Kraus9-2012For traditional practices and multidisciplinary offices, do the benefits of implementing electronic health records outweigh the effort?

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

When it comes to using electronic health record (EHR) software — whether in a traditional chiropractic practice or a multidisciplinary office — it usually comes down to just one question: Is it worth it?

For the vast majority of cases, the answer is “Yes.”

Keep in mind the considerations for traditional chiropractic-only clinics differ from those of multidisciplinary practices. So choose your EHR software based on what you want your clinic to look like in the future, not necessarily on what it is like today.

Perhaps you have a traditional practice now, but plan to build a multidisciplinary clinic down the road. You’ll want to make sure your software can accommodate your plans for growth, otherwise you’ll be faced with getting another software system later.

Great efficiency, lower expense

While both traditional and multi- disciplinary clinics can experience greater efficiency and lower expenses with EHR software, the method by which different clinic types see these gains is different.

For traditional chiropractic clinics: Of all the efficiencies EHR software creates, perhaps the greatest stems from integration — meaning one software package contains the key elements of scheduling, documentation, EHR, and billing. By integrating these important functions of a clinic, double entry is effectively eliminated.

For example: When you document a patient visit, elements of your documentation such as treatment CPT codes and diagnostic ICD codes are carried through to billing with the click of a button. You no longer need to give a travel card or paper note to an assistant to key information into one system, which you then send to a billing person to re-enter once again.

Also, with chiropractic-specific EHR software, you can quickly create compliant, professional notes. You can click diagrams to indicate areas of complaint; use drop-down lists and buttons to document test results, treatment, and care plans; and use macros to insert commonly used phrases. All the while, a compliant multi-page note is created in the background. When you’re done documenting, click another button to digitally sign off on your note.

For multidisciplinary clinics: In addition to reaping the same benefits as traditional practices, multidisciplinary clinics can gain even more traction from EHR software.

For example: Adding a provider such as a DC, MD, PT, or LMT becomes a non-issue in terms of cost. If your software is already set up for additional providers, you can start using the technology that’s already available.

You would look for an EHR that’s set up for shared scheduling, notes, and billing, so staff can access all providers’ information in one place. An EHR system in a multidisciplinary clinic should facilitate intra-office communications.

This provides an easy and efficient way to communicate with other providers in your clinic. All providers can access patient care plans, ensuring that each provider is on the same page when coordinating care.

The time savings here is significant because you can co-manage patient care in real time, rather than through group meetings or after-hours emails.

Intra-clinic communication is also important because regular emailed PHI to other providers is not HIPAA-compliant. EHR software eliminates that risk, because it acts as a lock box, with data only accessible by authorized personnel.

With the right EHR software set up for multiple providers, you can bill third parties and, on request, you can create a consolidated statement for patients showing all provider billings on one statement.

Increased collections

Through the use of EHR, both chiropractic-specific and multidisciplinary clinics can expect to see a marked increase in collections without a corresponding increase in patients.

For traditional chiropractic clinics: Collections increase (with EHR software that integrates documentation and billing) because services are less likely to “slip through the cracks.” When billing with paper notes or with separate documentation and billing systems, there’s always the chance of human error entering the picture.

EHR software reduces human error because every service code you document is billed, unless you indicate otherwise. A good EHR software system includes built-in reminders and suggestions for coding.

For example: If you adjust three separate regions of the spine, you may qualify for a 98941 instead of a 98940, and the software can provide an automatic alert. That can increase revenue for services you’re already providing.

For multidisciplinary clinics: In addition to revenue generators like those listed above, EHR software in a multidisciplinary setting can help capture services and billing information seamlessly, account for multiple services on the same visit, and bill separately for different disciplines and providers.

When multiple providers in the same clinic are involved with a patient’s case, it makes sense to establish which services are to be provided by which providers. For example: A patient who presents with severe antalgia with back pain and muscle spasms and who is unable to tolerate movement may need coordinated care between the MD, DC, and PT.

Assigning each provider specific services can help avoid duplicate services, allowing for better coordination. And when the care plan is accessible in real time via EHR, all providers see exactly what care is being provided.

Improved third-party audit results

With more than 10,000 audits expected to impact chiropractors in 2012, you should use treatment plans with all patients and document functional goals. An EHR system patients and document functional goals. An EHR system can help both traditional and multi- disciplinary clinics adhere by helping DCs quickly document findings and plans.

For traditional chiropractic clinics: An EHR system can help enhance a DC’s note — ensuring it’s complete and compliant — while also ensuring coding accuracy. The right system can also provide prompts to make certain recommendations to patients or make certain entries into notes.

Some EHR systems can provide customized templates for specific encounters, which is important to meet documentation guidelines and the criteria needed to pass an audit.

For multidisciplinary clinics: Beyond obtaining the same benefits as a traditional practice, a multidisciplinary clinic gains from improved documentation based on coordinated and informed care.

There are many more considerations. Medicare, state boards, and insurance carriers have established different documentation rules. If you have a multidisciplinary clinic or are considering forming one, make sure your other licensed providers have the tools they need to document quickly while remaining compliant.

It pays to look for an EHR system that can handle the full spectrum of providers that you envision having in your practice. Maintaining different EHR systems within the same practice would likely be a management nightmare, loaded with inefficiencies and added costs.

Worth the effort?

Not all software is created equal, so choose your system wisely, accounting not only for what you need in your clinic now but also for how you see your clinic down the road.

For a limited time, the government is prompting you to adopt EHR software in your practice through funds provided by the HITECH Act (part of the American Recovery and Reinvestment Act). You can collect up to $44,000 over the next five years by adopting certified EHR, depending on your Medicare-allowed charges submitted each calendar year.

No doctor should implement EHR software solely for the incentive. But if you’re already considering it, the incentive is icing on the cake.

StevenKrausSteven J. Kraus, DC, DIBCN, CCSP, FASA, FICC, is founder and CEO of Future Health, a company that partners with chiropractors to deliver a comprehensive clinic management solution, including fully integrated EHR. He can be reached at or through