Stephen Savoie, DC, FACO, was faced with a seemingly insurmountable challenge—how to record a patient's note in less than 30 seconds. He boasts that his old-fashioned handwritten note was fast. He had been able to get it down to 40 seconds—but he wanted to have something even faster and efficient without diminishing quality.

So during his speaking engagements about documentation at industry conferences and trade shows, Savoie spent his breaks talking to medical software sales representatives about their products. These talks netted a different kind of frustration. "I couldn't get my questions answered," he says.

And when he tried to use these software products, he found that they added time instead of saving it—requiring numerous "clicks" just to get to a screen that allowed him to get to the record. This defeated his purpose in having a software system with flexibility. "I didn't want to spend a lot of time record keeping," Savoie says.

Then, Savoie discovered the Future Health Virtual Office Suite (VOS). The software, which was designed under the guidance of Future Health CEO Steven Kraus, DC, is "deeply integrated," Savoie says. The software met his speed and efficiency requirements, and more important, "The company answered all my questions."

Savoie bought Future Health's VOS, and had it installed in his office in the fall of 2006. The system promises to allow him to achieve another milestone: a paperless office.

Going Paperless

Finding a software solution that would effectively eliminate the paper record was another overriding motivation for Savoie to get the VOS. This is because his practice, Chiropractic One in Clermont, Fla, is located in an area that has, in recent years, endured up to three hurricanes per storm season. Savoie also had friends who were affected by Hurricane Katrina—they lost months of paper records, which affected their ability to adequately care for their patients and to get reimbursed. As he notes, "You can't back up paper records." The ability to back up the electronic files either on a flash drive or at an off-site server was an attractive alternative to bulky records.

But going paperless did require Savoie to complete some additional work. Future Health technicians installed the equipment, and then they walked Savoie and his three employees through the data migration (Savoie was using a less-effective software suite at the time to store data).

Savoie can see that the future will be fully electronic, but he knows that it is a process. "It will take about 6 to 9 months until we're completely paperless," he says, and he has yet to fully implement the suite to include billing.

But the changes to his practice have happened quickly. Savoie says that within 3 to 4 weeks, 80% of his patients were in the system. And though he will be storing his paper records for his longtime (pre-Future Health) patients for a few more years, all of his new patients have a completely electronic record beginning from the day they first came into his office.

The Future Health VOS system became a way of life for the practice almost immediately. And Savoie relies on it daily to keep him on track and up to date.

Daily Record Keeping

When a new or returning patient now comes into the office, the front-desk personnel enters the patient's demographic information, starting the patient record. If the patient has an imaging study he has brought with him, the film—depending on the size of the study—will be scanned into the record. But Savoie notes that many hospitals in the area are also going digital, so the patient will more than likely be bearing a computer disk with the study on it. If the patient is a new one, Savoie will begin the clinical record during the first exam, but if they are a returning patient—having the electronic health record (EHR) at his fingertips has allowed him to be more prepared for the patient.

As soon as Savoie reaches the office, he can sit down in front of one of the Future Health workstations and review the day's schedule, and he can review each patient's chart and his own notes about their treatment or progress before they step foot into the office.

Though he has a workstation set up in the adjusting area, he refrains from entering data into the computer while he is treating a patient. He explains that many patients believe that the DC is not paying attention to them if the DC enters data directly into the computer. Instead, Savoie still uses paper—in this case, a form on which he can make brief notes. The notes are then transferred into the patient's EHR immediately after the visit.

Savoie has not found this system cumbersome. The Future Health VOS has several options, including the "speed note" and the "hyperspeed note" that allow him to click through pre-existing menus of treatments and symptoms, making the daily note something that can be completed quickly.

Among the features of the documentation software are the point-and-click interface, drop-down menus for SOAP notes, and outcomes assessments. The software also features more detailed assessment options, which eliminates catch-all "other" categories; customizable data interfaces; and automatic patient demographic fill-ins. The documentation software easily interfaces with other programs to transfer or receive data.

The documentation software also allows the chiropractor to mark treatments on a customizable body diagram, which can be inserted into the note. It automatically sets functional assessments and goals. And a radiology/x-ray generator allows for detailed reports on patient imaging studies.

An additional advantage of having patient data in an EHR is that it allows the DC to transfer data—in HIPAA-compliant conditions—to other practitioners in cases where the patient may be out of town and in need of treatment. The Future Health VOS allows the data to be attached to a standard e-mail and sent to the requesting practitioner.

Savoie had to sell his staff on the idea of getting a new, potentially life-altering piece of business hardware and software. But it was not a difficult task. The acceptance was almost immediate.

Although Stephen Savoie, DC, FACO, will continue to have paper records in storage for some time, he knows that the future is virtual and electronic.

Office Renaissance

Savoie says his staff members' first reaction was that they were happy to get rid of the old system. The second positive reaction came when he told them they would eventually get rid of all the paper records cluttering the office.

The result has been to streamline office operations. Though the initial inputting of data can be comparatively time-consuming, once the patient is in the system, time becomes less of a disappearing commodity. One advantage that the Future Health system gives the front-office personnel is that it automatically codes each procedure that Savoie indicates in the record. For instance, if he clicks that he performed a spinal adjustment on the patient, the computer system will list the corresponding billing code.

It also makes it much clearer what treatment(s) Savoie has performed. He explains that in the paper-form days of the practice, when he submitted his billing lists separately to the front desk, if he didn't circle the appropriate billing codes for all of the procedures that he performed, he would not get reimbursed for them. Now, that is not a problem. "It saves time, and it also means we don't miss out on reimbursement," he says. "It's much more efficient." And because the record is tied to all of the patient's information, the front desk personnel immediately know what the patient's insurance will pay and what co-pay needs to be collected.

The Future Health VOS also allows Savoie and the front desk to generate other sorts of data and forms. For instance, it can generate notes for school-age patients that they can present to their attendance office to explain that they had been at a doctor's appointment.

Support

Savoie says that the amount of "support was critically important" when he was evaluating software vendors. This was because of a poor experience with his previous software provider. "[For example], we could never migrate to electronic billing," he says, and after numerous complaints and service calls, "they wouldn't take our calls."

With Future Health, on the other hand, Savoie and his staff were trained via a live Webinar in which the trainer—who was in Iowa—manipulated the Clermont office's computer system live. The trainer could show the staff how to operate a particular function and then have the staff member take over and replicate the function. The connection was two-way; the trainer could see what the staff member was doing and correct any mistakes. The company runs virtual seminars as well, allowing participants to log in and get updated on any new features.

Savoie has also found that the Future Health VOS has provided him with a powerful tool to educate patients.

Savoie says staff members, including front desk administrator Lynn Firth, right, are enthusiastic about the prospect of eliminating all the paper records cluttering the office.

Patient Education

The Virtual Educator offers a menu of about 350 videos and posters that explains everything from the basics of chiropractic treatment to exercises that the patients need to do. As a frequent lecturer and chiropractic educator, Savoie is clearly impressed by this patient-education software.

The system is highly customizable. Savoie typically uses it with patients who are waiting for their appointments. Because of the deep integration of the VOS, the system can be quickly programmed—for instance, to present a video explaining the specific exercises that the particular patient needs to do. Diagrams are customized based on the sex of the patient. A male patient will be shown male diagrams; a female, female ones.

As the patient's condition changes, the videos or posters will be updated to reflect those changes. Further customization allows personal messages, such as birthday greetings, to be included in the presentation. The Virtual Educator can be set up for individual or group viewing.

Savoie has a separate patient-education area that is located near the practice's bathrooms, so even those who do not need specific education or a review can benefit from the daily program that is playing. Typically, the patient will spend some time in the video education area whether the video specifically relates to their condition or not. "The patients love the video," Savoie says.

For a roundtable discussion on software, go to the October 2006 article titled, "Get Technical."

Although Savoie will have paper records for some time yet in storage—Florida requires paper records be kept for 7 or more years depending on the age of the patient—he knows that the future is virtual and electronic. "[Going paperless] doesn't happen overnight. You have to reach a certain comfort level to throw away paper," he says.

Savoie points to the template orientation of the daily record as one of the biggest benefits of the Future Health VOS. "In other systems, there is too much customization. That's where it fails. You'll use it for 6 or 9 months and then abandon it, and then it's back to paper," he says.

But probably the best benchmark of Future Health's effectiveness is whether it meets Savoie's initial challenge—the 30-second patient note. His verdict: "Thirty seconds is a long one."

C.A. Wolski is a contributing writer for  Chiropractic Products. For more information, contact .