Imagine increasing the number of patients you see each day and eliminating some of those time-consuming office processes that divert your attention away from your patients and revenue stream.
Dr. Shane Fishbein has been able to do this. He has one staff person at his two-chiropractor office in Orange County, Calif.
He doesn't order office supplies like paper, travel cards and pens anymore. Instead, Dr. Fishbein spends his time treating his growing number of patients. "The only thing my staff has to worry about is greeting my patients with a big smile and showing them to a treatment room," Fishbein says.
Dr. Glenn Boley of Louisa, Va., agrees. Like most of us, if Dr. Boley had his way, he'd never do a lick of paperwork again. "What I love to do is treat people. All patients deserve to be treated well. Of course, I deserve to be paid, but it shouldn't be a hassle," says Boley. He points out that the billing maze for a Medicare reimbursement can often cost more in time and aggravation than the reimbursement check that may eventually arrive.
Going paperless has made the difference for both Dr. Fishbein and Dr. Boley. Unfortunately, going paperless has gotten a bad rap in some circles. Articles have been written about the struggles of electronic medical records (EMRs), the hassles of adopting technology into medical practices, the cost of software programs, training for staff, ongoing operational costs, and slow, difficult transitions. Software, in general, can be criticized for high upgrade costs, add-on fees for service and storage, and long training periods made worse by unresponsivecustomer service.
But there is another side to the story. A paperless EMR should streamline your practice, improve the bottom line and better serve your patients. It's time to look at adding technology to chiropractic practices as an investment that improves patient care, increases reimbursements and streamlines our practices for greater efficiency. I've done it, and so can you.
"I think the biggest hidden benefit of going paperless is the psychological impact. About 80 percent of the worry is gone. I don't have paperwork and administrative duties constantly on the brain," says Fishbein.
The Benefits of the Internet
I had a patient who marveled at the reporting capabilities of my new Web-based EMR. He was referred to me by his primary care physician. During the appointment, I asked if he would like me to send the doctor a report on his visit. I entered the doctor's fax number and sent a copy of the report from my treatment room. The doctor and the patient were amazed at the speed and the quality of the report. Neither had ever seen anything like it.
With two clicks, we were communicating without even trying. There was no dictation, report writing, printing or copying, and my staff wasn't involved at all. It was all automatic. And the doctor's contact information is in my system, so in the future, I can send the reports for any visit with a simple click. Best of all, referrals from this doctor have increased noticeably.
My colleague, Dr. Paul Kohake, who practices in a suburb of Cincinnati, reports that going paperless has made for less work, especially as it relates to reports. He says he has completely eliminated four to six hours of report writing he used to perform for workers'compensation claims. With a few clicks, our EMR generates the reports he needs. "The reports are the best I've seen and couldn't be simpler," says Kohake.
According to Kohake, he can document a note in two to three seconds and thanks to the EMR, there's no travel card to route, files to pull or in-boxes to clean. Those tasks used to take several minutes for every patient visit. Kohake says the biggest time-saver of the EMR is the auto-coding feature that allows him to drill through transcription notes, diagnoses codes, procedures and charges in mere seconds.
"If I'm not spending my time handwriting notes and typing them later, I'm able to spend more time with my patients," Kohake says. "Patients have noticed the difference and value the added attention. The Internet allows me to write and generate notes anywhere. I don't have to carry a stack of patient files around with me."
Dr. Fishbein has noticed the same improvements to his practice. "I have access anywhere, from my home, my office, a laptop at Starbucks," Fishbein says. "And I'm taking better and more consistent notes, and spending more time with my patients."
The Internet also has allowed Dr. Fishbein to save money and increase reimbursement by outsourcing his billing to the Midwest, thus tapping into a less-expensive employee pool than he's faced with in his hometown. Another added benefit of the Internet is that you don't have to back up on-site at the practice. The Internet server or servers where the files are housed, provides the backup. Power outages, surges and worst case, disasters, won't affect your data.
Dr. Boley, a chiropractor for 20 years, has seen the good and the bad of supposed computer solutions. But Boley has a particular favorite feature of the new brand of Web-based EMRs. "Everything can be done without charts, and I'm not wasting my time trying to find the right file," he said.
Dr. Boley also expects to make staff reductions soon. His practice, located in a town with more cows than people, he jokes, sees about 50 patients a week. But some travel from as far as Washington, D.C., and as much as 90 minutes to see him. The local patients, as well as the more urban and suburban patients, expect that kind of paperless technology to make managing their health information easier and less costly.
Patients Love It
"The patients really like it. It's a transition, but it's not complicated and once they get it, they can be as involved as they want to be," says Fishbein. That's because an Internet-based EMR can also include a patient interface. At the doctor's option, patients can:
- schedule their own appointments;
- choose to receive e-mail reminders of their appointments;
- keep their medical records -general and chiropractic - in one central location; and
- share their medical records with their other doctors or caregivers.
"Patients prefer to have control over their own appointments and their health," says Fishbein. "They can get online at 10 p.m. to schedule an appointment for the next day, and go to sleep knowing they'll see the doctor in the morning," he says. When they check in, patients are prompted at an optional kiosk with questions about their symptoms and pain rating.
"I get a better idea of what problems need correcting just from glancing at their subjective intake collected at check in," he adds. "It's fantastic information to have at my fingertips." And for those who aren't as familiar with the computer, staff can guide them through the system. It's as simple as a common ATM machine. "Most people are very media-savvy at this point and aren't resistant to the system," says Kohake.
Patients of a chiropractic practice and wellness center also in suburban Cincinnati say the technology upgrade makes going to the doctor simpler. "Instead of doing all the new-patient information paperwork on a clipboard, I enter everything about myself on the computer. It's really advanced and convenient," says new patient Tom Breitenbach. "And I like the fact that I can now easily access all my medical and treatment information, so if I have to see another doctor, it's right there for me."
All Systems AreNot Created Equal
Perhaps the reason so many of us view computerizing records as more hassle and unwanted expense than opportunity is we're not looking at the right programs. When shopping for an automated system, we should ask the following questions:
- Does this make less or more work for me?
- Is it truly paperless? If not, what's the point of changing?
- Will this lead to easier note-taking? My time is valuable.
- Will this make my reports easier and faster?
- Will billing become simpler?
- Will this help my patients?
- Will it lead to better patient care?
- Is the system HIPAA-compliant?
- How are the data backed up? Am I responsible for some expensive data-recovery system?
- How and when is it updated? Is there a cost for updates?
- How flexible is it? Can I customize it to my practice?
- How much will training cost?
- Will it help me reduce staffing or lighten the load on mycurrent staff?
Technology is supposed to make our lives easier, not more complicated. We should expect that using a computer can help us reduce costs. Automation should serve us, not the other way around. One of the reasons we, as chiropractors, have been so resistant to good record-keeping and going paperless is that the technology hasn't gone far enough for our profession.
Using the efficiency and organization only a computer can provide, along with the connectivity of the Internet, should be a good thing. A truly paperless EMR that's affordable, easy to use and helps save money is a huge plus for any practice.
