August 2002

Harness the Power
The Electronic Office: If Not Now, When?
By E.P. Cianciulli, DC, MS, FICC

Computer technology has been hailed as the great savior in the business world, but it must also be viewed as having a “dark side.” Technology can be harnessed for both good and bad, affecting both our professional and personal lives.

The explosive increase of computational resources, speedier computers, more comprehensive and efficient searches and queries, and voluminous amounts of data all can result in a treacherous “data minefield” for doctors.

Instantly, a physician’s profile - whether it be related to treatment protocols or billing procedures - can be monitored, scrutinized, and profiled. Electronic surveillance of professional offices will now be the turf of the future in health-care delivery.

The power of the federal government is being unleashed through the implementation of the Health Insurance Portability and Accountability Act (HIPAA). This broad legislation deals with a wide set of health policy issues ranging from health insurance access, to health-care reimbursement fraud and abuse, to simplification of a variety of administrative tasks associated with health-care services.

The question that logically follows is: “How does the physician not only survive, but prosper, in this new era?” The answer to the dilemma rests in technology itself - if it is harnessed intelligently by the practicing doctor of chiropractic. The old adage, “It takes a spy to catch a spy,” is in vogue as privacy concerns escalate.

Clerical and Clinical Needs
More than ever, today’s practices, either chiropractic-only or multi-discipline, necessitate the use of computers and technology. The cogent implementation of well-designed software, coupled with an integrated clinical workflow, will enable the doctor to navigate this era of reimbursement challenges, malpractice or medicolegal concerns, and increasing government oversight.

It is not enough for a software program to simply perform billing or reporting. The software must marry all the clerical aspects, such as billing, insurance tracking, scheduling, etc., with all the clinical aspects, including patient charts, treatment profiles, and outcome analysis. Increasingly, office software must also help the doctor with self-protection and growth.

The myth of being able to succeed with simplistic scheduling and cash practices will be in jeopardy. A practice can no longer be successfully managed using a paper and book system. In fact, the majority of legacy software programs will become obsolete.

Office management software must be sophisticated and easy-to-use. This mandates a design team of physicians and information technology specialists working together to define and sharpen the best workflow possible. Since ultimately it is the doctor who will use the system, the clinical workflow joined to the daily routines should be the main considerations in the design of the software.

As computers evolve and improve, and as the architecture progresses, the “gold standard” will be the software user interface as it relates to the daily patterns that are characteristic of a health-care practice.

Going With the Flow
The use of electronic claims will substantially increase cash flow, but it will demand flawless transmission, data encryption, and security of the highest order. Billing records and HCFA forms are now the primary information transmitted electronically, but it is only a matter of time before patient treatment records, documentation, substantiation of treatment necessity and procedures, and a milieu of other data will also be transmitted electronically.

The myth is that electronic patient records, or computerized patient records, will automatically save money and result in better healthcare. Canned, computer-generated, randomized notes will not be a part of the future of health-care documentation. Instead, successful computerized documentation must include data collection, and computerized, intelligent notes by a variety of original, efficient, and defensible methods.

Increasingly, doctors will need to learn to transform clinical notes and data into electronic form. But this adoption curve needs to be streamlined and easy-to-use, or much as physicians’ handwriting has deteriorated, so will computerized patient records (CPR). The doctor must become well-versed in computer technology, although it won’t be necessary to become a “tech freak.”

The Personal Touch
The office of the future will, in all probability, house a computer or monitor in every room; or may implement mobile computing via personal digital assistant systems (PDAs)/handhelds. The economics of the computer companies, coupled with the economics of running an office, will be the driving factors.

In answer to the question: “Will patient care be improved?”, the answer is yes, if we intelligently harness computer technology. If, in the process of caring for patients, the doctor is more engrossed in the technical aspects and not in direct contact, then the patients will not be as well-served. The “Golden Rule” when implementing computerization must be, “Never break patient contact or attention for the sake of the computer.”

If the doctor spends the majority of the patient encounter viewing and inputting into a monitor, instead of listening and treating the patient, then the doctor-patient relationship will suffer. Conversely, if the software is enabled to allow ease of entry without patient interference - i.e., voice, touch, PDA - then the reality of improved healthcare through CPR will be achieved.

The software must enhance the doctor’s performance and outcomes. It is not intended to replace or inhibit the staff, but rather to complement the office workflow and provide for efficiency and comfort. It should automate the mundane, repetitive aspects of an office, thus directing the energies toward better patient care and clinical excellence. Office software should serve as a silent, symbiotic partner to the entire enterprise. Hence, the multiplicity of demands on the office software is, and will continue to be, vast.

With the most recent tech craze, the rush to handhelds/PDAs is enormous. The convenience of Walkmans®, MP3 players, and cell phones has accelerated our desire for miniaturization, portability, and speed. This concept may offer the perception that PDAs/mobile systems will be the saving grace to many of our computing problems.

This is true to a degree, but with an important caveat: Namely, the PDA is simply the entry device into the software program. As such, it has little value as a stand-alone or non-integrated device. True functionality only derives from integrating the PDA with a compatible host system. Thus, it cannot simply be an add-on, but necessarily must be part of the total design of the workflow pattern. Anything less will ensure failure of the system, and more importantly, non-utilization.

Access to Information
A common myth of computerization is that the computerized office means the use of less paper. However, a review of the statistics reveal a startling increase in office paper consumption in the United States as computer technology has become more advanced.

In 1995, an estimated 24.4 million tons of paper were consumed, verses 27.3 million tons in 2000. Yes, computers have absolutely reduced the need for more and more paper in some instances (e-mails vs. printed memos and letters, etc.). However, the sheer computational power has created an atmosphere in which reports, records, searches, and queries that were previously impossible or at least extremely difficult, can now be produced by a single mouse click. And when we have that information available, we often print it out for our records.

The intelligent software programs will allow for a screen preview, whereby the data/report can be viewed and not necessarily printed. Only the essential information that you know you may refer to later needs to be printed. Again, it is the human interface that is of paramount importance.

Making the Transition
One of the most important elements in gaining benefits from electronic health records is the doctor - for it is the doctor and staff who must maximize the technology. In some cases, the transition to electronic health records may be a difficult segue. Reluctance to change, comfort, economic factors, training, support, and fear are variables that can impose barriers to an office adopting new technology.

A myth among physicians is that electronic health records require more time and are less convenient. Many are reluctant to end the paper-chase method of writing notes and handing them off to a CA to complete. What is not factored into that equation is the entry time, and the time wasted in filing, chasing, locating, and copying. We often fail to realize how many time-wasters we have become accustomed to in the paper world. Thus in reality, there is very little, if any, time loss stemming from going electronic - but the accumulated benefits are enormous.

The bottom line is that eventually, the transition must be made. The doctor of the future must migrate to a software integrating a clinical workflow. Out with the old and in with the new is appropriate, for doctors who want to thrive in today’s managed-care environment.

The implementation of the new generation of software will no longer be a static model as before; it will be a dynamic, vibrant, ongoing, evolutionary software design with the singular goal of achieving excellence in the clinical workplace. When everything is running as it should, electronic health records can bring Nirvana to doctors, staff, patients, and payors.

The type of technology envisioned in Stanley Kubrick’s “2001: A Space Odyssey,” is finally closer to becoming a reality: “Good morning Hal, please display my health-care profile and transmit it to Vulcan!”

Dr. Cianciulli is a former delegate of the American Chiropractic Association for New Jersey, past president of the New Jersey State Board of Chiropractic Examiners, and recipient of the John I. Crecco Foundation's 1999 “Chiropractor of the Year.” He is a clinical consultant to Pulse Software, LLC, Kenilworth, N.J., and oversees the clinical development of the company’s programming. Dr. Cianciulli maintains an active chiropractic practice, and he is co-founder and co-director of the Universal Chiropractic Physicians Nationwide. He can be reached at 908-289-9613, or sign on to www.chiropulse.com