Software companies continually offer new products and services to help DCs run their practices more smoothly

With all the different types of software now available for chiropractors, choosing the best products for your practice can seem to be daunting task. Depending on the individual needs of your practice, you might look to choose the software with the best electronic billing capabilities, the best note-taking technology, or the best appointment-scheduling method. But whatever the practice’s specific needs are, DCs are looking for products that can make their lives easier and reduce paperwork, for a reasonable price.

Chiropractic Products spoke with eight experts to get some insight on what the various products have to offer. Michael Silbert, DC, is co-president (with Russ Manktelow) of E-Z Notes in Chicago. Mike Norworth is president of MPN Software Systems Inc. Ken Schenley is vice president of Quick Notes Inc in Cooper City, Fla. Steven J. Kraus, DC, is founder and president of Future Health Inc in Carroll, Iowa. Greg Winterkamp is CEO/president of Addison Health Systems Inc in Addison, Tex. Paul B. Bindell, DC, is president of Life Systems Software in Rockaway, NJ. Nancy Smith is the CEO of PPT4Drs in San Diego. Hal Calisch is president of TGI Software in Pensacola, Fla.

What are the latest innovations in software programs?

Silbert: At E-Z Notes, we update our documentation software every 2 weeks; innovations are our middle name. We recently added the ability to sign the documents on the screen with the touch of a button (Randomized Signature Insert); we have been integrating to billing software (so far: Chiro Access, AMS, and Eclipse); and we always add new ways to customize the SOAP notes so it fits the chiropractor’s unique practice style.

Norworth: The ability to integrate and store the various types of data that encompass a patient’s health record digitally has finally become mainstream. Where applicable, biometrics are beginning to see an increased role as well.

Schenley: So many innovations have come about over the past few years. Virtually every company has a new product that gets marketed throughout the industry. But the bottom line is the same today as it was 10 years ago. Will the technology be easy for the doctor to implement? Will it get used on a daily basis? Will it truly save time? At Quick Notes, we have always been about portability and ease of use. We believe that a simple and powerful personal digital assistant system allows the doctor to get the job done while maintaining the necessary one-on-one time with the patient.

Kraus: Technology is transforming the way we do business every day, and Future Health Inc prides itself on being the innovator in the office-management software industry by creating the clinic of the future. We have drawable body diagrams that are inserted into the note; Digital Imaging and Communications in Medicine (DICOM)  software allowing doctors to send diagnostic-quality x-ray images that “zap to the wall”; a Medicare screen that is built into the SOAP notes so everything for a complete, audit-proof note is included with a touch of a button; a true electronic health record with records stored on a separate server; and diagnostic and demographically driven patient education.

Winterkamp: While there are many new innovations, the single most important is a patient portal. This is the capability to have a patient log in over the Internet and fill out patient-intake screens before they come in to see the doctor. The patient-input information turns into “data”; thus, no one needs to re-enter the information into the electronic medical record (EMR) system. This saves the doctor and staff many hours per week. That is an important distinction from forms a patient types and that a staff member would have to re-input into the EMR. Last year, more than 16 million people got on patient portals for the first time. That is up from 5 million in 2004.

Bindell: The most important innovation is the increased integration between documentation and management software, guaranteeing that the SOAP note generates, matches, and substantiates the services billed. These programs run on all computers, from lightweight handheld tablets to full-size desktops, giving each doctor greater access to data with a high level of security. Our newest innovation is the Diagnostic Imaging Report in ChiroPad, providing each doctor with the ability to read, analyze, and report not only x-rays, but also MRI, CT, ultrasound, and thermography on a single screen. Other innovations include the use of the National Provider Identification number and the redesigned CMS-1500 that replaces the HCFA-1500.

Smith: In a word, .NET. The ability to maintain all clients on a single version of any software is now possible using .NET. Just as Microsoft updates and maintains its XP operating system via .NET, programs designed in .NET can be updated automatically and supported in “real time.” Quixote is built from the ground up using 100% .NET technology. Since NET is Microsoft’s push for the future, inherently Quixote is able to take advantage of the newest features available on the Windows platform. With the release of Vista (scheduled to be released in December/January), .NET is built into the foundation of the operating system. Vista will change the way users interact with software.

Calisch: Automatic payment posting is probably the greatest time-saver to be introduced to any office-management software in the last 20 years. Posting explanation of benefits has always been arduous and time-consuming. Now that there is a true standard for electronic billing and electronic payment advice, potentially many chiropractic assistant hours will be saved each week. Pushing a few buttons can now cause bulk checks for many dates of service and multiple patients to be correctly posted, including accurately assigning the patient what his or her portion of the charges are and posting accurate amounts of claim adjustments based on network participation.

What would a chiropractor’s return on investment be for moving to electronic billing?

Silbert: We do not offer electronic billing; we link to the system the doctor has. In our chiropractic practice, we submit our claims electronically and love the ability to get paid faster.

Norworth: That depends on the size of the practice, percentage of claims submitted electronically, submission methods (direct or clearinghouse, for example), and cost. In general, when EDI is functioning well, an office can expect to devote fewer staff hours to followup and experience a much shorter cycle from submission to actual payment.

Kraus: For an average-sized clinic, doctor’s offices can save as much as $32,000 per year, and larger clinics could save more depending on the efficiency and functionality of the billing system used. We created a formula that calculates a chiropractor’s return on investment by factoring in the amount of time and expense it takes to use paper records and file claims the old-fashioned way. With the right billing system, significant staff time is saved with processing and electronic filing, paper costs are cut, postage is reduced, and money is definitely saved if everything is done in-house versus outsourcing.

Winterkamp: That is dependent on many factors, such as clinic size, present operation, staff expertise, current method of documentation, etc. However, typical returns are full payback of system costs within 3 to 6 months. For most clinics, the capability to add on more patients and better document services—thus realizing greater reimbursement levels—adds additional profitability not possible with paper systems. Most important is to have better documentation, which allows clinics to electronically bill with support for their claims.

Bindell: Return on investment for electronic billing depends on the service selected. Using ChiroOffice, commercial claims are free; government claims (Medicare, Medicaid, Blue Cross/Blue Shield) are 15 cents each. If an office is submitting more than 133 government claims monthly, there is a flat rate of $20 per month for unlimited claims. Since each paper claim has expenses of staff time to fold and stuff the claims in envelopes, cost of forms and envelopes, and postage of 39 cents, it is obvious that electronic billing makes it efficient and productive. Electronic claims improve cash flow because they are usually paid much faster than paper claims.

Smith: The obvious impact can be calculated by adding up the savings inherent in postage, envelopes, printer ink, forms, and employee time. The hidden benefits include getting paid quicker as well as faster notification of claim rejection.

Calisch: This depends on what type of electronic billing is done. Using a clearinghouse frequently carries some “per-claim expense” equal to or less than the cost of postage incurred sending a paper claim, but takes much less time to process than paper claims, and payment frequently comes sooner. Electronically sending directly to a carrier usually carries no expense per claim, but may take longer to set up and maintain in terms of CA hours spent. Processing electronic remittance advice (ERAs) electronically can save many CA hours per  week, whichever way the original bills were transmitted.

What type of training and support should be expected from the software company?

Silbert: E-Z Notes provides as much or as little as the doctor wants, for no additional cost. We have found that the learning curve to use our system is about an hour. That’s why we call it E-Z Notes.

Norworth: Whatever it takes to get clients trained efficiently and keep them functioning during their business hours with no downtime. These days, training should be available in-office, via interactive video, and via remote, online one-on-one training sessions at the discretion of the client. Clients should expect a well-trained, full-time technical support staff that handles questions quickly and knowledgeably.

Schenley: It is critical that the software company handles the installation and training effectively. Many systems out there can be quite complex, and it is imperative that the company works as closely as possible with the entire staff. The software must be seamlessly integrated into the daily office routine. With a documentation solution, the ongoing support is recommended to ensure that the verbiage remains up to date with current documentation requirements.

Kraus: Prior to starting Future Health, I purchased three other electronic health records that were tedious and difficult to understand, and support was unresponsive. I recommend before you purchase a system to make sure it’s user-friendly and the company will convert your system according to your schedule—whether you want to go paperless overnight or if you want to do it gradually. Don’t get nickel and dimed on the number of users and installation. Be sure they have a free 800 number for support and offer multiple support and training options such as training Web sites, Webinars, teleconferences, and informational newsletters.

Winterkamp: After selecting the right system, training and support is the most important requirement that can provide success. There should be multi-offerings from online one-on-one training to online training Webinars, to seminars and on-site training. Support should offer continued training opportunities, because health care has changed and will continue to drastically change over the next few years. We are just a few years away from doctors having to interact with the National Health Information Network. This will become a requirement in the future, and doctors will have to be computerized to connect to it.

Bindell: Life Systems Software provides training in four formats: 1) 6 hours of training videos; 2) 4 hours of training at one of our regional programs; 3) telephone training; and 4) a training database is built into the software so each office can practice using the ChiroSuite system without any danger of harming live patient data. The initial purchase of the Life Systems Software programs includes a full year of technical support and program updates. After the first year, each office has the option of subscribing to another year of support and updates.

Smith: At a minimum, online tutorials and/or on-site training if the practice is willing to compensate for time and travel. The most important question to ask is, “Does the training and support team fully understand the chiropractic industry?”

In many cases, support simply addresses the software and doesn’t fully understand the workflow or dynamics of a working office. Real software companies provide for a variety of communication vehicles, including instant messaging, phone, fax, and e-mail. Anyone not supporting in “real time” is simply not viable in today’s marketplace.

Calisch: Every clinic’s needs relative to training and support is different. The size of the practice varies from office to office, the computer expertise of the employees ranges from “idiot” to “geek,” and even the knowledge of how to bill insurance can be amazingly dissimilar. The software company that serves well serves according to the individualized needs of each customer, making available as much or as little support as the particular office needs. In-office training, over-the-phone training, Internet remote access, regular training seminars, or simply availability to answer an occasional question should all be reasonably priced and easily accessible as needed. This responsiveness must carry over to a strong willingness to adapt the software to the “real world” needs of the modern chiropractic office.

What should chiropractors look for when selecting a software system?

Silbert: We believe that the notes tell a story to the insurance adjuster, attorney, or another doctor. This story needs to be detailed, accurate, and generated quickly.

Since no two chiropractors practice the same way, it is essential that the software is customizable. You should be as proud of your notes as you are of your adjustment.

Norworth: Track record. Ease of use. Growth. And how each of these things ultimately affect return on investment.

Schenley: In recent years, so many companies have come and go; and currently, there are so many choices. It must be overwhelming for the practice to make an educated decision on which system is best. Make a short list of the most important questions, and set up a live demonstration of the product. Is the system truly portable? How long will it take to actually implement your program into my practice? How long has your company been supporting the chiropractic profession? Are the notes generated always in my own words?

Get the answers you deserve, and make a right choice.

Kraus: 1) Think to the future—make sure it is designed to hold a large volume of records. 2) Choose software that is designed by a chiropractor for chiropractors—the unique needs of a chiropractic practice can’t be met with software designed by those outside our profession. 3) Make sure it exceeds federal Medicare and third-party-payor standards. 4) Affordable and versatile—select a system that grows with your practice, from startup to multidisciplinary. 5) Customizable to how you practice—select a system so you can pick and choose features that fit your style of practice.

Winterkamp: While many things are important, two factors are paramount: 1) How long has the company been around, and how many systems are in place?
You want a stable company that has longevity and has many installations. There is a history of too many products that come and go, leaving users without updates and support. 2) Comprehensiveness—While it is important that a system is easy to learn, you do not want to purchase a system that you have completely mastered in a short period of time. Things that look difficult at first glance become easy with practice, and then you will be looking for more advanced capabilities.  You want a system that allows you to grow and meet more sophisticated requirements as you and your staff learn more about computerizing your practice.

Bindell: Ask, “What do I need a computer to do?” Find the program that fits your needs. Factors that are important are ease of use, training, functional ability, reliability, and comprehensiveness. An integrated program is intuitive and gives you freedom to operate the way you want. Does the software do what you need? Reliability is determined by the age and stability of the company. Comprehensive programs involve a suite that covers each aspect of practice. The best programs were designed by a chiropractor. Finally, tell the salesperson, “Show me.” Be sure that the software already does what you are told it does.

Smith: The latest technology. The impending release of the new operating system VISTA dictates the use of 100% .NET applications.

Between voice recognition and touch screens, providers and staff will have tools that reduce repetitive, recurring administrative tasks and offer comprehensive reports. The next question is “who programmed” the software, and are they still involved?

The creators must have an in-depth understanding of the chiropractic industry and the nuances of practice management. Many of the current offerings were designed by a single programmer with exposure to only one or two clinics. This is obviously not a good idea. Many others are being imported from the medical arena or from other countries. Again, this is not an ideal choice either.

Calisch: Happy customers are by far and away the most important “feature” of the system one chooses to run in his or her office.

It doesn’t matter how good the software is if the support makes you feel like you are not important and that your problems are not “shared” by the company.

The software should be affordable and perform efficiently all of the functions you need to build and maintain a thriving practice. It should be easy to learn and easy to use, and it should change frequently, as the landscape in which you operate changes.