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Dynamic Chiropractic – May 20, 2008, Vol. 26, Issue 11

Three Rules to Avoid Buyer's Remorse: Shopping Smart for the Digital Clinic

Shopping Smart for the Digital Clinic

By Steven Kraus, DC, DIBCN, CCSP, FASA, FICC

Buyer's remorse. It's that sick feeling we get when we realize the thing we just bought isn't what we needed. We acted on an impulse or incomplete information, and now we're stuck with something that reminds us of our bad decision.

Buyer's remorse is a terrible feeling, and unfortunately, it's felt by some chiropractors who've bought digital clinic documentation.

It doesn't hit the next day or even the month after. It hits several months later, when the doctor realizes the benefits they were supposed to see haven't materialized. It's when the doctor realizes they didn't buy an electronic health record (EHR) system. Instead they bought a glorified digital note system that hasn't offered one solution to the problems that led them to go digital in the first place.

Avoid Remorse With the Right Information

If you're looking to go digital, you want to avoid buyer's remorse. Because of the confusion I've seen among fellow chiropractors regarding EHR, I'd like to help you understand the basics of what you need in an electronic health record. Let's call them "Dr. Kraus' Three Rules for Successful EHR Shopping."

Rule #1: Think About the Future; Buy an Actual EHR

Don't make an EHR purchase without the same kind of serious thought you gave the details of your clinic facility. You're making a decision that's going to affect your practice for years to come. That means buying digital documentation based on what works right now is shortsighted.

Cheaper products work right now. Products without the proper support work right now. Products from companies that go bankrupt work right now. But there's no guarantee any system that's good enough or cheap enough for right now is going to meet your future needs. Let me give you a clear example of what I mean.

The empty Windows folder. It's common to go to professional seminars and see vendors selling digital documentation that's built to meet your immediate needs. Small and big companies sell sleek-looking digital SOAP notes under the guise of it being an EHR. You'll watch demonstrations of salespeople creating notes instantly and saving the documentation to a folder on that computer's hard drive. It looks efficient and hi-tech, and the price is just about right for what the digital neophyte is looking to pay. Nonetheless, there's a problem lurking.

What the salesperson fails to say is that you're not looking at a true EHR; it's just a digital note. It's a digital version of your current paper notes, saved to a file folder in the "My Documents" folder on your computer's desktop. At the seminar, the setup looks good because patient John Q. Public has only three other documents in his patient folder. However, when a doctor is trying to find information on a real patient who has 60 individual stored documents, plus images, EOBs and questionnaires in the patient folder, along with other notes, radiology reports, etc., the problem becomes apparent. You've got a disorganized mess on your hands, making retrieval more time-consuming than a paper file.

Remorse one year later. With note generators that are not true EHRs, the conveniences of the digital clinic break down under the weight of searching through 60 digital notes saved like any other file on your personal computer. There is no instantaneous searching based on multiple parameters unique to the patient. There is no option to create graphs with trends that demonstrate patient progress for patient education or insurance reports. There are few options to electronically send these files via HIPAA-protected methods to other providers. And of course, the files only exist in one place. There is no multilevel access for the multiple practice personnel who need access to the notes.

In other words, it's obvious that this is no electronic health record. It's a program for creating and saving digital notes. There's no EHR archiving. Instead of thinking about the future, the doctor was thinking about what was good for the moment. They were probably thinking, I just need something that makes my notes legible! Now, clicking through pages of digital notes has lead to buyer's remorse.

Rule #2: Know What You're Buying; Ask to See the Record

I know from talking to thousands of chiropractors that it's easy to get lost in the features. Program A offers features 1, 2 and 3; Program B offers features X, Y and Z. The DC will ask: "Which ones do I really need?" They're confused by the array of technical jargon and lose sight of what's important. That's why I usually remind anyone consulting with me of what they're really buying - the means by which their patient care is going to be judged from the outside.

Ultimately, your decision of which EHR company to contract with should come down to which one delivers the highest-quality documentation. The ability of your records to clearly and consistently communicate your relationship with the patient and their response to your care is what really matters. That means you can't just shop by comparing features and prices. You need to see what the final product actually is, whether it's a record of your focused or comprehensive exam, or your daily patient interaction. Of course, the design of the system for ease of use and speed also are important so it can be adapted into your workflow.

What will the record look like? Once you have established that your prospective company actually offers an EHR, the next step is to ask to see the documentation itself. What will it look like to an MD, PT or DC when they read it? How will it read in a Medicare CERT review? How will it look if your records ever make it into court? Is it robust, with charts, graphs and diagrams? Or is it strictly text-based? Is the text nonspecific and full of fluff?

It's only after you have seen the quality of the record that the price of the program is put in perspective. It's not uncommon for us to spend tens of thousands on the latest diagnostic tools, adjunctive therapy devices and breakthrough technique courses. But when it comes to spending a few thousand for a program that actually elevates the perception of our care and improves the professional image (resulting in payment for care and more referrals), some chiropractors continue to believe they're just looking for something to make their SOAP notes more legible.

My advice: Don't fall into the pricing trap by comparing apples to oranges. Ask to see the documentation. You're not just looking for legibility; you're looking to elevate the communication of care through the quality of your documentation. Image enhancement, medical-necessity approval, referrals from others, and getting paid are the benefits that result from a robust, comprehensive documentation system.

Also, the true EHR is a secure, real-time, interoperable point-of-care, patient-centric information resource. It can aid in providers' decision processes by delivering access to patient health information using evidence-based decision support. The EHR can automate and streamline workflow, improve communication with staff and improve response times to make the office more efficient. An EHR can also create alerts and reminders to improve quality of care. The EHR also supports data collection for billing, quality management, outcomes assessment and practice-management statistics. An EHR gives you the infrastructure you need to manage information and data about your patients and your practice overall. If chosen correctly, it's more efficient and more secure than paper.

Rule #3 Buy a System That Will Make You Faster

This might be the most obvious rule, as everyone is looking for speed - but it's often the hardest to guarantee. That's because most of us won't have the convenience of running our clinics on three different EHR systems in order to see what allows us the most efficiency. We have to evaluate based on limited information and guess which one we think will make us faster. This process is inexact, but perhaps I can help make it more reliable. Here are two key product benchmarks that will help you see what systems will actually allow you greater clinic efficiency.

Look for customization. Your system should have intelligent customization. Because of chiropractic's technique-based delivery system, you need documentation that works around your established workflow. A program that forces you to adapt to a new way of patient workup or forces you to fit your workup into their model is going to slow you down. You should be able to enter any free-form dictation or custom sentences, at any section of the note, for special circumstances. You also should be able to insert your unique treatment protocols so they're standard for your digital documentation.

Seek the future. Buyer's remorse over your digital-documentation purchase is a terrible thing to go through, because along with the remorse comes thousands of dollars in wasted time, opportunity and money. My hope is that this advice will stick with you as you go out and evaluate the many options you have in digital documentation.

The most important thing to keep in mind is to be patient with the process and always remember to think about the future. Keep asking, how is this going to help me three to five years from now? You'll be more likely to find a system that actually offers a true EHR that elevates your clinic records through its quality, even as it makes your clinic faster. Remember, you're not just looking for something that's good enough for today - you're looking for a solution that will transform your practice's future.

Click here for previous articles by Steven Kraus, DC, DIBCN, CCSP, FASA, FICC.

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