What To Look For When Going Digital
Written by Dr. Terry Yochum D.C.; D.A.C.B.R.; Fellow, A.C.C.R.   
Thursday, 08 November 2007 16:28

One of the biggest questions chiropractors are facing in X-ray today is what is the best way to "go digital".

The answer is, it depends on a lot of variables. However, proper up-front understanding of the technologies and alternatives can make for a better decision and can create a positive long term effect on your practice.

With respect to the different technologies, there are basically two approaches for going digital—CR (Computed Radiography) and DR (Direct Digital Radiography). Both technologies produce digital images, but in different manners, with their own set of pro’s and con’s.

CR (Computed Radiography)

A CR system includes CR cassettes and a CR scanner. The CR cassettes contain a special screen that captures the X-ray image. The cassettes are inserted into a bucky or grid cabinet, just like film cassettes, and all of the imaging is performed in the traditional manner. After the X-ray is taken, the cassette is removed from the bucky or grid cabinet and inserted into the scanner. The scanner can sit in the X-ray room, so no dark room is needed. The scanner will scan the image screen and display a digital image on the monitor. This process usually takes less than sixty seconds.

One of the biggest benefits of CR is that, in most instances, you can use your existing X-ray system, as long as it is reasonably current technology. It should be at least a 300mA/125kV system, preferably high frequency. Very old systems with limited power will have the same challenges making high quality CR images as they do making high quality film issues.


Things to look for in a CR System:

Image Quality: There is a variance in image quality of the different CR systems on the market. Much of that is due to image processing. This is a computer program within the CR system that takes the raw digital image data and converts it to an image which is displayed on the monitor. The top performing systems provide images that show excellent skeletal detail and soft tissue detail in a single image. The operator always has the capability to "window and level" the image further to enhance the visualization of specific pathology.

System Speed: This refers to the dose sensitivity of the system. Most chiropractors are using 400 speed film/screen systems with their current film imaging. CR systems also have a relative speed, although the measurement varies slightly from film. This relative speed may range from 200 to 400, based on the specific brand of CR. The higher the speed, the lower the dose and the shorter the exposure times. This is especially important on large patients where motion and overall system penetrating power can be a challenge.

Ease of use: All CR systems have a computer with monitor, keyboard, and mouse which are used for reviewing the images and managing the commucation/storage of the images. The software should be intutive and easy to use. Advanced systems will typically include a medical grade touch screen monitor. 

DR (Direct Digital Radiography)

DR uses a digital capture device that takes the place of the bucky or grid cabinet in a wall stand or an X-ray table. With DR, the image is captured directly with the digital image receptor, so there are no cassettes to handle or feed into a scanner.

One of the benefits of DR is that the image displays on a monitor within a few seconds after the image is taken, and there is no handling of cassettes. However, DR is substantially more expensive than CR. Also, upgrading to DR usually entails buying an entire new X-ray system as opposed to upgrading an existing one.


Things to look for in a DR system:

Image Quality and System Speed: There is also a variance in image quality of the different DR systems on the market. Much of that is due to the imaging system, itself. Most DR systems for chiropractic imaging use a CCD based digital camera system. The X-ray photons strike a scintillator plate and are then focused through a lens and on to a CCD chip. The material the scintillator plate is composed of plays a large role in the image quality and dose sensitivity. The two most common materials for the scintillator are Gadolinium Oxysulfide (Gad-OX) and Cesium Iodide. These materials affect both the image quality and system speed.

Cesium has substantially higher dose sensitivity and, therefore, requires less dose and the images typically have lower noise. However, a system with a Cesium Iodide scintillator is usually more expensive. Gad-OX has a lower dose sensitivity and, therefore, requires higher dose, but is typically less expensive. Image processing also plays the same role as mentioned with CR systems above.

Ease of use: All DR systems also have a computer with monitor, keyboard, and mouse which are used to review the images and manage the communication/storage of the images. As with CR, the software should be intuitive and easy to use. 

Which is best for you?

It depends on a number of factors, including your current X-ray system, exam volume, type of practice, and budget. The most important thing is to do your homework up front and make sure the system will provide the following:

• Excellent image quality at reasonable dose levels

• Ease of use

• Will perform well with your current X-ray system

• Fits within your budget

• Is supported by a dependable and knowledgeable local dealer who has exten sive experience with installing and servicing digital X-ray systems. This is crucial when making the decision as to from whom you will purchase the equipment. 


Additional important issue when you go digital   

The equipment discussion above dealt with the technologies used for acquiring the X-ray image digitally. Also important is the viewing, storage, and transferring of the images. The key is to establish a plan up front of where and how you want to be able to review, recall and store the images. A PACS system is the proper way to complete the system and accomplish these functions (Picture Archive and Communication System)

Viewing images: Most doctors will want to send the images from the digital imaging system, either CR or DR, to a computer in their own office where they can review the images, mark angles, and add annotation. In addition, some may want to be able to display the images in an exam room for patient consultation. This will require computers with the appropriate viewing software and licenses. Web-based access to the images is also available for reviewing images remotely.

Image Storage: This is an important area to focus so images are always safe and secure. There are a number of alternatives based on your volume and budget. In addition, you may want the ability to burn images on a CD for patients to take with them. This can be a good way to market the modern digital imaging technology that you are providing through your practice.

Terry Yochum, DC, DACBR, Fellow, ACCR is director of the Rocky Mountain Chiropractic Radiology Center in Arvada, Colorado. He can be reached with questions pertaining to this article at 1-800-742-4476 or at This e-mail address is being protected from spambots. You need JavaScript enabled to view it .


Low-Level Laser Therapy The Cold Laser: The Most Versatile Healthcare Tool of the 21st Century
Written by John Brimhall, D.C.   
Thursday, 05 July 2007 11:05


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, or call 1-480-964-5198; email This e-mail address is being protected from spambots. You need JavaScript enabled to view it . Brimhall Wellness Center may be reached at 1-480-964-5107 and

Why Electronic Notes Make Sense
Written by Gregg Church   
Thursday, 05 July 2007 11:00

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 This e-mail address is being protected from spambots. You need JavaScript enabled to view it .


Could New Scanner Redefine Wellness Care?
User Rating: / 1
Written by Filomena Lorocca, D.C.   
Thursday, 05 July 2007 10:55

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 or call 1-800-337-7715.

The Economic Interest of EMR (Electronic Medical Record)
Written by Etienne DuBarry, D.C.   
Thursday, 05 July 2007 10:50

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 ( 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 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+) . He can be contacted at: This e-mail address is being protected from spambots. You need JavaScript enabled to view it .



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