Narrative reports are a fact of chiropractic practice. They are needed for an attorney, an insurance company, an employer, or for another doctor. Each must be unique to the patient and include all the data and information requested or required for you to get paid. The old-fashioned way of producing a narrative report requires hours of time, digging through the patient's paper files to be sure all the necessary information is included. Then, you have to write or type it out in English, without mistakes. Next, you have to proofread it. The time invested in this endeavor feels like a waste, and no matter what you charge, it is not going to be enough to cover the number of hours you worked on the report.

But now there is a better way. With the right computer documentation software in your office, the report can be produced in a matter of seconds. This miracle of technology is accomplished by keeping your entire patient file in an electronic format.

History Selection

In a previous article, the basic electronic SOAP note was reviewed. In addition to the SOAP information, every patient needs history and examination information that typically does not go in the daily SOAP note, but is critical in narrative reports. It is equally critical to be able to enter this information in the computer rapidly and in a timely fashion, so that when you need the report it will be ready at the push of a button.

Figure 1. A high-quality documentation program must empower you to swiftly select each history section.

A high-quality documentation program must empower you to swiftly select each history section. Once you are in the history, most entries should be accomplished by the taps of a stylus or the clicks of a mouse. And if you need to customize some portion of the history, it should be simple and easy to do. The more comprehensive the history, the more accurate your conclusions will be.

When someone has been involved in an auto accident, it is of vital importance to have as many details as possible. The details of the accident provide information about the injuries to your patient based on the patient's position in the vehicle, the angle and tilt of his/her head, the use of seatbelts, how serious the accident really was, what caused the accident, and who or what was responsible. If the patient is litigating, the details in your report could make or break the case. The history can help you build your practice. If the patient was not the only person in the car when the accident occurred, it gives you a reason to encourage your patient to refer the other passengers to your office.

The Particulars

Equally important are the particulars of work-related injuries. In a workers' compensation case, it is your report that will determine whether or not you get paid and what benefits the patient may receive. Having the specifics of how, when, and where, and the circumstances of the injury, is essential to your report. A truly thorough report benefits the patient, you, the attorney, and possibly the employer.

For both the auto accident and work injury items, it is important to enter the information in the patient's file as soon as you receive it. Since this is history information, you can easily train a staff member to enter this data. It should never wait until you get the request for the report.

A Simple and Straightforward Process

Rapid entry of the information about the accident or injury is accomplished by having user-modifiable drop-down boxes and selection lists. All you need to do is select the item that is appropriate for the patient. And in the top-of-the-line systems, you can add to, edit, or delete from these lists very quickly. In other words, it should be a simple and straightforward process to modify the program to your specific needs.

Figure 2. Having the specifics of how, when, and where, and the circumstances of the injury, is essential to your report.

Once the history has been completed, it is time to move on to the various examinations. Here again, the ability to speedily choose and enter your findings is essential to you and your practice. And once the results are in the system, they are ready for generation in the narrative report. As with the history, as much as possible should be done with the mouse or stylus, with user-modifiable lists and drop-down boxes.

In order for documentation software to be used by everyone, it must be flexible and customizable. Really good programs allow you to follow any sequence and use only those items that pertain to you and your practice. For example, some doctors perform a range-of-motion exam on every visit while others never use a goniometer. So the better software programs do not force you to do a range-of-motion exam or any other procedure that you do not use in your practice.

Figure 3. You can design the narrative for your practice in any way that you want, with as many fields as you would like.

The Key Features

The same things that you should look for in a fantastic SOAP program are the key features that should be present in the narrative report section of documentation computer programs.

• Flexibility—Does the program allow you to do things in the order you are accustomed to doing them?
• Customization—Can you do your own customization of each section of the program?
• Personalization—Is it possible and easy to make each note you produce unique to the individual patient for each date of service? Can you enter both your own and patient comments as needed?
• Training—Is training included as part of the purchase?
• Randomization of Verbiage—The better programs include randomization of the generated text so your notes never look canned.
• Verbiage Library—Does the program include a substantial verbiage library in the software? Yes means that you can use the program right out of the box. No tells you that a lot of time will be invested creating the verbiage to make the program work for you.
• Speed of Entry—How fast can you make an entry? You should be able to enter the SOAP information rapidly and produce your note in dictation-quality English within seconds.
• Paperless—There should be no need for you to complete paper forms and no need to keep or file paper notes. The only time to print a note or any other document is when you must send it by mail.

Selecting a Narrative

As you receive information from or about the patient, the information should be entered or scanned into your computer documentation software. Once the data is part of the patient's file, it is very simple to produce a narrative report. From a list of templates, select which narrative is desired. The narrative templates are user-modifiable, so you can create, edit, and delete the templates as you see fit. As soon as the template is selected, the system generates the report, automatically fills in the information to each insertion field in the template, and produces the report within a few seconds.

Figure 4. The final narrative report includes all the patient's information in dictation-quality English.

The raw form of the template is filled with insertion fields that automatically pull the information from the patient's file. You can design the narrative for your practice in any way that you want. In the raw format, everything fits on one page. The final formal report may be several pages long.

At the bottom of the report is an insertion field for "Provider Signature." In the better documentation software programs, the doctor's signature is digitized and automatically appears on the report.

The Final Narrative Report

The final narrative report includes all the patient's information in dictation-quality English. The computer has taken all your taps and clicks and converted them into complete sentences that accurately describe the history, examinations, and other items that you want in the narrative.

Whenever you decide to produce the narrative, the documentation software reads through the entire file, inserts the data where it is needed, and issues the report within seconds.

After the report is produced, the option to edit, add, or modify the narrative is built into the software. When the narrative is saved and printed, a copy of the report is maintained in the patient's electronic file. The copy can be printed again at any time that it is needed.

The First Impression

Remember that narrative reports are the face that you give to attorneys and other doctors. For many, the narrative report is the first impression they will have of you. Giving a thorough and detailed, high-quality narrative is essential to your credibility and will generate referrals from attorneys and doctors, and contributes to making you the expert to whom everyone should turn. The bottom line is that great narratives build your practice.

Paul B. Bindell, DC, is president of Life Systems Software and is a 1975 graduate of Palmer College of Chiropractic. He has practiced in Rockaway, NJ, since 1976. He has lectured on chiropractic in Brazil and Israel. Contact him at , or at (800) 543-3001.