Chiropractic Products asks three documentation software experts for sane and sage advice on purchasing this vital program for your practice

Finding a documentation program that suits the needs of your practice can be frustrating to the point of insanity. The threat of a lawsuit or investigation because of improper documentation will strike fear in any chiropractor. To avoid these situations, Chiropractic Products asked three industry experts what chiropractors should look for when purchasing a documentation program.

Important features, training and technical assistance, input methods, and controversy over canned notes vs specific styles are just a few topics that are discussed with these documentation software experts: Steve Hixson, general manager, Anywhere MD, Atascadero, Calif; Ken Schenley, vice president, Quick Notes Inc, Cooper City, Fla; and Ken Strickland, DC, CEO and president, ClaKen Software, Huntsville, Ala.

Steve Hixson	Ken Schenley	Ken Strickland, DC

CP: What are the most important features a DC should look for in documentation software?
Hixson: The two most important features to look for are simplicity of program use and input speed at the point of care.

Schenley: A documentation program should be personal and easy to use. A program needs to be available to the doctor and the staff, and no one should be intimidated by the complexities of the system.

In addition, the solution should offer flexibility and custom features, so that everyone feels comfortable with not only the technical aspects of the program, but also the way in which documents are created.

Another good feature is portability, which means that a doctor can minimize, but not totally eliminate, time in front of a computer. Ultimately, the program must be able to save time—that’s the key.

Strickland: DCs should be able to customize the program to reflect the way they practice. Chiropractors should not have to conform to the way the program is written, but rather allow them to reflect their own verbiage.

CP: How important is training or technical assistance in the purchase of a program? Is there usually a fee for this service?
Hixson: If training or technical assistance were program features, they would be the most important. This service is the key to understanding how the program is designed for use and should be accomplished in about an hour. There should be a free period of training and assistance if a company stands behind its product. Look for a company that provides at least 90-days complimentary technical assistance to ensure that the program is used effectively.

After the training period, any technical support department needs only to cover its costs. Too many companies are trying to gouge the customer after the sale to make a profit.

Schenley: Training and technical assistance should be highly considered when purchasing a program. The practice is actually purchasing a relationship with [the software company] team, not just software. And that relationship includes factors such as loyalty, friendly communication, and a sense of urgency. Clients need to remain happy with not only the product, but also the team that stands behind that product.

There is typically an annual fee for unlimited support, and included in this plan would be ongoing computer and new product installation assistance, free updates, and discounts on new software and hardware.

Strickland: Proper training in the use of any new program is essential for implementation success in the practice. Look for a company that offers a "walk-through." Generally, this takes 45 minutes to an hour. After the walk-through, the doctor usually has a good understanding of how the program works.

CP: What are some of the questions a DC should ask a software representative?
Hixson: How long have you been in business? How quickly can I complete a daily SOAP note? How long will it take me to learn the program? How can I customize the terminology to my own? How can I have my normal tests and AMA normals applied quickly? How can I enter the patient information at the point of care without having to enter it again into a PC? How much paperwork will your program eliminate? Is there an initial period of free support? How long? How much do you charge a year for support? Is it unlimited? Does your program work on a hand-held? Can you reference past patient information at the point of care?

Schenley: How can your product save time for me and my staff? Please explain the various technologies that could be used to create notes and reports. What are the costs and benefits in purchasing, and using your program—short- and long-term? All notes systems have been known to sound canned. What are you doing to take care of this matter? How easy is it to customize and create documents in my own words? Why should I purchase your product?

Strickland: Does the price of the software include all modules? Do I get the entire program, or is there an additional charge for the narrative writer or the X-ray report module? Are there any ongoing monthly expenses? Are there any forms or special hardware items that I have to buy? How long does technical support last? What is the cost of technical support and updates? And is there a separate cost? If I miss an updated version (ie, version 2.0), will I have to buy the past version (2.0) and the most recent update (2.1) to be fully updated? Can I access updates on the Internet?

CP: Discuss your view on the controversy over canned notes vs specific style.
Hixson: Canned notes should be a thing of the past for most companies. Random text generation will change the verbiage even with several consecutive visits with no change in the patient’s condition. However, there is a certain amount of character in every individual’s writing that no computer or program can emulate. Always review and edit any computer-generated notes to your specifications.

Schenley: First, most DCs ask about the canned notes issue, but they also understand that, in most cases, patients have been complaining about the same problems, and they are getting treated in the same fashion; so the dialogue is, in fact, rather repetitive.

Many companies offer solutions with either computer-generated text or computer-randomized notes. Although this may seem like a good answer to the canned notes issue, there are different strategies and other avenues to take. Generated is not dictation and there can be a problem defending it. Computer-assisted, on the other hand, is representative of the doctors’ true dictation—DCs should look for products that are geared in that direction.

It is critical that doctors "touch" every document, and the words chosen must always be their own, not the computer’s.

Strickland: A good software program should allow the doctor to customize notes and say what he or she wants it to say. Randomized text is usually built into documentation software; however, some programs have enabled the doctor to input his or her own randomized text. While reading notes on-screen, they should also have the option to change text randomization with a simple click of the mouse.

CP: Discuss your view on the controversy over the method(s) used to input documentation data.
Hixson: This is really a personal decision. Handwriting is not always legible and can be interpreted inaccurately. The point of care is a crucial time for the DC. When using handwriting, it is very difficult to properly document patient findings, while keeping up with patients’ schedules. After the visit, DCs often try to remember what adjustment and treatments were performed on the patient. This can lead to inaccuracy, which can later result in issues. A quick and easy point-of-care program will eliminate most of these issues. The [reason] handheld programs are dominating the industry is because they are accurate, quick, and efficient.

However, not all handheld programs are alike. Using a handheld computer is very different than chicken scratch on paper. This is why simplicity, accuracy, and speed of input are what make a handheld system practical.

Schenley: Some companies do offer one or two choices, while others offer many methods. The key to any decision is versatility, time efficiency, and ease-of-use for the DC and the staff. As with any product, it is the buyer’s [responsibility] to do some homework to see which of the many technologies suit him or her best.

Some of the technologies available include point-and-click, personal digital assistants (PDAs) such as the Palm Pilot or Visor, templating, portable barcoding, and voice recognition. In some cases, traditional typing and transcription also work well. It all depends on the type of office, the make-up of the staff, and, most importantly, the comfort level and time-efficiency. Choose the program that will ultimately make life easier for the doctor and staff.

Strickland: Chiropractors should have several methods to input data. I have tried several methods that all work with the documentation program I use—touch screen, mouse, and light pen. Personally, I am comfortable most with the mouse.

Once familiar with the program, you can very quickly navigate through the screens with any device you choose.

CP: What are the advantages/pitfalls in proper documentation for court appearances?
Hixson: The advantage is obvious—proper justification for treatment is imperative in court in order to avoid embarrassing episodes and to accurately represent the patient’s condition as well as the treatment plan.

Schenley: Documentation is critical for the DC. It really can be very simple to understand: "touch" the patient, "touch" the documents. If it’s not properly documented, it’s as if it never really happened.

A documentation company should educate doctors on the proper documentation requirements, but it is also advisable for doctors to do their own research—talk to other DCs; read the local, state, or national journals; and speak with state and local associations, as well as an association’s legal and insurance advisors. In addition, DCs should always be able to call, fax, or email the software company with samples of notes and reports.

Remember, do not change your original documentation. However, clarifying [your notes is acceptable], as long as you date and document these updates. [Documentation should be] about why the patient is seeing you, how well the patient is doing, and an accurate and thorough justification of your treatment plan.

Strickland: In my own personal experiences, I have found that with proper documentation I have fewer depositions and appearances in court. Let’s face it—if you send an illegible stack of notes or a check-off sheet that really does not support your care of the patient, the defense attorney or the insurance company attorney will probably want to depose you or worse, embarrass you in court.

About the Author
Christina Chang is a contributing writer for Chiropractic Products.