At Nazareth University, therapy doesn't wait for graduation. Graduate students in physical therapy, occupational therapy, speech, music therapy, and art therapy begin treating real patients in their very first year. They work under direct supervision of licensed clinicians at a pro bono clinic that logs roughly 15,000 visits annually.
But for years, the infrastructure holding it all together was paper. And paper, it turned out, was getting in the way of everything the clinic was trying to do.
The Challenge
Season Bonino has supervised PT students at Nazareth's clinic for years. She describes a pre-EMR environment that felt less like a coordinated healthcare team and more like a collection of parallel silos.
"Physical therapy might have a chart on John Smith for the PT visits, but then speech therapy might have a chart on John Smith for speech visits, and they were separate," she recalls. "If you wanted to know what was going on in those disciplines, you had to go and ask. It was almost as if we were different entities."
The physical constraints were just as real as the clinical ones. Paper charts consumed space the clinic couldn't spare, and communicating with referring physicians meant faxing or mailing progress notes by hand. Meanwhile, the clinic's broader mission, training students in interprofessional collaboration, was quietly undermined every semester.
"One of the things that's really important to us is interprofessional collaboration," Season explains. "And that wasn't happening well because we didn't have access to what was going on in order to support the other pieces."
There was also a dimension unique to academic clinics: the documentation itself was a teaching tool. Every note a student submitted was an opportunity for a supervisor to give feedback, catch errors, and reinforce clinical reasoning. Paper couldn't do that. It just sat in a drawer.
About four years ago, the clinic formed a committee to look at EMR options. What they needed wasn't just digital record-keeping. It was a platform built for learning.
Finding ClinicNote
The committee evaluated several EMRs with a clear requirement: the platform had to support a back-and-forth feedback loop between students and supervisors before a note could be finalized.
"We are creating legal medical documents for these patients, but it's also a learning environment," Season explains. "We needed some way to give our students real-time feedback into their documentation."
Most systems weren't built for that. ClinicNote was, and more importantly, the team behind it was willing to work with Nazareth to get it right.
"One of the things that stood out for us, and why we ultimately went with ClinicNote, was because they offered a platform where our students could write their notes, submit them to us, we could make comments and suggested edits, send it back, have them make the edits, and then finalize the document," she says. "The ClinicNote team was just really willing to work with us, to say, 'What do you need? What do you need to make this work?'"
The workflow they landed on preserves the integrity of the legal medical record while building in an educational layer that paper never could: students draft, supervisors comment, students revise, and only then is the note finalized and sent to the portal.
Implementation and Onboarding
Nazareth didn't flip the switch all at once. With roughly 150 PT students at any given time, plus students across OT, speech, music therapy, and art therapy, a full simultaneous rollout wasn't realistic for the small committee managing the transition.
Season and a handful of colleagues started with a semester-long beta: four supervisors across PT, OT, and speech, testing the platform with their own students. The second semester, they brought in a few more colleagues. After a year of running the neuro, ortho, and speech clinics in ClinicNote, OT and the Multiple Sclerosis clinic joined. Eventually, every discipline was on board.
The hesitation, when it existed, was understandable. "We've been doing it the way we've been doing it for so long," she recalls hearing. "Is this necessary? We're a pro bono clinic in a university."
There was also the practical concern of training time and the backend administrative work that would shift to students. Nobody wanted to take on more.
But the phased approach did something the committee hadn't fully planned for: it created organic buy-in. Departments watched their colleagues figure it out and quietly decided they were ready, too. "I don't think anyone necessarily was like, 'We are not doing this,'" Season notes. "But there was a lot of just: is this necessary?"
The answer, it turned out, was yes.
The Results
Interdisciplinary collaboration that actually happens. The morning of the interview, Season had just come from clinic when one of her PT students stopped her. The student had read the OT notes on a shared patient, a stroke survivor, and had deliberately woven OT's approach into her own session to reinforce it. "In the past, that wouldn't have happened," Season says. "It was just too hard. Now you can sit down, pull it up, and say: oh, this is what they're doing."
Students learning the full scope of patient care. Before ClinicNote, administrative staff handled scheduling, check-ins, no-show documentation, prescription tracking, and consent management. Students showed up, treated, and wrote a note. Now, those responsibilities belong to the students. "It's not just about writing the note," Season explains. "It's about scheduling, keeping track of attendance, referrals, HIPAA forms, all of those things that were happening in the background. Now that it's in the EMR, we're like: that's on you." They graduate knowing the full picture.
A feedback loop that produces better writers. The track-changes and commenting system has become the backbone of clinical education at Nazareth. Supervisors comment in real time, students revise, and only polished notes reach the portal. "We do spend a lot of time giving feedback and creating well-crafted notes before we finalize them," Season says. "And when the students go out and they're working with EMRs in the community, they've had two full years of doing this with us."
Operational oversight, finally manageable. Before, verifying compliance meant physically pulling every paper chart. "I'd have to go into the office where we keep the paper, look through everybody's charts, and check: do we have a prescription for everybody? Do we have this? Do we have that?" Now Season and her GAs can confirm compliance in minutes. "Pop into ClinicNote, and there's the scanned copy. It's there. Move on."
Responsive support for a constantly rotating user base. With new cohorts arriving every year, Nazareth is in a perpetual state of onboarding. Students do unexpected things. "I think to myself, I didn't even know you could do that, but okay," Season laughs. When issues arise, the ClinicNote support team responds quickly and finds a path forward. "That has been one of the things that convinced the people who were hesitant. We realized we have the support we need if something does go awry."
Looking Ahead
Season is quick to point out that ClinicNote has continued to improve in response to user feedback. Features that once frustrated adjunct supervisors, like being overwhelmed by a long column of unresolved comments, have been addressed. Comments now collapse once a student marks them resolved, keeping the view clean while preserving access to the record.
"Our adjuncts would say, 'It's so overwhelming, there are so many comments,'" she recalls. "Now that they hide once you address them, that's been really nice."
"From an academic standpoint, it would be amazing," she says. "Yes, the finalized legal record has to exist in the portal. But if there was some way to access the feedback history from a student assessment standpoint, that would be great."
The need is real, and it speaks to something larger: ClinicNote has become foundational to how Nazareth trains clinicians. The platform isn't just an EMR anymore. It's part of the curriculum.
About Nazareth University
Nazareth University is a private university located in Pittsford, New York. Its graduate-level health sciences programs include physical therapy, occupational therapy, speech-language pathology, music therapy, and art therapy. The university operates a network of pro bono clinics that provide approximately 15,000 free therapy visits annually to community members who have exhausted their insurance benefits.
"Once we got rolling, it really made our lives easier here. And I think we're producing students that are better at documenting, and knowing all the things that go into a patient visit."
— Season Bonino, Clinical Associate Professor, Nazareth University