Data collection is vital to the healthcare system.
Not only does data provide information on the most common illnesses, it also outlines demographic information of patients who access the healthcare system. This data, quantifying the successes of chiropractic and acupuncture, is important given the struggle complementary medicine has being accepted by mainstream medical practices.1,2
What happens all too often with healthcare data of this type, particularly in the transition to electronic healthcare records (EHRs), is a familiar phenomenon: garbage in, garbage out. In other words, if the data put into the healthcare system is not accurate or complete, it should not be surprising that the results will be the same. A recent study published in the July 2015 issue of the American Journal of Managed Care exemplifies this exact problem with missing data from the system.3
Kaiser Permanente Northwest HMO members who had chronic musculoskeletal pain symptoms were asked to participate in a survey with questions about their symptoms, chiropractic or acupuncture treatments, other self-care therapies, and how they communicated with conventional medical practitioners about their chiropractic and acupuncture treatment.3 HMO patient use of acupuncture and chiropractic survey results are uplifting for DCs.
Of nearly 50,000 initial patients invited to participate in the survey, over 8,000 responded. Narrowing the criteria down further to patients reporting chronic musculoskeletal pain led to about 6,000 patients surveyed. Thirty two percent of the patients used acupuncture, 47 percent used chiropractic, and 21 percent used both treatment modalities.
A lack of communication
Almost a third of the surveyed patients used acupuncture, and almost half used chiropractic for their chronic musculoskeletal pain.3 These results appear to present a strong argument for Kaiser Permanente to offer coverage for such services.
However, looking at the number of patients who went to an acupuncturist or chiropractor within the plan, a different story emerges. For acupuncture, less than 700 patients had survey data captured by electronic medical records (EMRs). Of these patients, 25 percent saw an acupuncturist entirely outside the plan, so were also not captured in the EMR system.3
In the case of chiropractic care, survey data was captured for nearly 900 patients. Of those, over 40 percent of patients accessed chiropractic care outside of Kaiser, so also were not part of the EMS system. Furthermore, only 9 percent went to see a chiropractor based on referral from a physician.3
The upshot is there was a sizeable number of patients with chronic musculoskeletal pain using either one or both modality. Interestingly, more patients accessed acupuncture care via referral than for chiropractic care.3
For patients undergoing chiropractic care to be captured within EHR systems, they should feel comfortable discussing it with their primary care doctor. This can come in the form of education for the primary care doctor and the patients. Once patients feel at ease asking their doctor for a referral, there will be a more accurate picture of how many of them are accessing such services through HMO plans.
1 Burkhart LA. “Wilk v. AMA. 25 years later: Why it isn’t over.” ACA. https://www.acatoday.org/content_css.cfm?CID=4767. Published Accessed September 2015.
2 Lewin AJ. Acupuncture and its role in modern medicine. Western Journal of Medicine 1974;120(1):27-32.
3 Elder C, DeBar L, Ritenbaugh C, et al. Acupuncture and chiropractic care: Utilization and electronic medical record capture. American Journal of Managed Care 2015 21(7):e414-e421.