Rarely do we benefit from government mandates. Electronic medical records (EMR) is one of those rare mandates that actually is beneficial for us. In his 2004 State of the Union address, President George W. Bush stated, "By computerizing health records, we can avoid dangerous medical mistakes, reduce costs, and improve care." In April 2004, the president issued an executive order to accomplish computerization of health records by 2014. The computerization of patient files was further mandated by congressional action and signed into law by the president in the form of HIPAA (Health Insurance Portability and Accountability Act).
Various terms are used synonymously with electronic medical records. These include electronic health records (EHR), electronic chiropractic records (ECR) and electronic clinical records (also ECR). While some differentiation is being made between these terms, the majority of individuals and companies who use these terms interchangeably.
As you might expect, EMR is the patient's file in an electronic format; in other words, the file is not on paper. It is in a computer. Most offices already have a preliminary and very basic part of EMR in the form of billing software. However, this is not nearly the level of electronic documentation required by the government mandate.
Many doctors and insurance companies think EMR refers only to documentation, such as SOAP notes. The following definition is used by Princeton Insurance in New Jersey, where I practice. Princeton defines EHR as the total file, which I define as a complete EMR system. The complete EHR/EMR contains all the history, examination and SOAP note information for each and every patient. In addition, it should include (but not be limited to) appointment schedules and history, phone calls and other logs, memos, letters, e-mails, insurance data and billing information. Anything and everything that would normally have appeared in a patient's paper file must be in an electronic format, in more depth and detail than required with paper. There are a few comprehensive computer systems that are already at this level. A very small number of these EMR/EHR systems are chiropractic-specific, having been designed and developed by chiropractors.
You need an EMR system in your office for two reasons: the government mandates it, and it provides you and your practice with significant benefits. The most noticeable benefit is the elimination of most filing. Whether a patient's records are in a large paper file, travel cards or some other paper mechanism, someone must pull the files out of a cabinet every day. After you have made your entries, someone must put the files away. At least 90 percent of the time spent in the filing cabinet is eliminated with EMR. This gives you two options: make your staff more productive with re-calls and collections, or cut staff time and reduce your payroll expenses.
Additional advantages of EMR empower you and your staff in other ways. Files are never lost. Time spent on many mundane activities is greatly reduced. Complete EMR systems never forget appointments and include follow-up re-call features. They also never forget a bill so your staff can do a better job of collections. Pop-up messages replace the sticky notes that litter desks and bulletin boards.
Once a patient has signed in at the front desk in a comprehensive EMR program, that patient's account appears automatically on the computer in your adjustment/treatment room. If you enter your SOAP note in real time as you provide care to the patient, your documentation has generated the charges for the services you just performed by the time the patient returns to the front desk to check out. Fee slips, travel cards and the expenses that go with them have just been eliminated.
More time is saved when an insurance company requests information. With some EMR programs, all you do is push a print button. There is no time spent on pulling a file out of a cabinet, sorting through it to find the items to copy, translating your unique shorthand, copying the papers or placing a file back in the cabinet.
Some EMR systems include templates for narrative reports. If all the patient information has been entered as it was received, the process takes just a few seconds when you get the request. You select the template and push a "generate" button. The report appears on your screen. You can e-mail, fax, or print and mail the report. A copy of the report is saved as part of the patient file, so you can view and reprint it at any time.
As you know, various patient documents can show up at your office. These include items such as police reports, diagnostic studies (lab and imaging) and data from other doctors. EMR programs include scanning capabilities so these documents can be scanned into the patient's file. Once scanned in, depending on the state in which you practice, it may not be necessary to save the original. Whenever there is a need to reference the document, it can be viewed from the EMR program. Again, the EMR software has saved you and/or your staff a good amount of time, since there is no need to go in and out of a filing cabinet.
On the billing end, electronic claims are commonplace. Complete EMR makes sure you do not have to worry about being audited. Prior to producing insurance claims, the system checks to see if you have SOAP notes for the dates of services you are billing. If you don't have notes, the system gives a report listing each patient that is missing them. It is better that you find and enter the missing notes before an insurance auditor makes the discovery. The production of electronic insurance claims takes only a few minutes to create and submit. There is no money thrown away on postage, and no one has to stuff and mail envelopes.
Some EMR systems include letter-merge systems to produce personalized letters in bulk, based on criteria you select. These systems are based on templates, and a few of the EMR programs empower you to create your own templates and/or modify the templates in the system. The letter-merge systems can be used for patient education, re-call campaigns and collections. Some systems also have the ability to access lists of attorneys, employers, other doctors and diagnostic centers so the letters can be used for marketing your practice. The letter templates can also be used to create patient forms, with some patient data filled in by the EMR system.
The best news about an EMR software program is the return on investment it provides. Based on the time saved, the greater number of patients you will see, the improved staff efficiency, the increase in collections and the enhanced re-calls, a comprehensive and complete EMR system may save you literally thousands of dollars per month.
This may be a once-in-a-lifetime event; government actually has made our life better by forcing us to fully computerize our offices. Considering all the benefits, there is no reason to procrastinate until 2014. The best time to implement a comprehensive EMR/EHR/ECR system is now. Remember, we do not have a choice about computerizing patient files. It is wiser to do it earlier rather than later.
Dr. Paul B. Bindell, a 1975 graduate of Palmer College of Chiropractic, has practiced in Rockaway, N.J. since 1976. In the 1980s, he produced a chiropractic television program, newsletter and newspaper column called "The Chiropractic Answer," and in 1991, he co-founded Life Systems Software. For questions or comments regarding this article, contact Dr. Bindell at