Chiropractic Products asks four software experts how technology can ease documentation worries and workload

These days, documentation is an all-consuming effort in the medical office. From patient records to claim submissions to fee analysis, the paper trail is never ending. But technology has come up with yet another method of easing the workload—documentation software. What’s more, most documentation software can run on personal digital assistants (PDA). Medical references, patient notes, and prescription information can be found in the palm of your hand.

The convenience of this portable system is attracting many medical professionals. But for those who have not yet made the high-tech leap, the change can be daunting. After all, it is a fairly new trend, and some might argue the kinks are still being worked out.

If you are thinking about updating your office with new documentation software, Chiropractic Products can help. We interviewed four experts on the subject to help you decide whether documentation software is right for you: Steve Hixson, CEO of Anywhere MD Inc, Atascadero, Calif; Ken Schenley, vice president of Quick Notes Inc, Cooper City, Fla; Ken Strickland, DC, CEO of ClaKen Software in Huntsville, Ala; and Art Waldman, senior software engineer of Life Systems Inc, Longwood, Fla.

CP: What do you consider the three most important features of a documentation software program for DCs?

Hixson: The first is simplicity. If an application is too complex for the doctor and staff to use effectively, it will not be implemented and will be of no benefit. Customization of verbiage and terminology is crucial in order to properly reflect the doctor’s unique style. Speed of input is also essential. Look for a program that allows you to make diagnosis templates according to your normal tests, type of adjustment, etc. Using these types of templates can eliminate an enormous amount of tedious data entry duplication.

Schenley: The ultimate goal should be to find a program that will save the DC and staff time, such as the program’s ability to mix state-of-the art technology with portability.

Second, the documentation package must offer the ability to customize software to meet the needs of the practice while staying compliant. The notes and reports generated should always be “in your own words,” even if the software offers features such as computer assisted text or doctor randomized notes.

It is also always critical to choose a company that stands behind the program—look at the company history and be sure the company offers customer service and technical support, along with necessary training and upgrade packages.

Strickland: First, I think doctors should be able to customize the program to reflect the way they practice. Then find out if the price of the software includes all modules—do you get the entire program, or is there an additional charge for the narrative writer or X-ray report module? Ask whether there are ongoing monthly expenses and any forms or special hardware items that must be purchased from the software vendor. Lastly, consider the cost of technical support and updates. Ask how long technical support lasts, and whether there are separate costs for technical support and updates.

Waldman: The most important features of documentation software program for DCs are: customizable randomized text—a software program that randomly chooses from several iterations that doctors may customize to match their tone of reporting best accomplishes this; and program flow—this should compliment the way DCs see patients, which includes the ability to work with multiple patients at the same time.

CP: What are the costs associated with purchasing a documentation program?

Hixson: Consider several factors relating to what you get for your dollar. Try to find an application that is modular—unnecessary features cost extra money; take hardware into consideration; and make sure your network and/or computer(s) are up to par to attain the desired result.

Schenley: In most cases, the primary cost is associated with the actual purchase of the documentation program and necessary hardware. Virtually every program requires a computer and printer. The add-ons might involve handheld devices for portability, network upgrades for multiple users and clinics, and other devices such as voice recognition or barcoding tools.

Strickland: Costs to consider include the original cost of the documentation software and the computer system. Networks have become easier to set up; however, you may have to hire a local company to set up your network if you are not comfortable doing it on your own. If you choose to use one of the handheld devices you will still have to have a computer to store data.

CP: What should chiropractors expect in terms of training and technical support from the company? Are there fees for this service?

Hixson: There should be a free period of training and assistance. Make sure training is provided by a live person. Training—which should be accomplished in 1 hour—is the key to understanding how the program is designed for use and how to maximize the program’s potential in the clinic.

Schenley: All system purchases should include a fair amount of installation help and product training—typically done over the telephone. This initial step should be included in the cost. However, ask the company whether onsite training is available for an additional cost—this is a great tool for the DC and staff to learn the features within their own environment and with the specific documentation needs of the practice.

I recommend adding some type of annual support program for the office, which gives users unlimited access to the support department. In some cases, annual programs also include free updates and discounts.

Strickland: Look for companies that offer tutorial CDs, a walk-through with a trained program specialist, and technical support. Some companies may offer free technical support for the first year.

Waldman: The chiropractor should expect an initial period (30 to 90 days) of training and technical support to install the software and get up and running, which should be included in the purchase price. The software company should offer training sessions by telephone, onsite, or in a seminar environment. After the initial period, the chiropractor should expect to sign an agreement for ongoing technical support and program updates—typically this is an annual fee.

CP: Discuss some data input options available to practitioners.

Hixson: Data entry duplication can be eliminated by using point-of-care technology. Unless you have a computer in every room, the most practical method of input is with a handheld PDA device. This allows you to enter patient findings during the patient encounter, which increases accuracy and will dramatically decrease the amount of time spent on paperwork—ultimately resulting in saving money. Handheld data input is rapidly becoming the preferred method for health care practitioners for these reasons.

Schenley: One of the fastest and most accurate tools for portable notes is barcoding. It offers the DC the ability to create a personalized document and even doctor randomized in just a few seconds.

Strickland: There are several methods of operation offered by documentation programs—touch screens, a mouse, or light pens. Many choose to use a network system in their offices. Some prefer a PenPad for portability and a larger screen area for ease of input.

Waldman: Currently, the most popular forms of data input include a mouse, keyboard, Pocket PC, pen (or stylus), touch screen monitor, or a combination.

CP: How have documentation companies addressed the controversy between canned vs customized notes?

Schenley: Computer generated and computer randomized is not dictated, and there can be a problem defending it. On the other hand, computer-assisted and doctor randomization is, in fact, representative of the DC’s true dictation. The practice should look for products geared in this direction. It is critical that the DC touch every document, and the words chosen must always be their own, not the computer’s.

Strickland: Randomized text can be built into the software, and some programs enable doctors to input their own randomized text. For example, if doctors can figure out 50 ways to say, “the patient felt better,” they can add these to the system.

Waldman: The controversy stems from users wanting to avoid the canned results of ’80s-era software products, which left the impression that the notes were not genuine. Randomized text models the quality, content, detail, and authenticity of dictation.

CP: What technological advances do you see in the near future for documentation software?

Hixson: Wireless products will be very effective in the future. Microsoft® has built these capabilities into the Windows XP®.

Schenley: A new PDA technology called Bluetooth allows users to synchronize their handheld to the main computer database simply by walking into a room. Touchscreens are slowly coming down in price, and I envision the day when DCs can have screens on their walls with upgraded functionality. Voice programs still only offer decent accuracy at best, but the ability to use voice files with near-100% quality is right around the corner.

Strickland: I think as DSL lines and cable modem costs decrease, we will see the Active Server Page (ASP) evolve. Also, as processor speeds improve, voice activation programs will become more usable.

Waldman: Consider the Pocket PC technology that allows you to be portable. Information can now be collected at the point of care. As a result, the SOAP and narrative generation will be reduced to a click or two because necessary information is already available.

Julie Z. Lee is a contributing writer for Chiropractic Products.