Looking Back at A New Era in Podiatric Practice Management
A New Connection to Patient Care
Telemedicine and telehealth (defined slightly differently by the World Health Organization (WHO), but for the purposes of this piece, used interchangeably) began to emerge clearly in the 2010s, with tools to deliver patient care outside of the walls of traditional medical facilities.1 This began with a focus on high-risk conditions, like diabetes and congestive heart failure, with an eye towards preventing hospital admissions and readmissions. It presented benefits in provider communication and interdisciplinary care, as well. The COVID-19 pandemic resulted in an acute need for telemedicine services, with continued evolution of regulations and legislation still taking place today.1 Challenges associated with telehealth currently being addressed include user acceptance from both providers and patients, data security, and uncertainty about long-term regulatory guidance.
DPMs we spoke with noted opportunities in telehealth related to convenience, patient satisfaction, and broader access to care.
“While it may not yet be a mainstay in every podiatric practice, (telehealth) has certainly become a valuable option for patients who lack easy access to foot and ankle specialists or (who) are pressed for time,” said Jim McDannald, DPM, Founder and Owner of Podiatry Growth. “(This may result in) freeing up the doctor’s schedule and enabling the staff to focus on higher-value tasks.”
Andrew Schneider, DPM, current President of the American Academy of Podiatric Practice Management, noted that practical considerations in telehealth were previously lacking with respect to licensure and insurance.
“COVID-19 changed all that,” he said. “The healthcare system had to adapt and any shackles that were stopping practitioners from using telemedicine were off. At this writing, most of the leniencies regarding telehealth remain. Even if restrictions are placed, I do believe that telemedicine will continue to be a part of the health care system.”
Nicole Freels, DPM, FACFAOM, CPed, Founder and CEO of Lexington Podiatry and Modern Podiatrist, stressed that telehealth has broadened opportunities to deliver podiatric care, including to those living in underserved communities.
“Additionally, this expands our reach and enhances patient engagement and compliance,” she added. “Patients appreciate the ability to access care from their own homes.”
Charting a New Course
The Regenstreif Institute developed the first electronic medical records (EMR) system in the United States in 1972; however, cost, among other factors, resulted in slow integration until the American Recovery and Reinvestment Act of 2009.2 Regulations and incentives for meaningful EMR adoption then sparked a more widespread transformation across medical facilities and practices. Goals of EMR implementation included improving information accuracy, accessibility, care continuity, and supporting clinical and business decision-making in health care. Feedback on these systems, though, is mixed. While users can often take advantage of documentation tools, pain points still include templates, features to prevent medication errors, workflows, and coding support, interoperability, practical implementation, and time investment.2 The National Academy of Medicine shared that doctors and nurses spend an average of half of their work day using EMRs, and that this administrative burden is a significant contributor to clinician burnout.2
Over the past 20 years, EMRs have significantly evolved, transitioning from basic digital documentation systems to sophisticated, interoperable platforms capable of achieving far more than we ever thought possible.
Sharon Monter, DPM, shared her thoughts on the evolution of EMRs over the past few decades, commenting on increasing sophistication and performance. “During the early years of EMRs (pre-2010), they were primarily simple digital versions of our paper records, designed mainly for storing patient data within our practice settings. As time went on, these robust systems reduced the need for paper records.”
John Guiliana, DPM, added that with increased adoption, focus transitioned to interoperability, communication, and data sharing. “This led to the development of standards such as HL7 and FHIR, enabling data exchange and integration across healthcare networks.”
Later, the advent of patient portals encouraged transparency and engagement, said Dr. Monter, a Senior Client Relationship Manager for Modernizing Medicine. “The patients’ ability to access their EMR became a priority, and they could now view test results, schedule appointments, request prescription refills, and communicate with their doctors and staff without picking up the phone.”
Dr. Guiliana, Medical Director of Podiatry for Modernizing Medicine, pointed out that EMRs can now provide advanced analytics that can allow doctors to make informed clinical and business decisions. “Current trends now include mobile access, allowing doctors to travel to hospitals, assisted living facilities, and patients’ homes and complete their charting while in those settings,” he shared. “Today, EMRs are accessible across multiple devices, allowing podiatrists and patients real-time access to information. Cloud-based (systems) are becoming more common, reducing infrastructure costs and improving scalability and security.”
Scribes: A Practice Management Ally?
Although concerns remain related to EMR use as far as time investment, another development that gained steam over the past 25 years could help mitigate this challenge. Scribes can assist providers with documentation and sometimes other tasks such as order entry.3 In-person scribes attend the patient encounter with the provider to fulfill this role, but potential challenges can exist related to cost and having an additional person physically in the treatment room.3 A more recent development includes a newer model focusing on virtual scribes, who may attend the encounter via phone or computer, or use recordings to perform their role asynchronously.3 Studies have revealed that scribe use may contribute to decreased provider EMR time and improved provider well-being; however, data is still limited.3
Dr. Freels agrees that, in her experience, a scribe’s role has evolved dramatically over the years. “They not only aid me as an assistant in the exam room but also help alert me if I’m not following my own protocols.”
Instead of spending significant time after hours, and facing the challenge of remembering details of each encounter, Dr. Freels related that scribes facilitate a better ability to stay on point, streamline documentation, and improve efficiency. “This efficiency not only benefits our practice’s bottom line but also enhances the overall patient experience by allowing more time for personalized care and interaction.”
Early in scribes’ implementation, Dr. Schneider shared that many practitioners either trained a medical assistant or hired a medical student to serve in this role. “Technology improved and, with the advent of HIPAA-compliant teleconferencing, we now had the ability to have scribes in the room with us virtually.” He commented that cost-savings and international hiring opportunities resulted. However, he noted pain points including time zone mismatches and virtual staff absenteeism. Despite this, he feels the transition has been largely successful.
Now, with AI scribes becoming increasingly accessible, affordable, and trainable, yet another transition is in progress, explained Dr. Schneider. “While AI scribes have come a long way, there is more work to be done. While the ‘subjective’ and ‘plan’ parts of the SOAP note are more robust than even a human scribe would capture, the ‘objective’ section is limited, unless the practitioner narrates the exam. This is where the human scribe, whether in-person or virtual, has a leg up.”
A Closer Look at AI in Medicine
The American Medical Association refers to AI as augmented intelligence, emphasizing that these tools and services support, but do not replace, human thought and decision-making.4,5 Thus, AI in this piece also refers to augmented, not artificial, intelligence. The concept of AI in medicine is not particularly new, but recent years have seen rapid developments in its capabilities. Potential use cases include creating progress notes, discharge instructions, billing and coding tasks, translation services, diagnostic support, chart summaries, patient-facing support, risk prediction, education, remote patient monitoring, and more.4,5 Current concerns related to AI in health care include bias, hallucinations, liability, privacy and security, transparency, and oversight.4,5
“As a podiatrist who now provides digital marketing services, I see AI as a powerful ally—an efficient, data-driven assistant that helps doctors tailor their messaging, refine patient education materials, and optimize patient flow,” said Dr. McDannald. “Ultimately, AI frees up time and mental bandwidth, letting clinicians devote themselves to what matters most: delivering exceptional patient care.”
Dr. Freels agrees that AI has saved her significant amounts of time and money in her practice. But she said she does ponder where one should draw the line. “Personally, I feel artificial intelligence should not be in the exam rooms aiding the doctor in diagnosing and treating. Diagnosing conditions relies heavily on subjective analysis, experience, data input, and other intangibles that can’t be calculated with artificial intelligence at this point. Podiatrists process a lot of visual information that AI is not yet capable of analyzing. However, outside of the exam room, these tools enhance patient education and adherence by providing tailored information and reminders, fostering a better understanding of their conditions.”
Dr. Schneider also shared his view on where this concept is today in podiatry. “AI is, at this point, a smart shortcut. But to be clear, it is only as good as the instructions given to it. Whether you choose Chat GPT, Claude AI, Copilot, or the many other AI models, you need to learn how to get the best output from it. “It’s also important to note that the native AI programs are not HIPAA-compliant. That’s not to say that we can’t use AI for other tasks, like writing blast emails, website development, and marketing content creation. There will certainly be more medical-specific uses (over time). We’re at the very start of using AI and I believe we’re just scratching the surface of the potential.”
References
1. Hyder MA, Razzak J. Telemedicine in the United States: An introduction for students and residents. J Med Internet Res. 2020;22(11):e20839.
2. Honavar SG. Electronic medical records - The good, the bad and the ugly. Indian J Ophthalmol. 2020;68(3):417-418.
3. Rotenstein L, Melnick ER, Iannaccone C, et al. Virtual scribes and physician time spent on electronic health records. JAMA Netw Open. 2024;7(5):e2413140.
4. American Medical Association. AMA Future of Health: The Emerging Landscape of Augmented Intelligence in Health Care. Published Feb. 26, 2024. Accessed Jan. 2, 2025.
5. American Medical Association. Future of Health: The Emerging Landscape of Augmented Intelligence in Health Care. Accessed Jan. 2, 2025.
