Record-Keeping

There was great consternation in Arizona last month concerning the heavy-handed tactics of the Arizona Board of Chiropractic Examiners (BCE). This furor comes to me secondhand, but my guess is that the BCE probably had good cause when it began to crack down on poor record-keeping. While I was on the board of directors for the Arizona Association of Chiropractic (AAC), we were warned repeatedly by our licensing authority that there would be increased attention in this area. The AAC sent newsletters to our members to emphasize the seriousness of this issue, but these messages may have fallen on deaf ears. Folks, this is an issue we simply must attend to.

Before anyone jumps to the conclusion that our Arizona chiropractic board is just picking on its own kind, please take a moment to consider the larger picture. Let me tell you a little bit of my experience with the rest of the health care world.

As some of you know, for the past 10 months I've had the privilege to practice at the Carl T. Hayden VA Medical Center here in Phoenix. The orientation I underwent to gain this access involved two half-day sessions of instruction in the VA's electronic medical record-keeping system. There are more than 200 physicians and other health service providers practicing under one roof in this VA facility, and many of our patients see multiple clinicians. As you can well imagine, every doctor who sees a new patient wants to know that patient's history, what kind of examinations they've undergone, what sorts of treatments have been administered, and what results the patient has experienced. Let me tell you how delighted I have been with the detail that automatically comes to me before any patient begins chiropractic care. Yes, it took some effort to learn the VA system for communicating patient data, but the effort has been well worth the dividend.

My entry into the VA system was fortuitous in several respects.

I had been searching for a good record-keeping system for our private multidoctor clinic. It's tough to get consistency in our small facility, which raised the question in my mind: How does the VA get 200 doctors to use an electronic medical record-keeping system? When I made inquiry at the hospital, the answer came back promptly: "We gave them 30 days to learn it, and if they weren't in compliance, they were fired." As many as 20 percent of the physicians at this federal hospital were let go for this reason. I doubt that the BCE will be quite so heavy-handed, but the goal of relatively uniform, legible, useful health care records for every patient is not an unreasonable one. We must be able to explain and communicate with patients, third-party payers, regulators and other providers if we wish to maximize our service to patients and be compensated for our labors.

I've also been practicing at the Neighborhood Christian Clinic for the past five years. We have 30 volunteer medical doctors, six dentists and six volunteer chiropractors on staff. The allopathic physicians and dentists all make use of electronic medical records. The DCs, on the other hand, are still using paper. We have a growing problem: As the number of participating chiropractors increases, poor penmanship has become a serious barrier to communication and hence to patient care. As head of the chiropractic service at the clinic, it is my intent to have electronic records installed during the next six months. My problem has been finding a system that would meet our needs. With the experience I gained at the VA, I've now found a system that will work anywhere.

In the health care world of the 21^st century, an important standard of care is the electronic medical record-keeping system. Technology now provides the sort of quick, easy digital communication that increases the probable benefit to patients. We in chiropractic cannot ignore this development if we wish to participate fully as members of the wider health care system. I know it's not easy to change. I went from writing clinical notes out longhand, to two different scanner systems that required expensive paper, and finally, to seeing a technology emerge that is useful and practical for the average chiropractor's office.

For many years, people have asked me what makes a practice grow and then plateau. The answers are simple.'Sustained growth requires 1) the doctor's passion for his or her work with patients; and 2) the application of effective systems. If you have not established efficient, effective processes and procedures for your office, your practice will be limited by your staff. The electronic medical record-keeping system is part of the system/process you will want to establish for the mutual benefit of patients and their doctor. Please do us all a favor. Do not underestimate the significance of the record-keeping process.

During the next few months, I will be reporting on the sixth new clinic I've opened in my career. This new venture has taught this old dog a number of lessons, and I hope to share what I've learned about what it takes to get a practice to function optimally in the 21^st century. I invite your feedback.