Doctor Confidence: Now a Software Feature?

:dropcap_open:C:dropcap_close:hiropractic works. Chiropractic is powerful. Chiropractic is fun and rewarding. On a good day, many chiropractors would say all of that, but would they say the same thing about their chiropractic software?
confidenceCan chiropractic software be powerful, rewarding, fun, and, most importantly, work in such a way that it actually boosts your confidence as a doctor? If software helps you document exams more accurately, provide detailed care plans to better manage patients, and create encounter-specific daily notes in a way that is compliant, accurate, and leads to saving money while increasing efficiency, then yes! Software can be a source of confidence for any doctor.
Here are the top three ways EHR and documentation software can build your confidence.
#1: Improve your focus on your patients
How do you enhance your focus on patients and not simply go through the same old motions? Some doctors might use meditation or mind techniques before seeing patients. Others might use a subtle mental cue to remind themselves to be consciously present in the moment for their patients. Of course, many doctors try to delegate tasks not directly related to patient care to an assistant, as long as they can afford the hire and find someone they trust with the tasks.
Using technology to decrease the demands of multitasking is perhaps one of the most overlooked ways to shift focus from your “busy-ness” or the business of practice over to your patients. Rather than allowing technology to create more work for you during patient-care hours, you should demand that your software makes focusing on patients easier. How can software make you a more focused doctor?
The most powerful way to free you to focus on patients during patient-care hours is by simplifying your exam and daily visit documentation. Documentation is the one task that is difficult to delegate. It is also best to complete documentation at the time of service for greater accuracy and compliance—as Larry the Cable Guy says, it simply is better to “get ’er done.” It feels great to know that at the end of the day, your notes are compliant, detailed, and complete, especially if it’s all done by 6 p.m.
Relieving you of any irrelevant steps in an exam or SOAP note may be the most effective way to keep you focused on patient care, as long as you are not sacrificing the quality of documentation. This is a hard balance to achieve for any documentation program. A customizable yet chiropractic-specific design helps to ensure that every doctor has his or her favorite exam flow, list of tests, performance order of procedures, or codes included. However, this design also creates focus-stealing distractions if it does not allow you to filter out what you do not need. For example, if you do not utilize ultrasound or muscle stimulation, instrument adjusting, or take x-rays, why would you want to have to manually bypass those software screen options every time you create a new note? Being forced to mentally filter out 10 options on your EHR screens that you do not use becomes a source of distraction when you multiply this self-filtering over tens of thousands of notes.
Electronic documentation software that is pre-loaded with chiropractic nomenclature, clinical findings within your scope of practice, and procedures that you actually employ in your clinic will save you time over handwritten notes. To improve your focus, though, it is best if you have the option to choose how best you move through the documentation, including eliminating distracting options.
When software helps you do your job more efficiently and with greater accuracy, you will have more time to deliver care instead of thinking about everything that goes into the care you deliver. Software that revolves around your style of practice using your vernacular and your methods will feel right and empower you to practice your way, quickly, efficiently, and accurately.
Step 2: Eliminate any worry about compliance or oversight
No doctor wants to have the practice’s records scrutinized by anyone. Having a case reviewed by an independent medical examiner, an insurance company claim reviewer, or Medicare auditor is never a pleasant experience, especially when reimbursement for services already rendered are on the line. While it may never be fun to open your clinic records to a third party, you can gain confidence and worry less when it does happen with the right software that helps you create the best notes possible.
With the software that fits your practice, you should be able to reduce your multitasking, focus on your patients, and improve your compliance with the demands of your state board and third-party payers. You should not have to trade accuracy and consistency in your documentation with less time for patient care, or less family and personal time for you.
:dropcap_open:If you need a little extra help, custom buttons on specific screens to help you raise documentation and coding compliance may be possible depending on the program.:quoteleft_close: 
How can software help you raise your level of compliance, especially when different third parties want to see different items in your documentation and care plans? First, electronic health records can provide you with a template that contains all of the elements of compliant documentation so that you are always prompted to “cross your t’s and dot your i’s” right there on the spot. Second, electronic health records can provide chiropractic-specific alerts and reminders to encourage you to provide the proper criteria required or to better manage your patient. If you need a little extra help, custom buttons on specific screens to help you raise documentation and coding compliance may be possible depending on the program. You should note that chiropractic-specific alerts and templates for chiropractic-specific criteria are not going to be found in medical-based electronic health records. You may not be able to expect the same efficiency or compliance in this case.
The best part of improving your documentation quality with the right software is the ability to create documentation compliance immediately at the time of service. There is nothing that creates more confidence than knowing that your documentation is complete and above scrutiny—and not hanging over your head for another day. Having a system that helps you track completion of your notes is important at the end of the day. Should someone be interested in reviewing your records, you also waste little time wondering if you have left yourself exposed.
Step 3: Raise your efficiency while, keeping money in your pocket
Would you feel more confident as a doctor if you left less money on the table due to incomplete exams, or documentation vulnerable to nitpicky reviewers? What if your software could help you increase your chances of being paid consistently for the care you have already delivered? Would you feel greater confidence knowing that the evidence for your care (and therefore your reimbursement) was complete, robust, and just a few seconds away—available at the touch of a few buttons rather than recalling all the criteria from scratch or having to dictate from an empty slate?
When the compliance and quality of your documentation improves, so will your ability to explain your care to third-party payers in the language they understand. With better documentation, you will be able to use and justify higher code values (when appropriate) instead of automatically devaluing your care with a lesser code while hoping to fly under the radar. You will have the confidence to use appropriate billing codes and will be more likely to defend it, which will raise your chances of leaving less money on the table.
The right software should also increase your ability to actually bill for services you are already rendering. The reality of the clinic environment sometimes creates holes in communication where services are improperly coded or not even coded at all. Doctors are often surprised to learn that they lose thousands of dollars every year by simply failing to code services rendered, either in their documentation or in the billing process. Lost or dropped codes mean lost or dropped dollars.
Nothing can raise your confidence like the ability to raise your level of efficiency while saving you money.
Confidence, the next software feature?
Knowing that your documentation and daily notes look professional, legible, complete, detailed, compliant, and specific to the patient’s encounter is a powerful accomplishment and feeling. You will feel more confident knowing that your notes are not fluffy, verbose for the sake of lengthiness, or masquerading as detailed notes by using a lot of words to create a faux filled note. Can chiropractic software actually help boost your confidence as a doctor, which helps you, in turn, become more successful in practice? If confidence can come from eliminating distractions during patient care so you can focus on your patients, then yes. If confidence can come from not fearing any scrutiny over your documentation, then, again, yes. And if confidence can come from leaving less money on the table from incomplete or inconsistent documentation and coding, then yes. Make sure that greater doctor confidence is a main feature in your next software investment.

Steven  J. Kraus, DC, DIBCN, CCSP, FASA, FICC, is Founder and CEO of Future  Health Software ―the technology leader for chiropractic-specific EHR/practice management software.  He is an acknowledged expert in  Health IT, including EHR and the up-to-$39,000 ARRA incentive program to  implement EHR.  Dr. Kraus serves on numerous ACA committees and  regularly travels to Washington DC to meet with policy makers on the  subject of documentation and electronic health records.  He lectures to  state associations and at industry events regarding EHR and the  relationship to documentation.  He presents monthly webinars on how EHR  usage will impact doctors of chiropractic.  For more information, visit or call Toll Free 1-888-919-9919, ext. 616.


Facebook Is Growing and So Can Your New Patients

facebook7:dropcap_open:S:dropcap_close:o what is all this hype and talk about facebook? Is it here to stay? Do you really have to have a business facebook page? What will happen if you do not? Let me answer these important questions. In 2013 there are many social media outlets thrown at us, and if you are like most people, you have heard of Twitter, LinkedIn, Yelp, Instagram, Pinterest, Google+ and facebook. If you are like most professionals, you think that you should be using social media for your business but have no idea which ones to use and where to begin. All social media is very powerful and needs to be used by businesses if they want to prosper and grow in our high-tech, fast-paced world. Certain social media avenues better fit specific businesses. If you were a promoter for a band or a young teen clothing store, then it would be optimal to have a Twitter account and even a Keek account, which is a platform for creating and sharing short videos. I am going to break it down to what would be most beneficial for a chiropractic office. Studying all the demographics for various social media outlets is time consuming and can be overwhelming. I have spent a great deal of time researching this to find out what would be the best, most optimal way to use social media to grow a chiropractic practice. Hands down it is facebook. The other social media outlets are good for different types of businesses, but facebook blows the rest away when matching up the demographics of a good chiropractic patient. The end result is if you want to help more patients and streamline your time, effort and cash flow, then facebook is the answer. 
Allow me to explain why facebook is best to grow a chiropractic office. I would like to start out by saying that I do not work for facebook. I simply researched, studied and put time into figuring out this overload of social media information. Facebook use in the United States has grown by 11,000,000 users just in the past six months. ( The time to introduce and grow your business facebook page is now. I know this task seems overwhelming for doctors who are already stretched to the limit with paperwork, ever changing insurance guidelines and a competitive market. So I am going to share with you five helpful tips, from creating your business page to getting new “likes.”
  1. Go to Choose a category and a page name that represents your business/practice. Pick a professional photograph of the doctor or doctors that people associate with your practice to use as a profile picture. Write a sentence about your business so people understand what you do. Choose a memorable web address for your page that you can use for marketing material to promote your presence on facebook. Choose a cover photo that represents your office. Remember, the cover photo is the first thing people will see when they visit your page.
  2. Talk with your patients about your facebook page. This step is so simple yet often ignored. Put a notice up in your office announcing your facebook page.
  3. Use a script to invite patients to join you on facebook. For example: “How did we do today? Great! We have a facebook page for Dr. Smith, and it would really make her day if you left a comment for her there.”
  4. Post regularly but not too often. Remember, this is social media, so people do not want to read lengthy, boring articles. Keep it light and fun!
  5. Use printed materials to remind patients to share a comment and help them easily find your page.
Whether you implement some or all of the above tips, note that in the race of marketing, social media is slow and steady; that is what wins the race. You probably remember how long it took to grow your email list; that is not any different than inviting patients daily to comment on your facebook page. 
:dropcap_open:With a well-run, high-energy facebook page, your practice will see greater patient retention, more referrals and new patients.:quoteleft_close: 
Lastly, I would like to explore what exactly facebook can do for your individual chiropractic office. Patients that “like” your page will continually receive valuable chiropractic information and education. People in your community will know that you are there, have an opportunity to see photographs of you, your office and staff and feel comfortable before they even walk in your door. Facebook puts your face in front of many people’s eyes several times a week and gives your practice and the field of chiropractic credibility. With a well-run, high-energy facebook page, your practice will see greater patient retention, more referrals and new patients. You will see the best results when you have 400 legitimate friends or more.

Teri Kanan is CEO and founder of Connections Social Media Marketing. She has given presentations throughout the country to numerous associations. She has a master’s degree and earned her specialist degree in 2006. She has spent the last 25 years marketing chiropractic offices and managing hundreds of facebook pages. Teri Kanan can be reached at 586-703-3074 or

How to Empower Your Technology: Four essential choices that could make or break your investment in electronic health records

:dropcap_open:W:dropcap_close:hen purchasing an electronic health records (EHR) system, there are four important choices that could make or break your investment. How much you spend is a factor in each, but cost alone is not the only choice. 
technologyfourchoicesSo what are these four essential choices that can empower (or hinder) how you use your clinic technology? You have a choice between cloud-based software or an EHR that runs on a server in your office. You have a choice between documentation that is customized to your practice, an EHR system that arrives loaded with general-practice templates, or one that requires you to create and load nearly all commonly used material and selections in drop-down boxes. You have a choice between robust service, maintenance, and training plans, or the least-expensive, do-it-yourself support plan you can find. And finally, you have a choice whether or not to pursue a certified EHR, allowing you to be eligible for incentive payments from Medicare and to have a system that meets federal guidelines.
1. Cloud-based service or local server?
EHRs have two main platforms for delivery of software and data service options: cloud-based services or software that runs on a local server in your office.
What is the difference? To keep it simple, you can think of cloud-based service as largely working over the Internet and a server-based service working through business-class servers in your office. A local server is going to require more hardware costs, IT expertise, and ongoing IT maintenance of your internal network than a cloud-based service where someone else is managing these components for you someplace else (i.e., the cloud). 
And what about costs? With very rare exceptions, most doctors just do not have the background or the experience to set up their own server. Firewalls, user permissions, and the security required for HIPAA really require an IT expert. Depending on the size of your in-office network, the cost of maintaining the network and paying an IT professional can range from $1,500 to $3,500 per year for a small- to medium-sized practice. Larger clinics can pay $5,000 to $15,000 annually. Since a small business-class server can run from $2,000 to $3,000, many clinics will spend about $5,000 annually on their server equipment and maintenance. Plus, every four to five years you usually have to replace the server and continually update the operating software that the server requires.
Cloud-based EHR systems, on the other hand, can range from $39 to $399 per month depending on the service plan and robustness of the software functionality. There is an upfront licensing fee for purchasing most cloud-based software systems depending on if it is certified software and how much functionality initially comes with it. 
With higher maintenance and hardware costs, why would a doctor choose a server? There are three primary reasons why investment in a server would make sense: 
  • Geographic location and local Internet infrastructure may not offer enough Internet bandwidth speed for efficient cloud-based EHRs. If your Internet providers do not have higher speed Internet available and the transfer rate is really slow, it can decrease your efficiency and will become an annoyance.
  • Mid- to large-sized clinics with multiple employees, providers, workstations, and locations may find it more cost and user efficient to maintain a server because of the flexibility it offers.
  • There may already be server components in the clinic with digital radiology and other diagnostics. Upgrading to a larger server environment may not be that much of a jump since the investment is already made in larger practices that already have IT costs as part of their monthly overhead expense.
There is also a fourth aspect to choosing a server that should be mentioned: the psychological component. Some doctors really like being able to see the actual equipment on which all their valuable clinic data is stored. Cloud-based services are stored on high-end, fast servers in HIPAA-compliant environments. You cannot see them, but you can usually access your data from almost anywhere over the Internet. Cloud systems are typically more mobile than local server environments.
Besides cost, there are other advantages to cloud-based EHR systems. Security and accessibility are probably the largest advantages. Cloud-based services are responsible for keeping your EHR data safe and secure in their HIPAA-controlled environment. With a server, you are responsible for the security of your data. Secondly, with cloud-based services, your clinic data is available from anywhere, just as long as you have a username and password.
What’s the bottom line? Cost may be the number one factor for server versus cloud, but Internet speed and accessibility are important as well. It may be helpful to work with an EHR company that has experience in server-based and cloud-based services to understand all of your options. One area of confusion regards who owns the data if it resides in the cloud. You still own your patient data and can have a copy of your data should you decide to change software providers.

2. Customization, templates, or the best of both worlds? 
Selecting features makes a lot of doctors anxious. What do they need? What do they want? And what are they really going to use long after the ink is dry on their service contract? Many doctors want the best of both worlds.
Not wanting to be forced into a small-practice box, many doctors say that they want to customize their EHRs—but only to a point. They also do not want to do all the work themselves; they would like to have essential practice documentation information arrive loaded on their software. For example, the notes in pre-loaded EHR software can list information on orthopedic tests, their interpretation, and even how to perform the tests. Doctors also want to be able to easily add their information to an already existing library, while being able to turn on/off certain functions that are important to their practice. They want the software to feel personal, out of the box, and seamless.
If this description fits your own approach to EHR, then take note: this choice may be the most important to your own personal satisfaction with your software. There are some programs that come loaded with dozens and dozens of different screens for every kind of practice, but you cannot prioritize how they appear or turn them off. And there are programs that sell based on their customization capabilities but offer little more than a text box for each section of your SOAP note.
What’s the bottom line? Documentation means being able to tell the story of your care as accurately and efficiently as possible. Yes, the best of both worlds is possible to find, but you have to know what is essential to your clinical workflow and work with a company that understands the variety of options in chiropractic care. If you want all the bells and whistles handy, make sure they will not slow you down. Ensure it is possible to turn off options or at least to prioritize how they appear. And if you want customization, make sure that does not mean you have to do all the work. If you choose a system that is not pre-loaded with chiropractic-specific nomenclature and templates, you do not have years to get your documentation right, as some doctors have done. Having the system pre-loaded with chiropractic templates and list selections is great when combined with the ability to customize lists and insert your way of saying things into the note. Being able to save commonly used phrases for later use is key. The workflow design is important so that you can access custom methods quickly.
3. Limousine tech support, or bare-bones service?
There are a lot of factors that go into your EHR costs, and perhaps the most significant factor is service and support needs. There are associated costs with data storage, managed data services, customer service, ongoing training for new hires, and software updates. These expenses are the bulk of your annual fees for larger, more robust EHR systems. 
Do you need luxury-class technical support with e-mail hotlines, click-to-chat, one-on-one trainings, and other help available almost on demand? Or you can you thrive simply on watching a catalog of support videos while utilizing webinar-based training, or by just referring to a written manual—the bare-bones of tech support? 
The largest and most intensive maintenance and support contracts can range up to $6,000 per year for the above features; whereas, bare-bones service and support may cost only $39 per month. What your clinic needs depends on you and your staff’s technical confidence, the number of providers in your practice, and of course, patient volume. 
What is the bottom line? Some doctors try to get away with the lowest maintenance costs possible and will skimp on training and support. Beware if you are tempted to save costs here. If you pass up the upgrades, support, and training necessary to help your clinic run at maximum efficiency, then paying for technology that empowers your practice is an exercise in futility. Many doctors are often unaware of the full features and functionality of their software due to lack of training or due to an “I can figure it out on my own” mentality. Plus, due to changing government regulations and advancing EHR technologies in the healthcare industry, keeping your system updated is crucial to staying compliant. 
4. Medicare incentive payments: is it worth it or not?
The Centers for Medicare and Medicaid Services (CMS) incentive program is not a good reason by itself to adopt an EHR system. With that said, a $39,000 incentive payment is moving some doctors to adopt an EHR system faster than they would have otherwise, and doctors want to know if it is worth it. Here are some guidelines to help you make this choice:
  • Does your clinic have Medicare patients, and does the dollar amount of the allowed submitted charges for those patients total more than $5,000 in a calendar year? If the amount is less than $5,000, then working to demonstrate meaningful use (MU) may or may not be worth it since your payment will be around $3,750 at best. This $5,000 threshold is merely an opinion and not a federal regulation. After helping assist hundreds of DCs receive a check for $18,000 in just their first 90 days of MU, I can tell you that the amount of work to achieve MU was mostly done by chiropractic staff who needed about six to eight hours of training to fully understand it all. Now it is just a part of their normal duties and seems natural as they complete the data entry requirement without thinking about it.
  • If your clinic goes over $5,000 in allowed submitted charges for Medicare patients, do you have a few hours per week free to deal with MU? If your schedule is mostly booked and you have no down time, then the opportunity costs may not be worth it unless you have a staff person available who can do 90% of the data entry work for you for a few hours per week. Ninety percent of MU criteria can be performed by staff. 
  • If you have more than $5,000 in submitted charges and your schedule is regularly open a few hours per week with down time, then it will most definitely be worthwhile to demonstrate MU with your EHR program to qualify for the CMS incentive payment for up to $39,000. The amount you can receive is based on 75% of your allowed submitted charges in a calendar year. This in turn will determine the incentive amount that you are eligible for over a four-year period with maximum threshold amounts capped each successive year. You can learn more about the CMS incentive rules by downloading an article that explains it very well at
:dropcap_open:You know the saying, as Medicare goes, so too goes private insurance, and it may not be long before a certified EHR is necessary to be on a panel of preferred providers for general health insurance carriers.:quoteleft_close:
With the right combination of allowed submitted charges, Medicare patient volume, and down time, most clinics can pay for the bulk of their EHR system, covering the costs of hardware, software, and time invested to train and prove MU. 
What is the bottom line? If incentives for MU will help raise your profit and pay you for your time, then incentives make sense. But keep in mind that a certified EHR is still worthwhile even if incentive money is unavailable. You know the saying, as Medicare goes, so too goes private insurance, and it may not be long before a certified EHR is necessary to be on a panel of preferred providers for general health insurance carriers. The sooner you adopt a certified EHR, the sooner you reap the benefits of a more efficient practice. (Note: CMS will begin penalizing providers who do not perform MU with a certified EHR starting in 2015.)
These four essential choices will not only affect how much money you spend on EHR, but will also help or hinder how well you use your clinic technology. These choices will determine whether your technology actually empowers your clinic, or if the technology becomes just another cost of doing business. Who can help you make the right choices for your clinic? You can start by finding a company that understands each of these essential choices and even offers solutions from both sides of each issue. None of these choices has a universal right or wrong answer, just an answer that is best for your clinic. Will your choice be the empowering choice for you?
Steven J. Kraus, DC, DIBCN, CCSP, FASA, FICC, is Founder and CEO of Future Health, the nation’s #1 provider of chiropractic-specific EHR/practice management software. He is an acknowledged expert in Health IT, including EHR (electronic health records) and the up-to-$39,000 ARRA incentive program to implement EHR.

Dr. Kraus has served―and continues to serve―on numerous committees and boards, including:

  • ACA Computer & Technology Advisory
  • ACA Legislative Commission
  • ACA Quality Assurance and Accountability Committee

He lectures to state associations and at industry events regarding EHR and the relationship to documentation, and he presents monthly webinars on how EHR usage will impact doctors of chiropractic. For more information, visit or call Toll Free 1-888-919-9919, ext. 652.

Turn Patients’ Smartphones into Genius Phones with Spinal Specific Marketing

:dropcap_open:A:dropcap_close:s the original Chiropractic “Technogeek”, I feel obligated to make the lives of Chiropractors easier and more productive through the use of technology. One age-old issue screaming out for a technological solution has piqued my interest. It is well known that patients retain only 5-20% of what the doctor communicates; even less at a screening.  Without being able to reinforce the message we convey, and do so quickly and effectively we lose our patient’s attention.Traditional solutions have relied upon everything from general pamphlets and videos espousing the value of Chiropractic, to expensive celebrity endorsements. We have struggled for decades attempting to “sell the invisible” and still only appeal to 8% of the population. 
smartphonedoctorThe emergence of Static sEMG in the early 90’s attempted to provide a user-friendly technology that produced patient-friendly graphics, but was limited by technological and reliability issues.  This technology not only forged the way for evidence-based practice, providing objective data that Chiropractors need and patients want, but also provided an effective tool for internal marketing and spinal screenings, a mainstay for generating new patients.  Yet the problem still persists.  
What does a NASA researcher do?  Seek out data, and observe.  So that is what I did. Instead of interviewing doctors, I spent four months interviewing patients.
In the process of interviewing patients, an issue with significantly greater impact on the profession was exposed:  Those in pain easily garnered the support of friends and family members in choosing Chiropractic as the treatment of choice. Those not in pain seeking Chiropractic care for general health and wellness, clearly expressed one common challenge: Each and every one admitted they found it extremely difficult to justify their Chiropractic visits to family and friends.  
More important than this was the emotional response I received from patients who had taken home their Static sEMG test as it validated their complaints to cynical family members.  One patient actually cried saying “My husband didn’t believe me until I showed him my print out”.
You go to the doctor when you’re sick. You see the Chiropractor in pain. Why would you possibly go if not in pain?  
We’ve been attempting to implement the dental model of “preventive care” for years with little success. But to a Technogeek, this is just another fun problem to solve.

In reviewing the scientific literature on patient communication,I found some clear trends 1, 2, 3, 4.

  1. If you don’t reinforce the message immediately, you can assume your patient will forget your advice making the interaction unproductive at best.
  2. A follow up call or some form of personal communication immediately after each visit is ideal, as a reminder may help reinforce the importance of their visit. 
  3. Any report of findings provided the patient via “internet patient portals” or email is significantly more effective as the patient not only can review it at their leisure, but can show family members and friends their results. In addition, it does not get lost as does paper. 
  4. Visual data is significantly more effective. The more objective and personalized the data, the more effect it has on the patient and their family and friends. 
  5. Making the communication “Smartphone Friendly” is crucial, as the proliferation of Smartphones requires that your communications be easily readable on them. Many use iPads and Smartphones more than computers for “skimming” their electronic communications.

My girlfriend’s trip to the auto mechanic lead to the solution. She kept complaining of engine roughness. I didn’t notice it and to be honest thought she was a bit paranoid. Instead of the mechanic listening, touching, feeling and expressing an opinion, they plugged her car into a computer. On the screen was a visual image showing her “mass airflow sensor” was defective, They even faxed the results from the computer directly to me knowing that I would need to be convinced also. I know she got great pleasure in using this data to show me how much more right she was then I. I’m happy that makes her happy.

In the days prior to objective data, we would pleasantly say “thank you”, and go off to get several opinions potentially putting off fixing the problem for months or even years! Sound familiar?

We in the Chiropractic Profession share the mechanics dilemma, and may learn a lesson from their approach. We live in a data driven society. Show them why with “instant” indisputable, objective data and we overcome not only their objections and reinforce the need for care, but overcome family members objections. In a data driven world, objective data rules, and those with it have the power to convince. Whether it be mass airflow sensors or wellness care. The key is finding a way to transmit this data in an electronic, instantaneous form which is visual in nature for maximum effectiveness.

I realized that it would be most intelligent to meet the patient where they lived… on their smartphone! Nielsen reports that more than 50% of mobile consumers are using smartphones. According to Nielsen’s monthly analysis of cell phone bills for 65,000+ lines, smartphone owners – especially those with iPhones and Android devices — are consuming more data than ever before on a per-user basis. This is an enormous captive audience waiting to be engaged.

It was crucial that this process maximized the use of technology to remove the need for human interaction and labor. Unnecessary labor is proof of a poorly designed system. This tool had to be fast, allow for instant communication, and provide indisputable, objective data which could be easily presented to skeptical family members and friends. Due to the fact everyone has smartphones, it has to be easily viewable on the tiny screen. Allowing the texting of the image via SMS would improve its effectiveness.

With major technological improvements that have tripled the speed of muscle tension measurements, the tool of choice for this objective data would be Static sEMG. Although Thermography was considered, it is too finicky due to sensitivity to environmental heat and cold, making screenings difficult. Additionally, patients can’t feel temperature differences between left and right sides of their spines, making the results less “believable”. Modern, Wireless Static sEMG can be performed in virtually any environment. More importantly, everyone knows the ache of muscle tension, making instant credibility the doctor’s reward when the graphed results reflect what the patient feels. New University research has validated Standing Static sEMG studies as clinically valuable6. Even more important, a major study by the Veterans Administration established the Static sEMG as capable of accurately tracking patient progress 7, 8.

Impersonal is ineffective. If the patient’s personal Static sEMG results, graphical in nature could be instantly transferred to the patient’s smartphone, that crucial communication between doctor and patient would be reinforced within seconds. Unlike a generic pamphlet on the value of Chiropractic, the patient needing to prove the necessity for care can instantly forward from their smartphone the test results to skeptical family members. Another requirement is for the graphical image to act as an “E-Business Card”, presenting both specific information on the doctor’s office, and an easily customized special offer. The impact on those who’ve received the forwarded, visually appealing graphic would provide powerful advertising for the clinic.

So I built this thing, filed patents and tested it. And guess what else happened. In Beta Testing all of the above conditions were met, and more. The big surprise was how many patients posted this graphic image on Facebook, and did so while still in the doctor’s office! Imagine the impact of your office information marketed by your patients at no cost to you? With the average person having 120 Facebook friends 5,9, the value in terms of marketing alone is quite significant.

The tool proved invaluable at screenings where not only did the patient walk away with an instant personalized message, but also knew exactly how to reach you to take advantage of the special offer embedded in the graphic. Even better, the doctor stored the prospective patient’s email address for instant follow-up and future email marketing.

The term “Viral Growth” is an understatement when it comes to the impact of these visual images flying around the internet. The biggest surprise of all is that each and every patient tested said, and without exception (after saying “Cool”, that is): “Now I can show my _______ why I need my Chiropractor.” It is unknown if this can get us beyond that 8% of the population we’re seeking. Considering the massive proliferation of Smartphones, it at least takes advantage of a new form of high-tech, low cost marketing with potentially powerful consequences.

Technology can be your best friend or worst enemy. By finding the best product and support for your needs, you will have a great partner in building your practice. Follow the simple guidelines above and you will enjoy all the advantages of technology without the stress.

  1. Thom DH. Training physicians to increase patient trust. J Eval Clin Pract. 2000 Aug;6(3):245-53.
  2. Betancourt JR. Cultural competence—marginal or mainstream movement? N Engl J Med. 2004;351(10):953-5.
  3. Osborne H. In Other Words…Actions Can Speak as Clearly as Words. Boston Globe’s On Call Magazine. Jan/Feb 2006. (accessed Mar 3, 2006).
  4. Osborne H. In Other Words…Teaching with Pictures. Boston Globe’s On Call Magazine.  Nov 1999. (accessed Mar 3, 2006).
  5. Dunbar, R.I.M. (June 1992). “Neocortex size as a constraint on group size in primates”. Journal of Human Evolution 22 (6): 469–493. doi:10.1016/0047-2484(92)90081-J
  6. A Meta-Analytic Review of Surface Electromyography Among Persons With Low Back Pain and Normal, Healthy Controls. Geisser, Ranavaya, Haig, Roth, Zucker, Ambroz and Caruso published in the Journal of Pain, November 2005 p 711-726.
  7. VAS Score Correlates with Static Surface EMG Signal Intensity in Chronic Spine Pain.  Ambroz, Alex MD,VA Medical Center, Martinsburg, WV Ambroz, Clara MD, MPH, Disability Evaluation Services, Martinsburg, WV Zucker, Robert  MD, MPH,VA Medical Center, Martinsburg, WV Benjamin, Eugene MD,VA Medical Center, Martinsburg, WV
  8. Caruso, Marianne RN,VA Medical Center, Martinsburg, WV.  PAIN MEDICINE Volume 6, Number 2, 2005 p 28-29.
  9. Marlow, Cameron:  “Maintained relationships on Facebook” 2009, March 9,

David Marcarian, MA, founder of Precision Biometrics, and inventor of the revolutionary MyoVision 3G Wirefree PhysioMonitoring™ System. A former NASA researcher, Marcarian was awarded a $450,000.00 NIH grant to develop the MyoVision. As an expert witness, Marcarian was credited one of the largest PI awards in US history, and established the validity of sEMG in a major State Superior Court Decision. Recently the AMA selected his 3G Wirefree System as the “tool of choice” as presented in the medical text “The Practical Guid”. Contact at : [email protected] or visit or call 800-969-6961

Dr. Nancy Miggins has over 25 year’s clinical experience as a chiropractor. She excelled in the areas of procedures, ethical business practices and management.  After spearheading the development of a integrative health and fitness center, she spent 6 years as director of this clinic.  Although her main focus was in family practice, she also has aided Olympic Athletes and professional cyclists with optimizing sports performance through chiropractic. She is currently the Director of Clinical Applications & Product Development for Precision Biometrics, Inc. Contact at : [email protected] or visit or call 800-969-6961

Ignoring Patient Supplements Because of the Hassle?

Technology now makes it easy to prescribe supplements for better patient care and to create a successful new revenue stream

:dropcap_open:M:dropcap_close:any DCs avoid offering nutritional supplements because it can seem like a time-consuming effort for little reward.
clipboard14But the fact is, prescribing nutritional supplements can provide major health benefits for your patients and your bottom line–and it doesn’t have to be a hassle. You just need to have the right technology in place to help.
Here are just a few of the concerns about prescribing supplements commonly cited by DCs, and how the right EHR/practice management software can effectively turn them into non-issues.
Educating patients on the supplements you prescribe
Creating custom educational handouts can seem like a daunting task, particularly because you want ALL the specifics—including dosage and frequency—for every supplement you carry to be double- and triple-checked.
Depending on which EHR/practice management software you choose, you may find that your program comes pre-loaded with patient education materials, including nutritional supplement handouts. This makes educating your patients as easy as printing out the correct handout for your patient, or pre-printing a stack for your most commonly used supplements.
You may also have the ability to create macros within the software detailing specific instructions and then distribute that information to your patients.
Documenting supplement prescriptions and consultation
With all of the documenting you already do, adding supplements to the mix may seem like it will add even more time to your process.
However, not documenting supplements is not even an option in terms of good risk management practices and state board rules on documentation standard of care. Should a liability issue arise, you will need that information at hand.
The good news is, documenting nutritional supplements doesn’t have to be difficult or time-consuming. The right software will make it easily accessible and will accommodate your workflow. Depending on the software you use, you can customize dozens of macros to allow for the simple point-and-click entry of your most common prescriptions and dosages.
:dropcap_open:That way, patients will have all of their prescriptions, dosage and frequency information available at the click of a mouse.:quoteleft_close:
With EHR/practice management software, when you document a supplement prescription, it becomes part of your patient’s record. You and your staff can easily access prescription history in a consolidated patient-specific supplement log or in the encounter-specific note.
What happens if a patient loses their information? Your staff can quickly find the instructions and either reprint or resend the information via an encrypted email,  effectively eliminating the need for patients to catch you between patients to ask.
But perhaps the best part is that you and your staff can now send the clinical care summary–including prescription details–with encrypted data to the patient’s Personal Health Record (for instance, Microsoft HealthVault).  That way, patients will have all of their prescriptions, dosage and frequency information available at the click of a mouse.
Side effects and other unintentional reactions
Your EHR software should include a component for checking drug/drug and drug/allergy interactions and automatically alerting you of potential conflicts. That way you can avoid potential side effects and other unintentional reactions before they even happen. 
Inventory management
EHR/practice management software can easily automate your supplement inventory, enabling you to set a threshold and receive a notification when it’s time to reorder.  This not only allows you to provide on-demand nutritional services, but it also helps you avoid excessive shipping charges from continually restocking or ordering one-offs.
There’s no operational reason that you shouldn’t offer nutritional supplements to your patients
Technology makes it easy for you to provide patient education, document your prescriptions, avoid unintentional reactions, and maintain inventory.
Your EHR will help you track all of a patient’s prescriptions, dosage, and frequency so all parties can recall what was prescribed. Again, you can print the information out and provide it to the patient and send the encrypted data right to your patient’s Personal Health Record.
Managed properly, nutritional supplements can help improve patient care in an efficient, risk management-friendly way–without adding a lot of time and effort.
Steven J. Kraus, DC, DIBCN, CCSP, FASA, FICC, is founder and CEO of Future Health, the industry leader in EHR/practice management software for Doctors of Chiropractic. He is a recognized expert in Health IT, including EHR (electronic health records) and the up-to-$44,000 ARRA incentive program to implement EHR. Under Dr. Kraus’ direction, hundreds of Future Health DCs qualified for the 2011 ARRA incentive. In fact, more DCs collected incentive money using Future Health than any other software. Dr. Kraus is also an expert on practice management, with more than 23 years of experience in his own practice. He has developed and sold 18 practices and has provided strategic consulting to more than 400 healthcare businesses nationwide. For more information and to sign up for a free software demo, visit

Apple Invades Chiropractic

:dropcap_open:I:dropcap_close:t seems commonplace when we hear of yet another scenario where Apple has disrupted the status quo, redefined expectations, or created an entirely new industry. And chiropractic is no exception. From consumer-focused to EHR-integrated applications, Apple has indeed arrived. 
appleipadWhile the number of applications available at Apple’s App Store is in constant flux, a recent search revealed 111 results using the search term “chiropractic.” An additional 14 search results show up for the term “chiropractor.”
There are essentially two types of apps as they relate to the chiropractic profession: patient apps and apps for use by chiropractors.  That number is sure to grow as the market develops, and providers continue to create new apps which make the world easier to interact with for Apple users.
Patient apps
Patient-focused apps in the App Store generally provide users with information on how to maintain good posture and spinal health. Some apps provide search capabilities for finding chiropractors in the local area.
A good example of a patient-focused iOS app is MySpine by Hubbard Chiropractic Inc. The application broke into the Top 40 rankings for the Health & Fitness category at the App Store. 
MySpine allows users to learn about proper spine alignment, health and chiropractic. Features include an interactive spine display with a rotatable 3D image that shows nervous system connections from vertebrae to organ.
The app also includes a Vertebral Subluxation Chart of Affects that displays symptoms in the affected areas of the body. Users can view high-definition images and they can browse through a collection of informational videos, FAQs and a reference guide/glossary. 
MySpine also provides a guide on the symptoms to look for that tell patients it is time to see a chiropractic doctor. 

The iChiro app by Textmimedia is a free application with a 4+ rating in the App Store. The software program provides users with a wide range of stretches and exercises aimed at improving health and posture. 
Users can use their Apple device camera to check their posture and track improvement over time. The app also includes advice on chiropractic health and a directory that allows users to find chiropractors in their area. 
Chiropractor Apps
Chiropractors use existing apps or create their own apps for a variety of reasons. Devices such as iPhone and iPad are extremely popular and they have advantages over desktops and even laptops when in the clinic, giving the doctor the freedom that comes with having access to information wherever they are in their practice.
Apps for use by chiropractors are scarce, but one EHR company, ChiroTouch, does have a robust offering, with fully-integrated iPad apps for use with its total practice management system. 
The EHR-integrated apps from ChiroTouch integrate its server-based, desktop system with the lighter, ultra-portable iPad. The apps simplify the process of medical office management and make it easy for staff and patients to deal with medical records.
For example, the ChiroTouch CTintake App for the iPad allows patients to use the intuitive iPad interface to fill out patient intake forms while in the waiting room. The devices are much easier to use than desktops that require extra furniture for the monitors, towers and other equipment.

ChiroTouch’s Outcomes Assessment App for the iPad, CToutcomes, allows chiropractors to record patient health data through a series of questions. The data collection is recorded in real-time with the practice’s servers, where the ChiroTouch software can then generate reports automatically, allowing the chiropractor to build narratives based on stored information
ChiroTouch has recently launched its third iPad app, CTprovider, which is fully integrated with the ChiroTouch Provider All-in-One feature. This app gives doctors instant access to treatment plans, SOAP notes, and x-rays, among other features. And like the other ChiroTouch apps, information exchange between the iPad and the ChiroTouch system is both seamless and instantaneous – making it easy for doctors to operate their practice from literally anywhere they have an Internet connection.
One advantage of the App Store is that many of the chiropractic apps are available for free download. ChiroTouch apps are all free; however, users must first own the ChiroTouch total practice management system to take advantage of the power the apps bring to a practice.
Another example of a popular chiropractic app is PostureScreen Mobile from PostureCo, Inc. Recently identified as a must-download app by both GQ Australia and Details Magazine, this app is geared for chiropractors and priced at $9.99. PostureScreen Mobile helps users analyze a patient’s posture using an iPhone, iPod Touch, or iPad. Once demographic info is obtained, the postural photo can be obtained and digitized using patent pending technology ensuring reliability and validity.
:dropcap_open:Apps for use by chiropractors are scarce, but one EHR company, ChiroTouch, does have a robust offering, with fully- integrated iPad apps for use with its total practice management system.:quoteleft_close:
Once the patient’s posture is digitized, posture analysis reports can be generated in seconds and even delivered securely and password encrypted to the patient via email.  With an in-app module upgrade, follow up comparative analysis can be performed along with posture trend analysis documentation. Further powerful upgrades are a min history stress survey and demographic export to Excel. The app can even connect to large TVs through an HDMI connection or Apple’s wireless AirPlay.
The application is fully integrated with the free DropBox service, which allows seamless wireless syncing of your reports and analyzed posture images to any Windows or Mac computer for ease of importing to your current EHR system. And with the recent addition of WebExercises integration, doctors can prescribe corrective postural-based structural and functional exercises in seconds.  Once exercises are prescribed, they can be sent to a patient through a secure web portal, delivering patient-specific customized exercise instructions with color pictures and streaming tutorial videos.

Marketing Apps
Many chiropractors have applications custom made for iOS devices to help prospective patients find them on the Internet. These apps may provide basic information on the principles of chiropractic and the types of treatment available. 
Many apps allow users to schedule appointments with nothing more than a click using Apple mobile devices at home or in the office, or while on the road.
One popular marketing technique is to create applications that integrate with popular social media platforms like Facebook, Twitter, Google+ and YouTube. Social media is growing at an extremely rapid rate, with the largest sites attracting hundreds of millions of users. Nearly all of these sites allow mobile access using Apple devices like the iPhone, iPad or iPod Touch.
By creating a presence on social media platforms, chiropractors can take advantage of the popular practice of sharing and referral on these networking sites. A chiropractic office can post regular updates on their social media pages providing others in their online community with news and information related to chiropractic health.
Designing a custom app
While it may seem like a daunting task to develop an app for the App Store, the process is much simpler than many chiropractors realize. While it is most common to hire a professional developer to create an app, it is possible to do the job without knowing anything about Apple coding.
Special software applications provide highly intuitive and easy-to-use interfaces that allow you to design apps without any programming knowledge or training. These software solutions are generally of the “what-you-see-is-what-you-get” variety in that you can create an app simply by dragging, dropping, selecting and clicking.
Even for those chiropractors that are less enthusiastic about taking on app development on their own, it is relatively easy to find freelance software developers willing to bid on the project. Websites like Monster, Elance, Guru and Odesk have long listings of freelance developers looking for work. These sites allow users to post requests for proposals (RFPs) on any app development project. Bidding is competitive, helping to keep prices low.
Make no mistake, chiropractic apps are changing the way chiropractors do business, and the way they interact with patients. With the explosive use of mobile devices for Internet access, chiropractors empowered with iOS apps are in a better position to take advantage of a demographic that, with each passing day, is coming to expect mobile technology in their every interaction.
And those chiropractors looking to streamline their practices, make a positive impression on their patients, and embrace the power of mobility would be wise to jump on the iPad bandwagon.
Not convinced of the difference the iPad will have on our industry? Well neither were the recording industry, the phone industry, the movie industry, the medical device industry, the video game industry, the digital camera industry…just to name a few.
Cupertino isn’t coming to chiropractic – it’s already here.  The only question is when – not if – you adjust for it.

Empowering Your Practice with Certified EHR Software

:dropcap_open:P:dropcap_close:aperwork. Administration. ARRA. Eligibility. Billing.Employees.Supplies.Collection.Equipment.SOAP notes. Insurance claims. Legal issues. These are the realities of a chiropractic practice, and we haven’t even mentioned the adjustment. Did we all, prior to becoming chiropractors, tell our friends and colleagues that we had a burgeoning desire to open up a chiropractic practice so that we could dive right in to documentation, administration, and collection? Of course not. It is the patient, the one needing the adjustment, that drives our efforts. And yet, even with our best intentions, there are always the administrative duties that accompany those efforts. 
ehronipadSo, as chiropractors, it is our duty to minimize the administration of our practices while maximizing the care we provide our patients. But that doesn’t mean we have to take ourselves away from the patients and become pencil-pushers. Automation tools can empower our practices and help us get our hands off the paperwork and back on the patient.
Moving forward, and with the multitude of health care changes looming over us, automating the office is no longer an option, it’s a necessity. No doubt, there will be some who are pessimistic about the changes in EHR healthcare mandates, as it’s always easier to follow the path of least resistance. But in taking a closer look, integrating a complete, certified EHR practice management system into a practice is the bridge to the efficiency we as chiropractors need to not only improve our patient care, but to compete in the marketplace as well.
Either way, there will be changes in documentation procedures. New coding will have to be learned and software technology will be able to solve most of the difficulties these new changes will present. Chiropractic practices that convert to fully automated software systems will be able to greatly reduce office expenditures after these changes are implemented. In this case, the software automation will make the transition a much smoother process.
:dropcap_open:Automation tools can empower our practices and help us get our hands off the paperwork and back on the patient:quoteleft_close: 
The first and best approach to adopting software automation begins with an EHR-certified practice management software system. In addition to the ARRA Incentive Program, which offers a great opportunity for eligible providers who demonstrate meaningful use of a certified system to receive up to $44,000 in incentive distributions, the program really provides a framework of standards that constitute a national solution.
These standards have raised the bar in the EHR industry, and address:

Improvement of Patient Care

Clinical decision support rules are a requirement of EHR in an effort to help improve patient care through alerts based on certain key indicators in a patient’s health records.
Reduction in Drug-Drug and Drug-Allergy Interactions

Drug-drug and drug-allergy interaction checks are mandatory for those providers practicing meaningful use. With interconnected e-prescribing, medication lists, and drug allergy monitoring, doctors can prevent interactions through a collective effort. 
Decreased Costs

Being able to show clinical necessity based on more closely defined clinical quality measures can help garner more dollars from treatments. And because certified software must live up to a specific standard, purchasing under a certified label ensures that the piece of software you choose has passed governmental guidelines and functions as a complete EHR.
Improved Portability of Patient Records
files72The certification process is laying the framework for an interoperative national standard where patient records can be transferred easily—and really become the patient’s information, not the doctor’s. This means that soon, when a patient who sees multiple providers is admitted to the ER, all of their chart notes, x-rays, medication lists, allergies, and lab tests will be readily available because inter-provider electronic exchange of patient information has been realized. This potentially life-saving access to patient records can decrease the time to diagnosis, duplicated lab tests, and potential drug interactions to name a few.

Deciding the best path to take toward the EHR incentive is a question on the minds of many providers in this recent era, and your choice of software systems is one of the most important decisions you can make for your practice. Your choice to purchase certified software will ultimately result in much more than a dollar amount on your stimulus check. 
The decision comes with many factors, claims, and requirements to consider. And competing vendors are happy to speak for you when you begin assessing your needs and sorting out the fear from the facts. 
But whereas your software choice should be measured on how well the software itself will support the needs of your practice, the EHR incentive is not as subjective. It comes with due dates and eligibility requirements that can be measured specifically, and can be compared against the feedback you receive from every vendor you research. 
Automated software also provides your office with many solutions so that you and your staff can streamline many of the daunting tasks that managing the office requires. Electronic Health Records provided by automated software systems now combine documentation, billing, scheduling, reporting and much more into one HIPAA-compliant system to drastically reduce the time it takes to do the tasks that your office is already doing.
Also, it’s important to recognize that while many software solutions state that they provide the “right” solutions, they don’t necessarily get those solutions right. It may seem like semantics, but the deeper meaning here is found in the software’s approach to achieving a given automated task. Just because a software company states an automated solution is included in its capabilities doesn’t mean the method by which that solution is provided is ideal—and can even mean more work for the chiropractor and/or staff behind the scenes! Chiropractors are well advised to dig deeper and go beyond the surface when conducting their research.
Here are some of the features that software automation can take off your hands:
Streamlining the Signing in Process at the  Front Desk
:dropcap_open:Automation saves you valuable time, energy, and staff.:quoteleft_close: 
Modern systems can allow patients to check themselves in by fingerprint, pin number, bar code scan or swipe card. All of these features are now available through automation to streamline a patient’s arrival. Patients can arrive, check themselves in and then have a seat in the waiting room until you are ready to see them, and even be called back to a room through an automated announcement system.
Total Patient Flow Management
From one screen on the computer, the right automation can help staff manage the entire flow of the office. They can easily view the patient’s purpose of visit; their provider, who has arrived, who has checked-in, who has checked-out, who owes you money and who is running late.
Patient Scheduling

Automated software can allow the customization of several views so that your staff can easily keep track of a patient’s schedule. They can view past, present and future appointments with a patient all at once. Also, administrative notes and insurance information for each patient can be accessed within seconds.
Patient Billing and Collection
patientrecordsOne of the features that makes a software management system so attractive is the billing feature. Most chiropractic software systems have built-in electronic billing as well as standard paper billing. This feature can save your office thousands of dollars every year in billing and collection costs. The process is easy as well as efficient. Many systems can print monthly statements or use an e-mail system to remind your patients that a bill is due. They can also send out delinquency notices so that your office can collect past due payments.
Just as it is important to identify a software system that meets all of your needs, one must also look closely at the support that stands behind the software. Along with robust training, pick a software company that partners with you and your staff every step of the way. Do they have a dedicated representative that is there for you when a question arises? Do they offer access to a support community online consisting of other chiropractic offices that can readily help you with any questions or issues that may be encountered while adapting to the new system? Are they ONC-ATCB certified?
Truthfully, no doctor enjoys writing long chiropractic reports or creating SOAP notes. Chiropractors are starting to realize the advantages of using automated software, and most doctors certainly would agree that their time could be better spent caring for more patients and tending to other important things, including getting a little rest and relaxation for themselves.
I hear many colleagues talk about the ‘expense’ of practice management software, and I immediately counter by asking them to consider the expense of  NOT incorporating a fully-functioning practice management software into their offices. Automation saves you valuable time, energy, and staff. Automation allows the chiropractor to spend more time with more patients—while streaming operations, reducing staff, and increasing productivity. 
Ultimately, how you and your staff spend your time is the most important consideration. Time spent defines profitability, quality of patient care and the overall efficiency of the practice. Chiropractic office automation is designed to revolutionize your practice from beginning to end. Automation cuts costs, saves time and will provide you with the tools you need to improve the quality of care to your patients. It can improve work flow to keep your office moving at optimum speed. 
In our profession, change isn’t coming—it’s already arrived. General (Ret.) Eric Shinseki, former Chief of Staff of the Army, said it best when addressing change: “If you don’t like change, you’re going to like irrelevance even less.” As a community, it’s time that we embrace change, empower our practices with powerful automation tools, and ultimately improve the care we give to the patients we all collectively serve. 

Chiropractic Offices: iPad or Not?

:dropcap_open:W:dropcap_close:hile in the airport, I stopped at a news stand to buy a magazine and saw on the front page of Laptop magazine: iPad or Not? I thought this was a terrific question for the chiropractic field and thought chiropractors would be happy to hear the pros and cons of using an iPad or any other tablet computer in their office. 

ipadOne thing is certain: iPads are the flavor of the day. They are thin, light and have thousands of applications available. These applications are very easy to download and are free or inexpensive. iPads and tablets are touch screen, which makes them easy to use. They are also portable and capable of surfing the internet, and are invaluable for accessing social websites and email. 

In reality, can we use an iPad all day long in a chiropractic office as part of our Electronic Health Record system? Probably yes. But doctors need to be aware of the negative situations they may have to face when using them for daily operations in their office. I’d like to share 5 of them.

Risk of Theft or Breakage

If used by patients to enter subjective notes or case histories, iPads can be stolen or dropped (and broken), which can be costly to doctors. CAs would have to handle and take care of all iPads used in the office, which would not be a desired additional task. Patients can easily do the same task on a desktop computer, eliminating additional tasks to the CA and eliminating all risk of theft or breakage.

Small Screen

One of the greatest improvements for computers over the years has been the enlargement of screens. With a large screen, software programmers can simultaneously show multiple pieces of information and images, thus reducing (sometimes eliminating) the frequent changing of screens. No one will argue that large screens make software much easier to use. iPads have very small screens. These very small screens lead to a lot of screen changing. These screen changes take up a lot of precious time and may get some doctors very annoyed. If doctors see 60 patients per day and lose 1 minute per patient, they will work an additional hour in their office every day to achieve the same work. At the end of the year, this is 300 hours of productivity lost which, based on 40 hours of work per week, could have been turned into 7.5 weeks of vacation.

Application and Download

iPad software is downloaded and installed through the Apple store. If an iPad does not work, the software cannot be used on a regular desktop computer. The only solution possible is that the doctor will have to buy another iPad and reinstall the software. The lack of another temporary solution can lead to more expenses and hassles.

Freedom of the Chiropractor

Electronic Health Record systems have done something great for doctors. They have removed paper files from the chiropractor’s hands. Doctors don’t have to carry or search paper files anymore. This is one of the most appreciated changes software providers have invented for chiropractors. However, if used by chiropractors, iPads are loading doctors’ hands again. Using an iPad goes backward and eliminates this great hands-free improvement. Also, iPads can be forgotten somewhere and need to be searched for, exactly as with paper filing systems.

Powered Devices

iPads and tablets are battery-powered devices, and thus have reduced autonomy. This is a serious operating handicap for a chiropractic office. iPad 3 has anywhere between 8 and 10 hours of autonomy, depending of which application you are using. Videos and networking reduce the autonomy, and iPad 3 takes 7 to 8 hours to recharge*. As you can imagine, you may need more than one iPad, fully charged, to work for an entire day. The hassle of the constant recharge process for iPads or tablets can be very annoying to chiropractors.


In chiropractic or any other profession, reality always catches up with excitement. From there, we will have to find out if software programmers will be able to create applications that will overcome important inconveniences. Will they be able to provide software that will be more beneficial to use and limit the above risks and hassles? The least we can say is that the challenge is great, and overcoming it is no small task.

* iPad power consumption:

Claude Cote is an expert in EHR systems, insurance billing and chiropractic clinic management for 22 years. He has installed EHR system in 18 countries over 5 continents and nationwide in USA. He is the President and Founder of Platinum System C.R. Corp ( For comments or questions, please email to [email protected]


Local SEO Basics for Chiropractors

:dropcap_open:I:dropcap_close:f your practice does not show up in search engines for relevant queries, you are invisible and another chiropractor will gain a new patient. If you want your business to rank higher in Google, you need to get smart about local search engine optimization (aka “Local SEO”).
seooptimizingWhile SEO can work quickly and cheaply, in most cases it is a long-term, complex marketing strategy.  Your practice’s online presence is influenced by location, competition, links to your site and the hundreds of factors in Google’s algorithms.  
That said, there are simple things you can do to have the best shot of ranking well.
Learn the Keywords Used Most Often to Find Your Services
Keyword research involves finding the various terms people use to search for your practice, and emphasizing the most-popular terms on your web pages and in the text in links to your site. 
Think about different keyword combinations consumers are likely to use. Customers who know you may search by your name.  Many people will likely search “chiropractors” plus their home city. Do people abbreviate your city? New Yorkers often use “NYC”, and people in Fort Worth often spell the city name as “Ft Worth.”
Large metro area practitioners seeking customers from nearby cities should list the desired target cities on their website, or build pages targeting their services plus these city names.
Target Your Title Tags
The text used within webpage title tags (the words that appear at the top of the Web browser and as the blue links in Google) is an important SEO tool.
Your homepage title tag is key.  It should include your main keyword phrase, followed by your city and then business name.  I recommend adding the business name at the end of every page title. For example, a Boston-based practitioner might have this title tag: “Boston Chiropractor: John Smith, DC.”  
Each site page should have distinct title text and should accurately convey what the page is about. Titles should be brief and readable. Avoid targeting multiple phrases.
Use a Consistent Name, Address and Phone Number
Local search engines monitor multiple sites to find data about your practice.  Inconsistent listings of your practice’s name, address, and phone number on these sites can hurt your ranking. Write your address and phone number in regular text on every page of your site.
Optimize Your Profile In Top Directories
Google and other local search engines look for “citations” on top directories to help determine rankings. Citations can be a link to your site or mention of your business.
Google favors citations from established Internet yellow pages like and and industry-specific directories such as Planet Chiropractic.  Claim your listings in the top directories and make sure you are correctly categorized in each.Not sure which directories to optimize first? Search for your keywords in Google and see which sites appear on page one.
Claim Your Listing In Google Places & Social Network Sites
:dropcap_open:Google and other local search engines look for “citations” on top directories to help determine rankings.:quoteleft_close:
Claiming your business profile in Google Places, Yahoo! Local & Bing Maps helps ensure local search engines know your business is active. Enhancing your Places page with content like photos, videos and coupons increases your opportunities to persuade potential patients to visit your site. Also, claim profiles on the major social networks (Facebook, LinkedIn, Twitter, etc.) and link them back to your website.  These social profiles can rank well in search engines and help control how your brand appears to searchers. Large social nets like Facebook and Twitter provide many tools and opportunities for businesses to build social relationships with their customers. Don’t feel like you need to be active on every service.  Figure out which relevant social networks your customers use the most and be sure to set up and maintain an active presence there.
Obtain Citations From Local Authority Sites
Local authority sites include: chambers of commerce, newspapers, local blogs, local charities, local schools (including universities and community colleges), local TV & radio stations, etc. Contact these sites to request they link to your site and/or list your business. 
Start Blogging
Adding articles to your site that uses your target keywords can be effective for SEO and customer engagement.  Not sure what to write about?  Start with answering questions your patients ask most often.  Then pick three things you love (e.g. photography, sports and music) and discuss them from a chiropractor’s perspective. 
Encourage Customers To Rate & Review Your Business
Customer reviews are part of Google’s local ranking formula.  Tempting as it may be to write a glowing review of yourself, remember fake reviews are against the law.  Google, Yelp, and other review sites identify most hoax reviews, which are discounted and can count against you. 
When In Doubt, Ask An Expert
While DIY-types can do well with SEO, there are plenty of complications.  If you find yourself stuck, ask a colleague for a referral to a SEO consultant with an established track record in your niche.

Andrew Shotland is the proprietor of, a search engine optimization consultancy firm,and consultant for and The American Chiropractor Magazine have partnered to provide a free listing for each of our subscribers.  Go to to update your listing and look for more information about this great new product.

Technology Growing Fast in Chiropractic


:dropcap_open:T:dropcap_close:echnology is growing so fast.  Do you feel you can’t keep up with technology?  If you do, don’t worry because you are not alone.  No one can.  Technology, computers, software are growing so fast in so many areas of life, it is impossible for a human being to be aware of everything.  The good news is that everyone can adapt to technology at his own speed.  So, when you are ready to make a step up, you only need to open the door of technology and you can be assured there is something out there for you to keep you busy for a while.

Are you amazed about the planet being photographed by Google? You could see a real image of your house or you can go to Rome, New York, Sydney and walk virtually on any street.  Please take a moment to think about everything a cell phone can do now.  It takes pictures, records videos, makes them available to be seen by every human being on earth in seconds, has detailed maps and GPS, reminders, and thousands of other applications.  They say iPhone has more than 100,000 applications available.  OH! I almost forgot…. On a cell phone, you can make calls, too!  When we stop for a moment and think about it, we are all amazed and excited about all this.  It makes our life so much easier, saving precious time for other activities and having a much better control on our life.  Just think about paying our bills online replacing mailing checks every month, using bank teller machines, instead of waiting in line, and the list goes on and on and on….

Maybe you don’t realize it, but chiropractic is one of the best well served professions for technology.  Just like any other technology, it is hard for you to keep up with all the new  innovations.  I am sure there are a ton of new stuff you don’t even know about.  Knowing about a new technology does not mean you have to jump on it right now.  In fact, you should always be a little patient to make sure you will make good use of any technology before spending your money.   In the chiropractic profession, software competition is very strong. There are many companies out there battling to have new functions and tools to get or stay ahead of each other.  This competition creates an ideal situation for chiropractors.  Chiropractors can use the very best technology for a low price.  In fact, right now, chiropractors can use some amazing tools for way less money than what they should pay in reality, which is wonderful.  Lately, I have been thinking about how well served chiropractic is with technology and I wish to share with you some (just a few among so many) of the greatest chiropractic software innovations.

Computerized calling system

To my knowledge, chiropractic is the first profession to use an automated computerized calling system.  In fact, I have never seen another calling system anywhere else.  A member of your team uses a microphone to record the patient’s name.  This takes about 2 to 3 seconds and it is done forever.  On his arrival to the clinic, the patient signs in electronically by swiping a Chiropractic Health Card in a waiting room computer.  The system builds a queue of patients.  The magic starts here. When the doctor releases his treatment room, the system calls patients and directs them into the proper adjustment room, through speakers located in the waiting room.  You hear real human recorded calls and not a digital computerized voice.  I have personally seen this system in action and all patients are very impressed.  Many patients think someone from the back room is calling them with a microphone.  It frees up the CA completely and manages peak time perfectly.

Automated credit card and debit payment system

Everyone knows about how a credit card system works.  With the patient at the front desk, you grab his card, swipe it in a terminal, key-press the amount and wait for the approval.  After confirmation, you need to enter the payment transaction in your billing system. An automated credit card system is an upgraded version of what you have.  You do not swipe the credit card in a terminal anymore.  You swipe it in a card reader attached to your billing system.  While processing the payment, it updates your billing system simultaneously.  You can also set up recurrent monthly or weekly payments.  At a specific date, the system will process all the credit cards and update all patient financial files.  Great for a payment plan.  You will be able to keep your actual credit card processor or probably obtain a lower fee than what you actually pay.  Some software providers offer this system completely free of charge, included in their basic software package.

Insurance payments automatic posting

Talk about saving time!  This is the tool.  Imagine, no more insurance payments to enter in every single patient’s file.  Insurance carriers (clearing houses) are now providing an electronic remittance file.  They all do, unless you submit your claims on paper.  This software will read the remittance file and will automatically enter all insurance payments in every patient’s file.  This simply means turning hours of work into a few seconds.  No more mistakes, no more time lost searching why your billing system does not balance.


Digital X-Rays (with film, too)

Wouldn’t it be nice to have the patient’s X-rays on the screen on every single visit?  Now, it is easy, quick and cheap to get this.  When the patient gets in the treatment room, he swipes his Health card in a reader.  He lies down on the table, ready for his adjustment.  When you get in the room, there they are.  X-rays are displayed on the computer screen.  If you are using X-rays on film, there are some easy and quick ways to get them in the system and do the same thing.  You may also have other pictures, such as the patient’s posture, etc.

SMS (Short Message Service)

Time is to emails and cell phone texts.  You wish to remind all your patients about tomorrow’s appointments?  No problem.  Press on one single button and the software will select all patients with an appointment scheduled for tomorrow.  It will send them a formatted text message (including their name, the date and time of their appointment) on their cell phone.  The patient does not have a cell phone with text feature?  Then, the message will be sent to his email address automatically.  As a bonus, some software providers have found ways to send SMS free for you.


Good SOAP notes are an imperative requirement.  The patient’s subjective part is very important.  Don’t you think the patient is the best person to produce his subjective part of the SOAP notes?  So, why shouldn’t he do it? On his arrival to the treatment room, the patient swipes his health card in a reader attached to a touch screen computer. A series of personalized and issue-related questions appear on the screen.  The patient answers all questions by pressing on the touch screen.  While answering, the subjective part is getting built professionally and accurately.  Subjective notes entered by the patient himself…you can’t beat that!

Efficiency Control System

This morning, you are a little late and you arrive at your clinic a few minutes before the first patient.  Hurry up in the treatment room and start the day.  You have a busy day and have to cut out your lunch time.  At the end of the day, you are tired and want to go back home with your family and relax a bit.  As a business person, you need to take some time to make sure your office is running well.  Some doctors in chiropractic are now receiving all their office statistics and reports on their iPhone, Blackberry or personal email.  No human action is required. This is all done automatically, every day, every week and every month.  Being well rested and outside of the office, they can look at everything they need to maximize the potential of their practice.

These are a few examples only, among so many others, to show you how the chiropractic profession is well ahead of the game compared to many other health professions for technology.  Most of these features, or similar functions, are included in the basic price of some chiropractic software.

Now, you are excited and want to use all these features in your office right away? Don’t do that.  Don’t go from nothing to everything. The best way to make your office more efficient is to implement one new feature at a time, get used to it and, when it becomes transparent to your operation, you may implement the next feature.  A process like this will make you grow steadily and well under control.  Like everything else in life, common sense prevails.


Claude Cote  is an expert in EHR systems, insurance billing and chiropractic clinic management for 22 years.  He has installed EHR system in 17 countries over 5 continents and nationwide in USA.  He is the President and Founder of Platinum System C.R. Corp (  For comments or questions, please email to [email protected].