During our sixth trimester at Logan College of Chiropractic, we became concerned about our knowledge of the business side of the chiropractic practice. We realized chiropractic colleges do a fine job training us to become Doctors of Chiropractic, but we also knew that to be successful, we would have to be conversant with the business aspects of practice. During visits to field doctors, we noticed that many offices had one or more computers, primarily used for billing and insurance filing, though some offices also used them for narratives and still others used them for marketing. There appeared to be a large variety of applications.
As part of our education, we are required to do a senior research project. We decided that a group research approach would allow us to do work we could not be expected to do individually. All four of us wanted to know more about computer use in the chiropractic office. We had a wide variety of questions and concerns, including:
- What is the best hardware?
- Which software systems are easy to learn?
- How much does a system cost?
- Should we have a computer from day one?
Following a discussion with our adviser, Rudolf Vrugtman, we decided to do the obvious thing and ask the practitioners. We will discuss some preliminary findings from our survey research in the remainder of this article.
Study Design
While we would like to make statements about all chiropractors in the US and Canada, we have to limit our generalizations to Logan graduates. Our survey was mailed to a random sample of Logan alumni. A total of five hundred surveys were mailed and 128 practitioners responded. While we suspect that Logan graduates have similar habits and approaches in practice to those of graduates from other schools, we can not be certain. It would be interesting to repeat our survey with other schools’ graduates and we encourage others to pursue such an approach.
Universal Computer Use
We were pleasantly surprised to find 96% of the respondents indicated they use a computer in their practice. We anticipated that graduates of the last ten years would use them, but nearly all Logan graduates see the benefits of this modern convenience no matter what their experience, or how long they have been in practice.
Use of Computers in the Office
We wanted to know the purposes for which computers are used in the office. Figure One shows the results of the first question on the survey. We were not surprised by the use of computers for billing and insurance filing (98% and 97% respectively) but had not anticipated the low response for appointments at 30% and electronic claims at 34%. It would be interesting to pursue the motivating factors behind these low response rates. We presume that human nature and habit dictates the use of paper calendars, as we like to leaf through them. We further presume the cost of electronic claims filing may be the cause of the low response in this category.
- Billing 98%
- Insurance 97%
- Narratives 74%
- Record Keeping 63%
- Tracking Patients 62%
- Electronic Claims 34%
- Appointments 30%
- Inventory 8%
- Other 11%
Types of Computers
We were curious about the type of computer hardware used by doctors in the field, so we created an elaborate matrix question about equipment. We hoped this would provide information about the installed equipment, as well as plans for future upgrades. Clearly we made this particular survey question too complex. We did, however, manage to obtain information about the equipment currently used in the field.
Figure Two shows the distribution of the responses, which plainly indicated that Apple/McIntosh equipment is rarely used. We were surprised by this, as this type of equipment is quite prevalent in the educational institutions we have been a part of for the last decade or so.
Informal discussions with some knowledgeable individuals provided us with a likely explanation: application software for Apple/ McIntosh equipment is hard to find and likely to be relatively expensive. Patient accounting, claims filing, narrative databases or word processors and the like have been available almost since the inception of the PC industry fifteen years ago. Some of these software packages have been and remain rather inexpensive. High quality patient accounting programs, complete with account aging and electronic claims modules, can be purchased for $500 or less today. Thus, historical development is clearly the determining force behind the current situation.
Figure 2
- Pentium 32%
- 486 25%
- 386 2%
- 286 2%
- Power PC 1%
- AMDIC 6 4%
- Pentium II 7%
- Pentium Pro 4%
- No Response 13%
Training on Use of Equipment
We presumed that availability of training was a major part of the practitioners’ software decision-making process. It came as a surprise, therefore, that 32% received no training for the use of their software while slightly less than two thirds of the respondents (59%) did receive training (Figure Three). Maybe this indicates that the “natural feel” or “intuitive approach” that software publishers advertise is indeed being achieved. Our informal interviews with long-time users indicate major improvement in the design and usability of software. One such “old timer” (our adviser, Rudi) stated that in the early 1980s chiropractors almost had to be computer programmers to use some of the patient accounting programs available then. Clearly, there is a benefit to joining the office automation trend late.
- Received Training 52%
- Did Not Receive Training 39%
- No Response 9%
The Internet in the Office
The internet, that cyber village we hear so much about daily, has not yet made inroads into the chiropractic office. Forty six percent of the respondents do not use the internet (Figure Four). Of the 52% who do, nearly half use it at home and we suspect, not for business. Of course, we could just as easily assume that those who use the “net” in the office do so for personal rather than business purposes. Asked about their internet use, eight of the respondents indicated they use it for advertising, 20 for shopping, 58 for research and 14 for other purposes (Figure Five). We presume this last category includes uses such as e-mail and games.
Figure 5
- Advertising 8%
- Other 15%
- Shopping 23%
- Research 57%
A Picture of the Current Status
Our purpose in conducting this research was to discover how computers are used in the chiropractic office. In addition, we wanted to develop a feel for what type of hardware and software would be beneficial when we start our careers. We are in the process of developing answers to many of these questions. Though more work remains to be done before we submit our senior research project, we wanted to share the basic statistical information with our future colleagues as soon as possible.
We thank Chiropractic Economics for helping and encouraging us by publishing our preliminary findings. We hope that in the process we helped readers become familiar with some of the aspects of computer use, which in our mind implies a certain level of literacy in the profession. Clearly, running a chiropractic office is, in large part, a business and we need to pay attention to those tools that can make the office more effective and efficient. As chiropractors, we wish to run our office in a way that enables us to spend most of our time helping our patients to better health. Accordingly, any equipment that allows us to perform the chores and the “paper trail” faster, easier and more accurately is of interest to us.
More to Come
The survey responses contain a wealth of information over and above that discussed in this article. Before completing our senior research project we will have more information to share with the profession. In addition, there is data that can be used, separately or in combination with other data and information sources, to begin looking at the factors that drive the buying decisions of chiropractic practitioners. We will likely turn those tasks over to our mentors, Mr. Rudolf Vrugtman, adviser on the senior research project and Dr. Gary Sanders, Director of Research at Logan College of Chiropractic. We thank both gentlemen for their efforts in support of the project and for their patience with our learning processes.
Todd R. Barber has a Bachelors degree in Psychology and Exercise Physiology from Brigham Young University. He will graduate from Logan College of Chiropractic in August, 1998. Todd expects to join a group practice in Utah.
Barton J. Coleman received his Bachelors of Business Administration from the University of Missouri at Columbia. Bart will be joining a chiropractic group practice after graduating from Logan College of Chiropractic in August 1998.
Adam Vance has a bachelor’s degree in Human Biology from Logan College of Chiropractic. Upon graduating from Logan College of Chiropractic he expects to practice in Australia for a few years prior to settling with his family in the western parts of the United States.
Troy Warner earned his Bachelor’s degree in Botany and Environmental Biology at Eastern Illinois University in Charleston, Illinois. He expects to start practice in Illinois after graduating in August 1998.
Please contact all authors at Logan College of Chiropractic, 314-227-2100.
What Should I Buy and How Much Should I Pay
For the last fifteen years I have heard those two questions from practitioner and student alike. I first assisted in a conversion from a manual to an automated patient accounting system for an office in Belleville, Illinois, back in the summer of 1983. In those days, $2,800 bought a PC clone with a monochrome screen. The manufacturer proudly advertised that the keyboard was included in the price! The operating system was the MS-DOS version 1.1 ($120) and we thought the two floppy drives that sounded like a train passing by were really superb. Diskettes were nearly $2 apiece if bought in bulk of 25 or more. Each held 160 Kilobytes of information. To run the simple patient accounting program (written by a “techie” student from Washington University for $1,100), the disk in the left drive had to be switched a few times per data entry task. Printing the month-end patient statement was done just before we left the office for lunch on Wednesday. It would be completed about an hour after we returned. The doctor displays the dinosaur proudly to the preceptor students visiting his office today, and, yes it still works though, very, very slowly.
Since then, much has changed in the area of technology. Today hardware has become a commodity and software packages for the office abound. A group of student researchers at Logan College of Chiropractic recently recorded in excess of 50 different software titles from 128 responses to a survey about computer use in chiropractic offices. Chiropractors, like most professionals, have been subjected to sales pitches that seem unbelievable to someone with a little computer knowledge. Two to three years ago, you could buy an office system advertised as designed for the chiropractic office, for $14,500. When I reviewed the components of the system at the local computer store and software house, the same product could be purchased for less than $4,000. The only thing that could not be bought at the store was the “conversion assistance and training.” A data entry clerk hired locally and paid hourly, would have charged from $200 to $500 to do the required data entry. That leaves a charge of about $9,000 for training consisting of four video tapes and a person looking over the shoulder in your office for two half days. Pretty steep price.
The buying decision is a relatively easy one, but it requires a little inquiry and thought on the part of the purchaser. System hardware (PC clones) can be bought for $1,300 to $2,500 anywhere in the USA. This equipment will do anything a chiropractic office needs and then some. Today the equipment comes pre-loaded with high quality general-purpose software for that price. Software suites such as MS Office, Lotus Smart Suite, and Corel Perfect Office have advanced word processors, spreadsheets, presentation software and database managers included. Most come complete with “templates” that can be used immediately or require only very slight modification. What’s best about these packages is the on-line help and wizard features are superb. Very little training is required. In addition, many now include the communication software required to use the modem and access the internet. Patient accounting programs can be obtained for free or for very low cost (less than $500). Electronic claims filing modules are almost always included in the programs costing $100 or more. These are not demo programs; they are the whole thing. One of my clients runs his practice on software that cost $149 three years ago. The practice has annual collections in excess of $350,000 and is of the 1980s insurance practice variety. It took the doctor and the assistant less than two hours to learn the basic operations and less than a week to be totally proficient with the program.
The key to success in purchasing a system is to know what it should do for your office. I advise my clients to create a list of tasks they want the computer to accomplish (well, I mean the operator to accomplish using the computer). That list dictates the software desired. In turn the software specified dictates the hardware required. Spending more than $2,000 to $3,000 for a system is probably a waste of money.
