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Technology
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Technology
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Written by John Brimhall, D.C.
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Thursday, 05 July 2007 11:05 |
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Introduction
The cold laser suggests a way to reduce the mushrooming seven billion dollar costs of healthcare and lost productivity caused just by carpal tunnel syndrome, repetitive stress injuries, back and neck dysfunctions that occur in the factory and the office each year, incapacitating 185,000 workers, and to return these people back to work without debilitating pain, lengthy recovery time, or enormous heathcare bills. The cold laser can accelerate recovery time for many conditions that weaken and immobilize people for long periods of time, draining the economy, inflating healthcare costs, and interrupting careers.
The cold laser has been called "The Therapy" of the 21st Century. In over 1700 publications, there have been no recorded negative side effects. This versatile tool is totally safe, non-toxic, and easy to use. In around thirty years of using the cold laser, it has become one of the most versatile conjunctive tools we have ever used. It can do everything the acupuncture needle can do, without threat of infection or discomfort, and more. It has potent synergistic effects with nutritional therapies. It is both doctor and patient friendly.
This promising tool is called the cold laser, the soft laser, the low-power laser, or the low-level laser. The term laser, is an acronym for Light Amplification by Stimulated Emissions of Radiation. All lasers emit coherent, focused light that travels in a narrow beam in one direction.
• High Power, "hot" lasers have shorter wavelengths which have catabolic effects that can deliberately destroy tissue in cauterizing and surgical applications.
• Low Power, "soft," "cool," or "cold" lasers have longer wavelengths that have anabolic effects that promote rapid reduction of pain, accelerate healing time, and accelerate growth and repair.
Cold lasers have stimulative effects rather than destructive ones. It may be the perfect conjunctive tool for the chiropractor, the acupuncturist, the physiatrist, the physical therapist, the dentist, the surgeon, the neurosurgeon, the neurologist, the sports medicine doctor, the dermatologist, and the general practitioner. Clinical applications of the cold laser have included acute and chronic pain reduction from many etiologies, inflammation reduction, enhanced tissue healing, cell regeneration, and replacement of the needle in acupuncture. The results have shown very rapid pain reduction and accelerated recovery times, far exceeding conventional methods.
Pain Management
Carpal tunnel syndrome (CTS) and repetitive stress injury (RSI) are becoming common conditions in office workers using desktop computers, in meat packing factories among meat cutters, in auto assemblers, in musicians playing stringed instruments, and other groups where mechanically repetitive motions are performed throughout the workday. Those affected frequently experience pain, numbness, tingling in hands and wrists as well as in thumb, index, and middle fingers. Those diagnosed with CTS or RSI also show neuromuscular problems in the head, neck, and upper back upon examination.
Thirty-five patients diagnosed with CTS or RSI had performed the office tasks of using computers, typing, writing, answering phones, and other clerical work. All thirty-five had consulted neurologists, internists, acupuncturists, neurosurgeons, chiropractors, or physical therapists, having tried standard treatments such as splints and analgesics, without pain relief. Symptoms had persisted from one month to ten years. All patients had various degrees of abnormal posture with forward, rounded shoulders, and head and neck stooped forward. All patients showed tenderness upon palpation in spinous processes in the lower cervical and upper thoracic spine, especially between C5 and T1. Median angle of the scapula and tendinous attachment of the trapezius at the nuchal line were also tender.
Each tender site in the cervical and thoracic spine, but not the wrists and hands, was treated from two to five minutes with a cold laser touching the skin, perpendicular to the spinous processes. Each patient was followed for a mean of 8.2 months, averaging ten treatments per patient.
Pain, numbness, and tingling in hands and wrists subsided or disappeared in all patients. None of the patients reported adverse effects or deterioration in symptoms. In Case 1, the accountant who worked at a computer experienced immediate relief, felt less pain and tingling in arms, hands, and fingers, and less tenderness in lower and upper spine. Almost all symptoms cleared in less than two months, with the exception of residual fullness in the palmar aspects of the hands.
In Case 2, a secretary presented with headaches, pain in the neck, shoulder, upper arms, forearms, wrists, hands, and fingers. Cold laser treatment was given at the sites of tender spinous processes as well as medial angle of the scapula. The pains subsided in the first treatment. After three treatments, the patient reported being pain free as long as she maintained proper head and neck posture.
In most of these cases diagnosed as CTS or RSI, the patients also remembered long ago sports injuries, automobile accident injuries, and injuries from falls. It was believed that prolonged straining of these old injuries by improper posture and ergonomics aggravated and perpetuated old microscopic or macroscopic tears in soft tissues, resulting in noxious accumulation of chemical mediators such as histamine, kinins, and other substances. The low level laser may help modulate and drain these irritating chemicals through lymphatic channels.
In a 100-patient blind study, the Erchonia 635nm diode cold laser of ruby red, near-infrared light (630-640nm wavelength) was tested on chronic neck and shoulder pain associated with osteoarthritis, muscle spasms, or cervical/thoracic sprain conditions. The cold laser was used for short durations of apparently thirty to ninety seconds, 9 Hz for ninty seconds, 33 Hz for thirty seconds, 60 Hz for thirty seconds, or 4 Hz for thirty seconds, while the control group received placebo treatments with no irradiation from a "fake" laser. The results showed that sixty-five percent of the cold laser treated group met success criteria measured as a thirty percent improvement in pain, while only 11.6 percent of the placebo group improved to this degree.
In a clinical trial of another hundred subjects, the majority of the test group showed significant reduction in pain levels immediately following a single treatment. This pain reduction was stable or improved further levels after twenty-four hours. The test group receiving a single laser treatment also significantly improved in all linear ranges of motion, while the placebo group did not show significant improvement.
Cold laser irradiation of sports injuries has resulted in rapid recoveries that have profoundly benefited individuals’ personal and athletic careers. In treatment of fifty-seven athletic injuries, including lacerations, abrasions, strains and sprains, overuse conditions, and stress reactions, fifty-four of the fifty-seven showed dramatically positive reductions of pain levels and improvement in functional tests. The versatility of the cold laser is suggested by the following cases.
In Case 1, a soccer player using tibial shin splints was unable to play for three weeks because of acute pain while running. Anti-inflammatory medication, taping, and cryotherapy had helped only minimally. Acupoint and local site irradiation was added to these protocols for four consecutive days. On the fifth day, the athlete was able to resume practice with minimal discomfort. On the sixth day, the athlete was pain free and completed the season without recurrence.
In Case 2, a high school defensive tackle with a history of chronic ankle sprains had been taped. The tape caused an infection, which was treated by antibiotics, and whirlpool therapy. Cold laser therapy was added to his treatment protocols. After two treatments, the wound began to granulate. After four treatments, the wound had closed and healed. The athlete returned to competition ten days prior to the date the team physician had anticipated. Similar accelerated rates of granulation and epithelialization have been noted in burn cases.
In Case 3, a pole-vaulter suffered a contusion to his scapula and had significant spasm to his trapezius and surrounding shoulder musculature. The condition did not respond to conventional treatment of moist heat and electrical stimulation. After one treatment of cold laser irradiation to trigger points and acupoints, the patient reported a fifty percent reduction in pain. Two additional treatments on two consecutive days resulted in the patient’s becoming pain free, with normal range of motion, and normal strength. In other studies of spasm, it has been suggested that dramatic spasm reduction occurs because of the laser’s stimulation of depolarization and repolarization of cell membranes in individual fibers and reduction of arteriole spasm.
These kinds of rapid improvements in pain management with 635nm cold laser treatment have also been attributed to stimulation of the mitochondria with enhanced ATP production and protein synthesis, to photochemical changes converting prostaglandins to prostacylin endoperoxide, which reduce sensitivity of nerve endings, and modulation of cortisol levels with anti-inflammatory effects. These kinds of changes are accompanied by thirty to fifty percent improvement in collagen formation in wound healing.
In summary, the cold laser can be used every day and on almost every patient with speed, accuracy and with predictable results in complete safety for the doctor and the patient.
Drs. John and Brett Brimhall may be reached at Brimhall Wellness Seminars, visit www.brimhallseminars.com, or call 1-480-964-5198; email
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. Brimhall Wellness Center may be reached at 1-480-964-5107 and
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Technology
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Written by Gregg Church
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Thursday, 05 July 2007 11:00 |
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Iowa Chiropractor Dr. Lauri Wondra has been using a tablet PC-based automated practice management system for only a few months, but she is already on the way to her goal of doubling her patient volume to fifty visits per day. She hand-scribes some of her SOAP notes, but her use of electronic text linked to on-screen helpers plays an increasing role, one that continues to grow as she customizes the text with her own specificity elements and writing style. Dr. Lauri and her husband, Tim, also a chiropractor, have a young, progressive practice and, early on, the two decided that, to fulfill their growth and service goals, electronic office systems would have to play a part. Dr. Tim plans to open a second practice in a nearby community.
The most obvious benefit of electronic notes is the ability to employ standardized text in performing examinations and recording SOAP notes during patient visits. Doing so avoids the labor and distraction of hand-scribing, enabling doctors to preserve the intimacy of the patient visit and assure the quality of examinations, while accelerating visit procedure.
Helper-supported electronic notes software on a pen-based tablet also confers the ability to amplify text ad hoc with hand-scribed electronic notes to whatever extent the doctor chooses. However they are generated, storing the notes in a flexible, concept-based electronic database that builds the file automatically, visit-to-visit, precludes any need for the traditional paper jacket—along with the filing and maintenance that it implies.
The availability of the intelligent database, in turn, establishes the ability to automate production of interim and final reports and to eliminate the archaic, time-consuming processes of analysis, dictation, and transcription. An intelligent, template-based report writer can identify and selectively import specific fields that he/she needs to generate comprehensive, fully compliant clinical reports, literally, in seconds.
Expenditures of time and money for transcription services evaporate. Insurance claims and their supporting documentation can be dispatched quickly, even bypassing the hard-copy stage if the doctor and payer are set up to do so. The impact on cash flow cannot be overstated.
One cannot ignore the argument against electronic notes: that, although they support the precision and consistency that are critical to documentation of diagnoses and treatment, the uniformity that can result could reflect an indifferent attitude, even suggest to payer personnel reading the reports that indicated treatment might not actually have been performed. Regulatory discipline and/or professional censure are appropriate for the few unethical practitioners who might be guilty of this.
Fortunately, there are features within electronic clinical notes and reporting solutions that allow doctors to maintain unquestioned integrity as well as the uniqueness of their SOAP notes and reports as they gain the dramatic savings in time and effort afforded by standing text. These features are document cloning and documentation mutation.
Cloning allows doctors to import all or part of the data in any previously completed SOAP or exam note to create a new document, avoiding the need to begin with a blank page and reentry of personal, diagnostic, symptom and treatment information for each patient visit. Doctors can replicate any previous document, with the newly created document independent of the original and open to such modifications as are appropriate.
When treatments and conditions do not change from visit-to-visit, a mutation capability allows doctors to modify the cloned document using their own stored terminology to indicate that the patient visit has, in fact, occurred and that a treatment/exam has been performed. Time required to reconstruct the document is saved and the likelihood of a claim or billing challenge is avoided.
Simple observation is enough to convince almost anyone that paper processes in the chiropractic office—in any office—represent an enormous drag on productivity. And beyond the cost factors, the ever-present potential for challenges by medical examiners, regulators and litigators informs us that you can’t risk files getting damaged or lost. Increasingly, legal rulings demand that electronic files be available in litigation proceedings if requested.
In the contemporary clinic, electronic notes form the basis for reliable and systematic records. Using them leads to greater productivity and profitability, a more streamlined practice, and more effective communications with patients, payers, and other professionals.
Gregory T. Church is vice president and general manager of the Healthcare Business Division of ACOM Solutions, Inc. He can be reached at 866-286-5315, Ext. 401, or email
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Technology
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Written by Filomena Lorocca, D.C.
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Thursday, 05 July 2007 10:55 |
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It seems, at some time in the early 90’s, the buzzword throughout the natural healthcare market became antioxidants. Have a cold; grab an antioxidant…. Car is rusting; rub an antioxidant wax on it…. Forgot to pay your bills…take an antioxidant.
Sure, a little hyperbole here, but the reality is that oxidative stress (free radicals) has been implicated in the pathogenesis of many human diseases. In fact, the use of antioxidants has been intensively studied, particularly as treatment for stroke, cancer, and even neurodegenerative diseases.
At a recent anti-aging conference, Mark Bartlett, Ph. D., suggested that, "Increasing the antioxidant level in one’s body may be one of the most important keys to anti-aging and longevity."
Until recently, the methods available for measuring antioxidant levels in humans have consisted of severely flawed mail-in urine testing or expensive blood tests. Well, there was a need for a convenient, inexpensive method of testing, and now it seems to have arrived.
The University of Utah recently developed such a device—the BioPhotonic Scanner. Based on Raman Spectroscopy, the scanner is able to quickly, and non-invasively provide an accurate antioxidant score for patients. The original beta version scanner was ten feet long and took up an entire room. Pharmanex, a natural health company located in Provo, UT, invested around $50 million for the exclusive worldwide marketing rights to the antioxidant scanner. Working closely with the U of U, they were able to get the scanner down to the size of a toaster. Today, the scanner has completed its evolution. It is accurate, fast, very compact and easy to use.
With eight global patents on the technology that are good for the next twenty years, Pharmanex has positioned itself as a leader in this market for years to come. This is a useful patient education and monitoring tool, because patients may track the progress of their antioxidant level through time as they take supplements and increase their consumption of raw fruits and vegetables.
Dr. Lester Packer, author of The Antioxidant Miracle, known in some circles as the "Father of Antioxidants" explains, "The Pharmanex antioxidant scanner validates my life’s work." As head of research for over forty years in the Packer labs at the University of California, Berkeley, Dr. Packer is no stranger to rigorously evaluating studies. When recently interviewed by CNN Money, Dr. Packer explained, "Everyone should get their antioxidant score and begin increasing their intake of fruits, vegetables and dietary supplements to maintain their optimal score forever."
As the Wellness revolution sweeps the nation, at least one Chiropractic College has already caught on to the technology. Parker Seminars incorporated the use of the scanner as part of their CCE Accreditation course in 2007. Parker College’s Research & Development department did a complete review of the science behind the scanner and subsequently incorporated the training into their 2007 curriculum for their students as well. According to Parker College President Dr. Fabrizio Mancini, "This scanner will help all chiropractors maintain a better relationship with their patients through monthly counseling on how fast their body is aging."
Dr. Filomena Larocca is a family well-care physician in practice for sixteen years. She began her wellness studies at Springfield College in 1984 and graduated Magnum Cumlaude in the spring of 1988 with a BS in Therapeutic Rehabilitation. She continued on to New York Chiropractic in 1990, graduating with honors in August of 1993.
For more information visit www.AOLscanner.com, www.pharmanex.com or call 1-800-337-7715.
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Technology
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Written by Etienne DuBarry, D.C.
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Thursday, 05 July 2007 10:50 |
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The primary achievement Electronic Medical Records (EMR) lay claim to is to save time. Everyone knows, time is money; so which of these products is best for you and your patients? The EMR technology is quite advanced already but, because it is so recent and the development costs are so high, many of the technical assets and shortcuts are not grouped into a single product. Each is disseminated according to whatever the doctor’s specialty may be, advancements only being made when necessitated by the field. The real vision for the future of this market will take the best of each field to make one universal system.
Let me take you through a virtual office tour, where I will demonstrate an imaginary software named Dreamware-2007. This imaginary software will take current existing components of software sold on the market and group all of the best features together into one single package. One of our best resources for this endeavor is the EMR consultant website (www.emrconsultant.com) which harbors, by far, the most extensive collection of EMR software throughout the world (over 300).
First, from the Patient’s Perspective:
So you decide you’re ready to see your doctor. Do you grab your phone to get the voice-mail of your chiropractor. No, not this time; you go to your computer, then to your doctor’s online appointment book.1 That’s right, there you reserve a slot in the time grid proposed to you online. You are required an upfront deposit which is not refundable, and charged if you do not honor your appointment. Your credit card number is entered and will be processed in the doctor’s office. Additionally, you are given your own password for future appointments. As the patient, your time is also valuable so, to expedite your visit to the clinic, you are asked, online, to answer a health questionnaire.2 You can also go online to sign an authorization to release documentation from other doctor’s offices. As the patient, all you will have to do is to enter those doctor’s phone numbers, fax and emails, and the computer in the doctor’s office will auto-generate the form that will be directed to those doctor’s offices that will be releasing the documents.
Even though you have yet to see the doctor; the clinic is receiving all of its documentation ahead of time, and the time grid for the day is filling up with no personal interaction yet;3 the computer has generated and sent faxes (or emails or phone calls) to other clinics to ask for the relevant documentation about you the patient.4
To remind you of your appointment, the day prior, a computer generated voice mail is left reminding you of the time of your appointment. After the prompt, you listen to the short message and push "#" to confirm, or another key if you need to reschedule. Simple as that. The system automatically provides an easy to read report for the doctor at the start of the next day.5
Finally, you’ve arrived at the clinic. In the doctor’s waiting room, a kiosk touch screen system asks you to enter your password if you have been given one from the online appointment. You enter it, and you are greeted by your own name and asked to smile for a picture from the camera mounted on top of the kiosk.
You are also asked by the system if you would like a biometric finger scan or a facial scan to be saved in the system to avoid your having to memorize any password for next time.
You are then asked to swipe your insurance card on the card reader. The computer informs you of the price of the basic visit, which is owed prior to seeing the doctor. Your insurance card also has medical information about you, which the system asks you to release, and prompts you to enter a password in order to be HIPPA compliant.
Now, at this point, if you have not filled out your health questionnaire online, you are prompted to a series of questions on screen.7 You do not need to type, but just to touch one of the check boxes on the screen; this online questionnaire is asked of you in the language of your choice (English, Spanish, French), but the doctor will see the answers in plain English. You even have an audio file to each question in different languages, allowing the non-reading patient to still communicate. Those questions are interactive, meaning specific answer prompt to specific new questions. The questions are also illustrated with picture video clip animations to make them easy to grasp and understood by the patient, while keeping the questionnaire relatively entertaining.
Once everything has been answered, you are asked if you would like to have an electronic file of this questionnaire sent to your email address in an encrypted format, should you need to consult someone else; there is also a service you can purchase for a server in the US to collect all your medical data from every doctor that you ever consulted.
On the doctor’s personal screen, a warning informs the doctor that a patient has checked in and is currently filling out the questionnaire. The waiting room touch screen health questionnaire subsequently generates a form on the doctor’s computer screen. Additionally, the lab report, MRI pictures, and hospital records are directly wired and transferred to the doctor’s system and seen on his/her screen.8 The records are not shown on the screen as a faxed or scanned document, but much better. Each bit of data has been entered from the start in a particular field according to a nationally used format (HL7 or Health Level 7). Those fields can be retrieved and compared from different years, and analyzed in a way that the association search between diseases and abnormal values are automatically made. The doctor will also create for all his/her patients specific questions which seem important in his type of practice which have programmed specific warnings to be triggered following specific answers or abnormal biological values.
Finally, the personal encounter occurs, in which the doctor meets the patient after checking the result of the electronic questionnaire and the matching queries from each of the different electronic patient files. The system has already given him the type of exam he should perform and what different ailments he may be facing through the use of statistical projection.
The doctor is prompted through the exam via touch screen. Each test to be performed is shown on a screen as an animation or video that he taps to select. The result of the exam can be generated in several formats: form, text, text and pictures.
The doctor is prompted to several diagnostic possibilities and, for each diagnostic, a menu lists the findings that prompted such a potential diagnosis. The final decision is up to the doctor.
Then comes treatment; the treatment must be recorded with enough precision for exact duplication by any of his colleagues. If the doctor is an MD, then this is done in a very straightforward fashion, e.g., "5 milligrams of drug twice a day." Anyone would be able to duplicate this treatment.
If the doctor does hands on treatment, such as a chiropractor, physiatrist, PT, OT, then some amount of system customization needs to be done, because no two "hands on treatments" are the same. Every chiropractor customizes his adjustment to a certain extent.
To make things easy, the software has provided the doctors with pictures from a hundred animated adjustments, mobilizations and modalities; for each one of those, therapeutic protocol is described with a biomechanical precision following a standardized description, enabling another physician to duplicate it. The most comprehensive database to date may be found at http://docurehab.com/TechniquesEX/index.html. The doctor merely needs to pick what he uses daily; further, he has the option to customize the technique he uses and keep it in his "often used" technique folder. Once in the folder, those techniques are retrieved by tapping on the screen and they become part of a menu that the doctor uses daily.9 With this software, the doctor has access to hundreds of techniques taught by schools, universities or fellow chiropractors, therapists, and MD’s.
Insurance companies have a tool to establish statistical data on the effectiveness of a given technique for specific ailments. As the technique is selected, the insurance code is automatically assigned to the billing section of the program. Insurance is billed online daily. Payments are electronic and correlated to the EOB (explanation of benefits) automatically.10
The patient’s medical record is wired and stored off site, backed up routinely so, even if a hurricane destroys the office computer, data can be retrieved instantly from another location.11
All the elements of the system just described already exist in the industry; they are not yet found in a single source of software because there are too many health specialists with different needs to customize all of them at once. Many of those nifty applications require that all the ones that you communicate with be on an EMR system with a standard communication format such as HL7, which is not yet the case.
But our current systems already provide the most services by automating the patient’s health history, the note taking and the billing function; those functions, alone, have cut down at least two-thirds of the office clerical duties.
The industry is now gearing up toward the medical exactness of differential diagnoses from data retrieval. I predict the economic impact will be huge on the health market. On the level of the practitioner, initially, the benefit will be more available time. Second, reproducible therapeutic approaches will be more exchangeable, and assessable using statistics. The tedious function of billing will be expedited. Finally, epidemiologic studies will be streamlined with outcome assessment automatically quantified for each patient and each condition. The initial investment of a good EMR system is recouped fairly quickly through better billing, better collections, better time management, as well as better clinical presentation—which all equate to better medicine overall.
Etienne Dubarry has been teaching for twenty five years nationally and internationally, has published book s and articles on chiropractic, techniques, and rehabilitation exercises, their electronic documentation duplication and classification. He is the CEO of DocuRehab, documentation and rehabilitation software which has posted on line for every one to use the largest collection of animated treatments and rehab exercises (2000+) .http://docurehab.com/ExerciseExport/index.html. He can be contacted at:
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Technology
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Written by Patrick Gentempo, D.C.
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Thursday, 28 December 2006 23:05 |
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Dr. Patrick Gentempo, President and CEO of the Chiropractic Leadership Alliance (CLA) and the Creating Wellness Alliance (CWA), is one of the featured presenters at the Chiropractic’ 07 Convention sponsored by The American Chiropractor in The Republic of Panama, Feb. 22-24. His themes of “cutting edge chiropractic success” and “technology-based chiropractic practice” are resonating with many thousands of chiropractors worldwide.
Dr. Gentempo and Dr. Christopher Kent shared a vision, over two decades ago, of a technological revolution within chiropractic. That vision continues to become reality as the Insight surface EMG they first introduced to chiropractic in 1988 has evolved becoming a fully integrated multi-technology platform that will actually calculate a score indicating neurological function of those patients that are scanned. This technology is currently in use on six continents, in many thousands of chiropractic clinics.
In an interview with The American Chiropractor (TAC), Dr. Gentempo shares his views on technology, offering you a preview of what to expect in Panama in February.
TAC: By your interpretation, what is technology-based chiropractic?
Gentempo: Technology-based chiropractic is a model of thinking and practice where the traditional philosophical uniqueness of chiropractic meets 21st century technology and objectivity. When I graduated from chiropractic school in 1983 and started practice, I heard many leaders and mentors claim, “You have to believe in chiropractic or have faith in chiropractic in order to succeed in chiropractic.”
To me, chiropractic is NOT a religion. It shouldn’t rely on faith or belief. However, to practice with the premise that lifestyle stress causes neural disturbance in the form of vertebral subluxation and to recommend care for individuals without spinal pain, resulted in a significant challenge…especially in light of the fact that the majority of clinical evaluations performed by most Doctors of Chiropractic entailed traditional ortho/neuro tests that were designed to evoke pain. How was the DC supposed to transcend the limitations of the back-pain practice? Did their patients have to believe in the benefits of chiropractic also?
Surveys have shown that over 90 percent of our profession recommends wellness/asymptomatic care for their patients and over 88 percent use and recommend that we keep the term vertebral subluxation complex. This challenge caused us not only to create technology, but also training programs to compliment the technology to ensure success.
By now, I am sure most of your readers have at least heard of our four-day practice transformation training, called Total Solution. We have had over 5,000 graduates and it continues to grow each year. The number one reason DC’s come to Total Solution is because they have a back and neck pain practice, but want a lifetime, family wellness care practice. Our Insight technology with our Total Solution training combine to get the DC across that chasm. So, technology-based chiropractic is where the foundations of the practice literally rest: on the use of technology. The DC’s not only use technology as a basis for their care and recommendations—as compared to subjective and unproven assessments, such as orthopedic tests—but also use technology for their marketing, patient education, staff training, record keeping, and even in their adjusting. Welcome to the very exciting 2nd century of chiropractic!
TAC: How do you view CLA’s standards as a company?
Gentempo: Our standards are extremely high. I don’t settle for second best; never did and never will. I am obsessed with utilizing the absolute best technology available in every product we produce. I am also passionate about integration, meaning not only having multiple technologies, but having them integrate properly. Think in terms of a word processor, spreadsheet, database, e-mail and calendar management and presentation software…and then think, Microsoft Office. Integration translates into the whole being greater than the sum of its parts. Some vendors try to offer multiple technologies from multiple manufacturers. It has a cobbled effect that dilutes impact and usefulness. The Insight’s individual technologies shine as they stand alone but, through their integration, they create transcendence. I refer to it as technological poetry. An example of this is the overwhelming market response we are getting to our patent pending NeuroSpinal Functional Index, or NSFi for short. The findings of the Insight’s five technologies boil down to a simple, elegant, easy-to-understand number. With all this testing, the doctor now has one number to communicate and the patient has only one number to understand. It is simple, yet extremely powerful.
We hold several patents on the Insight and have several more pending. In the technology business, this is critical. It means other companies can be in our product category, but they can’t develop or sell what we do, because we have intellectual property protection.
Also, through technological superiority, we bring increased credibility to our clients. The Insight is the only technology in its category to receive certification from the Space Foundation, which was co-founded by NASA! An earlier version of the Insight was used on two shuttle missions and we are currently corresponding with NASA on proposals for new projects on which to collaborate. Our clients are trained to leverage this distinction with a press release and other marketing strategies to the benefit of their practice. When a DC can claim that he or she uses Space Certified technology in their practice, such a statement enhances the perceived value of their services and they, themselves, are held in high esteem by the general consumers.
Another clear standard that CLA has established is that we don’t sell a “machine,” we sell a result. Technology, by itself, does nothing. It is the person who uses that technology that gets the result. We are exacting experts on practice success. We have painstakingly analyzed where chiropractors have struggled, and often failed, and have developed systems of thinking and practice that resolve those issues. The technology is a critical piece to that puzzle. But, if someone is struggling in practice or seeking to move their practice in a new direction, simply adding technology without a strategy and the resulting tactics may compromise their desired result. In this scenario, they’ve now spent substantial money, yet failed to move forward. Our standards won’t allow for this to happen. That is why we have integrated programs like Total Solution with the Insight technology.
So, our standards are simply this: Get our technology, use it, come through our training. If, at that point, it is not right for you, give it back to us and we give you back all your money or cancel your lease. Our standard is that we only want people to win BIG with us, not spend money and get hurt. Our testimonials are strong evidence that our standards separate CLA from competitors, while having lasting benefits for our clientele.
TAC: What technologies have you put on the Insight platform and why?
Gentempo: CLA’s Insight platform utilizes up to five technologies. Surface EMG, infrared thermal scanning, pressure algometry, inclinometry (range of motion), and our most recent and immensely exciting addition, heart-rate variability. We chose these technologies based upon what is most critical for the DC to measure, along with what has the best literature support.
It all started with surface EMG or sEMG, for short. This technology measures patterns of motor nerve activity by looking at muscle energy patterns. There is published research that shows that chiropractic adjustments improve these patterns in a significant and positive way, as compared to controls. Since chiropractors are primarily concerned with the function and performance of the nervous system, it is important to note that the nervous system has three sub-systems: sensory, motor, and autonomic. We think it is critical to objectively and non-invasively assess all three—and we do. SEMG handles the motor portion.
What really excites me is that we have invested considerably in the Insight’s sEMG performance and features. Just recently, we released our newest version that performs full digital signal processing. The new Insight sEMG not only gives you signal amplitude, but also gives you a spectral analysis of each individual static site scanned. I realize I may be speaking Greek here for a lot of your readers, but I am excited because our technology developed for chiropractic is groundbreaking—the best EMG you’ll find worldwide. Not only is it number one in static performance, but the Insight’s dynamic sEMG performance also tops the industry. Bringing greater prestige to our profession is a major part of our company’s agenda.
The Insight’s infrared thermal scanner performs paraspinal thermal autonomic mapping. The autonomic system is the part of the nervous system that regulates one’s organs and glands. Rounding out the three dimensions of the nervous system is our Insight Sensory Sensitivity Mapper, generically referred to as an algometer. With this technology, we can measure and map sensitivity or pain, rather than subjectively recording it. The Insight maps spinal motion with our two-point inclinometer. It is critical, when measuring ROM, that it be done at two points, so that movement artifact can be removed and the clinician can measure pure spinal motion. The Insight ROM tester accomplishes this in groundbreaking fashion.
Last, but certainly not least is our Insight Pulse Wave Profiler, which measures heart rate variability (HRV). HRV is the most exciting new technology in the field of cardiology and, in my opinion, chiropractic. Recently, there has been research published by Zhang and his cohorts that concluded that chiropractic adjustments have beneficial effects on HRV measurements. This is a serious breakthrough! We are talking about the heart. The cholesterol craze has everyone concerned with the health of his or her heart. Imagine measuring the heart, adjusting the spine and then showing beneficial changes in heart function to your patients. The power of this is self-evident. This is why technology-based chiropractic is revolutionary.
To summarize all the Insight’s functions succinctly: We take the patient on a technological journey from pain (algometer), to movement (inclinometer/ROM), to non-symptomatic nervous system function (sEMG and thermal scanning) to whole body health and wellness (heart rate variability). Can you imagine the difference between lifting legs and pushing heads and this? When I graduated from school in 1983, this was inconceivable. Today, with the Insight, it is a reality. Technology is the best thing that ever happened to chiropractic practice.
TAC: What regulatory and research precedents are there for the technologies used by the Insight?
Gentempo: As for regulatory precedents, Dr. Chistorpher Kent and I have been, by far, the most active advocates of sEMG and the other Insight technologies in the profession. We—Dr. Kent more than myself—have helped write the regulations for sEMG in multiple States. We have been involved in writing diagnostic assessment and imaging chapters for a variety of guidelines documents. And, Dr. Kent has written chapters in leading textbooks on sEMG and thermal scanning.
A perfect example of how our years of work in this realm have benefited users of this technology, even if they aren’t our clients, comes from an article you recently ran in your magazine. The interviewee was describing what he referred to as a “landmark case” for sEMG in Florida. In essence, he had a client who purchased his equipment who was denied payment by insurance coverage. As a result, he went to Florida to testify on behalf of his client to help him get paid. The judge ruled in favor of the chiropractor. The funny thing is, if one were to read the Final Order of the Administrative Court Judge, the judge references the sEMG chapter in the Chiropractic Practice Guidelines and Parameters for the State of Florida. Well, Dr. Kent was the principal author of those guidelines. Due to his earlier work, this case was won.
In short, in defense and promotion of this technology, we have been to court, held high-level meetings with third party payers, testified in front of State licensing boards…you name it.
An extremely important regulatory issue is the Food and Drug Administration in the US, Health Canada (the FDA equivalent in Canada) and CE in Europe. You don’t want to even consider technology that has any issues complying with these federal agencies. This is a very tricky, resource-intensive road that some manufacturers don’t properly follow.
For example, if you can’t get a current FDA 510 (K) registration for the product, that lists the product’s name, all the technologies on its platform, and has displayed the intended uses of the technology, which must match up to the way you intend to use the technology, don’t buy it. Some manufacturers may try to skirt the issue by simply registering with the FDA as a manufacturer, but that does not suffice and is not the same as having the actual device you are purchasing properly registered.
All this legalese could comprise a book. But, suffice it to say, we are painstaking in our compliance issues with the Insight. Our exclusive manufacturer has ISO 9001 and ISO 13485 registration that was not even needed to comply—but it puts us at a higher standard.
As far as research goes, the Insight sEMG technology is unique in that its reliability, applications, protocols, indications and normative data have all been published in peer-reviewed journals and are taught at leading chiropractic colleges. Dr. Kent and I have ten peer-reviewed publications to our credit alone. Also, I would like to point out that independent researchers have performed and published very impressive research and reliability studies with the Insight. In one case, we only found out about it after it was done. Having published reliability studies is a critical credibility factor with clinical technology. I am proud to say the Insight has many of these.
TAC: Why are there some detractors out there as to use of technology in the Insight product category?
Gentempo: Thank you for this question. What would chiropractic be without detractors?!
Seriously, there are multiple reasons, none of them good. One is simply ignorance. They don’t know, understand, or have never used the technology. These people just parrot what others who are ignorant have said. In addition, there are some informed detractors who, to a reasonable extent, understand the technology. The problem is they have different views of what the clinical goals for a chiropractic patient should be versus the majority of the profession. If you subscribe to the attitude that chiropractors should limit their practices to a handful of uncomplicated musculoskeletal conditions then, perhaps, for those purposes the technology is inconsequential. However, if one is looking to measurably improve structure and function, one must measure it. Hence, the Insight technology becomes a necessity. Nobody debates that the Insight accurately and reliably measures what it claims to measure. The only question is, are these measurements of importance to the practitioner, given the clinical goals he or she has for the patient.
TAC: Lastly, what things should a DC consider when contemplating the purchase of technology?
Gentempo: I suggest the following:
• First and foremost, have a clear vision of what impact you want this technology to have on your practice and life. Believe it or not, we have a lot of DC’s who have purchased the Insight, but didn’t get the vision of the technology till after they came to Total Solution.
• Have reliability studies and protocols, specifically for the instrument you are purchasing, been published in the peer-reviewed literature? Is there any university-based research?
• Does the instrument have the proper federal agency registration (FDA, Health Canada, etc.), as I discussed earlier?
• What is the company’s and its principals’ reputation in the field? Have they received significant acknowledgements or awards from the field?
• What type of training and ongoing support can the company offer? Do they have the resources and expertise to help you overcome your practice challenges or reach your practice goals?
TAC: Any final thoughts?
Gentempo: In order for technology to succeed in chiropractic practice, it must serve a specific and meaningful purpose. When it does, the impact is immensely powerful. Our profession needs significantly increased credibility and certainty. The Insight technology does exactly that and I won’t rest till every DC recognizes the power and importance of technology to the future of this profession. When it comes to technology, I have three words: Resistance is futile!
You may contact Dr. Patrick Gentempo at 1 International Blvd., #750, Mahwah, NJ 07495. Phone 201-252-3220, Executive Assistant Mike Thompson, Ext. 114; www.subluxation.com; www.creatingwellness.com.
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