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Dynamic Chiropractic – March 26, 2009, Vol. 27, Issue 07

When Less Is More, Part 2

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

Editor's note: Part 1 of this article appeared in the Feb. 26 issue.

"The computer is a moron." Or so says Peter Drucker, a famous business management guru for several decades. You can tell he doesn't have a lot of love for computers, even though he was actually referring to software. But when he wrote this classic line nearly two decades ago, computers were in many ways moronic - or perhaps I should say unintelligent. I should know because I was on the frontier of clinic technology when it was still developing its smarts. In 1988, I bought two clunky 286 personal computers, running only DOS and a software billing program for more than $10,000. More on that adventure later.

I bring up Drucker's quote because it dovetails nicely with last month's column and its discussion of paradoxes, in which I relied on another quote from Drucker. I think he is wrong about computers, or if nothing else, developments in the way we use technology has made his quote obsolete. The transition from the days of the 286 to today's clinic technology is what has increased the intelligence of the ways we use computers. We have progressed to such a degree that doing less in our clinics can actually mean doing more.

And that's my paradox from last month, which is the paradox I will continue to explain today. When the doctor does less in their clinic, that's when they accomplish the most. A key ingredient to making this contradiction possible is the use not of moronic computers, but of intelligent clinical technology.

Paradoxes in Short

The less you do in your clinic, the more you accomplish. As I said, it's a paradox, a phrase or concept that seems contradictory, yet expresses something true about life. My paradox is a variation of the "less is more" paradox. I quickly threw in a qualification last month, however, and stated that this "less is more" power is only possible in the clinic guided by electronic health records (EHRs), digital documentation and electronic clinic management - intelligent technology. This technology, I maintain, is the only way any doctor can pursue something I call "clinical efficacy" and remain mainstream in modern health care.

Why Efficacy?

What is clinical efficacy? Efficiency and effectiveness defines efficacy. Efficacy is more than just efficiency and more than just effectiveness. Drucker said, "Efficiency is doing things right; effectiveness is doing the right things." I say efficacy is doing right things rightly.

Efficiency alone isn't enough because you can be efficient at doing the wrong things; clinic practices that might attract auditors, for example. Effectiveness alone also isn't enough because being effective is often inefficient, like the time it takes to be effective in patient education and win patient compliance. You need to be effective with efficiency; that's clinical efficacy.

If you want to read the dark side of efficiency without effectiveness, or the difficulties of being effective efficiently, then refer to last month's column. You'll get a better idea on why I emphasize my own concept of efficacy over and above efficiency and effectiveness alone. It will also help you understand why you can do less and be more in your clinic, even though on face value, it is a paradox.

Intelligent Technology and Moronic Machines

We often have a love-hate relationship with technology, a fact that I've explored in this column before. Most of us are young enough to know that we shouldn't fear technology and old enough to know that technology won't necessarily lead to a paradise on Earth. We've invested in enough clinical gadgets to know that promises of breakthroughs and revolutions through gizmos are often overstated. Just because something plugs into the wall doesn't mean it's going to change our lives, especially if it turns out to be just technology for technology's sake. You might say moronic technology.

So, what ultimately makes technology smart, and what makes it pointless and unintelligent? This is where we return to Drucker's criticism of computers. What makes technology helpful to the chiropractor is the way it handles redundant tasks and integrates parts of everyday practice in advantageous ways. Unintelligent technology complicates everyday tasks that we would do just as efficiently. Intelligent technology automates redundant tasks, integrates patient management milestones (such as scheduling, billing and patient education), and frees us to focus our attention on more important matters, like direct patient care. And in the end, we accomplish more by doing less.

1988 vs. Now

This brings me back to my first year in practice and my first investment in clinical technology. As I said, it cost me more than $10,000 to purchase a couple of desktop computers and billing software that allowed me to print, not handwrite, billing statements. Forget about electronic communication; that was still in its infancy. Everything was sent via snail mail. Chiropractic and medical billing software was in its first generation, and you almost had to have basic computer programming down to use the technology as it was designed to be used. Windows was still primitive and hadn't yet taken over the office computer. Most people couldn't afford a home PC and had no reason to have one. Little more than 10 percent of chiropractors even had a computer in the office.

Those of us who were exploring these new technologies knew we were dealing with technology for its own sake. In retrospect, it would be difficult to justify the time and cost of the investment with the limited functionality I received in return. Today the situation has changed dramatically.

Today you can invest that same sum of money and get intelligent clinic technology that helps you write faster, achieve more compliant documentation, generate referrals and build patient compliance, and get paid by third-party payers the first time you submit a claim - because of the accuracy and detail of the submission and the zero tolerance you have for coding errors. Technology that will actually help you accomplish more by doing less. Technology that allows you to be efficient and effective. Technology that doesn't just exist for its own sake, but is well-worth its return on investment.

Efficacy and Smart Technology

Clinical efficacy, the kind of management that allows you to be simultaneously effective and efficient, requires smart technology. Smart technology frees us from the repetition that imprisons clinics and buries them in paperwork. In Drucker's day and age, the computer may have been a moron, but today's technology is the only thing that's going to allow doctors to accomplish more through direct patient care in our health care environment.

The requirements of transparency, privacy, transmission, tracking, clinic management, and a sense of urgency when it comes health information technology as it relates to our EHRs, all make software technology that much more efficacious. It's a paradox, yet we'll be accomplishing more by doing less because redundant tasks can be done more efficiently and effectively by intelligent computers, which are better suited to the redundancy that is burdening all of health care. There is a reason $77 billion will be saved annually in the American health care system, according to the U.S. Government Accountability Office, if all health care providers adopt an EHR in their clinic. The reason is efficacy.

The goods news is that it no longer takes $10,000 and a degree in programming to use clinic technology to its fullest. Just as virtually every DC has some form of billing software, everyone of us will be adopting (or already have) EHR software technology sooner, than later. All it takes is a willingness to see the immediate return on investment,and the patience to learn which system best suits you. With the proper guidance, some computer software programs are now intelligent enough to do the rest.

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

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