By 2015, almost nine in every 10 physicians had some form of EHR capability, according to the Office of the National Coordinator for Health Information Technology (ONC).¹
This is roughly double the EHR adoption rate in 2008. Many chiropractors still use paper, however, even with the significantly greater number of offices now using electronic records. If your office still lacks an EHR system, it may be time to reconsider your relationship with paper.
Implementing EHR today
In the past, implementing EHR could be a real headache for some practices. Hours of scanning patient records and countless phone conversations with a vendor’s technical support team made abandoning paper or switching to new software seem unrealistic if not impossible.
While quitting paper records can still be an adventure, in most cases today the implementation process is less dramatic and more user-friendly. Finding the technology you need, starting a new system, and moving patient records into EHR is generally less arduous than yesteryear’s electronic records.
Current EHR is not terribly hard to implement, says Mike Norworth, president of MPN Software Systems. “These days, it’s not very difficult.
Computers have become ubiquitous in one form or another. And software has become more powerful. Thus, it’s easy to scan any patient’s older paper files for immediate future reference.” With most computers readily compatible with EHR systems, doctors can likely find the technology they need with relatively little fuss. From there, implementation now is a more accessible process.
“It’s not difficult and is rather dependent upon the user,” adds Nicole Cowley, a senior technology solution specialist at VitaLogics. Getting the right training and support for your system is a key part of implementing any new software. And help from your vendor can make the journey easier.
Patient records that are well- organized are also easier to transfer over, according to Cowley. “We have converted thousands of clinics over the years from pen and paper to VitaLogics and [we] help the chiropractor and staff break it down.”
The paperless route
While today’s EHR is adoption-friendly, you’ll likely still invest significant resources in your transition to new software. This may be particularly true if you do not have electronic records already or if you have other issues occur.
The most challenging part, as it happens, is transferring information into the new records system. For paper users, this step might involve scanning or manually entering information. This requires administrative hours and may mean hiring data entry assistance or even tackling the project yourself.
“You need to determine whether to do it all at once or as patients return for regular visits; and the types of data to move, such as names and addresses, appointments, and billing information,” Norworth says. Your vendor can help you navigate these decisions, so you won’t have to figure it all out on your own. Having a solid plan for how you will approach implementation is vital. Beware the temptation to take shortcuts.
Time and admin costs can add up, leading some practices to conclude that switching is not worth the effort. “Converting all-paper medical records to EMR is a costly and time-consuming approach,” says Damon Cozamanis, DC, founding partner and president of ChiroFusion Practice Management.
Instead of immediately changing over to fully electronic records, Cozamanis advocates a gradual transition that gives a practice time to transfer the essential data needed for each patient. In fact, you may only need to start with a small amount of digitized information. “Most practices find that scanning less than 10 percent of the paper chart gives them the data they need to fully transition a patient to the EHR,” Cozamanis says.
In addition to choosing whether or not to stop using paper, you need to find the right system for your clinic. “A more critical question is how should doctors choose the EHR that’s right for them,” says Brian Albery, DC, CEO of ChiroSpring practice management software.
Albery recommends that doctors should pay more attention to finding a great platform with the features they need, keeping in mind that an office with EHR is still not fully paperless unless sticky notes, patient intake forms, and other documents are totally digital.
Tackling problems and challenges
EHR is a worthwhile investment, but implementation costs are a barrier for some practices. Onsite installs can cost tens of thousands of dollars, while cloud-hosted software as a service (SaaS) systems may set chiro- practors back on upfront equipment purchases and ongoing monthly fees for maintenance. That said, many affordable systems available today offer the features and capabilities most practices need.
Installing a new EHR system can be for maintenance. That said, many affordable systems available today offer the features and capabilities most practices need.
Implementing a new EHR system can be expensive, but the return on investment can help your office recover those initial costs over time. Improved productivity may generate real savings for offices that previously dealt with confusing workflows and misplaced paper information. Retrieving patient data securely and effectively is usually much easier with EHR, enabling your practice to save even more.
“The only downside of switching from paper to an EHR would be the initial startup costs of software, hard- ware, and additional training and administrative hours for office staff,” Cozamanis explains. “EHR software can be a large investment, and practices need to do in-depth research to ensure that they choose the right product.”
Failures and learning curves
With all the advantages of electronic records, are there disadvantages? “Sure,” Norworth says. “Though we’d like to think that computers stay functional 24/7, they don’t. Be prepared.”
According to Norworth, this preparation means being ready to manage internet connectivity issues, computer problems, and malfunctioning software. Having redundant systems in place to address outages can help. Your EHR system is dependent on your technology and connection to the internet working properly, so you may want to conduct your own mini- audit and have contingency plans ready.
If your office has chiropractic assistants, co-workers, or other staff members, consider designating someone to communicate with your vendor and note the system begins working again following an outage. Ensure everyone on your team who uses electronic records is familiar with your EHR contingency plans and is ready to use an alternative process, if needed, or fall back on a redundant system such as an emergency internet connection.
Cowley believes it is also important to account for the learning curve of any new system. Implementation can temporarily introduce elements of controlled chaos in your practice. If you have co-workers or chiropractic assistants, it is imperative they be given time to learn.
For a short time, your office may seem to operate in slow motion as everyone acclimates to the technological shift. “New processes and systems can mean that your business could stall temporarily,” Cowley says.
Robert Moberg, CEO of ChiroTouch, says that clinics should not rush the learning process. Training can take time. Getting it right means not pushing too hard during implementation and not cutting corners.
“Don’t shortcut the training. These systems are not too terribly complicated, but they aren’t turnkey either,” Moberg says. He recommends using the first few months of EHR implementation as a time to adjust to changes and adapt your workflow to accommodate the new software.
Practices should take significant steps toward keeping patient information secure—especially now in the age of HIPAA. This does not change when you switch to electronic records, because practices are still expected to perform due diligence. Today’s cloud- based EHR systems take much of your records’ security off the premises of your clinic and place it in the hands of your vendor. However, cloud-based systems can actually be more secure in many respects than traditional on-site installations.
“While uncertainty is understand- able, cloud-based systems can actually deliver greater security than client- server systems and paper records.
They use data centers with bank-level security,” Cozamanis says. With state-of-the-art encryption, these technologies can make data unusable in the event of a security breach, securing your patients’ protected health information.
Ultimately, it is your responsibility to ensure your data is secure by choosing vendors carefully and keeping your clinic compliant with HIPAA. As such, choosing a hosted EHR system should involve both care and research.
“We recommend that customers do full due diligence into where their information is being stored, what type of cloud the company is using, and how the company is encrypting and backing up the data,” Cowley says.
Toward that end, prepare a list of your own questions and requirements and ensure that any software product or platform you choose meets all HIPAA security requirements.
Choosing your vendor
As Cozamanis points out, vendor decisions should be made with great care. He has four recommendations: Consider how the software is designed, find a vendor with a good reputation, compare overall costs, and choose a vendor who is compatible with your practice’s long-term goals.
Software design: “The user interface of an EHR system will be largely responsible for the success or failure of integration,” Cozamanis says. Easy-to-use software that your team can navigate should be a top priority. Your staff members can also demo the software and provide feedback to guide the selection process.
Vendor reputation: Spend time reading online reviews and ask trusted colleagues about their software to gauge whether a company is stable and reliable.
Cost: There are also long-term costs. Certain systems require additional hardware, networking, and monthly support and maintenance fees that all add to the price, Cozamanis says. “Asking questions can reveal hidden costs.”
Long-term goals: Evaluate whether your chosen EHR system will support your goals and fit with your strategic planning for growth and profitability. With these considerations in mind, you can generate questions for each vendor you want to demo or shortlist for your purchase decision.
Having a solid implementation plan, as previously mentioned, is essential. With a schedule and checklist that are sensible for your practice, you can begin the process of switching over to a new system or changing from purely paper records.
Your plan can help you save time and avoid significant headaches. If you start working without one, you may make mistakes that require substantial backtracking. And repeating your work can be costly. “Changing your mind about data entry after you’ve entered hundreds or thousands of patients can waste an enormous amount of time,” Norworth says. This translates directly into lost productivity and efficiency for a practice.
Being selective about patient information can help you. For instance, Norworth points out that some forms of data may not matter enough to keep in a new system. Depending on your own clinic’s operations and records requirements, transferring old appointments or services that were already successfully billed may not be necessary. “Ask your vendor for advice. Determine what’s important to transition and how to enter it.”
A customized approach
Implementation timelines vary depending on the system you use, whether you are transferring paper records into your EHR, and other factors. Generally, you can begin using your new system sooner than you might think. But exercising care by slowing down may be a wise decision for your practice.
Expect implementation to take some time. Moberg says a typical implementation process should probably take between four and six months. During that period, your office will still be learning the new system and adjusting to both the learning curve and any efficiency improvements that begin to manifest as you leave paper behind.
As Cozamanis notes, little initial patient data is needed to get started. With each new appointment, entering new data into the EHR can help you move into your new system gradually. “You should decide if you’ll opt for a shorter, more immediate transition from paper or do the transition in phases,” he says
With your vendor, create your own plan to minimize downtime and keep the transition moving. Cozamanis recommends a methodical approach: “The best advice I can offer is not to rush. Take your time and try to populate the EHR with only the essential data required to understand your patient’s health and deliver quality chiropractic care.”
Reap the rewards
Beginning your implementation process with the right information and planning may prevent many of the EHR struggles you’ve heard of from colleagues. An EHR system is a great investment for many practices looking to improve their productivity, secure patient data, and offer high- quality chiropractic care at lower costs.
Selection and implementation are definitely not worth rushing into. But these parts of the process needn’t be intimidating to the clinic that is properly prepared for the experience.
In addition to compliance, most certified EHR systems can help with coding and billing. They could reveal where and how you’ve been leaving money lying on the table.
Kaitlin Morrison is a freelance writer in Washington, and she specializes in healthcare and technology issues. A frequent contributor to this magazine, she can be contacted at firstname.lastname@example.org, or through kaitlinmorrison.com.
1 Office of the National Coordinator for Health Information Technology. “Quick Stats.” https://dashboard.healthit.gov/quickstats/ quickstats.php. Last updated Jan 2017. Accessed July 2017.