Properly designed and implemented software can keep costs down and improve efficiency

Use of software in chiropractic practices has grown to the point that most DCs could not imagine operating their practices without it. Chiropractic offices use software programs for such tasks as billing, appointment setting, form automation, and voice dictation.

Chiropractic Products turned to four experts for a discussion on what DCs should expect from the latest technology. Mike Norworth is president of MPN Software Systems Inc. Avi Bindell is vice president and chief information officer for Life Systems Software. Ken Schenley is vice president for Quick Notes Inc. W. Jay Taylor is vice president of marketing research for MicroFour.

What are some key factors chiropractors should look for when purchasing computer software for their practices?

Norworth: Track record. What are key features of the software today? What about 5 years ago? Ten years ago? Longer? Has the product shown development over this time period that would have benefited your practice had you owned it then? What type of support system does the vendor have in place? When you call, is there a department of trained personnel available? Do they have your entire call history at their fingertips? Does the vendor push “cool” features that—upon reflection—may provide no real cost benefit (such as time savings) to your practice?

Schenley: In today’s world, there are a number of very important issues to consider. One is time management at the practice. Any software solution must be simple to learn, simple to use, and portable. The staff must be able to implement the program in a week or two, and then be able to complete notes while the patient is in the exam/treatment room. Otherwise, the system is going to end up in someone’s desk drawer unused. The second is document security. The software must be secure and must protect the chiropractor from any sort of catastrophic data loss. Since it is imperative that every visit for every patient be documented, notes must be stored and accessible in an electronic medical record (EMR) solution.

Bindell: There are many factors that a chiropractor should consider when purchasing computer software for his or her practice. First and foremost is the question, “What do I need and/or want the software to do for me?” How will the software give me time, increase staff productivity, and build my practice? Quality integrated software does all this by merging management and documentation programs into an efficient unit. And always say, “Show me.” See the program in action so you know that it does everything that is claimed by the salesman.

Taylor: The system should be an electronic health record, which, by definition, is a comprehensive and integrated EMR and an office-management/accounting system. Integration will save significant data-entry time and reduce errors. Having two systems requires constant updating of information from one system to another, which wastes time and introduces errors into the process. An integrated package needs to be delivered by technology that improves work-flow ease and speed, such as touch-screen monitors and limited voice data entry. Touch screens and limited voice entry will speed your documentation and patient throughput.

How can software improve the overhead costs, staffing, and return on investment of running a practice?

Norworth: Properly designed and implemented software offers true time savings and improves efficiency. This is true whether you’re looking up a forgotten appointment for a patient who calls in, handling a multipatient check and explanation of benefits from a payor, or filling out treatment authorization request forms. For instance, filling out tedious authorization requests with patient and guarantor information invites mistakes. Mistakes cause payment delays, which require additional staff follow-up. Automation helps eliminate mistakes and improve productivity.

Software can also help ensure Health Insurance Portability and Accountability Act of 1996 (HIPAA) compliance by providing proper security and audit trails not easily implemented with a paper-based system.

Schenley: We firmly believe good documentation software can ultimately save a practice tens of thousands of dollars per year. If the chiropractor can select a note system that he or she can use at the point of service, then costs are greatly reduced. Transcription can typically involve either a full-time staff member, or outsourcing, and in either scenario, the costs can be prohibitive. In addition, there is the time factor that affects the incoming revenue for your services rendered. If the chiropractor can get the notes done quickly, accurately, and efficiently with a note system, then it’s a no-brainer.

Bindell: All records are stored in the computer, so paper files are almost never used. The integrated programs use digital travel cards, so fee slips and written appointment messages are things of the past. The overhead for paper is removed. Since 95% of filing is eliminated, between 1 and 3 hours per day of staff time can be spent on more productive functions such as recalls and collections. Responses to insurance companies or attorneys take only minutes. In larger practices, 1 or 2 administrative staff members may no longer be needed. And the right system has letters and messages for patient education, retention, and referrals.

Taylor: Quality software provides easily obtainable and updatable chart data. When compared to a paper system, the cost savings for pulling and refiling paper charts alone typically justify the cost of the software. In a single-doctor clinic seeing 22 patients per day, the annual cost to pull and file charts (based on $5 chart pull) is $45,500. Based on typical transcription costs, the elimination of the transcription process could cut up to $14,400 per year in a typical clinic. Using published downcoding trends as a guide, a small clinic could increase revenue due to proper charge capture by as much as $10,296 per year.

What are some of the latest technological advances out there for DCs?

Norworth: Form automation. Every payor, from Blue Cross/Blue Shield to your local HMO, has implemented a variety of forms that have created an avalanche of work over the past decade. It’s now possible to tie such forms directly to your patient database and print them from your computer so some or all required information prints automatically.

EHRs are rapidly becoming more important. Software needs to be capable of storing a wide variety of items together—not just scanned documents, but history and lab data that can be searched, reviewed, and e-mailed to colleagues.

Schenley: There are a number of technologies available these days. The most important of these involve the “front-end,” or dictation, tool used by the chiropractor. The most popular front-end devices are portable personal digital assistants (PDAs) and touch screens. In both cases, the DC and staff can create notes that are complete and compliant, with one go-through and without the need to review or edit at a computer. At Quick Notes, we have developed ThumbWare® technology that combines touch-screen functionality with the convenience of a PDA. In addition, any technology must provide the chiropractor with documents that are always “in your own words.”

Bindell: The latest technological advance in software includes fully integrated systems that merge documentation and narrative production with management, billing, and appointments. The result is a single powerful system that can run on all computer platforms from the Pocket PC to the tablet, notebook, laptop, and desktop computers, and be networked so several staff members can simultaneously do all their activities.

Taylor: As always, chiropractors are some of the leaders in helping develop trends and technological advances. The last several years have shown the tablet PC and the PDA (Pocket PC) devices and software starting to reach a level of maturity in capabilities and usability. Chiropractors are now more mobile than ever. Wireless PDA and tablets allow the doctor to roam from room to room, or even out of the clinic, while still updating and processing patient records. These advances are convenient for the doctor and the patient, as well as cost efficient by reducing the expensive “wired” PC networks that have been evident in the past.

What are the costs involved in implementing a software system in a practice?

Norworth: Costs vary widely. And to some extent—there are certainly exceptions—you get what you pay for.

Schenley: The cost of software solutions differs greatly based on technology, function (such as notes and billing), and number of users. Some products are priced entry level—a few hundred dollars—while others can range as high as $10,000 to $20,000. When looking at software solutions for documentation, there are two elements to the system—the EMR and the front end. Quick Notes has been an advocate of portability since the early days of chiropractic software. Typically, a quality portable note system with EMR and hardware should range in the $2,500 to $3,000 range. This should also cover your first year of technical support, plus installation and training. Of course, there are all sorts of upgrades and multiuser options, as well as numerous networking options, that can add to the price. A smart chiropractor will shop around and do some homework to find the best value, while meeting the needs of the practice.

Bindell: Based on the return on investment, the costs are minimal. The software makes the staff more productive, may eliminate one or two salaries, reduces the costs of insurance billing, eliminates paper supplies, and improves patient retention and referrals, so the system should more than pay for itself within a year.

Taylor: This initial cost is easy to track, but is only part of the larger cost to the clinic in terms of dollars, time, and commitment. Remember three things: First, no computer system will solve every situation or problem in your clinic. Prioritize your needs, and then work from this list. Second, the act of purchasing the system does not solve your problem(s). You have to work to implement the system and embrace the learning curve. The vendor can help, but it is up to you. Third, as you become more skilled and experienced, you will expect your computer system to do more. Make sure you select a computer system that has the ability to grow and expand with you. It may cost more on the front end, but it will pay dividends later on.

What is the training time DCs can expect, and what training tools or classes do computer-software companies provide?

Norworth: These days, interactive video training tools on CD and DVD provide a viable training supplement to in-office trainers and classes.

Schenley: We have always believed that installation and training must be done personally with the DC and/or the staff. Although there are tools in the software and manuals to be read, these are supplemental at best, and cannot truly show the user the features and functionality of the software. Always remember that a smart software company will realize and respect the fact that the chiropractor is an expert in chiropractic, and does not need to be computer savvy. Although on-site training should be an option, software should be simple to install, simple to learn, and thus, simple to implement. In most cases, 2–3 hours of telephone training should be enough to get a note system up and running. Internet support and computer linking is another great teaching tool that a software company should utilize.

Bindell: The time to learn the systems is relatively short. The better systems were designed by practicing chiropractors, meaning that the programs are based on real practices, not just a programmer’s concept. The result is that the software flows the way your office flows. Training classes are held periodically around the country. Video training modules are available to clients. And telephone guidance is provided for those that need it.

Taylor: Depending on the complexity of the software being installed, a typical software installation for a complete EHR system takes initial training of 3 to 5 days. Additional training may be required after the clinic has been using the software for an extended period. This add-on training is typically very fruitful after the staff has working knowledge of the product. Most companies offer on-line training that can be very cost efficient for the clinic, especially as the staff changes within the clinic. Of course, online help and tutorials are another method of training, although they are typically less effective than “directed” one-on-one training courses.