-
55 50
40 35 30 25
25
r--
20
16
15
r--
11
10
r--
5 0 fiGURE 1.
= 187).
158
FUNCTION Billing/reimbursement Correspondence/word processing Baltimore Therapeutic Equipment Scheduling Documentation Inventory management Cybex Treatment procedures Other None
TABLE 3.
CURRENTLY COMPUTER[ZED (%)
WOULD LIKE COMPUTER[ZED (%)
70 51
30 32
18
32
16 12 9 6 3
28 50 42 3 26 7 14
11
16
Evaluations Currently Used by Percent (n 187)
=
EVALUATIONS USED
Grip and pinch strength ROM-isolated joint goniometry Manual muscle test Two-point discrimination Volume-circumferential Volume-water displacement Monofilament sensory test Purdue Pegboard ADL check list/demonstration BTE Work Simulator Tcrtal active & total passive motion Moberg Pick-Up Test Minnesota Rate of Manipulation Jebsen Hand Function Test O'Connor Dexterity Test Valpar Work Sample Series Other
PERCENT (%)
100
98 90 90 86 85 78 70 68 66 63 54 52 48 26 26 21
55
r--
45
PERCENT
TABLE 2. Clinic Functions That Are Currently Computerized or That Therapist Would Like to Have Computerized by Percent (n = 187)
IBM
APPLE
OTHER
NONE
Computer hardware currently used by percent (n
JOURNAL OF HAND THERAPY
puterized. The other major category of current computer use was for correspondence or word processing (51 %). The two areas most highly desired by the respondents to computerize in their clinics within the next 2 years were documentation (50%) and inventory management (42%). 4. Evaluations Used in Hand Therapy (Table 3): One of the multiple-option questions in the survey concerned the use of specific evaluations in hand therapy clinics. The respondents were requested to mark each of the evaluations listed that they currently used. Table 3 is a summation of the evaluations listed on the survey and the percent of respondents for each of the items. 5. Frequency of Documentation (Fig. 2): The therapists were asked how often they were currently documenting results/progress in clients' medical records. Seventy-nine percent of the respondents said they were documenting on every visit, whereas 11 % noted they documented weekly (even if clients were seen more than once a week).
DISCUSSION Every Visit
79%
FIGURE 2.
Frequency of treatment notes by percent (n
187).
6. Method of Recording Documentation (see Figure 3): Therapists were also requested to indicate how they were currently recording their documentation in the medical record. The majority (65%) responded that they were currently handwriting their notes and placing them in the chart. Eighteen percent noted they handwrite notes but have office personnel type them. Only 9% of the respondents said they type some of their own notes. Almost half (49%) of the respondents have the opportunity to dictate notes and have office personnel type them.
The major aim of this study was to determine the current availability/use of computers in hand therapy clinics and how hand therapists would like to increase the use of computers for administrative and treatment purposes. With the current trend toward the use of computers not only at work sites but also at home, it was surprising to find 25% of the clinics surveyed having no access to computer hardware. The proliferation of software for various functions in recent years also suggests that hand therapy clinics with computer access are not using this tool to its greatest potential. This deduction is based on the fact that of all computer functions included in the survey, only two (biIIing and word processing) were used by more than 50% of clinics with computer access. Also, a high number of therapists indicated interest in expanding their current computerization of clinic functions. It is felt that, though the technology and software programs may currently exist, clinicians are not educated well enough in computerization to further develop use in their setting. It is apparent from this study that there is a strong interest among hand therapy specialists for software that would allow them to increase the computerization of their clinical setting. Computer use has become the norm, and greater development of software and communication among clinics is needed to derive the fullest potential of computer use for therapy clinics.
SUMMARY 65
65
,....-
60 55 49
50
r--
45 40
PERCENT
35 30 25 20
r--
10
1. English CB: Computers and occupational therapy. Am J Occup
9 r-
5 0
REFERENCES
18
15
A
B
This study was designed and conducted to gather informatioq about current use of computers in hand therapy clinics. Questions specific to current computer use were included in the survey questionnaire along with questions related to current documentation practices. It was found that the majority of clinics currently use computers and that most would like to expand their use to additional applications. Data were collected regarding current documentation practices as most respondents noted an interest in computer use for this purpose.
C
o
FIGURE 3. Current recording of evaluations and treatments by percent (n = 787). A = handwritten by therapist; B = handwritten by therapist and typed by office personnel; C = typed by therapist; and D = dictated by therapist and transcribed by office personnel.
Ther 29:43-47, 1975. 2. Lehmann JF, Warren CG, Smith W, Larson J: Computerized data management as an aid to clinical decision making in rehabilitation medicine. Arch Phys Med Rehabil65:208 - 209, 1984. 3. Crowe T: Physical therapy documentation: A model for the word processor. Phys Ther 64:1393- 1394, 1984. 4. Krebs DE: Statistical software packages for physical therapists. Phys Ther 65:1243- 1244, 1985. 5. Francis K: Functional assessment using the microcomputer. Phys Ther 68:261-263, 1988. 6. Cromwell F: Computer applications in occupational therapy. Occup Ther Health Care 3:1-208, 1986. 7. Spicer MM, McMillan SL: Computers and occupational therapy. Am J Occup Ther 41 :726-732, 1987.
July-September 1990
159