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Dynamic Chiropractic – January 1, 2009, Vol. 27, Issue 01

Get Your Life Back

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

As I travel, talking to members of our profession, I'm amazed by the number of doctors serving a prison sentence. Almost all have been wrongfully accused and don't deserve to be where they are. Yet the walls have risen so high that they're unaware there's an escape route right under their noses.

Of course, I'm not talking about true-life criminals in actual prison. I'm actually talking about the effects of the growing health care bureaucracy and associated paperwork. To use a cinematic comparison, thousand of chiropractors are like the Tim Robbins character in "The Shawshank Redemption" - wrongfully convicted. They are working more hours per week. They are seeing their families less. They are spending less time in direct patient care. They are being held down against their will for a crime they didn't commit. They're in paperwork prison.

If you're in paperwork prison, now is the time to consider why you're there. A new year is here, and resolutions for our practices and personal lives are in order. Why not make a resolution that can bring balance back to both? May I suggest that it's time to use the right technology to get your life back? Make a resolution to bust your way out of your paperwork lockdown. Let me tell how and why it should happen now.

Locked Behind an Unlocked Door?

"A man will be imprisoned in a room with a door that's unlocked and opens inwards; as long as it does not occur to him to pull rather than push." This is a quote by a famous philosopher named Ludwig Wittgenstein, and it describes many of us in practice. Overwhelmed by documentation, we have taken a defensive position behind an unlocked door, believing that it has closed us in. Some have pushed back; they've streamlined their clinics under current management ideas. They've revised intake forms and SOAP notes; they've retrained their billing staff to code everything out to five digits; they've rearranged their schedules to account for more and more paperwork. Yet the door is still closed because they're not asking if pushing isn't going to work in the long run.

It's not a problem of the door being locked. It's not a problem of it being shut, either. The problem is seeing the door and assuming that the way we've always opened the door is the way to do it now. So, we're stuck pushing. In other words, we're stuck doing clinical tasks in the same way we've always done them: inefficiently. The door isn't opening. Fresh air isn't getting in. For many, it's starting to feel as restricting as a jail cell.

the door will open. You just have to be willing to see that the same old clinic management isn't going to do it. As time passes, the failures of paper are going to force all of health care to rethink its traditional management approaches. And technology definitely will force us to change. For many of us, it's the very thing that's going to open up that closed door and give us our lives back.

The Beginning of the End of a Decade

Yes, 2008 is behind us and the end of a decade looms ahead. Back in 2000, Medicare audits weren't weighing on our minds and electronic health records (EHRs) weren't, either. We woke up in 2000 to discover that the Y2K bug didn't cripple the world, and right after, we swore in George W. Bush as president. In the past eight years, the health care and political landscape has changed enormously thanks to things like terrorism, wars, credit booms and busts, the baby boomers retiring, and health care costs growing exponentially. In just a few days, our country will inaugurate the first African-American president in history. What else will change in the next eight years?

With Barack Obama in the White House, we can expect to talk more often about national changes in health care documentation. He planned for EHRs being a significant part of the change in health care. I had the opportunity to sit down with Obama for almost a half hour and discuss how EHRs will be integrated into all practices in America over the next several years. I was in a room with the president-elect, one Secret Service agent and two policy advisors. In our conversation, Obama felt the adoption of EHRs into our practices would save the American health care system more than $77 billion annually.

If actions follow the 2008 election talking points, then the interest generated by George W. Bush in EHRs will probably develop into a specific federal EHR policy. As I outlined over the past year (way back in the presidential primaries), everyone is talking about the need to get health care costs under control, and the widespread adoption of EHRs are at the top of the list for controlling costs and medical errors. In eight years, there may be an EHR system in a majority of health care offices, including single and small-group practices. It's that very technology which will force us to change.

I don't believe that many of us can actually wait six years, however, to finally break out of our paperwork prisons with mandated EHR. Some will be audited. Many will burn out. Those who quit will be replaced by younger chiropractors who are already familiar with EHRs and digital documentation from their student intern experience. The question is: Why wait for forced change when we need that change now; when we need something to turn the handle and open the gates on our paperwork prisons?

The federal guidelines are already set as to how EHRs talk to each other and communicate and function. It has been planned since the origination of HIPAA in 1996 and was drafted more than 10 years ago. How do you think hospitals have universally adopted EHRs already? Thousands of your peers have already seen the light and adopted an EHR into their practices.

Get Your Life Back

What would it look like to have your life back through the proper clinic technology? Allow me to conduct my own retrospective look at this past year's columns, and draw out three key highlights from some topics I've presented. Hopefully they'll inspire you to make 2009 your year to break free of your paper prison.

First, the right clinic technology offers true clinical integration that completes the five necessary tasks of patient care (documentation, complete chart storage of all documents and images, billings, scheduling, and patient education) with greater efficiency and fewer mistakes, saving you time and an incredible amount of office energy.

Second, the right clinic technology can essentially erase any concern over paper-file storage and management, so there's no losing files, searching for files, or reorganizing files - key slowdowns that lead to paperwork overtime. Even better, there's no spending time and resources on these repetitive clerical tasks, so you can actually save money and get a return on your investment.

Finally, the right clinic technology can help you customize your transition away from paper to digital, so you become more efficient at doing what you do, the way you do it. This includes working up patients and documenting daily patient encounters. Your workflow shouldn't be a causality of giving up paper. For example, customization of digital documentation has been an important factor for the early adopters of the NCQA low back guidelines, as clinic technology can help you anticipate what third-party payers and guidelines want to see in your documentation. Being able to customize workflow for patients based on the demands of their third-party payers helps to ethically streamline patient care in a way that encourages proper reimbursement through proper billings and the creation of an incredibly detailed record. All without the clinic overtime.

Break Free in 2009?

The right clinic technology (EHRs and digital documentation to start) can do all of these things. And best of all, it can help you escape your paperwork prison and get your life back. The key point to take away from this column is this: Don't wait until it's mandated by the federal government to break free. You'll be sacrificing too much from your personal life. Besides, the solution is right in front of you in the form of EHRs, advanced digital documentation and digital clinic management. Approaching the problem from the usual paper-based perspective isn't going to help you open the door to documentation freedom. It isn't going to get you home any sooner or help you play paperwork catch-up any faster. It isn't going to give you more time in direct patient care.

You may think you can tunnel your way of out of Shawshank over the next several years, but there's an easier way to get out of your paperwork prison; one that doesn't rip you away from your family. Just get rid of the paper. It's as simple as turning and pulling the handle of an unlocked door and opening it to the clinic of the future.


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

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