Before I begin, you need to know something. The clinician in charge of our new chiropractic-specific SOAP templates has 25 years of experience treating patients in a busy, multidisciplinary environment, testifying in court on their behalf, handling depositions, preparing reports that don’t compromise attorney cases, and performing independent medical examinations (IMEs) for insurers. OK. There. I said it. Now that that’s out of the way …
As patient documentation has gradually moved to electronic formats, efficiency has been a goal … and a cause for concern. Though ECLIPSE Practice Management Software® from MPN Software Systems Inc. has been used by thousands of chiropractors for more than 2 decades to manage billing and appointments, we’ve often watched our clients attempt to reach their electronic documentation objectives using third-party tools with an unintended sacrifice: time. Some of these tools work well and interface with ECLIPSE. Yet many provide long learning curves, are expensive and/or difficult to customize, and can’t be used "out of the box." Ironically, we often find that clients have paid thousands of dollars for documentation software that they purchased but never used. Ultimately, even when doctors are somewhat satisfied with the end result, it takes longer to create and maintain such documentation as compared with the traditional travel card and manila folder.
ECLIPSE now provides extensive documentation with an easy-to-use, fully integrated approach that can only be provided by 2 decades of real-world experience in thousands of chiropractic offices. And the new features don’t a cost a penny more to buy, own, or use. They’re part of the package. And we know it works, because clients who had purchased and abandoned other SOAP systems are raving about it.
From our perspective, anything that limits efficiency impairs your practice in significant ways. Studies show time and time again that when physicians feel rushed, nothing good results. For instance, a recent New England Journal of Medicine article reported that the amount of time gastroenterologists spend on colonoscopies seems to be the primary determining factor in how many tumors are found.1 (Of course, third-party reimbursement is the same regardless of how much time the physician takes with this procedure.)
So, if time is our enemy, how do we simplify the process of documenting patient visits, making information available to payers and attorneys, and using that documentation as we continue to provide and evaluate care?
Ideally, all documentation should be available in one place. (Don’t forget the tried-and-true manila folder.) So, if you need to add SOAP for the current visit, perform an exam, review lab results, review an attorney letter for this patient’s personal injury case, e-mail a report, or send a precertification request, you can accomplish all these tasks from a patient’s electronic health record (EHR). In ECLIPSE, each patient’s EHR tab serves as the repository for all such information—including potentially "unexpected" documentation such as video created to document a visit. First, let’s explore the new SOAP capabilities.
To reiterate, the clinician in charge of our chiropractic-specific SOAP templates has 25 years of experience treating patients, testifying in court on their behalf, handling depositions, preparing reports that don’t compromise attorney cases, and performing IMEs for insurers. The resulting templates automatically randomize your selections to create custom notes. Documentation that contains as few as 10 sentences allows for tens of thousands of combinations. Even basic information such as a patient’s subjective statement with regard to her neck might appear as: "Mrs. Smith states that her neck symptoms are improving," or "Mrs. Smith reported that her neck symptoms have improved," or "Patient indicated that her neck symptoms have improved."
Building a complete note is fast and easy, because the choices you make on your tablet or desktop determine the appearance of your screen. ECLIPSE automatically minimizes and maximizes information based on those choices so you see what’s pertinent. Moving among and between different body parts (e.g. areas of complaint) is as simple as pointing your pen (or mouse) at anterior and posterior 3D anatomical views and clicking. If you’re unable to finish a note before you move on to the next patient, simply mark it as pending. You can even route it to another staff member for later review. Finally, your documentation is associated directly with services for that date—which you can optionally enter without changing screens—and is printed on demand with bills.
So … how do you get this information into your computer system as you move between treatment rooms in a busy office? Though touch screens are terrific in some situations (restaurants, for example), we prefer portable tablets. Why? Where do I begin? Touch screens are cool. But they’re also expensive and require more screen real estate to display less information (fingers require bigger buttons)—which means it takes more time to get to the same place. Tablets don’t require keyboards and allow you to write with a "pen" on your screen. Tablets also allow you to face your patient—not a computer screen. Of course, tablets aren’t perfect, either. For example, though handwriting recognition on a tablet is solid, it’s not always perfect.
|Figure 1. This handwritten Blue Cross/Blue Shield form took 5 minutes for the chiropractor to fill out and is likely to contain errors in ID numbers.
||Figure 2. This ECLIPSE-generated standard precertification form used by Blue Cross/Blue Shield was launched and printed in seconds.|
Your notes are just the tip of the documentation iceberg. Documentation is also about things like "pre-certs." If you review Figures 1 and 2, note that the handwritten version took 5 to 10 times as long to create. It’s also more prone to errors. Rejections that result from typos should be avoidable. Hand entry of identification numbers is avoidable. For the past 2 years, ECLIPSE clients have been able to take advantage of technology that allows virtually any form required by payers, schools, etc, to be filled out by computer and printed on demand. Document automation can simultaneously help you save time and reduce errors that cause payment delays.
|For a roundtable discussion on software see the October 2006 article titled, “Get Technical.”|
Finally, the EHR allows you to import electronic documents, images, and video in various formats. Scan single- or multi-page documents from lab results to insurance cards to explanations of benefits (EOBs). In fact, documents such as EOBs—which often affect multiple patients—can be scanned once and then easily added to multiple patient files.
Document-level permissions allow you to fine-tune access to each "document." You can also separately track access and edits of each document by user. At this point, everyone should be familiar with The Health Insurance Portability and Accountability Act of 1996 (HIPAA). Though it’s required by law, many practice-management systems that handle tasks such as documentation and billing don’t track data access (for example, who edited or reviewed a SOAP note and when).
In the coming months, we have plans to expand and enhance these new capabilities extensively. Stay tuned.
Mike Norworth has graduate degrees in computer science and is the chief architect of ECLIPSE Practice Management Software. For more information, contact .
- Barclay RL, Vicari JJ, Doughty AS, Johanson JF, Greenlaw RL. Colonoscopic withdrawal times and adenoma detection during screening colonoscopy. N Engl J Med. 2006;355: 2533–2541.