Twenty years ago, both MD’s and DC’s could get by with a couple of lines of documentation for a patient encounter: "The patient feels X, so now we’re going to do Y." Today, that’s not sufficient. The "getting by" days are over. We need a new level of responsibility and commitment to our role as an equal player in the healthcare landscape. Because we are in the business of helping people (and let’s acknowledge it is a business), doctors need technology in order to succeed. We record what we found, did, and recommended in a quick manner—while maintaining a high level of care—in order to see a certain volume of patients each day.
Surveying chiropractors on their perceptions of Electronic Health Record (EHR), it is clear that the concept has some doctors confused about what it truly means. To boil it down simply, many think EHR is computerized documentation of the patient encounter—what happened, what was reported, the patient’s current status and health history, diagnosis and treatment, and measure of the treatment’s success. In a nutshell, that’s only one component of several, which comprise True EHR.
I want to crack that nut wide open for you now.
We need a new level of responsibility and commitment to our role as an equal player in the healthcare landscape.
EHR is not just a note generator or documentation tool. EHR is everything inside a paper chart, but in a more user-friendly format. If you go to any health clinic that’s on a paper system, records are likely broken up into tabs: radiology, laboratory, daily clinical notes, hospitalizations, health history, and miscellaneous. EHR is digitization of these "tabs"—whether that’s scanned files of printed documents or files created within the EHR itself (the latter of which is infinitely better. I’ll discuss why in a bit).
The benefit of EHR to the patient is that the computerized system can review the data and create analysis of all information within the electronic file. This equates to an efficient office and accurate clinical decision making at the point of care.
Let’s go one step further. Let’s say you want to review or manage patient populations within your entire clinic.
• What is the overall picture?
• Do they follow your care plan?
• What types of ancillary support have I given—exercise, nutrition?
• Do they show up to appointments on time?
Pulling up cross-sections of your EHR gives you instant access to data for identification of common patient characteristics, patterns and outcomes. Why not look at surgical histories, current medications, and lists of conditions to see how those factors may play a role in your patient’s recovery and outcomes? It’s all at your fingertips, and it’s coming. Pretty slick. Pretty powerful.
Even better? EHR’s worth their salt can show you the information in the format you want it delivered—graphs, charts… your call. Customization allows you to analyze the data your way.
There’s nothing truly wrong with dictating records or scanning documents in an EHR (such as pain and outcome scores), but that allows no customization and, worse, no data fields for analysis. This is not true EHR, and working this way is not unleashing anything. With no fields to extrapolate data, you cannot manage a patient’s case over time with assistance from technology, or manage a population within your practice with the speed you need.
The next evolution of EHR software can allow the system to literally become your clinical assistant. It will emit complication alerts when triggered by certain data. The software will also look at outcome assessment scores to measure results, and analyze trends demonstrating progress to help you make decisions about future care.
For example, if the diagnosis is a herniated disk, the software will alert you to best-practice protocols for that condition. This directly and positively affects the quality of care you’re delivering to the patient—and that’s the vision of true EHR. That’s the point at which all parties win. Insurance companies want to know they’re paying for something with an expected outcome. Patients want to know the plan you’ve laid out has the most likelihood of success. The way to achieve both is with evidence-based outcomes. Doctors have extreme time constraints and the only way you can manage your caseload effectively and efficiently is through technology. All three parties win with EHR.
Patients have a better understanding of the care you provide and know you are using a best practice from evidence-based resources.
In the medical world, it’s heart disease and diabetes that get the most best-practice attention. In our world, it’s low back pain guidelines. Chiropractors who follow these guidelines can electronically analyze groups of patients (inside and outside of their clinic walls) to ensure they’re following evidence-based protocols. They can then develop their own practice profile and create a mechanism to administer personal best practices.
Further, chiropractors who demonstrate best practices to insurance companies can negotiate preferred status. EHR is the framework to register and manage the data you need to demonstrate the required practice profile. Now, there aren’t best practices for all conditions and situations but, for common conditions, there are. Sometimes, it’s just a published study that gives you additional credibility, and confidence that you’re making the best decision for treatment.
All healthcare organizations (from Medicare, to managed care to PPO’s) will become dependent upon EHR’s to assure certain guidelines are followed. Automatic reporting of adherence will be coming in the future as part of the claims submission process. If deviation from the standards occurs, the doctor simply documents the reason for deviation. There is nothing to say a provider cannot modify a protocol, as long as the reason for doing so is documented to substantiate why the provider deviated from evidence-based protocols.
In the end, we become better practitioners with more reliable outcomes. Patients have a better understanding of the care you provide and know you are using a best practice from evidence-based resources. You become their technologically savvy, cutting-edge doctor. This helps with referrals and compliance. Payers know they have a superior doctor and will pay appropriately. Doctors have an easier time with treatment plans and can educate patients more definitively. Plus, the healthcare community sees your results through technology communicating the outcomes. More medical referrals, more professional integration, and the elevation of chiropractic as evidence-based cost-effective care can result from the technology framework in EHR. Embrace it. It’s just around the corner.
Dr. 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
for more information.