Doctor Confidence: Now a Software Feature?
Written by Steven J. Kraus, DC, DIBCN, FASA, FICC   
Sunday, 25 August 2013 20:06
hiropractic works. Chiropractic is powerful. Chiropractic is fun and rewarding. On a good day, many chiropractors would say all of that, but would they say the same thing about their chiropractic software?
confidenceCan chiropractic software be powerful, rewarding, fun, and, most importantly, work in such a way that it actually boosts your confidence as a doctor? If software helps you document exams more accurately, provide detailed care plans to better manage patients, and create encounter-specific daily notes in a way that is compliant, accurate, and leads to saving money while increasing efficiency, then yes! Software can be a source of confidence for any doctor.
Here are the top three ways EHR and documentation software can build your confidence.
#1: Improve your focus on your patients
How do you enhance your focus on patients and not simply go through the same old motions? Some doctors might use meditation or mind techniques before seeing patients. Others might use a subtle mental cue to remind themselves to be consciously present in the moment for their patients. Of course, many doctors try to delegate tasks not directly related to patient care to an assistant, as long as they can afford the hire and find someone they trust with the tasks.
Using technology to decrease the demands of multitasking is perhaps one of the most overlooked ways to shift focus from your “busy-ness” or the business of practice over to your patients. Rather than allowing technology to create more work for you during patient-care hours, you should demand that your software makes focusing on patients easier. How can software make you a more focused doctor?
The most powerful way to free you to focus on patients during patient-care hours is by simplifying your exam and daily visit documentation. Documentation is the one task that is difficult to delegate. It is also best to complete documentation at the time of service for greater accuracy and compliance—as Larry the Cable Guy says, it simply is better to “get ’er done.” It feels great to know that at the end of the day, your notes are compliant, detailed, and complete, especially if it’s all done by 6 p.m.
Relieving you of any irrelevant steps in an exam or SOAP note may be the most effective way to keep you focused on patient care, as long as you are not sacrificing the quality of documentation. This is a hard balance to achieve for any documentation program. A customizable yet chiropractic-specific design helps to ensure that every doctor has his or her favorite exam flow, list of tests, performance order of procedures, or codes included. However, this design also creates focus-stealing distractions if it does not allow you to filter out what you do not need. For example, if you do not utilize ultrasound or muscle stimulation, instrument adjusting, or take x-rays, why would you want to have to manually bypass those software screen options every time you create a new note? Being forced to mentally filter out 10 options on your EHR screens that you do not use becomes a source of distraction when you multiply this self-filtering over tens of thousands of notes.
Electronic documentation software that is pre-loaded with chiropractic nomenclature, clinical findings within your scope of practice, and procedures that you actually employ in your clinic will save you time over handwritten notes. To improve your focus, though, it is best if you have the option to choose how best you move through the documentation, including eliminating distracting options.
When software helps you do your job more efficiently and with greater accuracy, you will have more time to deliver care instead of thinking about everything that goes into the care you deliver. Software that revolves around your style of practice using your vernacular and your methods will feel right and empower you to practice your way, quickly, efficiently, and accurately.
Step 2: Eliminate any worry about compliance or oversight
No doctor wants to have the practice’s records scrutinized by anyone. Having a case reviewed by an independent medical examiner, an insurance company claim reviewer, or Medicare auditor is never a pleasant experience, especially when reimbursement for services already rendered are on the line. While it may never be fun to open your clinic records to a third party, you can gain confidence and worry less when it does happen with the right software that helps you create the best notes possible.
With the software that fits your practice, you should be able to reduce your multitasking, focus on your patients, and improve your compliance with the demands of your state board and third-party payers. You should not have to trade accuracy and consistency in your documentation with less time for patient care, or less family and personal time for you.

If you need a little extra help, custom buttons on specific screens to help you raise documentation and coding compliance may be possible depending on the program.

How can software help you raise your level of compliance, especially when different third parties want to see different items in your documentation and care plans? First, electronic health records can provide you with a template that contains all of the elements of compliant documentation so that you are always prompted to “cross your t’s and dot your i’s” right there on the spot. Second, electronic health records can provide chiropractic-specific alerts and reminders to encourage you to provide the proper criteria required or to better manage your patient. If you need a little extra help, custom buttons on specific screens to help you raise documentation and coding compliance may be possible depending on the program. You should note that chiropractic-specific alerts and templates for chiropractic-specific criteria are not going to be found in medical-based electronic health records. You may not be able to expect the same efficiency or compliance in this case.
The best part of improving your documentation quality with the right software is the ability to create documentation compliance immediately at the time of service. There is nothing that creates more confidence than knowing that your documentation is complete and above scrutiny—and not hanging over your head for another day. Having a system that helps you track completion of your notes is important at the end of the day. Should someone be interested in reviewing your records, you also waste little time wondering if you have left yourself exposed.
Step 3: Raise your efficiency while, keeping money in your pocket
Would you feel more confident as a doctor if you left less money on the table due to incomplete exams, or documentation vulnerable to nitpicky reviewers? What if your software could help you increase your chances of being paid consistently for the care you have already delivered? Would you feel greater confidence knowing that the evidence for your care (and therefore your reimbursement) was complete, robust, and just a few seconds away—available at the touch of a few buttons rather than recalling all the criteria from scratch or having to dictate from an empty slate?
When the compliance and quality of your documentation improves, so will your ability to explain your care to third-party payers in the language they understand. With better documentation, you will be able to use and justify higher code values (when appropriate) instead of automatically devaluing your care with a lesser code while hoping to fly under the radar. You will have the confidence to use appropriate billing codes and will be more likely to defend it, which will raise your chances of leaving less money on the table.
The right software should also increase your ability to actually bill for services you are already rendering. The reality of the clinic environment sometimes creates holes in communication where services are improperly coded or not even coded at all. Doctors are often surprised to learn that they lose thousands of dollars every year by simply failing to code services rendered, either in their documentation or in the billing process. Lost or dropped codes mean lost or dropped dollars.
Nothing can raise your confidence like the ability to raise your level of efficiency while saving you money.
Confidence, the next software feature?
Knowing that your documentation and daily notes look professional, legible, complete, detailed, compliant, and specific to the patient’s encounter is a powerful accomplishment and feeling. You will feel more confident knowing that your notes are not fluffy, verbose for the sake of lengthiness, or masquerading as detailed notes by using a lot of words to create a faux filled note. Can chiropractic software actually help boost your confidence as a doctor, which helps you, in turn, become more successful in practice? If confidence can come from eliminating distractions during patient care so you can focus on your patients, then yes. If confidence can come from not fearing any scrutiny over your documentation, then, again, yes. And if confidence can come from leaving less money on the table from incomplete or inconsistent documentation and coding, then yes. Make sure that greater doctor confidence is a main feature in your next software investment.

Steven  J. Kraus, DC, DIBCN, CCSP, FASA, FICC, is Founder and CEO of Future  Health Software ―the technology leader for chiropractic-specific EHR/practice management software.  He is an acknowledged expert in  Health IT, including EHR and the up-to-$39,000 ARRA incentive program to  implement EHR.  Dr. Kraus serves on numerous ACA committees and  regularly travels to Washington DC to meet with policy makers on the  subject of documentation and electronic health records.  He lectures to  state associations and at industry events regarding EHR and the  relationship to documentation.  He presents monthly webinars on how EHR  usage will impact doctors of chiropractic.  For more information, visit or call Toll Free 1-888-919-9919, ext. 616.
Facebook Is Growing and So Can Your New Patients
Written by Teri Kanan   
Thursday, 25 April 2013 19:35
o what is all this hype and talk about facebook? Is it here to stay? Do you really have to have a business facebook page? What will happen if you do not? Let me answer these important questions. In 2013 there are many social media outlets thrown at us, and if you are like most people, you have heard of Twitter, LinkedIn, Yelp, Instagram, Pinterest, Google+ and facebook. If you are like most professionals, you think that you should be using social media for your business but have no idea which ones to use and where to begin. All social media is very powerful and needs to be used by businesses if they want to prosper and grow in our high-tech, fast-paced world. Certain social media avenues better fit specific businesses. If you were a promoter for a band or a young teen clothing store, then it would be optimal to have a Twitter account and even a Keek account, which is a platform for creating and sharing short videos. I am going to break it down to what would be most beneficial for a chiropractic office. Studying all the demographics for various social media outlets is time consuming and can be overwhelming. I have spent a great deal of time researching this to find out what would be the best, most optimal way to use social media to grow a chiropractic practice. Hands down it is facebook. The other social media outlets are good for different types of businesses, but facebook blows the rest away when matching up the demographics of a good chiropractic patient. The end result is if you want to help more patients and streamline your time, effort and cash flow, then facebook is the answer. 
Allow me to explain why facebook is best to grow a chiropractic office. I would like to start out by saying that I do not work for facebook. I simply researched, studied and put time into figuring out this overload of social media information. Facebook use in the United States has grown by 11,000,000 users just in the past six months. ( The time to introduce and grow your business facebook page is now. I know this task seems overwhelming for doctors who are already stretched to the limit with paperwork, ever changing insurance guidelines and a competitive market. So I am going to share with you five helpful tips, from creating your business page to getting new “likes.”
  1. Go to Choose a category and a page name that represents your business/practice. Pick a professional photograph of the doctor or doctors that people associate with your practice to use as a profile picture. Write a sentence about your business so people understand what you do. Choose a memorable web address for your page that you can use for marketing material to promote your presence on facebook. Choose a cover photo that represents your office. Remember, the cover photo is the first thing people will see when they visit your page.
  2. Talk with your patients about your facebook page. This step is so simple yet often ignored. Put a notice up in your office announcing your facebook page.
  3. Use a script to invite patients to join you on facebook. For example: “How did we do today? Great! We have a facebook page for Dr. Smith, and it would really make her day if you left a comment for her there.”
  4. Post regularly but not too often. Remember, this is social media, so people do not want to read lengthy, boring articles. Keep it light and fun!
  5. Use printed materials to remind patients to share a comment and help them easily find your page.
Whether you implement some or all of the above tips, note that in the race of marketing, social media is slow and steady; that is what wins the race. You probably remember how long it took to grow your email list; that is not any different than inviting patients daily to comment on your facebook page. 

With a well-run, high-energy facebook page, your practice will see greater patient retention, more referrals and new patients.

Lastly, I would like to explore what exactly facebook can do for your individual chiropractic office. Patients that “like” your page will continually receive valuable chiropractic information and education. People in your community will know that you are there, have an opportunity to see photographs of you, your office and staff and feel comfortable before they even walk in your door. Facebook puts your face in front of many people’s eyes several times a week and gives your practice and the field of chiropractic credibility. With a well-run, high-energy facebook page, your practice will see greater patient retention, more referrals and new patients. You will see the best results when you have 400 legitimate friends or more.

Teri Kanan is CEO and founder of Connections Social Media Marketing. She has given presentations throughout the country to numerous associations. She has a master’s degree and earned her specialist degree in 2006. She has spent the last 25 years marketing chiropractic offices and managing hundreds of facebook pages. Teri Kanan can be reached at 586-703-3074 or
How to Empower Your Technology: Four essential choices that could make or break your investment in electronic health records
Written by Steven J. Kraus, DC, DIBCN, CCSP, FASA, FICC   
Monday, 25 March 2013 22:33
hen purchasing an electronic health records (EHR) system, there are four important choices that could make or break your investment. How much you spend is a factor in each, but cost alone is not the only choice. 
technologyfourchoicesSo what are these four essential choices that can empower (or hinder) how you use your clinic technology? You have a choice between cloud-based software or an EHR that runs on a server in your office. You have a choice between documentation that is customized to your practice, an EHR system that arrives loaded with general-practice templates, or one that requires you to create and load nearly all commonly used material and selections in drop-down boxes. You have a choice between robust service, maintenance, and training plans, or the least-expensive, do-it-yourself support plan you can find. And finally, you have a choice whether or not to pursue a certified EHR, allowing you to be eligible for incentive payments from Medicare and to have a system that meets federal guidelines.
1. Cloud-based service or local server?
EHRs have two main platforms for delivery of software and data service options: cloud-based services or software that runs on a local server in your office.
What is the difference? To keep it simple, you can think of cloud-based service as largely working over the Internet and a server-based service working through business-class servers in your office. A local server is going to require more hardware costs, IT expertise, and ongoing IT maintenance of your internal network than a cloud-based service where someone else is managing these components for you someplace else (i.e., the cloud). 
And what about costs? With very rare exceptions, most doctors just do not have the background or the experience to set up their own server. Firewalls, user permissions, and the security required for HIPAA really require an IT expert. Depending on the size of your in-office network, the cost of maintaining the network and paying an IT professional can range from $1,500 to $3,500 per year for a small- to medium-sized practice. Larger clinics can pay $5,000 to $15,000 annually. Since a small business-class server can run from $2,000 to $3,000, many clinics will spend about $5,000 annually on their server equipment and maintenance. Plus, every four to five years you usually have to replace the server and continually update the operating software that the server requires.
Cloud-based EHR systems, on the other hand, can range from $39 to $399 per month depending on the service plan and robustness of the software functionality. There is an upfront licensing fee for purchasing most cloud-based software systems depending on if it is certified software and how much functionality initially comes with it. 
With higher maintenance and hardware costs, why would a doctor choose a server? There are three primary reasons why investment in a server would make sense: 
  • Geographic location and local Internet infrastructure may not offer enough Internet bandwidth speed for efficient cloud-based EHRs. If your Internet providers do not have higher speed Internet available and the transfer rate is really slow, it can decrease your efficiency and will become an annoyance.
  • Mid- to large-sized clinics with multiple employees, providers, workstations, and locations may find it more cost and user efficient to maintain a server because of the flexibility it offers.
  • There may already be server components in the clinic with digital radiology and other diagnostics. Upgrading to a larger server environment may not be that much of a jump since the investment is already made in larger practices that already have IT costs as part of their monthly overhead expense.
There is also a fourth aspect to choosing a server that should be mentioned: the psychological component. Some doctors really like being able to see the actual equipment on which all their valuable clinic data is stored. Cloud-based services are stored on high-end, fast servers in HIPAA-compliant environments. You cannot see them, but you can usually access your data from almost anywhere over the Internet. Cloud systems are typically more mobile than local server environments.
Besides cost, there are other advantages to cloud-based EHR systems. Security and accessibility are probably the largest advantages. Cloud-based services are responsible for keeping your EHR data safe and secure in their HIPAA-controlled environment. With a server, you are responsible for the security of your data. Secondly, with cloud-based services, your clinic data is available from anywhere, just as long as you have a username and password.
What's the bottom line? Cost may be the number one factor for server versus cloud, but Internet speed and accessibility are important as well. It may be helpful to work with an EHR company that has experience in server-based and cloud-based services to understand all of your options. One area of confusion regards who owns the data if it resides in the cloud. You still own your patient data and can have a copy of your data should you decide to change software providers.

2. Customization, templates, or the best of both worlds? 
Selecting features makes a lot of doctors anxious. What do they need? What do they want? And what are they really going to use long after the ink is dry on their service contract? Many doctors want the best of both worlds.
Not wanting to be forced into a small-practice box, many doctors say that they want to customize their EHRs—but only to a point. They also do not want to do all the work themselves; they would like to have essential practice documentation information arrive loaded on their software. For example, the notes in pre-loaded EHR software can list information on orthopedic tests, their interpretation, and even how to perform the tests. Doctors also want to be able to easily add their information to an already existing library, while being able to turn on/off certain functions that are important to their practice. They want the software to feel personal, out of the box, and seamless.
If this description fits your own approach to EHR, then take note: this choice may be the most important to your own personal satisfaction with your software. There are some programs that come loaded with dozens and dozens of different screens for every kind of practice, but you cannot prioritize how they appear or turn them off. And there are programs that sell based on their customization capabilities but offer little more than a text box for each section of your SOAP note.
What's the bottom line? Documentation means being able to tell the story of your care as accurately and efficiently as possible. Yes, the best of both worlds is possible to find, but you have to know what is essential to your clinical workflow and work with a company that understands the variety of options in chiropractic care. If you want all the bells and whistles handy, make sure they will not slow you down. Ensure it is possible to turn off options or at least to prioritize how they appear. And if you want customization, make sure that does not mean you have to do all the work. If you choose a system that is not pre-loaded with chiropractic-specific nomenclature and templates, you do not have years to get your documentation right, as some doctors have done. Having the system pre-loaded with chiropractic templates and list selections is great when combined with the ability to customize lists and insert your way of saying things into the note. Being able to save commonly used phrases for later use is key. The workflow design is important so that you can access custom methods quickly.
3. Limousine tech support, or bare-bones service?
There are a lot of factors that go into your EHR costs, and perhaps the most significant factor is service and support needs. There are associated costs with data storage, managed data services, customer service, ongoing training for new hires, and software updates. These expenses are the bulk of your annual fees for larger, more robust EHR systems. 
Do you need luxury-class technical support with e-mail hotlines, click-to-chat, one-on-one trainings, and other help available almost on demand? Or you can you thrive simply on watching a catalog of support videos while utilizing webinar-based training, or by just referring to a written manual—the bare-bones of tech support? 
The largest and most intensive maintenance and support contracts can range up to $6,000 per year for the above features; whereas, bare-bones service and support may cost only $39 per month. What your clinic needs depends on you and your staff’s technical confidence, the number of providers in your practice, and of course, patient volume. 
What is the bottom line? Some doctors try to get away with the lowest maintenance costs possible and will skimp on training and support. Beware if you are tempted to save costs here. If you pass up the upgrades, support, and training necessary to help your clinic run at maximum efficiency, then paying for technology that empowers your practice is an exercise in futility. Many doctors are often unaware of the full features and functionality of their software due to lack of training or due to an “I can figure it out on my own” mentality. Plus, due to changing government regulations and advancing EHR technologies in the healthcare industry, keeping your system updated is crucial to staying compliant. 
4. Medicare incentive payments: is it worth it or not?
The Centers for Medicare and Medicaid Services (CMS) incentive program is not a good reason by itself to adopt an EHR system. With that said, a $39,000 incentive payment is moving some doctors to adopt an EHR system faster than they would have otherwise, and doctors want to know if it is worth it. Here are some guidelines to help you make this choice:
  • Does your clinic have Medicare patients, and does the dollar amount of the allowed submitted charges for those patients total more than $5,000 in a calendar year? If the amount is less than $5,000, then working to demonstrate meaningful use (MU) may or may not be worth it since your payment will be around $3,750 at best. This $5,000 threshold is merely an opinion and not a federal regulation. After helping assist hundreds of DCs receive a check for $18,000 in just their first 90 days of MU, I can tell you that the amount of work to achieve MU was mostly done by chiropractic staff who needed about six to eight hours of training to fully understand it all. Now it is just a part of their normal duties and seems natural as they complete the data entry requirement without thinking about it.
  • If your clinic goes over $5,000 in allowed submitted charges for Medicare patients, do you have a few hours per week free to deal with MU? If your schedule is mostly booked and you have no down time, then the opportunity costs may not be worth it unless you have a staff person available who can do 90% of the data entry work for you for a few hours per week. Ninety percent of MU criteria can be performed by staff. 
  • If you have more than $5,000 in submitted charges and your schedule is regularly open a few hours per week with down time, then it will most definitely be worthwhile to demonstrate MU with your EHR program to qualify for the CMS incentive payment for up to $39,000. The amount you can receive is based on 75% of your allowed submitted charges in a calendar year. This in turn will determine the incentive amount that you are eligible for over a four-year period with maximum threshold amounts capped each successive year. You can learn more about the CMS incentive rules by downloading an article that explains it very well at

You know the saying, as Medicare goes, so too goes private insurance, and it may not be long before a certified EHR is necessary to be on a panel of preferred providers for general health insurance carriers.

With the right combination of allowed submitted charges, Medicare patient volume, and down time, most clinics can pay for the bulk of their EHR system, covering the costs of hardware, software, and time invested to train and prove MU. 
What is the bottom line? If incentives for MU will help raise your profit and pay you for your time, then incentives make sense. But keep in mind that a certified EHR is still worthwhile even if incentive money is unavailable. You know the saying, as Medicare goes, so too goes private insurance, and it may not be long before a certified EHR is necessary to be on a panel of preferred providers for general health insurance carriers. The sooner you adopt a certified EHR, the sooner you reap the benefits of a more efficient practice. (Note: CMS will begin penalizing providers who do not perform MU with a certified EHR starting in 2015.)
These four essential choices will not only affect how much money you spend on EHR, but will also help or hinder how well you use your clinic technology. These choices will determine whether your technology actually empowers your clinic, or if the technology becomes just another cost of doing business. Who can help you make the right choices for your clinic? You can start by finding a company that understands each of these essential choices and even offers solutions from both sides of each issue. None of these choices has a universal right or wrong answer, just an answer that is best for your clinic. Will your choice be the empowering choice for you?
Steven J. Kraus, DC, DIBCN, CCSP, FASA, FICC, is Founder and CEO of Future Health, the nation’s #1 provider of chiropractic-specific EHR/practice management software. He is an acknowledged expert in Health IT, including EHR (electronic health records) and the up-to-$39,000 ARRA incentive program to implement EHR.

Dr. Kraus has served―and continues to serve―on numerous committees and boards, including:
  • ACA Computer & Technology Advisory
  • ACA Legislative Commission
  • ACA Quality Assurance and Accountability Committee
He lectures to state associations and at industry events regarding EHR and the relationship to documentation, and he presents monthly webinars on how EHR usage will impact doctors of chiropractic. For more information, visit or call Toll Free 1-888-919-9919, ext. 652.
Turn Patients’ Smartphones into Genius Phones with Spinal Specific Marketing
User Rating: / 3
Written by David Marcarian, MA and Nancy Miggins, DC   
Monday, 25 March 2013 17:56
s the original Chiropractic “Technogeek”, I feel obligated to make the lives of Chiropractors easier and more productive through the use of technology. One age-old issue screaming out for a technological solution has piqued my interest. It is well known that patients retain only 5-20% of what the doctor communicates; even less at a screening.  Without being able to reinforce the message we convey, and do so quickly and effectively we lose our patient's attention.Traditional solutions have relied upon everything from general pamphlets and videos espousing the value of Chiropractic, to expensive celebrity endorsements. We have struggled for decades attempting to “sell the invisible” and still only appeal to 8% of the population. 
smartphonedoctorThe emergence of Static sEMG in the early 90’s attempted to provide a user-friendly technology that produced patient-friendly graphics, but was limited by technological and reliability issues.  This technology not only forged the way for evidence-based practice, providing objective data that Chiropractors need and patients want, but also provided an effective tool for internal marketing and spinal screenings, a mainstay for generating new patients.  Yet the problem still persists.  
What does a NASA researcher do?  Seek out data, and observe.  So that is what I did. Instead of interviewing doctors, I spent four months interviewing patients.
In the process of interviewing patients, an issue with significantly greater impact on the profession was exposed:  Those in pain easily garnered the support of friends and family members in choosing Chiropractic as the treatment of choice. Those not in pain seeking Chiropractic care for general health and wellness, clearly expressed one common challenge: Each and every one admitted they found it extremely difficult to justify their Chiropractic visits to family and friends.  
More important than this was the emotional response I received from patients who had taken home their Static sEMG test as it validated their complaints to cynical family members.  One patient actually cried saying “My husband didn’t believe me until I showed him my print out”.
You go to the doctor when you’re sick. You see the Chiropractor in pain. Why would you possibly go if not in pain?  
We’ve been attempting to implement the dental model of “preventive care” for years with little success. But to a Technogeek, this is just another fun problem to solve.

In reviewing the scientific literature on patient communication,I found some clear trends 1, 2, 3, 4.
  1. If you don’t reinforce the message immediately, you can assume your patient will forget your advice making the interaction unproductive at best.
  2. A follow up call or some form of personal communication immediately after each visit is ideal, as a reminder may help reinforce the importance of their visit. 
  3. Any report of findings provided the patient via “internet patient portals” or email is significantly more effective as the patient not only can review it at their leisure, but can show family members and friends their results. In addition, it does not get lost as does paper. 
  4. Visual data is significantly more effective. The more objective and personalized the data, the more effect it has on the patient and their family and friends. 
  5. Making the communication “Smartphone Friendly” is crucial, as the proliferation of Smartphones requires that your communications be easily readable on them. Many use iPads and Smartphones more than computers for “skimming” their electronic communications.
My girlfriend’s trip to the auto mechanic lead to the solution. She kept complaining of engine roughness. I didn’t notice it and to be honest thought she was a bit paranoid. Instead of the mechanic listening, touching, feeling and expressing an opinion, they plugged her car into a computer. On the screen was a visual image showing her “mass airflow sensor” was defective, They even faxed the results from the computer directly to me knowing that I would need to be convinced also. I know she got great pleasure in using this data to show me how much more right she was then I. I’m happy that makes her happy.

In the days prior to objective data, we would pleasantly say “thank you”, and go off to get several opinions potentially putting off fixing the problem for months or even years! Sound familiar?

We in the Chiropractic Profession share the mechanics dilemma, and may learn a lesson from their approach. We live in a data driven society. Show them why with “instant” indisputable, objective data and we overcome not only their objections and reinforce the need for care, but overcome family members objections. In a data driven world, objective data rules, and those with it have the power to convince. Whether it be mass airflow sensors or wellness care. The key is finding a way to transmit this data in an electronic, instantaneous form which is visual in nature for maximum effectiveness.

I realized that it would be most intelligent to meet the patient where they lived… on their smartphone! Nielsen reports that more than 50% of mobile consumers are using smartphones. According to Nielsen’s monthly analysis of cell phone bills for 65,000+ lines, smartphone owners – especially those with iPhones and Android devices — are consuming more data than ever before on a per-user basis. This is an enormous captive audience waiting to be engaged.

It was crucial that this process maximized the use of technology to remove the need for human interaction and labor. Unnecessary labor is proof of a poorly designed system. This tool had to be fast, allow for instant communication, and provide indisputable, objective data which could be easily presented to skeptical family members and friends. Due to the fact everyone has smartphones, it has to be easily viewable on the tiny screen. Allowing the texting of the image via SMS would improve its effectiveness.

With major technological improvements that have tripled the speed of muscle tension measurements, the tool of choice for this objective data would be Static sEMG. Although Thermography was considered, it is too finicky due to sensitivity to environmental heat and cold, making screenings difficult. Additionally, patients can’t feel temperature differences between left and right sides of their spines, making the results less “believable”. Modern, Wireless Static sEMG can be performed in virtually any environment. More importantly, everyone knows the ache of muscle tension, making instant credibility the doctor’s reward when the graphed results reflect what the patient feels. New University research has validated Standing Static sEMG studies as clinically valuable6. Even more important, a major study by the Veterans Administration established the Static sEMG as capable of accurately tracking patient progress 7, 8.

Impersonal is ineffective. If the patient’s personal Static sEMG results, graphical in nature could be instantly transferred to the patient’s smartphone, that crucial communication between doctor and patient would be reinforced within seconds. Unlike a generic pamphlet on the value of Chiropractic, the patient needing to prove the necessity for care can instantly forward from their smartphone the test results to skeptical family members. Another requirement is for the graphical image to act as an “E-Business Card”, presenting both specific information on the doctor’s office, and an easily customized special offer. The impact on those who’ve received the forwarded, visually appealing graphic would provide powerful advertising for the clinic.

So I built this thing, filed patents and tested it. And guess what else happened. In Beta Testing all of the above conditions were met, and more. The big surprise was how many patients posted this graphic image on Facebook, and did so while still in the doctor’s office! Imagine the impact of your office information marketed by your patients at no cost to you? With the average person having 120 Facebook friends 5,9, the value in terms of marketing alone is quite significant.

The tool proved invaluable at screenings where not only did the patient walk away with an instant personalized message, but also knew exactly how to reach you to take advantage of the special offer embedded in the graphic. Even better, the doctor stored the prospective patient’s email address for instant follow-up and future email marketing.

The term “Viral Growth” is an understatement when it comes to the impact of these visual images flying around the internet. The biggest surprise of all is that each and every patient tested said, and without exception (after saying “Cool”, that is): “Now I can show my _______ why I need my Chiropractor.” It is unknown if this can get us beyond that 8% of the population we’re seeking. Considering the massive proliferation of Smartphones, it at least takes advantage of a new form of high-tech, low cost marketing with potentially powerful consequences.

Technology can be your best friend or worst enemy. By finding the best product and support for your needs, you will have a great partner in building your practice. Follow the simple guidelines above and you will enjoy all the advantages of technology without the stress.

  1. Thom DH. Training physicians to increase patient trust. J Eval Clin Pract. 2000 Aug;6(3):245-53.
  2. Betancourt JR. Cultural competence—marginal or mainstream movement? N Engl J Med. 2004;351(10):953-5.
  3. Osborne H. In Other Words…Actions Can Speak as Clearly as Words. Boston Globe’s On Call Magazine. Jan/Feb 2006. (accessed Mar 3, 2006).
  4. Osborne H. In Other Words...Teaching with Pictures. Boston Globe’s On Call Magazine.  Nov 1999. (accessed Mar 3, 2006).
  5. Dunbar, R.I.M. (June 1992). "Neocortex size as a constraint on group size in primates". Journal of Human Evolution 22 (6): 469–493. doi:10.1016/0047-2484(92)90081-J
  6. A Meta-Analytic Review of Surface Electromyography Among Persons With Low Back Pain and Normal, Healthy Controls. Geisser, Ranavaya, Haig, Roth, Zucker, Ambroz and Caruso published in the Journal of Pain, November 2005 p 711-726.
  7. VAS Score Correlates with Static Surface EMG Signal Intensity in Chronic Spine Pain.  Ambroz, Alex MD,VA Medical Center, Martinsburg, WV Ambroz, Clara MD, MPH, Disability Evaluation Services, Martinsburg, WV Zucker, Robert  MD, MPH,VA Medical Center, Martinsburg, WV Benjamin, Eugene MD,VA Medical Center, Martinsburg, WV
  8. Caruso, Marianne RN,VA Medical Center, Martinsburg, WV.  PAIN MEDICINE Volume 6, Number 2, 2005 p 28-29.
  9. Marlow, Cameron:  “Maintained relationships on Facebook” 2009, March 9,

David Marcarian, MA, founder of Precision Biometrics, and inventor of the revolutionary MyoVision 3G Wirefree PhysioMonitoring™ System. A former NASA researcher, Marcarian was awarded a $450,000.00 NIH grant to develop the MyoVision. As an expert witness, Marcarian was credited one of the largest PI awards in US history, and established the validity of sEMG in a major State Superior Court Decision. Recently the AMA selected his 3G Wirefree System as the “tool of choice” as presented in the medical text “The Practical Guid". Contact at : This e-mail address is being protected from spambots. You need JavaScript enabled to view it or visit or call 800-969-6961

Dr. Nancy Miggins has over 25 year’s clinical experience as a chiropractor. She excelled in the areas of procedures, ethical business practices and management.  After spearheading the development of a integrative health and fitness center, she spent 6 years as director of this clinic.  Although her main focus was in family practice, she also has aided Olympic Athletes and professional cyclists with optimizing sports performance through chiropractic. She is currently the Director of Clinical Applications & Product Development for Precision Biometrics, Inc. Contact at : This e-mail address is being protected from spambots. You need JavaScript enabled to view it or visit or call 800-969-6961
Ignoring Patient Supplements Because of the Hassle?
Written by Steven J. Kraus, D.C., DIBCN, CCSP, FASA, FICC   
Sunday, 25 November 2012 18:40
Technology now makes it easy to prescribe supplements for better patient care and to create a successful new revenue stream

any DCs avoid offering nutritional supplements because it can seem like a time-consuming effort for little reward.
clipboard14But the fact is, prescribing nutritional supplements can provide major health benefits for your patients and your bottom line--and it doesn’t have to be a hassle. You just need to have the right technology in place to help.
Here are just a few of the concerns about prescribing supplements commonly cited by DCs, and how the right EHR/practice management software can effectively turn them into non-issues.
Educating patients on the supplements you prescribe
Creating custom educational handouts can seem like a daunting task, particularly because you want ALL the specifics—including dosage and frequency—for every supplement you carry to be double- and triple-checked.
Depending on which EHR/practice management software you choose, you may find that your program comes pre-loaded with patient education materials, including nutritional supplement handouts. This makes educating your patients as easy as printing out the correct handout for your patient, or pre-printing a stack for your most commonly used supplements.
You may also have the ability to create macros within the software detailing specific instructions and then distribute that information to your patients.
Documenting supplement prescriptions and consultation
With all of the documenting you already do, adding supplements to the mix may seem like it will add even more time to your process.
However, not documenting supplements is not even an option in terms of good risk management practices and state board rules on documentation standard of care. Should a liability issue arise, you will need that information at hand.
The good news is, documenting nutritional supplements doesn’t have to be difficult or time-consuming. The right software will make it easily accessible and will accommodate your workflow. Depending on the software you use, you can customize dozens of macros to allow for the simple point-and-click entry of your most common prescriptions and dosages.

That way, patients will have all of their prescriptions, dosage and frequency information available at the click of a mouse.

With EHR/practice management software, when you document a supplement prescription, it becomes part of your patient’s record. You and your staff can easily access prescription history in a consolidated patient-specific supplement log or in the encounter-specific note.
What happens if a patient loses their information? Your staff can quickly find the instructions and either reprint or resend the information via an encrypted email,  effectively eliminating the need for patients to catch you between patients to ask.
But perhaps the best part is that you and your staff can now send the clinical care summary--including prescription details--with encrypted data to the patient’s Personal Health Record (for instance, Microsoft HealthVault).  That way, patients will have all of their prescriptions, dosage and frequency information available at the click of a mouse.
Side effects and other unintentional reactions
Your EHR software should include a component for checking drug/drug and drug/allergy interactions and automatically alerting you of potential conflicts. That way you can avoid potential side effects and other unintentional reactions before they even happen. 
Inventory management
EHR/practice management software can easily automate your supplement inventory, enabling you to set a threshold and receive a notification when it’s time to reorder.  This not only allows you to provide on-demand nutritional services, but it also helps you avoid excessive shipping charges from continually restocking or ordering one-offs.
There’s no operational reason that you shouldn’t offer nutritional supplements to your patients
Technology makes it easy for you to provide patient education, document your prescriptions, avoid unintentional reactions, and maintain inventory.
Your EHR will help you track all of a patient’s prescriptions, dosage, and frequency so all parties can recall what was prescribed. Again, you can print the information out and provide it to the patient and send the encrypted data right to your patient’s Personal Health Record.
Managed properly, nutritional supplements can help improve patient care in an efficient, risk management-friendly way--without adding a lot of time and effort.
Steven J. Kraus, DC, DIBCN, CCSP, FASA, FICC, is founder and CEO of Future Health, the industry leader in EHR/practice management software for Doctors of Chiropractic. He is a recognized expert in Health IT, including EHR (electronic health records) and the up-to-$44,000 ARRA incentive program to implement EHR. Under Dr. Kraus’ direction, hundreds of Future Health DCs qualified for the 2011 ARRA incentive. In fact, more DCs collected incentive money using Future Health than any other software. Dr. Kraus is also an expert on practice management, with more than 23 years of experience in his own practice. He has developed and sold 18 practices and has provided strategic consulting to more than 400 healthcare businesses nationwide. For more information and to sign up for a free software demo, visit

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