Chiropractic office software can help your office reduce paperwork.

Thanks to ever-changing technology, chiropractic software has improved over the last few years, with added features to help chiropractors and staff move away from paperwork and spend more time caring for their patients. But choosing from different software companies and programs can be challenging. CP interviewed nine software company representatives to give you a better understanding of how their programs can help benefit your practice: Paul B. Bindell, DC, is president of Life Systems Software, Rockaway, NJ; Marilyn K. Gard, MBA, is CEO of Clinic Pro Software, Sedona, Ariz; Derek Greenwood is CEO of EON Systems Inc, Clearwater, Fla; Steven J. Kraus, DC, is founder and CEO of Future Health Inc, Carroll, Iowa; Mike Norworth is the president of MPN Software Systems Inc, Upper Saddle River, NJ; Ken Schenley is executive vice president at Quick Notes Inc, Cooper City, Fla; Michael L. Silbert, DC, is co-owner and co-president of E-Z Notes Inc, Chicago; Paul Thompson is vice president of business development at Softworx Solutions Inc, Altamonte Springs, Fla; and Greg Winterkamp is CEO and president of Addison Health Systems Inc, Dallas.

What are some of the first things chiropractors should look for when selecting a software system?

Bindell: Identify what the software should do, including billing, scheduling, electronic claims, marketing, SOAP documentation, narrative reports, and statistics. Research which programs fit your needs. What is your goal? Increase income, reduce expenses, eliminate a staff person, become paperless, or a combination? Evaluate the cost. Expensive programs may not have features that less expensive software includes. "Cheap" software may be a gimmick forcing you to spend a fortune on additional modules. Does the purchase include training, updates, or support? What are maintenance costs after the initial purchase? Does the doctor buy or have a permanent rental? Some companies sell software with a small annual fee for updates and support. Others lease, locking you into a monthly expense of $700 or more forever, so the annual cost is more than the full purchase price of other systems.

Gard: Ease of use and ongoing cost to operate.

Greenwood: The software should solve the problem that the chiropractor is trying to solve. The chiropractor has to look at his or her practice and list the problems that he or she wants solved and determine whether that software will solve those problems.

Kraus: Buying office-management software is a tedious process. You want to make the right choice, the first time. Select a system that has full integration with your scheduler, billing, documentation, electronic health records, and patient education, as well as with digital x-ray and diagnostic devices. Make sure that the system is versatile to grow with your practice, is easy to use, is efficient, and provides value as a return on investment.

Norworth: Track record, ease of use, growth, and how each of these things ultimately affect the return on investment.

Schenley: When a chiropractor is considering the purchase of a software product, it is critical that the software company has a well-established history in the marketplace. You also want a company with a solid reputation and visibility in the chiropractic community. Many companies come and go in the software industry, and the worst thing for a practice would be to purchase a software solution that simply doesn't have an understanding of the profession, or the ability to develop and upgrade the product in the future.

Silbert: If the software is for clinical documentation, the chiropractor should speak to someone at the company to find out the cost of the software, its hardware requirements, its ease of customization, the company's return policy, the type of training that is available, and its ability to integrate with billing software.

Thompson: Chiropractors should be looking for products that are easy to use and offer a feature set that will meet their needs. The chiropractor needs to envision himself using the system and ensure that it's something he will like and use without causing problems in his practice. Chiropractors should also be concerned with the price. They should weigh the cost of the product versus what they will actually use in that product. If there are lots of bells and whistles, but the chiropractor will never use them, why pay extra? Costs for training, support, and new releases need to be taken into consideration.

Winterkamp: Of the utmost importance is you want to select a company with a proven track record that has staying power. There are countless software companies that come and go, and you do not want to end up with a software system that is not supported or updated to the changes in health care.

How has chiropractic software improved over the past few years?

Chiropractors should choose a software system that is supported or updated to the changes in health care.

Bindell: Comparing current software with that of years ago is like comparing tricycles and aircraft as methods of transportation. More features and greater integration result in paperless offices. Wireless networks and the Internet provide freedom to carry a tablet or laptop anyplace with access to all patient data. In some systems, SOAP documentation generates billing, eliminating fee slips and travel cards. The system that does electronic billing produces marketing letters to attorneys, employers, other doctors, and patients. Appointment schedulers monitor and track missed appointments, so staff cannot forget them. Pop-up reminders ensure that nothing is forgotten, so the office becomes more productive, more efficient, and more profitable.

Gard: Chiropractic software has changed from billing software to complete practice management, which includes schedulers and mail-merge marketing.

Greenwood: Software does more for less money. The fact of one company developing and supporting a suite of integrated software tools that can result in a digital office makes it easier for the practitioner to move toward a "less-paper" office.

Kraus: Technology has improved immensely and has opened up so many options. You have the option of using tablets, voice-recognition software, touch screen, or whatever data-entry method makes you comfortable. Plus, some integrated documentation and billing systems have built-in error alerts. With a totally integrated system, your system has built-in intelligence where it actually "pulls" the patient's diagnostic information and automatically plays educational material based on it. It's really amazing.

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: Every year, it seems that software solutions are getting better and better. Some of the key improvements revolve around ways to make things easier and faster, while never sacrificing quality or compliancy. If a documentation software can help the chiropractor complete a daily note in under 1 minute, without making the DC jump through endless hoops, then it's a winner. The key, in my opinion, is true portability and ease of use. When a software company improves its product in these two areas, it has done its job. Thus, the DC and the entire staff are happy with the product.

Silbert: As with most technology, the changes are exponential and limited by the imagination. We have seen bar codes, scanned sheets, and now, touch-screen portable tablets that can be programmed by the chiropractor to reflect what he or she has done and why.

Thompson: Chiropractic software has improved over the past few years by offering systems with more functionality and ease of use while keeping price points around the same level. Software has also become more integrated. More systems have opened up interfaces that allow one system to "talk" with another system.

Winterkamp: There are better graphics and faster and more efficient ways to process a patient. The more progressive companies are providing the capability for connecting a doctor to their patients over the Internet, and that is very important for the future of health care. It is also very important for increasing patient compliance and retention. However, that is in its infancy. 

What type of training and customer support is available?

Bindell: Each company provides some form of training and support. At Life Systems Software, training is provided by attendance at one of our regional training programs, over the Internet with training videos that are available 24 hours, 7 days each week, by using the product manual provided with the software, and by telephone access to our support department. The first year of technical support is provided with the purchase of our products, and after that, there is an annual nominal fee.

Gard: Web-based training with individual trainers. Customer telephone support from 8 am to 8 pm.

Greenwood: At EON, we assign a training consultant to make sure that the new user is up and running on our software. They do this by appointment, so there is no waiting. We also have comprehensive training CDs, intermediate and advanced training seminars, a knowledge base, and the ability to e-mail a specific question to a technician on our Web site. We also offer an online help manual and call-in technical support.

Kraus: Future Health offers daily module training on all of our components free to our customers for as many times as they want. We also offer on-site training, user-guides, an 800 number, and soon, a whole video training library. Our customer support is by phone, online, and also via the Internet in real-time.

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, via remote, and 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: Quick Notes offers a thorough and complete package that includes product installation, training, and customer support. We have developed our product to such a level that all of our support is done through the telephone and Internet. With some of the advances in support software, we can safely "log on" to a client's computer and do our installations while the client sits back and watches.

Silbert: We believe that the system should be intuitive and contain clues and hints to remind the chiropractor to bill for x-rays. As initial training, we advise a 60-to 90- minute session over the phone.

Thompson: We offer up to 3 hours of one-on-one training conducted over the Web where users can "walk through" the software with the trainer and ask questions as the training progresses. After training, we offer continued support by telephone, e-mail, and fax.

Winterkamp: Much of the training has been moved to online training. This allows doctors and staff to learn at their own pace, to learn important processes over time,  and to save the cost of paying for a trainer's expense. Also, customer support is better handled electronically where your support person can log in and be able to electronically fix things and see what a customer has done on the customer's computer from a remote access.

How can software help a chiropractor work toward the goal of a paperless office?

Bindell: Integrated systems eliminate most paper and protect you from audits by ensuring that billing and documentation match. Paperless means that a patient signs in, his or her name appears in the adjusting room, the doctor enters the documentation as the patient returns to the front desk, the system shows a travel card message, when to schedule, and enters fees. One entry places information everywhere needed. Paper (travel cards, appointment books, fee slips, ticklers, form letters, and memos) are gone! The file is stored and accessed electronically, including scanned in documents and pictures. Filing is eliminated. ICD and CPT code usage is tracked, so you know if any code is used "excessively." Paperless systems include pop-up visit counters when a diagnosis or insurance coverage has expired. Paperless saves trees.

Gard: With tablet PCs and touch-screen note-taking, drawers of paper files are no longer necessary.

Greenwood: To be honest, a paperless office is not possible. As soon as you have to print a receipt for a patient, that concept goes out the window. We are going with the "less-paper" concept starting with an electronic appointment book. Documentation software electronically stores notes, and e-billing saves lots of paper. An insurance follow-up center can do away with lots of insurance paper files. With a digital document manager, any documents can be scanned and stored, but also e-mailed and faxed without having to print the document first. This includes digital x-rays. Of course, digital sign-in is a paper-and time- saver. All the practice has to do is find and block information out on sign-in sheets one time and the digital sign-in pays for itself. Getting all these integrated products from one source is the key to having it all work together smoothly.

Kraus: As long as the software incorporates the following essentials—integration, versatility, ease of use, efficiency, and value, attaining a paperless office is much easier. Make sure the software is adaptable to how you practice and your transition speed. Some offices want to go paperless right out of the gate. Others want to make the transition gradually. Whichever vendor you choose, make sure their software will accommodate your needs and your practice flow.

Norworth: Electronic billing and remittance, OCR friendly fonts for printed forms, the ability to electronically bill secondary carriers after importing EOB information from remittance files imported at the press of a button can streamline both follow-up and payment.

Schenley: Most chiropractic software systems have evolved to this level. When searching for a product, simply ask whether a solution can help the office go paperless. One key to paperless is to determine whether a chiropractor can view a patient chart in the treatment room with the patient. Whether it is on a PDA, a tablet, or a computer monitor, the notes should be available for review, and in some cases, you should be able to actually use a previous note to help create your current note. In the near future, archiving of patient records will also help an office eliminate paper.

Silbert: When the patient data is stored and backed up appropriately, the need to print all the documentation is a matter of personal choice. If the chiropractor would rather only print the notes when they are requested, he or she can save a lot of paper and toner.

Thompson: Software can help the chiropractor go paperless in many ways. To start off with, the system may allow them to input all exam findings and daily follow-ups directly into the computer. This allows the chiropractor to remove the use of travel cards or other paper systems that they were using to record this type of information. Software may also provide the ability to store and display documents that may have been scanned. Documents such as initial forms that the patient fills out can be scanned into the system and viewed later as needed. Other items such as x-rays can also be attached to the patient's electronic file so that they can quickly be viewed.

Winterkamp: There is no doubt that a chiropractor can become paperless. Many of our clients have. The software must have an automated way to collect patient intake information. Then, the software product has to organize all the information electronically that comes into the clinic from outside sources, and connect it to the patient file along with all the notes and reports generated from the patient's electronic medical record. Then the patient's generated documentation must drive the CPT and ICD codes to the billing. The billing software must then electronically bill, and some companies are already submitting back electronic payment to the doctor's banking accounts.

How can software help a chiropractor get more timely insurance reimbursement?

Bindell: Paperless integrated programs enhance reimbursement. The systems perform electronic billing, so within minutes of submission, it is processed by the carrier. Typical turnaround time for an electronic claim is under 14 days, whereas paper claims take 4 to 8 weeks. Electronic submission eliminates problems with paper claims. The carrier can never assert the claim never arrived; there is no postage, no envelope, no stuffing envelopes, and no expensive form. Accuracy and thoroughness of the computer software substantiates what was done with the patient. Since documentation generates the billing, there are no discrepancies that cause claim denial. The computer software produces dictation quality SOAP notes to submit with claims, or when requested.

Gard: Electronic claims can greatly improve timely reimbursement, not only because of the decreased turnaround time, but also because of fast identification of rejections and subsequent correction. Medicare, for example, pays in 14 days on an electronic claim and 27 days on a paper claim. If a paper claim gets rejected, the 27 days starts over from the day they received the corrected claim. If that same claim is billed electronically, the claim can be corrected the next day and resubmitted.

Greenwood: Billing electronically makes insurance payment more timely. An insurance follow-up center is a must. It tells the staff what insurance companies need to be called and when.

Kraus: Claims are rejected because of incorrect codes, improper use of forms or incorrect forms, and the changing authorization and requirements of third-party payors. Our Intelligent Billing is user-friendly and intuitive to reduce, if not eliminate, rejected claims, coding errors, and charges that are assessed but not covered by the patient's third-party coverage. All coding is updated annually, and the system has built-in alerts regarding policy coverage. If all errors are caught prior to the claim getting submitted, you can guarantee faster reimbursement.

Norworth: More consolidation and integration of separate features to complement one another and provide greater functionality.

Schenley: Documentation is a critical part of insurance reimbursement. Every patient encounter should have an accompanying note or entry in the patient record. To take this concept further, the document should be created in a timely fashion, preferably in the room with the patient. With wireless capabilities, like WiFi on a PDA, notes can reach the front desk faster than the patient.

Silbert: The software can remind the chiropractor to bill for things that he or she is doing, but may not know that he or she can bill for. It can remind him or her to put better diagnosis codes, which pay better. When the documentation is requested, it can address the concept of medical necessity, contain the correct modifiers, and demonstrate to the insurance adjuster a confidence that says, "Go ahead. Make my day."

Thompson: Electronic documentation software that is easy to use and provides output that the insurance companies will accept can make the life of a chiropractor much easier. Software can help the chiropractor get more timely insurance by keeping track of billing requests and providing ways to track what's been paid and what has not been paid. Software that is configurable to a point where it knows what billing codes will be paid with what diagnosis also makes it easier on the chiropractor because he or she is not forced to remember this information constantly.

Winterkamp: The doctor must have the correct documentation that guides the doctor to provide correct coding. There has to  be proper and efficient communication between what the doctor documents and does intheir treatment and what the billing/insurance people bill for electronically. All doctors should be doing electronic billing and making sure that the billing software traps incorrect information in the claim before it goes out.

What innovations do you see in the future for chiropractic software?

Bindell: The future is bringing many innovations to enhance the chiropractic office. These innovations include, but will not be limited to, biometric sign-in such as a fingerprint scanner, reception room computers where patients will complete forms on the computer screen instead of on paper, and automatic electronic posting of insurance payments, in which the insurance company downloads an explanation of benefits into the computer as the check is deposited electronically into the doctor's account.

Gard: Internet access for patient scheduling and patient education. Transportable personal health records that can be carried from one chiropractor to another. Biometric check-in kiosks that can also be used to record progress and enhance patient education.

Greenwood: The future in chiropractic software holds more management aids, including income projection and using the Internet for things such as patient self-scheduling. We will also see better and faster tablet PCs for doing notes. We will see more software vendors following EON's lead in producing all the integrated components of a digital office, so the practitioner has only one vendor to deal with. In the future, we will get closer to the software running the office rather than the office staff running the software.

Kraus: In some regards, the future is now. The deeper integration with different modules of practice-management software such as scheduling, documentation, and billing all talking to each other result in the removal of redundancies that are currently experienced in many "paper" practices. The future is bringing an outside integration where all diagnostic equipment in an office connects and shares information in the electronic health record (EHR). Especially, digital x-ray, MyoVision devices, thermal scans, inclinometers, mechanical adjusting instruments, or any other diagnostic software within a chiropractor's office. Having all of these devices connect to each other and going directly into a true EHR will provide efficiencies and immediate access to records. This allows for all documents and reports to be contained within one software, making it accessible with appropriate administrative privileges from anywhere.

Schenley: I believe in more of a good thing—more portability, more time savings for the chiropractor and staff, simplicity in terms of technological innovations and ease-of-use, and hopefully, a continued emphasis on quality, ethics, and integrity.

Silbert: At E-Z Notes, we have the advantage of tapping into our client base and asking for suggestions. We have found that "all of us are smarter that any one of us." We add 10 to 20 suggestions to the software updates that are done online every other week (26 times a year). In the near future, I see that the patient will do most of the intake forms directly online, and this will be inputted to the software. This will save a lot of time and create pop-ups to red-flag conditions. The future is so bright that you will need shades.

Thompson: We see continued integration and interaction between the patient and caregivers. The ability for the patients to enter their information (initial information and follow-up subjective information) either through a machine or kiosk in the waiting room or over the Web. We also see more integration between systems as technology makes it easier to interact, such as the ability for thermal scans or EMGs to be loaded directly to the patients' file within the main documentation system for easy retrieval later. Also, as systems become more connected, we can expect that electronic submissions of bills and documentation to insurance companies and other agencies will become the normal practice.

Winterkamp: The big thing is doctor-to- patient electronic connectivity so the patient is better informed and monitored and can help the doctor by submitting fast and efficient updates for the doctor's patient file. Also, because of the increased scrutiny by Medicare, doctors will need to better document their encounters or face reimbursement issues and especially because of the new national provider index, face the possibility of post-payment audits. Chiropractic software must provide the doctor guidance systems to ensure proper E/M coding documentation. The software must have tracking and workflows systems in place to ensure proper documentation.