Documentation


The Power of Software Automation
Documentation
Written by Dr. Michael Failla, D.C.   
Monday, 03 October 2011 16:34

P
aperwork.  Administration.  Billing.  Employees.  Supplies.  Collection.  Equipment.  SOAP notes.  Insurance claims.  Legal issues.  These are the realities of a chiropractic practice, and we haven't even discussed the adjustment.  Did we all, prior to becoming chiropractors, tell our friends and colleagues that we had a burgeoning desire to open up a chiropractic practice so that we can dive right in to documentation, administration, and collection?  Of course not.  It is the patient, the one needing the adjustment, that drives our efforts.  And yet, even with our best intentions, there are always the administrative duties that accompany those efforts.  So, as chiropractors, it is our duty to minimize the administration of our practices while maximizing the care we provide our patients.  But that doesn’t mean we have to take ourselves away from the patients and become pencil-pushers. Automation tools can empower our practices and help us get our hands off the paperwork and back on the patient.

softwareautomationMoving forward, with the multitude of health care changes looming over us, automating the office is no longer an option, it's a necessity.  No doubt, there will be some that are pessimistic about the changes in EHR healthcare mandates, as it's always easier to follow the path of least resistance.  But, taking a closer look, integrating a complete practice management system into a practice is the bridge to the efficiency we as chiropractors need to not only improve our patient care, but also compete in the marketplace as well.  Either way, there will be changes in documentation procedures. New coding will have to be learned and software technology will be able to solve most of the difficulties these new changes will present. Chiropractic practices that convert to fully automated software systems will be able to greatly reduce office expenditures after these changes are implemented. In this case, the software automation will make the transition you will experience a much smoother process.

Automated software also provides your office with many solutions so that you and your staff can streamline many of the daunting tasks that managing the office requires. Electronic Health Records provided by automated software systems now combine documentation, billing, scheduling, reporting and much more into one HIPPA-compliant system to drastically reduce the time it takes to do the tasks that your office is already doing.

Here are some of the features that software automation can take off your hands:

Streamlining the Signing in Process at the Front Desk

Modern systems can allow patients to check themselves in by fingerprint, pin number, bar code scan or swipe card. All of these features are now available through automation to streamline a patient’s arrival. Patients can arrive, check themselves in and then have a seat in the waiting room until you are ready to see them, and even be called back to a room through an automated announcement system.

Total Patient Flow Management

From one screen on the computer, the right automation can help staff manage the entire flow of the office. They can easily view the patient’s purpose of visit, their provider, who has arrived, who has checked-in, who has checked-out, who owes you money and who is running late.

Patient Scheduling

Automated software can allow the customization of several views so that your staff can easily keep track of a patient’s schedule. They can view past, present and future appointments with a patient all at once. Also, administrative notes and insurance information for each patient can be accessed within seconds.

Access to the Patient’s Entire File

Imagine seeing your chiropractic SOAP notes, procedure and diagnosis codes, treatment plan information and imaging within one comprehensive screen that gathers and inputs the information you need at the touch of your finger.

Appointment Reminders

Having patient retention problems? Automatically send e-mail reminders of their upcoming appointments to your patients. You can also send out alerts to your staff to remind them of insurance expirations, new patient exams, or sale item suggestions. Why not let your software remember to remind your staff?

Patient Billing and Collection

ehrmoneysavingsOne of the features that makes a software management system so attractive is the billing feature. Most chiropractic software systems have built-in electronic billing as well as standard paper billing. This feature can save your office thousands of dollars every year in billing and collection costs. The process is easy as well as efficient. Many systems can print monthly statements or use an e-mail system to remind your patients that a bill is due. They can also send out delinquency notices so that your office can collect past due payments.

Just as it is important to identify a software system that meets all of your needs, one must also look closely at the support that stands behind the software.  Along with robust training, pick a software company that partners with you and your staff every step of the way.  Do they have a dedicated representative that is there for you when a question arises?  Do they offer access to a support community online consisting of other chiropractic offices that can readily help you with any questions or issues that may be encountered while adapting to the new system?  Are they ONC-ATCB certified?

Truthfully, no doctor enjoys writing long chiropractic reports or creating SOAP notes.  Chiropractors are starting to realize the advantages of using automated software, and most doctors certainly would agree that their time could be better spent caring for more patients and tending to other important things, including getting a little rest and relaxation for themselves.

I hear many colleagues talk about the 'expense' of practice management software, and I immediately counter by asking them to consider the expense of NOT incorporating a fully-functioning practice management software into their offices.  Automation saves you valuable time, energy, and staff.  Automation allows the chiropractor to spend more time with more patients—while streaming operations, reducing staff, and increasing productivity.

Ultimately, how you and your staff spend your time is the most important consideration.  Time spent defines profitability, quality of patient care and the overall efficiency of the practice. Chiropractic office automation is designed to revolutionize your practice from beginning to end. Automation cuts costs, saves time and will provide you with the tools you need to improve the quality of care to your patients. It can improve work flow to keep your office moving at optimum speed.

In our profession, change isn't coming—it's already arrived.  General (Ret.) Eric Shinseki, former Chief of Staff of the Army, said it best when addressing change:  "If you don't like change, you're going to like irrelevance even less."  As a community, it's time that we embrace change, empower our practices with powerful automation tools, and ultimately improve the care we give to the patients we all collectively serve.

 
The Pressure of Technology
Documentation
Written by Claude Cote   
Monday, 03 October 2011 15:51

D
on't you think life is going too fast?  Do you feel you need more free time for yourself?  Do you have some financial pressure? Do you feel the pressure of evolution?   If you have answered “Yes” to any one of these questions, let me tell you that you are not alone.  In fact, we all feel a lot of pressure.  That pressure comes from thousands of advertisements we see and hear every day.  They keep telling us:  Act fast, this offer will end soon, you will miss the opportunity, let's go, hurry up!  It is well known, one of the best marketing techniques is to create urgency.  More than ever, we are living in an “urgent” world and, in my humble opinion, this is why we are breaking records for burned-out people.  My specialty is chiropractic software and I can see how chiropractors are getting a great deal of pressure from the software industry.  Chiropractors are constantly under pressure from colleagues who are using an Electronic Health Record system, from the government, including the stimulus incentive, from software providers with tons of offers and advertising and even from patients who are requiring more and more technology.  The technology pressure comes from everywhere.  My message today is:  Doctor, as far as technology is concerned, you don't need to go that fast.  You don't have to hold that pressure.  Go at your own pace.  If you are still using a simple billing system, there is no doubt you will have to upgrade to an automated Electronic Health Record system sooner or later.  Probably the sooner, the better, but you don't have to do this next week or next month.stopwatchcomputer

Upgrading to an automated E.H.R. system is much more than writing SOAP notes electronically.  The list of new automated features you may use is really, really impressive and creates much efficiency.  For example, you may have electronic sign-in, bar-coded Chiropractic Health Cards for each patient, waiting room calling system, care plan management, automatic recurrent credit card processing, mass email, imaging system for X-Rays and posture images, automatic insurance billing processing and so many more.  This upgrade process does not have to be fully implemented at the same time.  It could and should be done step by step, at your own pace.  Let's call this process:  “Upgrading without stressing”.  To relieve stress while upgrading, you need to follow a plan in 3 simple steps.

Step 1, choosing the new automated system.

Software providers are all claiming they have the best system and the lowest price in the world.  Honestly, I do not believe that one system is perfect for all chiropractors in the world.  Your practice is different from your colleague’s.  Practicing as a single doctor is much different than practicing within a multi-practitioners office.  Your office operation is different based on the chiropractic techniques you are using and all the services you are offering.  Choosing the right system for you is crucial.  I personally know chiropractors who have bought 5 different systems before they found the perfect fit for them.  This is a very costly way to shop for a software program.  The competition in the software industry is stronger than ever and this is a great benefit for chiropractors.  You may take advantage of this new war.  Many software providers are now offering a free trial period for their products.  For a full automated Electronic Health Record system, the minimal trial period should be 6 to 12 months.  This way, you will have time to give it a good trial and test all crucial features to make sure everything suits your needs perfectly.  Avoid a reimbursement clause because you may need a lawyer to get your money back.  Go for the free trial, why not? A 9 to 12-month free trial proves to you that the provider stands strong behind his product and his service.  You have nothing to lose starting with a long and fair free trial software offer before spending your money for something to try anyway.

The list of new automated features you may use is really, really impressive and creates much efficiency.

Step 2, implementing the new system

Once you choose the software you will try, it is time to start the transition to this new system.  The software provider you chose has to understand everyone has a different learning speed and different time availability.   Make sure this implementation will go at your own pace, not the software provider’s. Choosing your own installation speed is another stress relief.  Some chiropractic teams will be able to use 75% of the system within 2 weeks and some others, 50% in 6 months.  But it does not matter at all.  Using an automated Electronic Health Record system at 50% still provides the team a lot of clerical and repetitive work relief.  This means much more attention to the patient and to his chiropractic care.

Step 3, maximizing the use of such a system.

This is by far the easiest step of automation.  You will want to use your system better at your own pace and extract more benefits from your investment.  The key is to have instant live and training support.  Some software providers will supply some very good electronic documentation.  Some others will provide you a toll-free phone number and will have some trainers available for you at all times.  It will be at your discretion if you prefer reading or have a personal and live advanced training.  It may be a great advantage to have a live personal training because the person you are talking to is doing training every day for hundreds and hundreds of different chiropractic clinics.  You may benefit from his experience and receive advice (when requested) which becomes much more than just basic training.  In any case, you will decide the easiest type of implementation and training you want.

Now, it is up to you to say “Yes” to evolution and “No” to pressure and stress.

 

Claude Cote  is an expert in EHR systems, insurance billing and chiropractic clinic management for 22 years.  He has installed EHR system in 17 countries over 5 continents and nationwide in USA.  He is the President and Founder of Platinum System C.R. Corp (www.platinumsystem.com).  For comments or questions, please email to This e-mail address is being protected from spambots. You need JavaScript enabled to view it .

 
The Power of Information
Documentation
Written by Claude Cote   
Saturday, 25 June 2011 23:08

infopowerjune

D
o you believe in the power of information?  Do you believe media such as TV, radio, newspaper, magazine hold a lot of power by providing information to people?  If your answer is “Yes,” we are on the same page and you may find this article very interesting.  Now, have you ever thought you can use the power of information to be a better doctor?  Have you ever thought you can use the power of information to improve your practice?  Let's talk about it and see how we can achieve this.

Every day in your office, you use the power of information.  As an example, during the first visit of a new patient, the doctor asks a bunch of questions to the patient.  He extracts as much information as possible to understand what is going wrong.  The more accurate the information is, the easier it will be to establish a precise diagnosis.  This also means it will be much easier for the doctor to provide accurate treatments and obtain better health improvement results for his patient.  This process started with information given by the patient.

Another example is insurance.  Let’s assume you are involved in an auditing process for some insurance claims.  The only thing the auditor wants from you is information.  That's it; that's all.  No more and no less.  He wants information about the diagnosis of the patient, on how you established his frequency of care, what kind of treatments you were providing, etc.  Information runs your practice and your life every day.

Providing information is what computer software does the best.  Good chances are that you already have a computer system in your office; but, are you using it the right way?  Are you using it to improve yourself as a doctor?  Are you using it to improve your practice overall performance?

Providing information is what computer software does the best.

I am positive, a good computer and software system can help you to improve your patient health, improve your practice, and can provide you a better quality of personal life.  This is a huge statement, but I will strongly defend my position for the rest of my life.  There is a good reason why I use the verb "can" instead of "will".  Because the computer system will not do it by itself.  You, as a doctor, will have to do it, using the information system.

I could probably write one hundred pages on how to use your system more efficiently to achieve these goals.  For the purpose of this article, I will share a few scenarios on how you can use the power of information for an overall improvement.

Scenario 1:  Let’s say you are working with a paper documentation system. Today, you have 40 patients coming in.  You enter in the treatment room for the first patient.  He is in the treatment room, waiting for you.  You ask your patient a few questions to establish the subjective part of your documentation and to find out where he stands with his chiropractic care.  Although this patient has been under your care for 3 weeks, he says he is not really improving, he is still in pain and you can feel he is starting to have some doubts about his chiropractic care.  You are very surprised about the patient's statement.  To find out why this is happening, you are trying to read your notes from previous visits, but your writing may not be very clear to a point where you can hardly read it yourself.  And, for some reason, you cannot find anything that could give you a clear answer as to why this is happening.

This scenario can be very different with an automated EHR system.  While waiting in the treatment room, the patient answers a pesonalized subjective questionnaire using a simple Touch screen.  This patient action will feed you with valuable information.  When you enter into the room, you press a key to display the doctor’s section of the system and you can easily read the subjective documentation on the screen.  As a bonus, you also have a note from your CA saying that this patient made a complaint at the front desk about his pain and lack of improvement.  At a glance, you see the patient's frequency table, which indicates if the patient follows your care recommendations.  Although you have recommended 3 treatments per week for the first 3 weeks, you are instantly informed by your computer system that this patient only came once last week and he missed his 2 other appointments.  You press another key and your patient's X-Rays display, full screen.  Instantly, you see (thus, remember) severe cervical and thoracix subluxations.  No question, no doubt.  All this precious information is giving you all the answers you need.  Then you turn around and tell your patient, "Gary, you and I realize it is difficult to resolve your pain and improve your health.  Unfortunately, you could not make it twice last week and you missed 2 important treatments.  At this early stage of your care, it is important to get 3 treatments per week in order to get better health results and obtain improvement.  Can you make it 3 times this week? "

Scenario 2:  You are not really happy about how your chiropractic office goes, particularly with patient visits.  It was much better a few years ago.  Is the problem related to the bad economy? You can help a lot more people, but it seems very difficult to grow back to where you were or surpass it.  You have enough new patients, but you still do not grow.  Your bills are coming in fast each month, much faster than your insurance checks.  You have many discussions with your CA and nothing important seems to be going wrong.  You are slowly losing patience and, at home, you constantly think about this situation.  This is not fun for you, your staff or your family.  If you do have an automated EHR system with an integrated statistic and graphics module, the scenario may be much different.  These graphics will give you very important information.  You select your graphic section and look at a few of them to see what is really happening.  Compared to last year, you see that the percentage of patients who missed their appointments is slowly increasing from 5% to 15%.  Worse, you see that the percentage of patients who leave your practice after a treatment without any other appointment goes from 10% to 30%.  These statistics graphics are telling you that more chiropractic commitment and patient education are needed.  So, maybe the problem was not related to the bad economy at all.  This kind of information is crucial to maintaining your practice to its best possible potential.  Please get it, one way or the other, but get it.

You can have that peace of mind, if you know that your documentation and billing were done real time and accurately.

Last scenario:  Your personal life.  Are you working 50 or 60 hours a week?  Are you still in your office 1 hour after the last treatment, trying to keep up with billing and documentation?  My father used to tell me, "If you work hard, it is because you do not work smart enough"  Now, I understand what he meant.  Good organization is the key to the success of any business, including health businesses.  Everyone agrees that balance in life is important.  This means spending our time efficiently between work, family, vacations and activities.  The better you are at using your computer and software system, the more time you will have for you.  This is not a mere statement, this is what many doctors experience every day.  Five minutes after your last treatment, your office door should be locked.  While at home, you should never have negative thoughts about your office.  You can have that peace of mind, if you know that your documentation and billing were done real time and accurately.  Then you are not scared about any possible auditing.  You and your staff will be happy.  This is how a powerful information system will help you to get your life back.

The power of information is much stronger than most people think.  The biggest marketing companies are very careful about which information is given and how it is spreading out.  Are you doing the same thing for your office?  Information is a powerful tool you can use for your benefit.  As everything else, it has to be well planned and well implemented in every aspect of your practice.

 

Claude Cote  is an expert in EHR systems, insurance billing and chiropractic clinic management for 22 years.  He has installed EHR system in 17 countries over 5 continents and nationwide in USA.  He is the President and Founder of Platinum System C.R. Corp (www.platinumsystem.com).  For comments or questions, please email to This e-mail address is being protected from spambots. You need JavaScript enabled to view it .

 
Meeting Patient Information Demands In An On-Demand Society
Documentation
Written by Dr. Steven J. Kraus, D.C., D.I.B.C.N., C.C.S.P., F.A.S.A.   
Thursday, 30 September 2010 09:32

Meeting Patient Information Demands In An On-Demand Society

by Dr. Steven J. Kraus, D.C., D.I.B.C.N., C.C.S.P., F.A.S.A.

 

Sports scores delivered to your mobile phone. News feeds direct to your inbox. Instant Twitter updates to your online followers. You may not be taking advantage of all of the personalization and immediacy that the information age affords, but many of your patients are. It’s a fast food world of information and immediate gratification, and consumers are saying, “Feed me now.”

 

PHR's being fed from your EHR

New meaningful use rules point to patients having access to clinical data such as test results, radiology findings, etc. – to their personal health records (PHR). But what are the requirements for your qualified electronic health record (EHR) to accomplish this? Your system has to have the ability to send information digitally – internally and externally. This facilitates instant, also potentially more secure and accurate, data sharing with other healthcare facilities and with patients themselves.


56_TAC_Vol31No12_img_3

It's a fast food world of information and

immediate gratification, and consumers

are saying, "Feed me now."

 

In addition to office efficiencies, you can create closer relationships with your patients simply by way of “looping them in” to their own health information, as quickly as possible. Because, let’s be honest, what’s more frustrating and nerve-wracking than waiting for test results?

 

In the current paper world – which is still the M.O. for many doctors – it can take two to three days to send and receive information. For clinical test results of, such as an MRI, that are normal, you can give the patient peace of mind quicker when you inform them electronically. More and more, they will be looking for that report sent directly to them digitally. If the results are abnormal, you can add to the digital message, “You are scheduled for Thursday at 9am to review the actual MRI images. Dr. Modern will explain your options with you at that time. Please call if you need to reschedule.” Doctors on top of their communication game are favored by patients and perceived as efficient AND caring because you demonstrated the concern for immediate feedback and communication to help the patient understand. Of course, nothing is better than an immediate phone call to the patient from the actual doctor. In today’s world, getting hold of some patients is difficult during business hours. Automated communication electronically saves time and still gives the patient what they want; information now.

 

With either method of information delivery, you’ll still have to follow-up in many cases for abnormal results or next steps discussion in your evaluation and management of the case. When patients learn about their health status faster, they gain a sense of security rather than the fear of the unknown. Do they have a disc herniation? Do they have cancer? Fear of test results or X-ray findings can create anxiety in some patients or a restless night of sleep loss. Anyone who’s ever waited for results, knows that time is priceless. Therefore, you can significantly elevate your status with patients who feel you’re responding to them quickly and with due care.

 

PHR vs. EHR

Patients own their PHR's. As PHR's become the standard, patients will have all of their health data at their fingertips, literally. The time is not far away when everyone can carry their records around on their mobile devices; iPhones, cell phones, PDA's and mini laptops. This gives patients control of their own information. And that’sa good thing. This is different from the information in your EHR, which is still yours. Consider a PHR the patient's athome health file containing their records from all healthcare providers they have seen. Some patients may even maintain all their test results.

 

Further – based on current CMS objectives and national health information technology directions – insurance companies and Medicare will likely require that documentation for every patient encounter be attached to your bills possibly as soon as 2015. Sounds like a bit much? The healthcare world had better get used to it – EHR will be a central component of your practice, or you won’t be in mainstream practice at all. If EHR isn’t in your repertoire soon, you will simply be out of modern practice and isolated on a fringe island, practicing as though you are not interested in the patients’ total health nor interested in communicating with the patients’ other health care providers, for the betterment of the patients’ overall health management.


Some states have already passed legislation requiring you to have a CCHIT-certified system in your clinic by 2015 or you won’t be allowed to practice in good standing; just check out Minnesota for example.

 

You might ask, “If the federal government can’t see my records, how will they know if my system is compliant?” Big Brother can audit and look at your EHR records… just not over the internet; you’ll still have to submit data, for now. As mentioned, in the future, they will have your records because each encounter will have digitally attached documentation to the billing claim that was also submitted electronically.  Requests for records will be a thing of the past in the next decade, third party payers will have it in advance of your getting paid.


Only you can decide if your patients’ records are sent out (after patient consent, of course). And, even then, it will go out encrypted. Just as with today’s compliance regulations, you should get prepared for being unable to bill third parties, unless you’re on the EHR path.


It’s an instant world and everyone wants instant results.  And, let’s face it: This is as it should be. Patients should have access to their own healthcare information when they need it, without delay. Our role is to get it to them, to help them understand it, and to use it toward a positive outcome. This leads to increased patient satisfaction and affirmation that working with you was the right choice for doctor selection. Being a part of the healthcare system is the only way chiropractic will significantly increase our market share.

 

 

Steven_Kraus_thDr. Steven J. Kraus is CEO of Future Health, Inc., a company that partners with chiropractors to deliver a comprehensive clinic management solution, including fully-integrated EHR. Dr. Kraus is a recognized expert in building successful clinics, having developed and sold 18 practices of his own and provided strategic consulting services to more than 400 healthcare businesses.  He offers leadership to numerous industry associations and currently serves as the Chairman of the Iowa Board of Chiropractic. Contact Dr. Kraus at skraus@Future- HealthSoftware.com for more information.

 
Electronic Health Record for Income Do Not Lose Profits in the Cloud
Documentation
Written by Paul B. Bindell, D.C.   
Thursday, 16 September 2010 15:23

Electronic Health Record for Income

Do Not Lose Profits in the Cloud

by Paul B. Bindell, D.C.

 


The sales people make cloud computing sound like the greatest thing.

 

 

For your practice to stay alive, you must have profit from your practice. It must do more than just pay your food and mortgage. Electronic Health Record (EHR) is the tool that maximizes your profit margin, empowering you to collect and keep the greatest amount of your income in your own pocket. EHR enables you to keep up with all the legal requirements (State and Federal) and insurance company demands while continuing to treat a significant number of patients without getting bogged down in bureaucratic paperwork.

 
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