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This is a special advertising section sponsored by MPN Software Systems, Inc.

Computers & Information Systems

Mike Norworth
President
MPN Software Systems, Inc.

With graduate degrees in Computer Science and over 20 years of experience in chiropractic, Mike is the chief architect of ECLIPSE Practice Management Software.

Legal Disclaimer:
The opinions/insights expressed herein are those of the sponsor and do not reflect the opinions or policies of this magazine or Ascend Media, nor do we endorse the sponsor's products and/or services in any way.

Q

A friend was looking at chiropractic software. The owner of one company (Quixote) noted that she had developed ECLIPSE and had moved on to develop another product. Is this true? If not, what’s the real story?

Please don’t place my name on the website. I’m just a concerned DC and a firm believer in “truth in advertising.”

Thanks.

A

I generally make it a rule to avoid commenting on other products or people. I can assure you that I have never met the individual you reference -- nor has she (or anyone else at her company) ever been employed here. I realize that the widespread use of ECLIPSE since 1985 often invites comments. Regardless, anyone who works here is either a DC or has a minimum of a graduate degree in computer science. As for the “real story,” I suggest your friend carefully investigate any potential purchase rather than make assumptions about other products based on hearsay.


Q

A vendor was really pushing me to buy their practice management product because it was .NET. What does that mean? And is it really a big deal? -- Daniel Picard, DC, Huntington, NY

A

Just this past weekend, we were at the beach with friends. Mike (popular name) is a senior software developer with a major international bank. He was bemoaning the fact that recent job applicants didn’t seem to have a grasp of what’s actually going on “under the hood.”

Traditionally, programming time is expensive. Thus, we’ve been building tools to make computer programming faster and more efficient for decades. .NET is an example of both the good and bad aspects of this approach. It operates as an extra layer that hides the underlying intricacies from programmers. Though this can be a tremendous time saver, applications may run much slower than their counterparts which access the Windows API (Application Programming Interface) directly.

Imagine running a relay race and passing a baton to the next runner. Now imagine that you did this every 3 feet. It would be faster to run the race yourself! That’s why mission critical programs like Windows VISTA, XP, 2003, and ECLIPSE don’t rely on .NET. They’re written in C++.

Oh! I forgot… Space requirements… .NET 2.0 requires about 280 MEG of hard disk space. Thus, if you purchase a .NET application that takes up 5 MEG on disk, you need 285 MEG of free space to install and run it along with .NET framework. Applications like ECLIPSE run directly without all the extra overhead.

Finally, when programmers don’t have the requisite skills to create programs without .NET plug-ins, programming defects may be harder to trace and fix – especially if they require patches from third parties.

So, .NET is a boon for programmers and for situations where a quick fix is necessary. However, when performance is important, it may not always be the best long-term solution for the end user.


Q

How do you see the movement toward requiring health care professionals to utilize electronic medical records affecting chiropractic practices, and in particular, single practitioners? Is an electronic medical records system an affordable option for solo practice chiropractors? -- Gerald Anzalone, DC, Peekskill, NY

A

First, if EMR requirements are standardized by government agencies, the standards will be the same for single practitioners as they are for those in group practices. As to affordable, all I can do is point out that the extensive documentation capabilities in ECLIPSE are included at no additional charge across all versions of the program.

Now, will future EMR requirements force you to go electronic when dealing with third-party payers? If you look at billing as an example, the answer is, “unlikely.” In fact, the ANSI 837 electronic billing standard doesn’t include specs for electronic documentation. On the other hand, there are groups working on such specs. Bottom line: in the near term, I don’t see an EMR documentation standard that could be forced on you the way CPT & ICD codes have been. As for the long term… ask me again in five to ten years…


Q

I have been going back and forth for months now about whether to switch my SOAP notes and record keeping over to one of those companies that utilizes the PDAs that you can carry from room to room. On the one hand, it sounds like great technology, but do you think it is worth the cost? Do you think it makes it any easier to deal with insurance companies? Any thoughts you have would mean a lot in helping me make the decision. I also want to know if your company, Eclipse, provides this service. -- Kevin M. Wong, DC, Orinda, CA

Thank you,

Kevin M. Wong, D.C.
orindachiropractic.com

A

Though some offices make extensive use of our PDA technologies to handle service entry & appointment review, we prefer tablets for wireless, network-based SOAP notes. You can refer to my recent Chiropractic Products article at http://www.chiropub.com/issues/articles/2007-02_03.asp if you’re interested in my comments on tablets, touch screens, and SOAP. Note that PDAs aren’t mentioned at all. Why? Screen real estate. In my opinion, the trade-off of space for portability is too great and the result is a note that takes too long to create.

Is it worth the cost? What’s your time worth to you? Do you believe the system will improve your efficiency? Do you derive other benefits? Is your handwriting illegible? Do you neglect to document patient status manually now? Are you searching for a quicker way to create a more robust note? EMR systems are not magic. Clear, concise documentation – whether manual or electronic – is important. However, the payer is only interested in the content – not the methodology.

Sales reps for various products will insist that you can’t live without their EMR/SOAP systems. You can. But only you can determine whether you want to.


Q

Looking into the future, will it become increasingly common to see Internet-based office management billing software? What concerns would you voice regarding things to look out for or warnings with this developing scenario? -- Craig Nelson, Nelson Chiropractic Clinic, Omaha, Neb.

A

I can only assume that you’re referring to a situation where your patient data is off-site (hosted) and your access is via thin client PCs from your office? In the mid to late 90’s – when it was predicted that all of us would be renting software this way rather than purchasing licensed copies to put on our own computers – a variety of startups relied on this business model (hosting everyone else’s software). Later, during the “DotCom” bust, these companies virtually disappeared along with the business model. Of course, like everything else, this approach has pluses & minuses. It simply provides another choice to consumers. Will it become more likely for you to see it? Sure. As technology improves, such approaches become more viable. However, let’s look at the advantages & disadvantages of this approach.

First, let’s discuss what’s great about hosting. Ideally, you don’t have to worry about backups or upgrading the server where your data resides. If the company that created your software is hosting your data, they will automatically handle updates and should respond instantly to data corruption. Also, you ultimately may be able to spend less on computers. Certainly, startup costs may be much lower. Sounds pretty good thus far? Well, the world rarely seems to work as envisioned by Voltaire’s Candide. So let’s visit some of the more likely issues that you’re bound to experience sooner or later.

Performance. Even a fiber optic connection to the Internet won’t buy you performance as good as you can get with a $100 gigabit router on your own (local) small network. Also, if the company hosting your data is either growing too fast, or not fast enough, you may suffer the consequences of too many users (from other offices just like yours) accessing data on the same servers, or equipment that simply can’t keep up with volume. Since the host server isn’t dedicated to you alone, any performance benefits over a local network are generally lost.

Cost. When you’re paying “by the month” forever, you will eventually pay a huge premium compared with having all the hardware at your location. Monthly costs include your connection (usually via the Internet), hosting costs (your data is on someone else’s computers), and potentially enforced software contracts. From a business perspective, this is the best possible scenario for the vendor you chose. They get perpetual income as long as you’re in business!

Connectivity. In your office, when the power goes out, it’s likely you can’t use your computers. When your data is hosted by a third party, you must also worry about their power and the integrity of your connection. Depending on where your office is located, this can be a serious problem.

Control. Suppose you want a contract programmer to create a custom interface or report of some sort? She may not be able to get access to your data! And a HIPAA contract with the vendor is essential in the event your data is compromised. Suppose the vendor raises the monthly fee? Think how this may affect you over the life of your practice. Suppose you discover some cool new feature in another product and want to purchase it. Is the data yours? Will the vendor make your data available along with the necessary documentation to convert it? Suppose you want to continue the hosting but discontinue your ongoing support contract? What if the business is sold? Or goes bankrupt?

My wife started her practice in 1982 – renting office space. As soon as her cash flow allowed it, she purchased a nearby building. Over the life of her practice, this has saved a minimum of tens (if not hundreds) of thousands of dollars. Rent only goes up. It may be a write-off, but it still comes out of your cash flow. If you’re concerned about how rapidly technology makes your equipment obsolete – consider leasing. But some hosting situations leave you permanently indebted to a new landlord – the software landlord. If you’re comfortable with that, go for it.

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