A Chiropractic Vision for the 21^st Century

If you have ever wondered what life would be like now if chiropractors could have had more influence on health care in the past, then please keep reading. Today I'm presenting my vision for the way our profession can finally seize recognition for the contribution we make to the health of the world. Before us stands an opportunity we haven't had since before the dawn of organized medicine almost 100 years ago. I truly believe the health care game is about to change, and our profession could be the force that reboots the whole system.

In order to ascend to greater recognition on the national scene, our profession will need to achieve the three following things: universal adoption of electronic health records; sharing of electronically generated practice data; and a systematic mining of that data for information on patient outcomes under our care. These three achievements will prove without a doubt that our profession is technologically modern, collaborative and willing to prove our outcomes with clinical data. 

Yes, it is a tall order, but we are clearly up to the challenge. The timing is right, the technology is available, and all chiropractors, regardless of practice style and philosophy, and regardless of their financial means, clearly stand to benefit. Ultimately, that means our future patients and health care itself will benefit. Let's see how this game-changing shift could potentially unfold.

On the Tip of Everyone's Tongue

In the health care industry across America, there are three main topics on everyone's mind: the economy, health care reform, and electronic health records (EHRs). They are having the same discussions in medical societies that we are having in our state associations. Not long ago I spoke separately to the COCSA Board of Directors, the ACC presidents, and the ACA Board of Governors; what did we talk about? EHRs and health legislation.

With EHRs on the tip of everyone's tongue, chiropractors could be on the verge of leading a public-relations coup with widespread adoption of EHR technology. I believe it would be a revolution in the way the rest of the health care community views us. Clearly, over the past century we've made contributions that have deserved recognition, but nearly no one knows about it. Our pioneering of X-ray use, our participation in public health initiatives, and our basic science research into spinal neurophysiology all come to mind. Yet, never have we had a chance to interrupt and join a national dialogue happening on such a wide scale.

Quick and universal adoption of the same EHR platform by private chiropractic practices would draw the eye of the entire American health care system on us - every government health agency, every third-party payer, and every state's department of health. Plus, all other health care providers would take notice of articles touting that the first profession to lead all health care providers in adoption of EHR is the chiropractic profession. Such a move would outpace the adoption of EHRs by medical doctors and allied health practitioners, with the exception of hospitals and extended large group practices.

Once and for all, we could permanently close the door on any criticism that we aren't interested in modernizing our own profession or being involved in modern health care through collaboration and communication with our local hospitals and medical counterparts in the sharing of health information. Whether it's from sharing MRI results or an outcome summary from the course of your case management with a patient, we would be a part of the care of the patients rather than some alternative sideshow. We will demonstrate our interaction in the care of the patient by communicating electronically immediately at the point of care or in a timely fashion that makes a difference in the clinical decision-making of our own treatment, as well as other providers' decisions to refer patients to doctors of chiropractic from the medical community.

Strike While the Iron Is Hot

Many chiropractors are already deepening their interest in EHRs, both because of a new legal climate and federal encouragement of adoption via incentive payments. The new legal climate comes with the passing of health care reform legislation that names doctors of chiropractic as medical home managers. Not only are chiropractors joining medical doctors, podiatrists, optometrists, and dentists as having the capacity to be eligible for federal incentive monies to adopt an EHR in the federal HITECH Act, but we are also approved to be a medical manager to help patients manage and coordinate their primary care. (Think of a medical home manager as a patient-selected gatekeeper in the EHR-based health care system.)

If you can imagine the benefits of having chiropractors as patient-chosen gatekeepers in our health care system, then I think you can imagine the remarkable opportunity this offers; especially as we see a climbing shortage in primary care providers. Any medical home manager will need an EHR system in order to communicate with other providers and state health care information exchanges. While this role isn't going to appeal to every chiropractor, those who do take it on can be a remarkable asset to the profession as the mindset of the health care community begins to change more rapidly as a result of DCs being placed in positions of authority.

Sitting on Cloud Nine

The second step in my vision is the power of electronically generated practice data across the profession. With an aggregation of certain de-identified data compiled by ourselves, chiropractors have the ability to show that we're truly interested in the kind of inter- and intradisciplinary collaboration that is good for our patients. We can demonstrate to third-party payers, government agencies, law makers, and referring medical physicians the outcomes of chiropractic care in a faster, more affordable manner with meaningful data in the hundreds of thousands of patients of specific case, versus the few isolated cases in a few isolated studies we use today.

New developments in how clinical data is processed and stored is also making this amalgamation of data possible. The recent shift to cloud computing by Amazon, Google, Microsoft and IBM can be replicated by our profession; that means we could be sending de-identified outcomes data to a universal chiropractic database. In next month's column, I'm going to expand on cloud computing in detail, as it's going to permanently change the way you interact with your clinic records and your software. For now, let me offer a summary of what's now possible.

Cloud computing benefits private chiropractic practices in several ways. As there is little investment in computer hardware, it doesn't require a lot of capital. Because it involves remote servers, professionals help maintain a powerful server that safely stores your data, yet the software of the EHR still resides in your office without slowing down your PC, since the data and compilation of documents is backed up in a secure, protected environment offsite, accessible via the Internet. Information on the cloud is available from anywhere, not just your office, thereby increasing its accessibility - from your home, on a beach, etc. Because the location is remote and protected, the security of your patient information can be stronger than anything you can offer in your practice without the hiring of networking personnel, expensive IT consultants, and server management.

With universal adoption of EHRs by chiropractors, the greatest benefit offered by cloud computing is the ability to turn our data into a large chiropractic database. A database full of evidence of how and when chiropractic works. Data that gives our profession greater credibility, authority, elevates us in the eyes of referral sources, and results in better negotiating to third-party payers and government agencies.

Mining for Leverage

With chiropractors' adoption of an EHR that is on the same platform-designed database, combined with the power of cloud computing, we will have access to chiropractic data on a scale that has never existed. I've written about the leverage offered by mining our clinical data before, but that has always been within the private or group practice with doctors evaluating their own personal statistics. 

Over the past three decades, we have created far more information about how we practice and its effectiveness than we had in our first 80 years. Thousands of researchers have worked millions of hours in order to bring chiropractic into health care literature. And we have all benefited from this work. Yet when over 84 percent of Americans still go to the allopathic provider as their first choice for low back pain treatment and we cannot get one-fifth of the referrals for low back pain (which has the most published evidence of anything we do for patients), this data remains incomplete. Randomized, controlled trials can cost a million dollars and take years to complete and longer to publish. Chiropractic practices could generate enough data to compete with the most significant chiropractic research. The problem is, until now, it hasn't been electronic and accessible.

Within one to two years of universal EHR adoption and data sharing, chiropractors could create enough clinical data to re-order the health care system, starting with musculoskeletal complaints and continuing from there. Within a few more years, we would have more data than any single insurance network; all of it providing evidence for the patient populations and conditions that see improvement under our care. And it could all be analyzed by whatever factors we want: geographic location, patient age, practitioner experience, cost, etc.

Leveraging our data could provide us strategic advantages to dramatically increase our market share. Think more referrals, more access to patients in emergency or primary care settings, and better evidence to negotiate reimbursements. In other words, widespread recognition from the system we all belong to for our contribution to the health of the nation. A reboot of the mindset based on data that is in our favor.

Do We Share a Vision?

Chiropractic's greatest arrival to the national scene is within reach as the health care system faces several game-changing developments. Here's one thing I know: After 2015, when 90 percent of all health care providers have adopted EHR technology (according to federal CMS and ONC estimates), the way all providers will be getting paid for providing health care will truly transform, as it will be based on outcomes and case reimbursement versus line-item services.

Being prepared will position us well. If we lead in the adoption of EHR, we have the ability to shape and steer our course. If we fall behind the times and fail to act, or choose to ignore the direction it is quickly moving, we will be at the mercy of others, as we have in the past, and relegate our profession to a trivial sideline CAM provider.

With our adoption of the same EHR platform, gathering of chiropractic data, and mining of that data for the evidence of our care outcomes, we could reboot the system in a way that hasn't happened since medicine became organized early last century. These three achievements will show that our profession is 1) modern; 2) ready for collaboration and working within the health care community as an integral component of patients' health care; and 3) willing to demonstrate our outcomes to the world.

The timing is right, the technology is ready, and regardless of how we practice, we and our patients stand to benefit. It's time to leverage our collective clinical experience on a massive scale; leverage where our influence knows no bounds. That is my vision for our profession.