Experts agree that accurate, legible, thorough documentation is an essential strategy for reducing potential liability, substantiating billed services to third-party payors, enhancing precise communication among providers, and simply practicing good health care skills. Electronic health records (EHRs) may help chiropractors achieve these goals if the doctor takes the time to research and implement the most appropriate system for his practice.

Better Care with EHRs?

Some DCs believe that EHRs may improve the standard of care by standardizing practice procedures. "I think we can drive a lot of quality initiatives using EHRs, such as the National Committee for Quality Assurance (NCQA) Back Pain Recognition Program," said John Ventura, DC, DABCO, of Rochester Chiropractic Group, LLP, in Rochester, NY.

The NCQA is a private, not-for-profit organization dedicated to improving health care quality. The Back Pain Recognition Program identifies physicians, spine specialists, and chiropractors who provide care for patients with back pain and who help avoid inappropriate treatment.

Ventura is co-developer of Integrative Health Care Practice Resources Inc, a team of professionals with experience in business, health care, and information technology that assist chiropractors in developing evidence-based, interdisciplinary practices. Ventura is also a clinical instructor in family medicine at the University of Rochester School of Medicine and assistant clinical professor at New York Chiropractic College.

"An EHR can help to bring about standardization in both the documentation and the delivery of care, which is assumed to be care of a higher quality," he said.

Increased Efficiency, Accuracy

Electronic health records are part of Future Health's documentation, billing, electronic health record, scheduling, and patient education components that work together in integrating office-management technology.

One of the clearest benefits of an appropriately implemented EHR system is increased documentation efficiency and accuracy, says Matthew J. Roes, DC, MD, of Metropolitan Family Medicine and Chiropractic in Hiawatha, Iowa. "My efficiency is increased tenfold by using an electronic medical record system," he said.

Roes recently purchased the McKesson Provider Technologies Practice Partner system. He dictates his notes, which are electronically transferred via the Internet to transcription. The notes are later uploaded into the patient's electronic chart, and he then edits them.

Roes emphasizes that electronic recordkeeping speeds up his ability to maintain, access, or transfer notes.

"Paper notes are inefficient, and they can be lost or misfiled," Roes says. "Using electronic templates, I can produce patient notes faster than anyone can write by hand. They also give me the ability to retrieve patient files instantaneously, organize notes by patient and date, and fax prescriptions or patient data directly from my laptop computer. I can access my records via the Web anywhere in the world."

Transitioning to EHRs

Transitioning from a paper-based documentation system to an electronic system can initially be a stressful process for patients, staff, and doctors. However, a 2005 article in the Annals of Internal Medicine, which investigated the effects of implementing an EHR system in a small medical practice, found that EHRs eventually helped the authors to better meet patient expectations and expedite many tedious work processes, including patient documentation.¹ The authors concluded that once they got used to the electronic system, they would never go back to a paper-based system.

"Having looked at countless EHRs and having used a medical software package, they are all cumbersome until you are used to doing data entry in their format," Ventura says.

To minimize the stress of transition, however, experts emphasize spending the time required to adapt their EHR to suit the practitioner's practice needs. This typically involves adding or modifying existing templates, terminology, and voice-recognition software.

Ventura purchased the Future Health Virtual Office Suite system for his practice.

"A good feature to look for in an EHR is a built-in template that you can tailor to your patient and your practice, such as a Medicare template, and speech-recognition software that allows you to dictate directly into the EHR," Ventura says. "Our system also comes with patient-education modules that are superb."

"The ultimate beneficiary of the clinical record is the patient, and they deserve nothing but our best," says Richard E. Vincent, DC, FICC, clinical director and executive vice president, Graston Technique, and co-developer of Integrative Health Care Practice Resources.

Gerald A. Anzalone, DC, is a graduate of New York Chiropractic College and a writer and lecturer on health care topics. He can be reached via e-mail at .

Reference

1. Baron R, Fabens E, Schiffman M, Wolf E. Electronic Health Records: Just around the Corner? Or over the cliff? Ann Intern Med. 2005; 143(3):222–226. Available at: www.annals.org/cgi/content/full/143/3/222. Accessed November 1, 2007.