With the Supreme Court's decision to uphold the Patient Protection and Affordable Care Act, adopting an Electronic Health Records (EHR) system is no longer an option—it's a requirement. And while many chiropractors understand this, choosing a system can be a daunting task. After all, chiropractors didn't go through chiropractic school to become experts in software, let alone manage records, notes, insurance claims, billing, and perform other forms of administration.
Ultimately, and regardless of the mandate for the healthcare industry to adopt an EHR system, incorporating automation into a practice is simply a smart choice for one very good reason: time. How you and your staff spend your time has a definite impact on practice profitability, the quality of patient care, and the overall efficiency of your office. With the right software empowering your practice, you can free up time to see more patients while improving the level of care those patients receive.
Tools of the Trade
The general purpose of any EHR system is to automate those tasks you're already performing. Electronic Health Records provided by automated software systems now combine documentation, billing, scheduling, reporting, and much more into one HIPAA-compliant system. Most of the automated systems are very simple to use and yet powerful enough to manage your entire practice.
Here are just some of the features you should expect when reviewing software automation systems:
Streamlining the Sign-in Process at the Front Desk -In order to streamline a patient's arrival, your software should allow your patients to check themselves in by fingerprint, pin number, bar code scan, or even via a mobile device such as an iPad. In addition to increasing check-in efficiency, the check-in is the first impression made on a patient, so automating the process can set the tone for the level of sophistication they can expect from the practice.
Patient Scheduling-A truly automated software system should incorporate scheduling features that allow the customization of several views so that your staff can easily keep track of a patient's schedule. They should be able to view past, present, and future appointments with a patient all at once. Also, administrative notes and insurance information for each patient should be immediately accessible.
Total Patient Flow Management-For most chiropractors, and in the interest of efficiency, the ability to manage the entire flow of the practice from a single screen can be highly valuable. Whether it be on a computer or mobile device, this gives you the opportunity to easily view the patient's purpose of visit, their provider, who has arrived, who has checked-in, checked-out, who owes you money, who is running late, etc.
Appointment Reminders-Missed appointments can have a serious effect on practice cash flow. Software automation can significantly mitigate this issue with automated appointment reminders that can be sent via e-mail or text.
Access to the Patient's Entire File-Software systems should provide you with the ability to see your chiropractic SOAP notes, procedure and diagnosis codes, treatment plan information and imaging with just a few brief clicks.
Patient Billing and Collection-One of the features that makes a software management system so attractive is its billing capabilities. Most chiropractic software systems have built-in electronic billing as well as standard paper billing. This feature can save your practice thousands of dollars every year in billing and collection costs. The process should be as easy as it is efficient, and one should search out a system that accommodates both singular and bulk payments. The system should also be able to print monthly statements or use an e-mail system to remind your patients that a bill is due. It should also, of course, send out delinquency notices so that your office can collect past-due payments.
Mobility-Until very recently, mobility wasn't necessarily a topic that would be addressed when considering EHR systems. But as it has with countless other industries, the iPad has provided chiropractic with the opportunity to manage many elements of the practice using an iPad. The ability to share x-rays, notes, and other patient data all from a mobile device can have a direct impact on patient care, communication, and practice efficiency. Mobility empowers you to perform the adjustment, take notes, communicate with your patient, schedule the next appointment, and be on to the next patient—all from the palm of your hand.
[pb]Reports-Reports are critical to evaluating your practice, and the EHR software should provide a plethora of options that can be tailored to your particular requirements. The report options should include filters to sort and specify report information by any user-defined criteria, and be available for export to multiple formats.
Training and Support
While the concept of moving to, or switching from, a software system to a new software system may seem daunting, that need not be the case. It's critical to review the support and training provided by those software companies under consideration. One should expect a dedicated account liaison—at the very least—that can answer your questions, collaborate with you on best practices, and stay in contact with your team to ensure that your practice runs smoothly during and long after the transition.
Additionally, look to see the kind of online user support communities that exist where chiropractic practices can interact and help each other with any questions or issues that may be encountered while adapting to the new system.
Cost Versus Investment
Cost, as they say, is simply price without value. And in regards to the costs associated with integrating EHR software in your practice, and just as in most cases, you get what you pay for—and there is quite a range out there, from a few hundred a month to several thousands of dollars. There are systems that promise ";full" EHR solutions for a monthly fee, but while the entry costs are low and attractive from a budgeting standpoint, the question of reliability becomes a critical factor. Considering that EHR software is the backbone of the operations and billing of your practice, is finding the cheapest solution the best idea?
An investment, on the other hand, is where a price is paid in exchange for value. In the case of an EHR system, that value should be found in one all-encompassing result: more time. Automation and mobility are critical factors when assessing the true value of an investment in any EHR system as they give the doctor more time to see more patients while improving patient care. This directly impacts the health and prosperity of the practice and gives peace of mind to the doctor knowing his or her data is theirs, secure, and immediately available to them.
The Cloud: Whose data is it anyways?
Cloud computing has become the new buzzword in many industries, and chiropractic is no exception. The idea of not having to worry about keeping your hardware up to date or installing new software every time a new version comes out is certainly attractive—not to mention having all your chiropractic documentation available to you at any time with the simple click of a button.
However, there are some downsides to using cloud computing too, which is why many doctors are choosing to use a private server for their EHR needs. Late last year, for example, Redpine Software suddenly announced it was closing its doors and unable to provide its cloud-based billing services moving forward, leaving many chiropractors in a dire situation. One would imagine that, in the end, the system ";cost" the practices much more than their monthly payment.
Further, when considering cloud-based software, one must look at the true cost associated with downtime, or even ";slow time," where heavy Internet traffic slows down the practice's ability to upload and download files. It can be very frustrating indeed when you need to access a patient's records or upload billing files and are stuck with a slow connection. With a client-server EHR system, you enjoy a private network that can be accessed without having to compete with other users for bandwidth.
Lastly, paying monthly over time adds up to thousands and thousands of dollars, and practices end up paying much more for their EHR system than they certainly would have, had they invested in a system that provides true ownership of their data and software.
The Certification Factor
Simply put, integrating a complete, certified EHR practice management system into a practice is the bridge to the efficiency that not only improves patient care, but positions your practice for eligibility for the ARRA Stimulus funds. And further, regardless of your intent to claim your share of the funds, the certification itself speaks volumes as to each individual software company's commitment to the chiropractic profession.
The chiropractic industry is better served by the improved standards being set with certification:
[pb]Improvement of Patient Care-Clinical decision support rules are a requirement of EHR in an effort to help improve patient care through alerts based on certain key indicators in a patient's health records.
Reduction in Drug-Drug and Drug-Allergy Interactions-Drug-drug and drug-allergy interaction checks are mandatory for those providers practicing meaningful use. With interconnected e-prescribing, medication lists, and drug allergy monitoring, doctors can prevent interactions through a collective effort.
Decreased Costs-Being able to show clinical necessity based on more closely defined clinical quality measures can help garner more dollars from treatments. And because certified software must live up to a specific standard, purchasing under a certified label ensures that the piece of software you choose has passed governmental guidelines and functions as a complete EHR.
Improved Portability of Patient Records - The certification process is laying the framework for an interoperative national standard where patient records can be transferred easily—and really become the patient's information, not the doctor's. This means that when a patient who sees multiple providers is admitted to the ER, all of their chart notes, x-rays, medication lists, allergies, and lab tests will be readily available because inter-provider electronic exchange of patient information has been realized. This access to patient records can decrease the time to diagnosis, duplicated lab tests, and potential drug interactions, just to name a few.
Return on Investment
A recent study by the Bergen Medical Alliance revealed the productivity of four doctors before and after the implementation of an EHR system. All the doctors worked exactly the same number of hours during the study, and after EHR implementation, they were able to see from four to eight more patients per day. Further, expenses were reduced because of reductions in the need for manpower and transcription, while revenues increased through timely and more accurate billing. EHR software should automatically remind you when there are errors, so they can be addressed immediately and not hold up claims processing.
Other ROI considerations are found in patient satisfaction (a smooth-running practice always makes an impression); improved patient outcomes; the ability to easily and quickly comply with insurance requests, audits, and responses to legal matters (reduced risk mitigation); accurate documentation; and greatly improved efficiencies in the general administration of the practice.
Ultimately, and as I mentioned in the beginning of the article, it comes down to time. The more time automating processing can free up, the more patients you can see and the better care you can provide them. How you spend your time is at the heart of any successful practice.
Getting It Right
It's important to recognize that while many software companies state that they provide the ";right" features, they don't necessarily get those features right. That may seem like semantics, but the deeper meaning here is found in the software company's approach to achieving a given automated task. Just because a software company states an automated solution is included in its capabilities doesn't mean the method by which that solution is provided is ideal—and it can have the inverse effect of creating more work for the chiropractor and/or staff behind the scenes.
Change isn't coming; it's here. Doctors that embrace this change will empower their practices and find that integrating a complete, certified EHR practice management system into a practice is the bridge to the efficiency and flow they need to not only improve patient care, but to compete in the healthcare industry as well.
Indeed, the investment in an EHR system is a critical one, and you should go beyond the surface when conducting your research. Ensure that training, support, the right features, mobility, certification, and the commitment towards future innovation are all a part of your total solution.
Continuing to impress the advertising and marketing world, The Foundation for Chiropractic Progress (F4CP) has again been recognized by industry organizations for its excellence in educating consumers on the benefits of chiropractic, this time through social media, newsletters, and demonstrating thought leadership by promoting holistic well-being.
Dr. Louis Sportelli received the Lee-Homewood Chiropractic Heritage Award during the annual conference of the Association for the History of Chiropractic (AHC). During his nearly 60-year career, Dr. Sportelli has embodied the spirit of the award, given to “living individuals who have made outstanding contributions to the chiropractic profession.”
Presently there is no consensus on the best treatment for Achilles tendon rupture; and its management is still controversial. The treatment options are conservative treatment and surgical repair. With either treatment, be it conservative or surgical, Achilles tendon tears necessitate prolonged recovery and rehabilitative management.
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