Integration. Why is integration important to your practice growth, clinical case management and office overhead? Real integration results in expense reduction, office efficiencies, and better practice management for patient care and profitability. I have to admit integration is a hard concept to explain. It's hard to explain because it's so widely used, often in ways that water down its meaning. In its strictest sense, integration means bringing together two or more pieces and joining them to create something that's larger than the pieces themselves. The dictionary calls it "an integral whole."
I like the word whole because it's so precise. You can't have a "whole" thing unless all of its parts are present. If you have less than the whole thing, it obviously stops being a whole. Then it's a half or a quarter, etc. Real integration requires something becoming a whole.
In my world, the world of integrating the component parts of the digital practice, integration is all about the whole. And while this is starting to sound like an English lesson, it's really about knowing why some uses of the word integration don't really qualify as integration at all. You have to define the whole you're trying to form through integration in order to see it. And that's what we're going to do today: identify the "whole" of the chiropractic practice and see how it can be completely integrated.
What Is the Whole?
Each patient who walks through your door requires more than just care. By passing the threshold of your practice, they put you and your staff through five essential tasks or components of practice. These five components make up the whole of what you must achieve on a daily basis for each and every patient. From a clinic management perspective, this is the clinical whole that requires integration.
What are these five component tasks? You have to document the encounter, store the record of the encounter, bill for what took place and then schedule according to a well-conceived care plan. If you want the personal and financial rewards that come with patient retention and compliance, you're also going to need to educate them; that's the fifth and final component.
How everyone in the practice, doctor and staff, executes and fulfills these five components ultimately determines the successful management of a practice. Even the world's best diagnosticians and charismatic healers require that these five basic components of practice be fulfilled in order to do what they do best. These are the tasks that allow the doctor-patient relationship to thrive and be effective. Ultimately, your practice growth is dependent upon these components being integrated and operating seamlessly for better efficiency and profitability.
Less Than Integration?
When I talk about the "whole" of clinic management, I'm talking about fulfilling these five tasks. So it would make sense, based on our definition of integration, that if a chiropractor purchases technology that emphasizes "increased integration" and "improved clinic management," it would actually offer an integrated whole of each of these five components. In other words, you could plug in and turn on this technology, and you could do all five of these tasks better and more efficiently. Unfortunately, this isn't always the case.
Integration sounds impressive and it's a great selling point in ads, on Web sites, and in one-on-one discussions. For example, even though a software company might not offer a program that does all five components, that's not going to stop them from talking about integration like they do. In fact, you might not realize the difference between their integration and a true integration of the whole until you have everything installed.
What does this type of untrue or superficial integration look like? Many times it's the sharing of patient demographic information between software programs. The patient's name, address and insurance information are transferable from documentation into scheduling or billing. On occasion, sister software programs will even share visit dates. Where the superficial integration usually ends is at the sharing of diagnosis and CMT codes between documentation and billing programs.
Compared to what we could do in the 1990s, these features are a great start, yet the five components of practice aren't running smoothly together, and therefore these products haven't yet been integrated in hyperspeed. Worst of all, it can still mean running three to four different software programs, each with their own support lines, support contracts and varying degrees of incompatibility to overcome. The integral whole hasn't been formed.
Where's the EHR?
The lack of integration across the five components creates another problem besides the misuse of the word integration: It leaves out the possibility of an interoperable electronic health record (EHR). To reiterate what I've said many times in this column and elsewhere, an EHR is the summation for which HIPAA was created: a fully electronic digital patient chart that contains demographic information, diagnoses, visit dates, provider data, treatment codes, digital SOAP notes, X-rays, other diagnostic studies, radiology reports, records of counseling and instructions in home and self-care, and the copies of communications between providers in the case of co-care. It's the whole of what you do within the five components of practice (and then some), all stored in a single electronic chart.
Unfortunately, I don't have the space here to explain why patient EHRs are going to be absolutely fundamental to the chiropractic practice in the very near future, if not already in some states. (For a more comprehensive discussion, see my previous articles online at www.chiroweb.com/columnist/kraus.)
Nonetheless, I think you can see the problem in trying to create an EHR with a software package that can barely share patient demographic information between scheduling, billing, documentation and the ancillary notes such as work excuse reports, radiology and other clinical notes. You're going to have to upgrade to some real integration once EHRs are made mandatory in your state.
Seeing the Integrated Whole
Once we see superficial integration for what it is, we can explore the possibilities that come with clinic technology that actually offers deeper integration, both internally and externally. Put into its simplest terms, true internal integrationis the ability of your clinic to execute the five component parts of clinic management simultaneously. In the best of situations, it means being able to achieve all of these components from one interface on a single digital screen. That means your clinic documentation shares complete information with billing, which shares complete data with scheduling, which is all stored automatically in your digital chart or EHR. Any patient education that you do, whether it's instructions for in-home stretches and exercises, modifications of ADLs, or digital presentations of informed consent, are all automatically entered into the patient's record, coded and billed if they are a billable part of the care plan.
This kind of clinical integration has been recognized as ideal by nearly everyone in the software industry for quite some time, but there are few companies out there that are actually trying to achieve it, let alone accomplishing it. Yet the ability to share information across the five components is really just scratching the surface of integration functionality. Sharing information enables you to do case management analysis, patient progress reports, global practice analysis, treatment, billing and coding, and scheduling reminders - all in addition to avoiding redundancy of data entry. If you're seeking deeper integration, you want to find clinic management software that links the five components, but also offers features that allow you to mine the information you want from your practice.
With proper communication between the five components, what you can call horizontal communication, you have the potential to achieve vertical integration or external integration: the ability of your clinic to interact with multiple outside data sources - sEMG devices, inclinometers, algometers, MRIs, digital X-rays (DICOM), radiology reports, and other HL-7 formatted diagnostic reports. If one or all of your patients require you to import data from other clinics or external devices, true integration allows you to make it part of the five components of clinic management instantaneously and automatically.
EHR-Ready
With the five components of practice working together from the same data stream, integration becomes fundamental to establishing a functional EHR. Every part of the EHR, patient record, diagnoses, reports, visit data, is already interconnected through everyday clinic management. There's no need to do extra work to create a digital version of the patient chart. As long as you have an EHR program that communicates with your integrated management software, the EHR is the natural fruit of deeper integration.
Deeper Integration
When you take time to define the functionality meant to be achieved through clinic integration, it becomes pretty clear that true integration is hard to find among software programs. By definition, integration is the drawing together of component parts into a single whole. For the chiropractor, that whole must include the five component parts of patient management: documenting the visit, storing the document, billing the visit, scheduling according to the care plan and educating according to the care plan. Anything less than instantaneous communication between these parts just isn't integration. As the inevitability of EHRs grows, the reasons to settle for less than true integration become smaller and smaller, especially when we consider how fundamental the five components are to the success of every chiropractic practice.
