Four computer software experts share how your office can become an efficient, profitable, paperless practice

Society is on the road toward a paperless existence. Email has reduced letters to kilobytes. Online bill paying and registration systems have all but eliminated the need for envelopes and cumbersome forms. Paper-crammed day planners have given way to sleek personal digital assistants.

There are computer software programs that promise to transform a chiropractic office into a well-tuned, profit making—and possibly paperless—vehicle of efficiency. With the right program, such a claim can be true. Everything from billing to creating patient records can be expedited through a computer program.

Chiropractic Products invited four experts to discuss the process of choosing proficient software for managing a practice, ways a computer program can save money, and the outlook for developments on the horizon.

Donn A. Bauer, DC, is managing director of International Diagnostic Technology and a national and international lecturer on computer-aided digitizing mensuration and clinical interpretation certification program. Bauer has been developing a computer-aided digitizing software called DXAnalyzer Professional since 1998.

Paul Bindell, DC, is the president of Life Systems Inc. He has been in active practice in Rockaway, NJ, since 1976 and started Life Systems in 1990. Bindell has lectured internationally and is dedicated to the growth and success of chiropractic.

Mike Norworth is president of MPN Software Systems, Upper Saddle River, NJ. He has been developing chiropractic software for the past 2 decades and has an MS in computer science. MPN is the developer of programs, such as Eclipse and Prelude, which provide doctors with integrated appointment scheduling, paper and electronic billing, SOAP/progress notes, statistics, and practice management reports.

Greg Winterkamp is the founder and CEO of Dallas-based Addison Health Systems Inc (AHS), the developer of the WritePad integrated documentation/EMR software product line. Over the past 26 years, Winterkamp has lectured extensively and written articles on various subjects on computerizing health care. Before starting AHS, he was the vice president of marketing for a Wall Street software developer computerizing Fortune 500 companies.

What are three key factors to look for when purchasing computer software for chiropractic practices?

Bauer: Purchasing cost, practical clinical applications, and whether it is user friendly.

Bindell: Ability, reliability, and comprehensiveness. The functional ability of the software is critical in a chiropractic practice. Reliability can be determined by the age and stability of the company. The most comprehensive program involves a software suite of programs that covers each computerized aspect of your practice.

Norworth: The vendor’s ability to keep up with the current state-of-the-art technology as relevant to chiropractic, its ability to implement changes (eg, HIPAA EDI requirements, Medicare changes) in a timely manner, and a strong vendor infrastructure that can provide appropriate support services after the sale.

Winterkamp: One, look for a proven track record. Two, competent support/consulting is important. Three, look for progressive technology. Most doctors and software companies are not aware that on April 26, 2004, President Bush announced a 10-year plan to have complete electronic records for all of health care. There is a significant shift from paper to electronic accountability for all doctors and their patients. Companies that offer such progressive technologies give their chiropractic clients a definite edge in competition for patients because patients will increasingly want to maintain their own health records.

What are the most common mistakes DCs make when purchasing software?

Bauer: Purchasing on an initial knee-jerk reaction. It would behoove chiropractors to do their homework. Is the technology established in the mainstream? Will it benefit the staff’s efficiency, a doctor’s productivity, or improve the quality of treatment?

Bindell: First-time buyers make two errors. First they forget to say the magic words: show me. Ask the salesperson to demonstrate the software does what is claimed. Second they make the mistake of looking for only one feature, not realizing the importance of having integrated software that takes care of insurance, appointments, documentation, recalls—features that create a successful, efficient, and paperless office.

At the opposite extreme are those doctors buying for the second time. Because they made a mistake the first time, they now demand excessive proofs. In the end, they may not get the software that is truly the best.

Norworth: Purchasing solely on a colleague’s recommendation without investigating some alternatives.

Winterkamp: I think too often doctors rely on their staff to help make evaluation and purchase decisions. Staff turnover in clinics has traditionally been a problem. Doctors need to be fully involved in their software decisions, and they need understand how it should be implemented into their clinic.

What technical assistance/customer service should DCs expect?

Bauer: Doctors should expect to receive adequate instructions on operating the software. Instructions should include tutorials within the software package and the availability of downloads and printouts from the Internet. There should be free upgrades and training, via upgraded tutorials for a minimum of 1 year after purchase. Manufacturers should keep abreast of all the latest in software technology and innovations in programming techniques.

Bindell: There should always be service with a smile. There should be 90 days of free support, including technical support, and program updates, with every purchase. When doctors call for support, the call should be returned as rapidly as possible—in a matter of hours.

Norworth: A large, well-trained support staff that can handle problems through extended operating hours. Who wants to hear that the support staff is out with the flu or on vacation?

Winterkamp: The company should offer a full implementation guide with schedules and timelines, CD tutorials, training seminars, and on-site support. They should have pride in their customer service. Finally, they should have very low turnover and detailed training for employees to ensure a high level of support.

What are some ways software can improve the overhead costs, staffing, and return on investment (ROI) of running a practice?

Bauer: Computer and office software should, by its inherent design, improve the quality of production and decrease the time required to enter or obtain specific information. Billing and management software should be simple, intuitive, and provide all the necessary reports and tracking requirements of a productive clinic. It should include a flexible narrative report writing technology—this feature is a must in any business management software.

Bindell: Good software really does a number on expenses and substantially increases income. Electronic billing, done through a specific program, is free. The right software makes the office as paper-free as possible so that time spent in a filing cabinet is eliminated. The staff can concentrate on recalls, reactivation, collections, and marketing. Fully integrated programs need only one entry; redundant entries are gone. A smaller staff accomplishes much more with the right tools.

Norworth: Electronic claims substantially reduce payment turnaround. Good software can help pinpoint staff members who repeatedly make errors during data entry that slow claim processing and affect scheduling.

Winterkamp: There are many studies that show that the cost of initial patient processing (setting up a patient file) costs between $10 to $25 (depending on collection detail). These studies also show that each patient encounter generates three to five pieces of paper, which is costly in staff time, material, and storage costs. ROI models provide both direct and indirect/intangible costs that doctors need to learn more about.

What are some technological advances in software for DCs?

Bauer: Outcome assessment documentation software is the new paradigm in validating the existence of spinal trauma. Qualifying and quantifying the functional or structural impropriaties that may exist as a result of spinal trauma are on the forefront of the objective-based chiropractic practice.

Bindell: Insurance processing that took a computer 3 days to complete in 1985 is now done in a matter of minutes. Electronic billing with the right software is a free service. The use of mobile computer devices has made digital record keeping simple. Digital appointment scheduling ensures that missed appointments are not lost patients. Narrative reports are generated rapidly. All office functions are enhanced with faster processing and increased collections.

Norworth: Imaging (eg, scanning) seems to be among the more recent trends that have managed to find its way into a growing array of products.

Winterkamp: Doctors can have better HIPAA compliance with software that allows them to lock down the patient file after a note is done. Doctors can have better audit trails by having the patient use fingerprint biometrics to log themselves in (versus a sign-in sheet), and have the patient set up their own patient record to save doctor/staff time. Documentation can automatically drive the CPT codes into the billing systems. And doctors can communicate with their staffs electronically within their clinics, which saves a lot of time and paper.

What is the training time DCs can expect? What training tools/classes/etc does computer software provide?

Bauer: There are many contributing factors to determining training time: previous experience, sophistication of the software, intuitive, objective-oriented software versus software developed in the 1970s and 1990s. Most software on the market provides basic information and offers expensive training classes throughout the country. A good program should include automatic update tutorials as the software is improved.

Bindell: The learning curve varies depending on the computer literacy of each office. As a general guideline for software that is user friendly, preliminary understanding of the program should take a few hours. Use of the basic functions of the software should be within 2 to 4 weeks. And the ability to use the full functions of all program features should happen in 1 to 3 months.

Norworth: Basics can usually be taught in a few hours, maximum. More detailed training is usually necessary for more complex features. Software training is generally available in classes, one-on-one office training, and in CD training or training supplements.

Winterkamp: Software that can be learned too easily does not offer much depth. It means the doctor will run out of capability and have to recomputerize their practice again, which is a costly mistake. The software company should offer a clear implementation plan with training CD tutorials, well-organized documentation, and training and technical support that all align together. During implementation, clients should know where they are in their training and what CD tutorial they should watch at each phase. The company should rate clients and their staffs as to their proficiency of the software. Clients should also continue to invest in training/education seminars.

What are the costs involved in implementing the software system in the office?

Bauer: Cost for new office software should be reasonable and have a higher rate of return value than the doctor’s investment. I would be concerned about how long the technology will remain practical, whether is there an anticipated future for this software beyond the end of my practice years, and what it will cost to maintain it.

Bindell: The costs vary greatly. Buying an assortment of less costly programs reduces the functional ability of the office, limiting income and the number of patients. Purchasing one quality, fully integrated suite of programs ensures maximum productivity from the office staff. Since investment in the right software pays for itself, the cost for the right software is minimal.

Norworth: This varies greatly from one product and practice size to another and can range from hundreds of dollars to more than $100,000.

Winterkamp: The costs are dependent on the goals of the client. The more paperless the office, the less cost for supplies, but the more cost for training and setup. However, having a better trained staff usually means fewer turnovers, less space requirements, and less overhead.

Tell us a success story of one of your clients.

Bauer: A Montana doctor used our x-ray digitizing services. The digitizing technology revealed that his patient had a 25% whole person impairment. The patient was initially offered a $5,000 settlement. The doctor coached his patient regarding her digitized objective findings. She went to arbitration, representing herself, and was awarded $90,000. He has reported success with diagnosing and implementing treatment plans based on objective evidence. He has spoken to the trial lawyers association in his state and has dramatically increased his professional business referrals.

Bindell: One specific clinic was having trouble collecting on insurance claims. Almost every claim was rejected with a request for the doctor’s notes. The doctor submitted copies of his handwritten shorthand, and the carriers rejected his claims, stating “inadequate documentation.” The doctor computerized his office and began using our software system, submitting our random text generation progress notes with properly completed computer-generated HCFA forms. Immediately, his claims were paid, and he has been collecting consistently ever since. The doctor’s income has steadily increased, while his overhead was reduced. The computer eliminated two staff positions, the need to buy more filing cabinets, and other expenses.

Winterkamp: We have a client who has a computer server in a high-rise building with four clinics in different locations with up to 60 users that log in daily. Patients can see up to five different providers throughout 1 day, and the patients come in every day for up to 30 days of treatment. It is a very complicated setup that has been a huge success. The patient file is electronic and easily shared among providers.

Tell us about your company’s commitment to the chiropractic profession.

Bauer: International Diagnostic Technologies is committed to offering digitizing services to any doctor who wants to obtain the highest level of digitizing accuracy. My goal is to prove that chiropractic does work and to place the practice of chiropractic on the leading edge of health care.

Bindell: Chiropractic is the life of our company. In addition to owning Life Systems for more than 12 years, I have been a practicing chiropractor for more than 28 years. Life Systems began with the purpose of providing reliable software for my colleagues in my chosen profession. Chiropractic needs software that is designed and developed by a practicing chiropractor, and that is what we are dedicated to providing.

Winterkamp: We have been in the chiropractic business since 1985. We have thousands of chiropractors using the software daily in small to very large facilities. We have the capability to supply the chiropractic industry with technology that will ensure its competitiveness with other health care providers as well as the third-party payor system.

Any last words of advice?

Bauer: It is my hope and goal to enable chiropractors to set aside petty squabbles and pursue the fulfillment of our destiny to be the greatest of all health care providers in the world.

Bindell: Look at the big picture in your office and get a package of integrated software that is thorough and comprehensive enough to enhance and improve that big picture. A user-friendly, integrated system pays for itself and is much more valuable than an inexpensive assortment of programs that wastes staff time and minimizes productivity.

Winterkamp: Yes, doctors and staff have to be committed to learn the system. Medicare already has plans within the next couple of years to only reimburse doctors who can provide electronic claims and supporting documentation in a electronic codifiable format. Also, health care is opening up to chiropractic; there is an increase in multidiscipline clinics and hospital privileges for more chiropractors. This means chiropractors need to report their patient findings in terms that other doctors can understand. Without the commitment and great training, your clinic will not to be able to successfully compete in the future. CP

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