Steven J. Kraus, DC, DIBCN, CCSP, FASA, FICC, is Founder and CEO of Future Health Software ―the technology leader for chiropractic-specific EHR/practice management software. He is an acknowledged expert in Health IT, including EHR and the up-to-$39,000 ARRA incentive program to implement EHR. Dr. Kraus serves on numerous ACA committees and regularly travels to Washington DC to meet with policy makers on the subject of documentation and electronic health records. He lectures to state associations and at industry events regarding EHR and the relationship to documentation. He presents monthly webinars on how EHR usage will impact doctors of chiropractic. For more information, visit www.FutureHealthSoftware.com or call Toll Free 1-888-919-9919, ext. 616.
- Go to http://www.facebook.com/pages/create.php. Choose a category and a page name that represents your business/practice. Pick a professional photograph of the doctor or doctors that people associate with your practice to use as a profile picture. Write a sentence about your business so people understand what you do. Choose a memorable web address for your page that you can use for marketing material to promote your presence on facebook. Choose a cover photo that represents your office. Remember, the cover photo is the first thing people will see when they visit your page.
- Talk with your patients about your facebook page. This step is so simple yet often ignored. Put a notice up in your office announcing your facebook page.
- Use a script to invite patients to join you on facebook. For example: “How did we do today? Great! We have a facebook page for Dr. Smith, and it would really make her day if you left a comment for her there.”
- Post regularly but not too often. Remember, this is social media, so people do not want to read lengthy, boring articles. Keep it light and fun!
- Use printed materials to remind patients to share a comment and help them easily find your page.
Lastly, I would like to explore what exactly facebook can do for your individual chiropractic office. Patients that “like” your page will continually receive valuable chiropractic information and education. People in your community will know that you are there, have an opportunity to see photographs of you, your office and staff and feel comfortable before they even walk in your door. Facebook puts your face in front of many people’s eyes several times a week and gives your practice and the field of chiropractic credibility. With a well-run, high-energy facebook page, your practice will see greater patient retention, more referrals and new patients. You will see the best results when you have 400 legitimate friends or more.
Teri Kanan is CEO and founder of Connections Social Media Marketing. She has given presentations throughout the country to numerous associations. She has a master’s degree and earned her specialist degree in 2006. She has spent the last 25 years marketing chiropractic offices and managing hundreds of facebook pages. Teri Kanan can be reached at 586-703-3074 or http://www.facebook.com/ChiropracticSocialMediaMarketing.
- Geographic location and local Internet infrastructure may not offer enough Internet bandwidth speed for efficient cloud-based EHRs. If your Internet providers do not have higher speed Internet available and the transfer rate is really slow, it can decrease your efficiency and will become an annoyance.
- Mid- to large-sized clinics with multiple employees, providers, workstations, and locations may find it more cost and user efficient to maintain a server because of the flexibility it offers.
- There may already be server components in the clinic with digital radiology and other diagnostics. Upgrading to a larger server environment may not be that much of a jump since the investment is already made in larger practices that already have IT costs as part of their monthly overhead expense.
- Does your clinic have Medicare patients, and does the dollar amount of the allowed submitted charges for those patients total more than $5,000 in a calendar year? If the amount is less than $5,000, then working to demonstrate meaningful use (MU) may or may not be worth it since your payment will be around $3,750 at best. This $5,000 threshold is merely an opinion and not a federal regulation. After helping assist hundreds of DCs receive a check for $18,000 in just their first 90 days of MU, I can tell you that the amount of work to achieve MU was mostly done by chiropractic staff who needed about six to eight hours of training to fully understand it all. Now it is just a part of their normal duties and seems natural as they complete the data entry requirement without thinking about it.
- If your clinic goes over $5,000 in allowed submitted charges for Medicare patients, do you have a few hours per week free to deal with MU? If your schedule is mostly booked and you have no down time, then the opportunity costs may not be worth it unless you have a staff person available who can do 90% of the data entry work for you for a few hours per week. Ninety percent of MU criteria can be performed by staff.
- If you have more than $5,000 in submitted charges and your schedule is regularly open a few hours per week with down time, then it will most definitely be worthwhile to demonstrate MU with your EHR program to qualify for the CMS incentive payment for up to $39,000. The amount you can receive is based on 75% of your allowed submitted charges in a calendar year. This in turn will determine the incentive amount that you are eligible for over a four-year period with maximum threshold amounts capped each successive year. You can learn more about the CMS incentive rules by downloading an article that explains it very well at www.ehrresourcecenter.com.
Steven J. Kraus, DC, DIBCN, CCSP, FASA, FICC, is Founder and CEO of Future Health, the nation’s #1 provider of chiropractic-specific EHR/practice management software. He is an acknowledged expert in Health IT, including EHR (electronic health records) and the up-to-$39,000 ARRA incentive program to implement EHR.
Dr. Kraus has served―and continues to serve―on numerous committees and boards, including:
- ACA Computer & Technology Advisory
- ACA Legislative Commission
- ACA Quality Assurance and Accountability Committee
He lectures to state associations and at industry events regarding EHR and the relationship to documentation, and he presents monthly webinars on how EHR usage will impact doctors of chiropractic. For more information, visit www.FutureHealthSoftware.com or call Toll Free 1-888-919-9919, ext. 652.
In reviewing the scientific literature on patient communication,I found some clear trends 1, 2, 3, 4.
- If you don’t reinforce the message immediately, you can assume your patient will forget your advice making the interaction unproductive at best.
- A follow up call or some form of personal communication immediately after each visit is ideal, as a reminder may help reinforce the importance of their visit.
- Any report of findings provided the patient via “internet patient portals” or email is significantly more effective as the patient not only can review it at their leisure, but can show family members and friends their results. In addition, it does not get lost as does paper.
- Visual data is significantly more effective. The more objective and personalized the data, the more effect it has on the patient and their family and friends.
- Making the communication “Smartphone Friendly” is crucial, as the proliferation of Smartphones requires that your communications be easily readable on them. Many use iPads and Smartphones more than computers for “skimming” their electronic communications.
My girlfriend’s trip to the auto mechanic lead to the solution. She kept complaining of engine roughness. I didn’t notice it and to be honest thought she was a bit paranoid. Instead of the mechanic listening, touching, feeling and expressing an opinion, they plugged her car into a computer. On the screen was a visual image showing her “mass airflow sensor” was defective, They even faxed the results from the computer directly to me knowing that I would need to be convinced also. I know she got great pleasure in using this data to show me how much more right she was then I. I’m happy that makes her happy.
In the days prior to objective data, we would pleasantly say “thank you”, and go off to get several opinions potentially putting off fixing the problem for months or even years! Sound familiar?
We in the Chiropractic Profession share the mechanics dilemma, and may learn a lesson from their approach. We live in a data driven society. Show them why with “instant” indisputable, objective data and we overcome not only their objections and reinforce the need for care, but overcome family members objections. In a data driven world, objective data rules, and those with it have the power to convince. Whether it be mass airflow sensors or wellness care. The key is finding a way to transmit this data in an electronic, instantaneous form which is visual in nature for maximum effectiveness.
I realized that it would be most intelligent to meet the patient where they lived… on their smartphone! Nielsen reports that more than 50% of mobile consumers are using smartphones. According to Nielsen’s monthly analysis of cell phone bills for 65,000+ lines, smartphone owners – especially those with iPhones and Android devices — are consuming more data than ever before on a per-user basis. This is an enormous captive audience waiting to be engaged.
It was crucial that this process maximized the use of technology to remove the need for human interaction and labor. Unnecessary labor is proof of a poorly designed system. This tool had to be fast, allow for instant communication, and provide indisputable, objective data which could be easily presented to skeptical family members and friends. Due to the fact everyone has smartphones, it has to be easily viewable on the tiny screen. Allowing the texting of the image via SMS would improve its effectiveness.
With major technological improvements that have tripled the speed of muscle tension measurements, the tool of choice for this objective data would be Static sEMG. Although Thermography was considered, it is too finicky due to sensitivity to environmental heat and cold, making screenings difficult. Additionally, patients can’t feel temperature differences between left and right sides of their spines, making the results less “believable”. Modern, Wireless Static sEMG can be performed in virtually any environment. More importantly, everyone knows the ache of muscle tension, making instant credibility the doctor’s reward when the graphed results reflect what the patient feels. New University research has validated Standing Static sEMG studies as clinically valuable6. Even more important, a major study by the Veterans Administration established the Static sEMG as capable of accurately tracking patient progress 7, 8.
Impersonal is ineffective. If the patient’s personal Static sEMG results, graphical in nature could be instantly transferred to the patient’s smartphone, that crucial communication between doctor and patient would be reinforced within seconds. Unlike a generic pamphlet on the value of Chiropractic, the patient needing to prove the necessity for care can instantly forward from their smartphone the test results to skeptical family members. Another requirement is for the graphical image to act as an “E-Business Card”, presenting both specific information on the doctor’s office, and an easily customized special offer. The impact on those who’ve received the forwarded, visually appealing graphic would provide powerful advertising for the clinic.
So I built this thing, filed patents and tested it. And guess what else happened. In Beta Testing all of the above conditions were met, and more. The big surprise was how many patients posted this graphic image on Facebook, and did so while still in the doctor’s office! Imagine the impact of your office information marketed by your patients at no cost to you? With the average person having 120 Facebook friends 5,9, the value in terms of marketing alone is quite significant.
The tool proved invaluable at screenings where not only did the patient walk away with an instant personalized message, but also knew exactly how to reach you to take advantage of the special offer embedded in the graphic. Even better, the doctor stored the prospective patient’s email address for instant follow-up and future email marketing.
The term “Viral Growth” is an understatement when it comes to the impact of these visual images flying around the internet. The biggest surprise of all is that each and every patient tested said, and without exception (after saying “Cool”, that is): “Now I can show my _______ why I need my Chiropractor.” It is unknown if this can get us beyond that 8% of the population we’re seeking. Considering the massive proliferation of Smartphones, it at least takes advantage of a new form of high-tech, low cost marketing with potentially powerful consequences.
Technology can be your best friend or worst enemy. By finding the best product and support for your needs, you will have a great partner in building your practice. Follow the simple guidelines above and you will enjoy all the advantages of technology without the stress.
- Thom DH. Training physicians to increase patient trust. J Eval Clin Pract. 2000 Aug;6(3):245-53.
- Betancourt JR. Cultural competence—marginal or mainstream movement? N Engl J Med. 2004;351(10):953-5.
- Osborne H. In Other Words…Actions Can Speak as Clearly as Words. Boston Globe’s On Call Magazine. Jan/Feb 2006. www.healthliteracy.com/article.asp?PageID=3763 (accessed Mar 3, 2006).
- Osborne H. In Other Words…Teaching with Pictures. Boston Globe’s On Call Magazine. Nov 1999. www.healthliteracy.com/article.asp?PageID=3822 (accessed Mar 3, 2006).
- Dunbar, R.I.M. (June 1992). “Neocortex size as a constraint on group size in primates”. Journal of Human Evolution 22 (6): 469–493. doi:10.1016/0047-2484(92)90081-J
- A Meta-Analytic Review of Surface Electromyography Among Persons With Low Back Pain and Normal, Healthy Controls. Geisser, Ranavaya, Haig, Roth, Zucker, Ambroz and Caruso published in the Journal of Pain, November 2005 p 711-726.
- VAS Score Correlates with Static Surface EMG Signal Intensity in Chronic Spine Pain. Ambroz, Alex MD,VA Medical Center, Martinsburg, WV Ambroz, Clara MD, MPH, Disability Evaluation Services, Martinsburg, WV Zucker, Robert MD, MPH,VA Medical Center, Martinsburg, WV Benjamin, Eugene MD,VA Medical Center, Martinsburg, WV
- Caruso, Marianne RN,VA Medical Center, Martinsburg, WV. PAIN MEDICINE Volume 6, Number 2, 2005 p 28-29.
- Marlow, Cameron: “Maintained relationships on Facebook” 2009, March 9, www.facebook.com
That way, patients will have all of their prescriptions, dosage and frequency information available at the click of a mouse.[/pullquote]
Apps for use by chiropractors are scarce, but one EHR company, ChiroTouch, does have a robust offering, with fully- integrated iPad apps for use with its total practice management system.[/pullquote]
One thing is certain: iPads are the flavor of the day. They are thin, light and have thousands of applications available. These applications are very easy to download and are free or inexpensive. iPads and tablets are touch screen, which makes them easy to use. They are also portable and capable of surfing the internet, and are invaluable for accessing social websites and email.
In reality, can we use an iPad all day long in a chiropractic office as part of our Electronic Health Record system? Probably yes. But doctors need to be aware of the negative situations they may have to face when using them for daily operations in their office. I’d like to share 5 of them.
Risk of Theft or Breakage
If used by patients to enter subjective notes or case histories, iPads can be stolen or dropped (and broken), which can be costly to doctors. CAs would have to handle and take care of all iPads used in the office, which would not be a desired additional task. Patients can easily do the same task on a desktop computer, eliminating additional tasks to the CA and eliminating all risk of theft or breakage.
One of the greatest improvements for computers over the years has been the enlargement of screens. With a large screen, software programmers can simultaneously show multiple pieces of information and images, thus reducing (sometimes eliminating) the frequent changing of screens. No one will argue that large screens make software much easier to use. iPads have very small screens. These very small screens lead to a lot of screen changing. These screen changes take up a lot of precious time and may get some doctors very annoyed. If doctors see 60 patients per day and lose 1 minute per patient, they will work an additional hour in their office every day to achieve the same work. At the end of the year, this is 300 hours of productivity lost which, based on 40 hours of work per week, could have been turned into 7.5 weeks of vacation.
Application and Download
iPad software is downloaded and installed through the Apple store. If an iPad does not work, the software cannot be used on a regular desktop computer. The only solution possible is that the doctor will have to buy another iPad and reinstall the software. The lack of another temporary solution can lead to more expenses and hassles.
Freedom of the Chiropractor
Electronic Health Record systems have done something great for doctors. They have removed paper files from the chiropractor’s hands. Doctors don’t have to carry or search paper files anymore. This is one of the most appreciated changes software providers have invented for chiropractors. However, if used by chiropractors, iPads are loading doctors’ hands again. Using an iPad goes backward and eliminates this great hands-free improvement. Also, iPads can be forgotten somewhere and need to be searched for, exactly as with paper filing systems.
iPads and tablets are battery-powered devices, and thus have reduced autonomy. This is a serious operating handicap for a chiropractic office. iPad 3 has anywhere between 8 and 10 hours of autonomy, depending of which application you are using. Videos and networking reduce the autonomy, and iPad 3 takes 7 to 8 hours to recharge*. As you can imagine, you may need more than one iPad, fully charged, to work for an entire day. The hassle of the constant recharge process for iPads or tablets can be very annoying to chiropractors.
In chiropractic or any other profession, reality always catches up with excitement. From there, we will have to find out if software programmers will be able to create applications that will overcome important inconveniences. Will they be able to provide software that will be more beneficial to use and limit the above risks and hassles? The least we can say is that the challenge is great, and overcoming it is no small task.
* iPad power consumption: http://www.onebitzero.com/iPad-3-battery-life-recharging-overheating-issues-review/
Claude Cote is an expert in EHR systems, insurance billing and chiropractic clinic management for 22 years. He has installed EHR system in 18 countries over 5 continents and nationwide in USA. He is the President and Founder of Platinum System C.R. Corp (www.platinumsystem.com). For comments or questions, please email to [email protected]
Google and other local search engines look for “citations” on top directories to help determine rankings.[/pullquote]
Andrew Shotland is the proprietor of LocalSEOGuide.com, a search engine optimization consultancy firm,and consultant for MyLocally.com. MyLocally.com and The American Chiropractor Magazine have partnered to provide a free listing for each of our subscribers. Go to www.mylocally.com to update your listing and look for more information about this great new product.
Technology is growing so fast. Do you feel you can’t keep up with technology? If you do, don’t worry because you are not alone. No one can. Technology, computers, software are growing so fast in so many areas of life, it is impossible for a human being to be aware of everything. The good news is that everyone can adapt to technology at his own speed. So, when you are ready to make a step up, you only need to open the door of technology and you can be assured there is something out there for you to keep you busy for a while.
Are you amazed about the planet being photographed by Google? You could see a real image of your house or you can go to Rome, New York, Sydney and walk virtually on any street. Please take a moment to think about everything a cell phone can do now. It takes pictures, records videos, makes them available to be seen by every human being on earth in seconds, has detailed maps and GPS, reminders, and thousands of other applications. They say iPhone has more than 100,000 applications available. OH! I almost forgot…. On a cell phone, you can make calls, too! When we stop for a moment and think about it, we are all amazed and excited about all this. It makes our life so much easier, saving precious time for other activities and having a much better control on our life. Just think about paying our bills online replacing mailing checks every month, using bank teller machines, instead of waiting in line, and the list goes on and on and on….
Maybe you don’t realize it, but chiropractic is one of the best well served professions for technology. Just like any other technology, it is hard for you to keep up with all the new innovations. I am sure there are a ton of new stuff you don’t even know about. Knowing about a new technology does not mean you have to jump on it right now. In fact, you should always be a little patient to make sure you will make good use of any technology before spending your money. In the chiropractic profession, software competition is very strong. There are many companies out there battling to have new functions and tools to get or stay ahead of each other. This competition creates an ideal situation for chiropractors. Chiropractors can use the very best technology for a low price. In fact, right now, chiropractors can use some amazing tools for way less money than what they should pay in reality, which is wonderful. Lately, I have been thinking about how well served chiropractic is with technology and I wish to share with you some (just a few among so many) of the greatest chiropractic software innovations.
Computerized calling system
To my knowledge, chiropractic is the first profession to use an automated computerized calling system. In fact, I have never seen another calling system anywhere else. A member of your team uses a microphone to record the patient’s name. This takes about 2 to 3 seconds and it is done forever. On his arrival to the clinic, the patient signs in electronically by swiping a Chiropractic Health Card in a waiting room computer. The system builds a queue of patients. The magic starts here. When the doctor releases his treatment room, the system calls patients and directs them into the proper adjustment room, through speakers located in the waiting room. You hear real human recorded calls and not a digital computerized voice. I have personally seen this system in action and all patients are very impressed. Many patients think someone from the back room is calling them with a microphone. It frees up the CA completely and manages peak time perfectly.
Automated credit card and debit payment system
Everyone knows about how a credit card system works. With the patient at the front desk, you grab his card, swipe it in a terminal, key-press the amount and wait for the approval. After confirmation, you need to enter the payment transaction in your billing system. An automated credit card system is an upgraded version of what you have. You do not swipe the credit card in a terminal anymore. You swipe it in a card reader attached to your billing system. While processing the payment, it updates your billing system simultaneously. You can also set up recurrent monthly or weekly payments. At a specific date, the system will process all the credit cards and update all patient financial files. Great for a payment plan. You will be able to keep your actual credit card processor or probably obtain a lower fee than what you actually pay. Some software providers offer this system completely free of charge, included in their basic software package.
Insurance payments automatic posting
Talk about saving time! This is the tool. Imagine, no more insurance payments to enter in every single patient’s file. Insurance carriers (clearing houses) are now providing an electronic remittance file. They all do, unless you submit your claims on paper. This software will read the remittance file and will automatically enter all insurance payments in every patient’s file. This simply means turning hours of work into a few seconds. No more mistakes, no more time lost searching why your billing system does not balance.
Digital X-Rays (with film, too)
Wouldn’t it be nice to have the patient’s X-rays on the screen on every single visit? Now, it is easy, quick and cheap to get this. When the patient gets in the treatment room, he swipes his Health card in a reader. He lies down on the table, ready for his adjustment. When you get in the room, there they are. X-rays are displayed on the computer screen. If you are using X-rays on film, there are some easy and quick ways to get them in the system and do the same thing. You may also have other pictures, such as the patient’s posture, etc.
SMS (Short Message Service)
Time is to emails and cell phone texts. You wish to remind all your patients about tomorrow’s appointments? No problem. Press on one single button and the software will select all patients with an appointment scheduled for tomorrow. It will send them a formatted text message (including their name, the date and time of their appointment) on their cell phone. The patient does not have a cell phone with text feature? Then, the message will be sent to his email address automatically. As a bonus, some software providers have found ways to send SMS free for you.
Good SOAP notes are an imperative requirement. The patient’s subjective part is very important. Don’t you think the patient is the best person to produce his subjective part of the SOAP notes? So, why shouldn’t he do it? On his arrival to the treatment room, the patient swipes his health card in a reader attached to a touch screen computer. A series of personalized and issue-related questions appear on the screen. The patient answers all questions by pressing on the touch screen. While answering, the subjective part is getting built professionally and accurately. Subjective notes entered by the patient himself…you can’t beat that!
Efficiency Control System
This morning, you are a little late and you arrive at your clinic a few minutes before the first patient. Hurry up in the treatment room and start the day. You have a busy day and have to cut out your lunch time. At the end of the day, you are tired and want to go back home with your family and relax a bit. As a business person, you need to take some time to make sure your office is running well. Some doctors in chiropractic are now receiving all their office statistics and reports on their iPhone, Blackberry or personal email. No human action is required. This is all done automatically, every day, every week and every month. Being well rested and outside of the office, they can look at everything they need to maximize the potential of their practice.
These are a few examples only, among so many others, to show you how the chiropractic profession is well ahead of the game compared to many other health professions for technology. Most of these features, or similar functions, are included in the basic price of some chiropractic software.
Now, you are excited and want to use all these features in your office right away? Don’t do that. Don’t go from nothing to everything. The best way to make your office more efficient is to implement one new feature at a time, get used to it and, when it becomes transparent to your operation, you may implement the next feature. A process like this will make you grow steadily and well under control. Like everything else in life, common sense prevails.
Claude Cote is an expert in EHR systems, insurance billing and chiropractic clinic management for 22 years. He has installed EHR system in 17 countries over 5 continents and nationwide in USA. He is the President and Founder of Platinum System C.R. Corp (www.platinumsystem.com). For comments or questions, please email to [email protected]