Playing Offense in the Digital Clinic

How many of you remember hearing this one? You only remember 20 percent of what you hear, 30 percent of what you see, 50 percent of what you see and hear, and 80 percent of what you hear, see and do. If those stats are right, then very few have some vague recollection of it. Twenty percent of what you hear? That's a humbling statistic for those of us who rarely are at a loss for words. We may talk a lot - to our patients, for example - but the ability for it to stick is pretty low. That's why all the top communication experts say it's not enough just to speak your message; you've got to show what you're trying to say. You've got to paint a picture.

What follows is my attempt at painting such a picture; to give you access to the details of what's behind my hope for the future of the chiropractic clinic. What I find most exciting about this picture is that it's based on a real-life example of how a couple of young guys in practice are changing the face of patient care in their community. And they're doing it through the simple use of clinic technology that already is available.

This isn't a picture that involves DCs in brightly colored jumpsuits adjusting on space stations, or wherever the future according to Hollywood is supposed to take us. I'm talking about the future happening now, maybe just down the street from you. Does that sound like a picture you'd love to see? I hope so. While I'd like to fly you out to this practice and let you experience it in the flesh, the best I can do is sketch it out for you here. I'm going to try my best.

Context for the Picture

But first, let's catch up those who have never read about clinic technology before. This column is a kind of blueprint. It's a hopeful blueprint for where chiropractic might go under the current health care revolution that quickly is moving us toward electronic management and digital documentation. If you don't believe that revolution is happening, let me point you toward the archives for this column, (www.chiroweb.com/columnist/kraus), where I've put a lot of time into explaining the current events that point to this reality. I believe our future can be a bright one amidst the waves of this sea change, if we're willing and innovative participants in this revolution. Willing participants already are using the best of what modern clinic technology can give us to create a brighter future for chiropractic and for their own practices.

What are some of the benefits this digital revolution can offer us? I can say the following with confidence about clinic technology:

• It raises our documentation standards and therefore our standards of care. It enables chiropractors to move their patients through a comprehensive, documented plan of care that is intelligible to other health care providers and third-party payers.
• It reduces the intrusions of managed care in the doctor-patient relationship by streamlining redundant paperwork.
• It allows more time for direct patient care by reducing the time demands of documentation and reproduction of clinic records.
• It can empower the doctor with analysis of clinic statistics that can be used as leverage in the doctor's interaction with third-party pay programs and providers that are open to co-care opportunities.
• All of these together mean that clinic technology can put systems in place that elevate our profession in the minds of our patients, their pay programs and other providers. Ultimately, that means a greater prosperity for doctors on board with this change.

It's these last two points I want to especially illustrate in the following tale from the clinic trenches, where two clinicians are using clinic technology to change the world for themselves and their patients. It's my attempt at showing what the future already could look like for a practice like yours.

The Data Harvesters

Recently, I had a conversation with two doctors who were excited about data mining and the possibility of statistics. One of these docs is a chiropractor and the other is a physical therapist, as in DPT. They are in an interdisciplinary practice together, based in the eastern U.S. These providers are doing so well that they've expanded their multiple practice locations into seven interdisciplinary clinics. However, this success hasn't led them to simply rest on their laurels. They're out to negotiate for even more success with those who might limit their potential: third-party payers.

If you've ever been limited in your ability to treat a patient because of a third-party pay program (most hands should go up), you should know the fundamentals of what's motivating these two clinicians. I think most chiropractors, at one time or another, have had a desire to drive a patient to the headquarters of their patient's insurance carrier, present them to a review board, and say, "See? This patient was in pain, experiencing XYZ. Now, six visits later, they're good as new. I'd like my money now." What these docs achieve is just this scenario, but they do it even more dramatically.

Each quarter, they have a meeting with Blue Cross Blue Shield, but they don't bring a single patient with them; they bring a whole busload. Or better said, they bring a whole stack of data, cross-referenced and analyzed for the convenience of the pay program. The data are drawn from their multiple practice sites. It shows what kind of conditions they're seeing in patients, how they're managing those patients and the outcomes under the chiropractic and physiotherapy protocols in use in their clinics. Perhaps most important of all, these data are tabulated to show how their approach to musculoskeletal conditions actually is superior to traditional medical approaches and how much Blue Cross Blue Shield actually is saving in payouts by allowing 100 case studies at once. Or, for a more vivid analogy, that's the equivalent of flying a jumbo jet of patients onto the front lawn of the CEO and CFO of the "Blues" and having those patients give their testimonials about the effectiveness of their care, right after all of those patients write out checks for premium payments to the CFO.

Essentially, these two outcome-based providers are showing this third-party pay program that they're making the company money by being good at what they do. And they have the data to prove it. A real best practice. There's nothing that's going to win them better rates and more access to patients than the sound of money in the managed care cash register.

Data That Are Ripe for the Picking

This is a picture of what's possible today with clinic technology. Fifteen years ago, under a paper-only system, such a scenario would have been too time-consuming to consider practical. That's assuming the quality of the data were good enough for such an analysis.

With the advent of electronic health records and digital note-taking systems, we've been given the opportunity to capture and package the strengths of our practices so we can offer hard data to those who are limiting the scale of our practice success. We can quickly and efficiently build ourselves a lever that will open access to new opportunities because we can approach health care decision-makers in our community, either individually or collectively, with the data that get people's attention. The kind of data that analyze cost-effectiveness. And this isn't just applicable to third-party payers either. I can imagine that reputable medical groups would have a hard time ignoring your request for referrals when your data are so neatly organized and accessible, addressing the outcomes of patient complaints that they manage poorly (headache, low back pain, etc.) and they see as a hassle anyway.

After all, it's hard to say no to thousands of patient histories that show everyone is saving money by having you involved.

Illustrating the Future

My hope is that this success story isn't like so much of our clinic data: stuck on paper with no utility. I admit that it didn't have all those storybook elements of good versus evil, knights in shining armor or vivid descriptions of magical places. What I do believe it does is show a possibility for the future of your practice that you might not have considered before: the fact that you don't always have to react to third-party impositions. You can negotiate, and you can take the offensive. But it will only be effective and worth your time if your offense is powered by the clinic of the future; one where the ability to document efficiently and effectively becomes the benchmark for the quality of the care that's going on between your clinic walls. Where you're not fearful because of increased scrutiny, and you're not anxious over the movement toward limiting health care costs. Because you know at the end of the day that you're getting good results, saving the system money, and you have the data to prove it. That makes you too valuable to try to limit, as the digital health care revolution rolls on with an electronic health record that has our profession's efficacy at heart.