Prevent Missing in Action Patients from Becoming Lost in Action

Every doctor has patients that miss appointments. There are numerous reasons for this, and it is up to you and your office staff to make sure that those missed appointments do not become lost and forgotten.

In the past, there have been many methods that were used to keep track of missed appointments, but they all required that someone in the office remember to look in a special file, or print a special report. Now there is a better way.

When you use a full-featured office management computer program, your MIA (missing in action) patients remain on your computer screen, until each appointment has been resolved. You and your staff have them as a constant reminder, until each has been rescheduled. No one must remember to look in the special file. No one needs to print a special report. All you have to do is look at your computer and make the recall and reactivation phone calls.

This is only one of many features that should be present in your office management computer program. A full-featured office management program is designed to keep your office efficient and productive. Other features include electronic claims, remembering every insurance claim submitted so you no longer print and file a copy, scanning of documents, and full integration with the your documentation software.

Computer programs designed by a chiropractor give many functional benefits. The right program makes your office as free of paper as is possible. Search out and take advantage of these programs and make your office more efficient with greater productivity than it has had before. The result will be more income and more time that you can spend with family, friends, or in any way that makes you happy!

Dr. Paul Bindell, President of Life Systems, Inc., is a 1975 Palmer graduate, in practice in Rockaway, NJ, since1976.  In 1991, he began Life Systems so that the profession would have reliable computer programs based on chiropractic practice.  Dr. Bindell can be reached by email at [email protected].

Integrated Software

Once you have had the pleasure of working with automated SOAP notes, you know the benefits of software that automates patient care.  In all cases, patient notes are only a portion of the paperwork in a chiropractic office.  In addition to SOAP notes, it is now possible.  Each program eliminates the need for paperwork, but the main concern when finding the right software combination is that all the different programs are fully integrated and compatible with each other.  Integration is the crucial element that allows patient information to flow freely between programs allowing for quick and accurate data sharing that saves time, effort, and money.
When billing insurance, both the doctor’s notes and the bill for services rendered must correlate.  In fact, Medicare requires that your progress notes document and match your billing, and in any case in which they do not, Medicare can fine you up to $10,000 for each progress note and bill that does not match. The software you utilize should be checking to make sure that your office notes and insurance bills always match.  You should not have to waste time comparing your notes and HCFA forms.  A fully integrated suite of software programs issues a warning notice anytime a dis-crepancy occurs.  With integrated software checking for differences, thousands of dollars are saved by keeping billing and progress notes in unison.

A fully integrated suite of software programs issues a warning notice anytime a discrepancy occurs. With integrated software checking for differences, thousands of dollars are saved by keeping billing and progress notes in unison.Integrated software allows patient information to automatically flow from the doctor to the billing office to the receptionist, eliminating duplication of effort from having to reenter information many times.  Such information includes diagnosis, treatment plan, transactions, and personal information that could take hours to recreate. In integrated software, this crucial data is entered only once and is shared automatically by the programs with no additional human effort whatsoever.  Therefore, you and your staff save an abundance of time and are able to concentrate more on patient care, recalls, and collections.

Integration goes a step further when a Pocket PC, a hand held computer, is involved.  Technology has reached the point where a Pocket PC is connected over a wireless network, and the information is updated on all your computers as soon as you file and save your SOAP note entry.  Immediately, your front desk has the information needed to schedule an appointment and enter the visit charges, your billing office knows what to send to the insurance, and your clinical findings are part of the patient’s permanent record.  This technology gives the doctor complete freedom of movement while treating patients and entering notes.  The Pocket PC allows the doctor to have one hand-held computer that he carries with him, which eliminates the need for a desktop computer in every room.  The doctor is also able to carry the Pocket PC wherever he goes outside the office and, upon return, all the new entries automatically synchronize with the main office computer.  Pocket PC technology revolutionizes your practice on so many levels that it will be discussed in greater detail in future articles in this series.

Integration of the software is achieved using a computer network that is set up within your office.  It is critical that you have software that is compatible with your network.  For wireless connections to work, both your computer and the Pocket PC must have the proper wireless equipment installed.  A “hard wired” network means that you have wires connecting all the desktop computers in your office, and you have a wire connecting your computer to a docking station for the Pocket PC, so it can synchronize with your main computer.  In order for software integration to be complete, it is necessary for all the software programs to come from one company. This avoids conflicts between the programs, databases, and development from different companies.

Once set up with fully integrated software, you will immediately notice a simplified, more efficient routine in your office.  You will rapidly process insurance, schedule appointments, produce narratives, and reduce paperwork.  This increases the time that you and your staff will spend on patient care, recalls, collections and expanding your practice.  As a result, you are likely to have more time to do the fun things in life with your friends and family, and you are likely to have more money to do it with. TAC

Dr. Paul Bindell is a 1975 Palmer graduate, in practice in Rockaway, NJ, since 1976. In 1991, he began Life Systems so that the profession would have reliable computer programs based on chiropractic practice.  Dr. Bindell can be reached by email at [email protected].

“Digital Analysis” of Plain Film Radiographs – A Superior Tool to Better Educate Patients and Attorneys

A benefit of being a doctor is the opportunity to see patients improve while treating them.  Most patients are quite grateful for the constant support and will return for more treatment if their conditions are exacerbated or new problems develop. 




However, receiving payment for services rendered is a different story.  Today’s healthcare practitioners have to be quite savvy in the business aspect of their practice.  How can a doctor enjoy the pleasures of treating patients, limit liabilities, contain costs and maintain a reasonable steady increase in revenue?  One answer today can be found in diagnostic radiology. 




Chiropractic doctors perform systematic and thorough physical examinations using methods, techniques, and instruments standard across all healthcare professions:  X-rays, MRI, PET and CT scans are essential parts of a practice.  However, another imaging service available is Digital Radiographic Mensurations.  It is often referred to as a “computerized enhancement” and “digital analysis” of plain film radiographs. 




Spinal X-raysSpinal X-rays are taken when a comprehensive history and thorough examination have determined probable musculoskeletal involvement.  The results from the analysis of X-rays that have been digitized and analyzed produce an outcome assessment process that helps establish the following:


a)     A chiropractic diagnosis for the correction of specific motions’ segment and functional units.


b)     A scale to assess the patient’s current conditions, compare serial studies, and determine maximum clinical improvement.


c)     Help provide a specific treatment plan with the clinical goal of restoration of the functional biomechanics. 


d)     Provide a unique graphical information format of the patient’s biomechanical findings for reference during each treatment session.




These will clearly help the doctor determine the need for treatment, the type of treatment to be administered, and monitor changes during treatment resulting from any re-injury. 




A comprehensive Digital Radiographic Mensuration should include three reports:  Biomechanical, Pathology and Digitized analysis.  Well-referenced Biomechanical reports produced by patented advanced technology are recognized by some of the most notable institutions in the country.  Those including impairment ratings per the latest edition of the American Medical Association’s Guide to the Evaluation of Permanent Impairment help justify medical necessity.  Multiple studies have shown X-rays read by board certified radiologists gather a much greater amount of information and are able to deliver more extensive pathology reports and data analysis.  Digitized analysis reports, especially those with the patient’s actual images imprinted onto photographic paper, provide a superior tool to better educate patients and attorneys.




Patients, by nature, are mostly visual people who understand pictures and graphs.  A patient’s X-ray images, when printed onto photographic paper with mensuration lines and statistical analysis graphs displayed next to normal spine images, illustrate to them their biomechanical differences as well as structural improprieties.  This gives the patient information that will motivate him to continue treatment and comply with further recommendations.  In addition to increased patient retention and compliance, the potential for lawsuits is lowered due to the fact that the patients have been well informed with documented references and research data about the necessity of their treatment protocols. 




One major complaint by doctors’ billing offices is the demand by insurance companies for detailed documentation to justify medical necessity.  The general medical profession and third party payors do not quite understand the vertebral subluxation complex.  By using the documentation from objective detailed reports provided with a comprehensive Digital Radiographic Mensuration and Analysis, insurance companies will not only approve longer treatment but also reimburse with greater compliance.  




Digital analysis of spinal X-ray films is a tremendous diagnostic resource available to help today’s chiropractors restore their patients to health and wellness.  What criteria should you consider when choosing a digitizing company?  Look for a service that provides:


  1. Board certified radiologists licensed in the state where patients are treated.


  2. Professional Comprehensive Reports


  3. Free shipping/handling of films to your clinic


  4. A reasonable turnaround time on reports


  5. Continuing Education seminars/lecture and materials


  6. Certification program for your clinic


  7. Availability to discuss cases with radiologists when necessary


  8. Newsletters to improve technique and further education


  9. Knowledgeable support for you and your staff




It is easy to see how diagnostic radiology and the use of Digital Analysis of spinal X-ray films in your practice can help you provide better patient care, limit liabilities, contain costs and increase revenue.  TAC



Aadam Z. Quraishi, M. D., specializes in Vascular and Interventional Radiology MRI (Neuro and Musculosketal), MRA Mammography, Breast Localization, Nuclear Medicine CT and Ultrasound.  Dr. Quraishi has board certification in Diagnostic Radiology.  To contact Dr. Quraishi please call 866-4PDI-PDI or you can email him at [email protected].

Marketing, Retention, and Patient Base

What are the common points in the strategies employed by growing successful practices?

In the first few weeks of this year, a series of surveys caught my eye. The new statistics coincided from one survey to another on the topmost issues on chiropractor’s minds…Patient Retention and New Patient Recruitment. No big surprise there, yet it hangs around like a chronic sore back, refusing to go away. Patient turnover is at an all time high and competition for new patients is a fierce, ever-escalating contest. Recruiting new patients can be a costly, drawn out affair, filled with frustration and uncertain results.

Aside from throwing advertising and gimmick money at the problem, which only lowers your ROI (Return on Investment), there are simple, motivating factors that any practice can find with a little introspection. Further looks into the cause and effect of the situation will provide some information to work with. Every clinic and every patient is different, and what may be your Achilles heel may not be the same for another practice across town.

We know from experience that the best and cheapest form of advertising is word-of-mouth. The trick is nurturing a strong patient base that believes your vision of health. If you don’t already have one, your first step is to launch a customer service campaign to earn their hearts and loyalty. Once again, you need to know what will positively work for your practice and your patients.

What would make a person not return…or start going to someone else? Why would they not say anything? Why would they want to put themselves in the hands of a stranger? What went wrong?

A little research into past patients will uncover the most common reasons for patient exodus. There’s always a reason.

Let’s take a look at some of the more prevalent remarks from ex-patients.

  • Moved to another city or state. 
  • No progress in my recovery.
  • Therapy too painful. 
  • Was not a covered expense.
  • Too expensive.
  • Had no way to get there anymore. 
  • Didn’t listen to what I said.
  • They wanted me to buy stuff I didn’t want.
  • Clinic didn’t seem to care.
  • They changed my doctor
  • Never gave me a new appointment.
  • People only wanted my money. 
  • Their people weren’t very nice.
  • Never called to see how I was doing.

If any of these sounds familiar, you have plenty of company. Unfortunately, this happens even to the best. The good news is that you can reduce it to an acceptable level. The great majority of the above kinks are created by inadequate communication. The solutions can only follow after we find out what the problems are.

Highly underutilized in practices, surveys can provide a gold mine of information which is actionable and inexpensive. Not only will these surveys help you with your current clientele, they may unearth strong phrases to use in your advertising. Once you’ve gotten strong agreement on recurring answers from patients or public, you can begin to take action.

Being human, we may falter in our resolve to change things around and discontinue programs, features or services that should have stayed in place. Fortunately your practice software, if it is one of the good ones, can help you stay on track. It can make absolutely sure that you never send anyone out of the office without their next appointment. It can remind you of that one patient that always forgets her appointment, or Mrs. Johnson’s birthday, or that she prefers Dr. Bill. Software can help you track the effectiveness of your promotional activities and provide statistics to gauge response. In short, most of what you need to correct a decline or accelerate growth is within your reach today.

Depending on what your survey turns up in the form of needed changes (survey your patients twice a year minimum), you can implement a five- to-ten point service campaign that preserves your current roster of clients, while you concentrate on marketing/advertising to bring in new patients. What could the five or ten points to your campaign include? It will all come out in the survey…more communication, temperature of the rooms, ask if hurts, a birthday card, reminders, shorter waits, free pick-up at the home, mints…almost anything.

Even the best-thought-out promotional strategy, including letters, cards, phone calls, service awards for staff, package discounts, newsletters, ads, radio/TV, articles, seminars, earned free services and a host of internet and web applications, will be for naught, if they do not connect with the emotional triggers that patients or the public may have. Find out!

As for the growth of your patient base, chances are that, if your patients are happy with you, they’ll bring all their friends with them. And how can you use this to market to the broader public? Let them tell you. Surveys, once again, are the cornerstones of the future. Surveys, planning, a warm, caring staff and the correct software will keep your practice growing, profitable and full!

Derek Greenwood is Chairman of EON Systems, Inc., manufacturers of TPS 2000, a software program for practice management.  For additional information, please call (800) 955-6448.

Chiropractic Marketing 101

It is simplistic in appearance. Many may say that it is even naïve. Yet “hidden” in the simplicity may be just what you were looking for: a low stress, high return approach to marketing. It is a chance to build a practice that is consistent and dependable in an economy that is anything but.

On the surface, marketing is far more art than science. I have read—and continue to read—the bestselling marketing books that crop up each year. I do it because I, probably much like you, want to know the “answer” or the “solution”. In spite of my chiropractic beliefs, I still find myself looking for the magic pill. Yet, too often, I read books back-to-back, each written by an expert with impressive credentials, each story told with unshakable confidence, and each completely contradicts the other. Direct mail is in. Direct mail is out. Telemarketing is in. Telemarketing is out. Big yellow page ad in. Big yellow page ad out.

Whenever I get hit with these opposing “truths”, I am haunted with echoes in the recesses of my brain—areas not touched since college economics: “This is true as long as everything else remains the same.” The reality is this: Nothing remains the same. What works in Atlanta may not work in Albuquerque. What works in Davenport may not work in Denver. What works in Timbuktu may not work in your neighborhood. And that is just looking at geographic differences. What about demographics? What about technique? What about socioeconomic differences? Listen to the experts, if you want. I do. They have great ideas. But keep this in mind: It is not the art of marketing that is efficient or successful. It is the science. And how does this relate in any way to chiropractic software? I’m glad you asked.

For years and years advertising was the king of the marketing hill. You spent money. You waited for new business. You spent money. And waited for business. The problem was—and is—trying to determine how effectively you spent your marketing dollars. Direct marketing—either by mail or phone—was the answer to many peoples’ marketing prayers, because it gave a direct and measurable return. The value here is having the ability to test different approaches. People are fickle. People are finicky. Try what you think will work…and measure to see if it does. It is in this process that you will quickly discover where to spend your marketing dollars…and where you are just wasting your money. Repeat what works. Discard what fails. The challenge that most chiropractors have is collecting accurate numbers with which to make these decisions. So, before you drop next year’s Annual City [fill in community event of choice] Screening, make sure you are looking at the proper numbers. It’s easy to keep track of how much you spend and how many new patients it generated, but is that really the whole picture?

Lets say you are trying to prepare a marketing budget for next year. You sit down with all the numbers to figure out what worked and what didn’t over the course of the year. You see that Spinal Screening A cost $450, generated 9 new patients, and you ultimately collected $6000. Looking at Spinal Screening B you see that it also cost $450, but it only generated 2 new patients and $1800. If forced to choose one screening over the other, the logical choice with the available data appears to be Screening A. But, again, is that the whole picture?

Patient referrals should play a tremendous role in the growth and health of your business. Yet, how many offices take them into consideration when analyzing the return on investment of their marketing efforts? Let’s take the previous example. What if the two people from Screening B were business owners, or community leaders, or medical doctors, or attorneys? What if those two referred five, and those five referred twenty-three, and so on and so forth? Looking below the surface and including the money collected from the referred patients, we may find that Screening B ultimately brought in $30,000 or $40,000. Trying to judge one marketing effort from another without all of the facts can be a costly mistake. This is where most office systems fail; they don’t report patient referral information completely. This leaves you to make business decisions without some of the most critical information about your practice: The complete effects of patient referrals.

Though the task of collecting this information may seem daunting, a software tool called the Cascading Referral Analysis™ has recently become available to do it for you. It allows doctors to calculate their Return on Investment (ROI) on any marketing effort—including patient referrals resulting from that source. The Cascading Referral Analysis™ gives you the exact number of patients and the collected dollar amounts for each event, plus those generated by their referrals. You can also look at that information per patient. If you are a visual thinker, you can even see the connections on screen and step through them one at a time. This detailed information is not only fun or interesting to look at; it can be critical in allocating your marketing dollars.

The science of marketing can be a powerful tool. Yet there is one component to the Cascading Referral Analysis™ that falls more into the mystical art side of the marketing equation. B. J. Palmer stated that, “You never know how far reaching something you may think, say, or do today will effect the lives of millions tomorrow.” With a tool like this, you can demonstrate for your existing patients how important it is to refer other people. It is a powerful thing to actually see the far-reaching effect…to know that referring one person was the catalyst that cascaded into a group of twenty or thirty people. Maybe next time they think about sharing the chiropractic story, they will realize that the health and well being of many others is counting on them as well.

David and DeDe Van Riper of InPhase Technologies Group have worked in the chiropractic profession at many levels for more than a decade. InPhase Technologies Group is a company dedicated to providing a comprehensive approach to chiropractic office systems.

For more information contact [email protected]  or 800-490-3780.

Diagnostic Tools in Chiropractic

Diagnosis, the basis for determination of treatment, is defined as “the art or act of recognizing the presence of disease from its signs or symptoms”. Diagnostic tools help you uncover or establish the characteristics of the disease(s) or condition(s). Chiropractors have a wide range of diagnostic tools available to them today …from the old stand by’s to newer technologies. New procedures, tests and technologies continue to be developed, some complementing diagnostic tools of long standing and some replacing them.

The most advantage is gained in determining the appropriate procedure when you know the type of information to expect. Additional benefits come from the documentation of the findings and application to the treatment plan…the ultimate goal of diagnosis.

X-Ray’s: The plain film radiograph of the spine is still considered the simplest and most common diagnostic tool used by doctors to evaluate skeletal problems. X-rays can gather an astonishing amount of necessary information about the patient. Above and beyond ruling out pathologies and possible fractures, X-rays can be used to show mensuration lines that can be used to determine and document specific structural impairments. X-ray’s are the basis for documentation of structural and spinal abnormalities.

MRI: Developed in the 1980’s, Magnetic Resonance Imaging (MRI) produces images of the anatomy without the use of radiation, as in X-ray and CT scanning. An MRI scan, with its enhanced image resolution, can be an extremely accurate method of disease detection throughout the body and is most particularly useful when considering problems associated with the vertebrae or intervertebral discs of the spine. An additional benefit is that an MRI is a non-invasive procedure, and there are no known side- or after-effects.

Typical MRI results of the spine can provide information such as spinal alignment, disc height and hydration, configuration of vertebral bodies, the appearance of intervertebral discs—normal, bulging, herniated, dehydrated or degenerated, the size and appearance of the spinal canal—compression of cord or nerve root, and other abnormalities or inflammation. An MRI cannot distinguish between painful and non-painful anatomical problems in the spine. The patient’s physical exam and symptoms must be correlated with the MRI findings to arrive at a clinical diagnosis.

CT Scan: Computerized (Axial) Tomography, often referred to as “CAT” scans, has been described as a fancy X-ray that can take cross-section (axial) images of the body. They are extremely useful for assessing fractures, because of the bony detail provided. Nerve roots, however, are not clearly shown and smaller disc herniations can be missed. The highly invasive combination procedure of a CT scan combined with a myelogram is a very sensitive test for nerve impingement. A CT scan is a diagnostic alternative for patients who are not candidates for an MRI because of the presence of a pacemaker, metal slivers in eye, aneurysm clip in brain, etc.

Musculoskeletal Ultrasound: Musculoskeletal ultrasound scans of the spine and extremities can provide differentiation of soft tissue, including ligaments, tendons, nerve root area, facet area, costovertebral junction and muscle spasms, for evaluation and documentation. Extremities, such as shoulders, knees, ankles, hips, wrists and elbows, can be imaged and reviewed. Ultrasound allows for real-time scanning of moving and static soft-tissue structures, an important consideration in injuries such as rotator cuff. One limitation is that ultrasound does not pass through bone, so some soft tissue areas cannot be imaged. It is excellent, however, for imaging soft tissue and documenting trauma to tendons, tendonitis, tears, inflammation and ruptures, ligament strains and tears; injury or rupture of muscles, bursitis, capsulitis, neuromas, fibromas and cysts. Musculoskeletal ultrasound is a very “patient friendly” procedure, and there are no known side- or after-effects to its use.

Videofluoroscopy (VF): The American Chiropractic College of Radiology has stated that videofluoroscopy is a useful imaging modality for the demonstration of spinal intersegmental joint dysfunction. VF can display the abnormal motion of the cervical spine, showing the point in motion the hypermobility or aberrant motion occurs. VF is valuable in detecting instability in flexion and extension not otherwise visualized or detected on plain films. VF can be used to document hypermobility, hypomobility, aberrant motion, instability, aberrant coupling, paradoxical motion and evaluation of spinal arthrodesis. Videofluoroscopy is an X-ray procedure and, as such, is contraindicated during pregnancy. Some other contraindications are when motion would be detrimental to the patient; restrictive muscle spasm, dislocations, recent fractures and severe neurological deficit.

Consultation & Physical Exam: The most important diagnostic tool available in your practice is you. Diagnostic tests and procedures can provide targeted information about anatomical regions, physiological systems and more. Your training, and the examination and diagnostic skills you employ enable you, as a chiropractor, to take the best advantage of the data produced by these other tools. Your expertise is required to correlate the assembled findings and determine the best course of treatment for your patient.

Ms. Plank has an extensive background in medical and facilities management.  Before making the transition to healthcare, for over 10 years she was the Practice Manager for a large veterinary hospital and a “first of its kind” commercial veterinary blood analysis laboratory.  During the past 15 years, Ms. Plank has provided technical and management services to healthcare providers, specializing in radiology and neurology.  She is currently the Vice President of Corporate Services for Practice Perfect.  Contact her at [email protected].

Serial Ports Are Going Away, and USB Is Here to Stay: Are You Ready?

Remember the good old days, when you used to plug your mouse into a serial port on the back of your computer, and IT DID NOT WORK? And when you finally loaded the right driver, you were SO HAPPY that it worked? And then you got REAL techno-geekish, and purchased a PDA (Palm Pilot) and/or digital camera and you REALLY found out how difficult serial ports were, since your PDA required the same serial port used by your mouse? Well, those days are over and so is the serial port. The serial port is rapidly going the way of the rotary dial phone, and is being replaced by the USB (Universal Serial Bus) port. What is really cool is that one USB port is capable of supporting many devices simultaneously, making it perfect for the technologically advanced doctors office.


Now here is the bad news: Virtually all chiropractic electronics devices (instrumentation including Range of Motion, Muscle Testing, SEMG and Thermography) utilize the serial port, leaving you totally stranded if you opt to purchase a newer computer (especially the lower cost computers). Serial ports still exist, but they are disappearing fast, so it is time to find a techno-solution.


A little background first: There are basically three ways to connect peripheral devices (such as cameras, chiropractic instrumentation, scanners etc.) to your computer: The serial port, USB port, and Firewire (also known as IEE1394) port. Some rare nut cases actually try to use the infrared ports, but anyone who has tried has found out how difficult that can be. There is also Bluetooth (which is a wireless standard), but it is not functional enough at this point to discuss. Parallel ports are disappearing along with serial ports.


USB is broken into USB 1.1 (low speed, used with mice or printers), and USB 2.0 (high speed, as is used with external hard drives and CD burners). USB 2.0 is rapidly becoming standard on new computers. Firewire (IEEE 1394) runs at about the same speed as USB 2.0, but is used mainly in digital video cameras and some hard drives only.


With chiropractic instrumentation typically outliving computers by many years, when you go to upgrade your computer, you’ll find that you simply cannot connect your instrumentation to your computer, leaving you without the essential instrumentation and clinical data every modern office relies upon.


How do you interface that ROM device, Muscle Tester, SEMG and Thermography devices to you computer when there are no serial ports?


One solution is to purchase “off the shelf” serial to USB converters for each of your serial devices. The problem is that they are typically “general purpose” converters, and are not designed to function with your specific instruments. I have found that they work around 80% of the time, which may be acceptable for some people.


As one who is easily frustrated, I gave up, and decided to design my own serial to USB converter. Customizing it to our specific needs provides significantly greater reliability. In addition, it is backwards compatible with all of our instruments going back to approximately 1991, and is truly “Plug & Play” on most operating systems, meaning there is little or no setup required.


The advantage of this solution is so great that, prior to purchasing ANY equipment in the next year, you should make certain that it is “designed for USB”. Note that marketing people are great at twisting the facts, and will try to claim that off-the-shelf USB to serial converters are built for their devices; so buyer beware, and ask several questions prior to purchasing any instrumentation any time in the future.


Questions to ask to determine if the product you are interested in is truly USB compatible:

1.  Does the device function or have a connection which works on a serial port? If the answer is, “Yes,” then you know that the device is a serial device, and the next few questions are very important ones.

2.  Will it function on a USB port at all?  If the answer is, “No,” be aware that you may have trouble connecting it to your computer, or a computer you purchase in the future. If the answer is, “Yes,” ask the following question:

3.  Does it use a serial to USB converter? If the answer is, “Yes,” ask:

4.  Does it use an “off the shelf” converter, such as a brand name model, which can be purchased online, or from a computer store? (Some brand names include Belkin, Keyspan, and Radio Shack) If the answer is, “Yes,” you may experience more difficulty with the product.

5.  Is the product designed to be used with USB without an off-the-shelf converter? If the answer is, “Yes,” this is the product you will most likely be happiest with.


Not only will the purchase of a product designed for USB be more reliable, easier to use, and protect your investment by interfacing to computers you may upgrade to in the future, but you can also purchase a less expensive computer. To put it into perspective, Dell now sells a notebook computer for $799.00 without a serial port. The least expensive model with a serial port costs $1199.00. What they are trying to communicate is, “We are getting rid of serial ports, so listen up!”


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.

 The author, David Marcarian, MA, is founder and president of Precision Biometrics, supplier of the MyoVision SEMG and Thermoglide systems. He has worked for NASA, and was awarded a $450,000 grant from the NIH for developing the MyoVision. He lectures for Palmer College of Chiropractic and his course is endorsed by all U.S. chiropractic associations that mandate SEMG training. He has personally instructed more than 6,000 chiropractors on proper SEMG use. Mr. Marcarian can be reached at 800-969-6961, by email at [email protected], or visit his company’swebsite at

“Technologize” Your Screenings for 10 Times More New Patients

Visiting the Seattle Boat Show recently, I was amazed to find a perfectly located and great looking booth, with energetic DC’s chomping at the bit to sign up new patients.  They were literally following people as they walked by, but everyone kept on walking.  I said to the doctor in charge, “Why would you spend all this money on this show, and not be using a Static SEMG?”  Although he had never used one, he had no trouble listing a million reasons why it was a waste of time.  I suggested we try it for an hour just for grins.  He begrudgingly agreed. 
Needless to say, with the SEMG setup, potential new patients were literally lining up to be tested.  One screener said, “Wow!  I can’t believe they are actually coming to us.”  After an hour, I was getting bored, so I packed it up when he wasn’t looking and left.  I did not even make it to my car before my cell phone started ringing.  It was the doctor, of course.
“Where did you go?” he said. 
“You told me it was a waste of time to use an SEMG, so I left,” I responded.
“No, No, No….  Please, bring it back!” he said.    
What made the huge difference?  Technology.  Our society eats, breathes, and believes in technology.  We don’t trust it unless it has been “blessed” by a computer of some sort.  Add to this the fact that 80% of us are visual learners, and it is obvious. 
Doctors report a five- to ten-fold increase in number of new patients when using instrumentation in comparison to traditional screenings, and agree that the machines are paid for in their first couple of screenings
1. Instrumentation:  Static Surface EMG (approximately $5000):  Why?  SEMG’s can be used in all environments, regardless of temperature (unlike thermography), and people naturally understand muscle tension, making it simple to explain.  Since they can feel it, you establish credibility with them very quickly.  What characteristics make an SEMG optimal for screenings?
a. The lighter the weight, the better.  Every piece of equipment, including the SEMG, should be as light as possible.  A solid, easy-to-use transport case is a nice option, but is not totally necessary. 
b. Standing Neutral SEMG tests are optimal for screenings.
i. Load bearing, “chiropractically” sound standing tests bring out more abnormalities, and you don’t have to lug a couple of chairs with you.
ii. You are more visible than when doing seated tests, as you are at or above eye level when testing.
iii.Psychologically, people associate the seated position with making a commitment, as with purchasing a car.  People are much more likely to allow you to test them standing, as they feel less threatened. 
c. Software should be simple to use, fast and should not require that you enter patient names (both for speed and HIPAA).  Systems that use Function keys instead of the mouse allow you to test in sunlight where the screen is less visible.  This is particularly important in spring and summer screenings, which are often outdoors.
d. Graphics should be clean, simple and are much more powerful if presenting a sample “ideal” test alongside the results, for comparison purposes.
e. Voice prompts and/or sound is very important, as the more senses appealed to, the more people you will attract.
2. MONITOR:  Price:  $180 to $3000.  Best value:  19” Color Monitor.  Most “Punch”:  Data Projector or Plasma Screen.
a. Considering that 19” monitors are under $180, it makes more sense to use a monitor than a TV.  If you can afford an LCD, purchase at least a 17” screen.  42” Plasma screens are great, but cost upwards of $3000.
b. If you can afford a data projector, they are very powerful when used indoors.  (Must be at least 1000 lumens, and 800 x 600 resolution).  The best projector screen is the Dalite Instatheater 60” (around $350).  The screen rolls itself into a solid carry case, and looks like an expensive big screen TV when setup.  
3. SPEAKERS:  $20 to $40.  Labtec “Spin” series computer speakers are inexpensive, small and work well. 
4. MONITOR RISER: Fellowes Premium Monitor Riser (model 91717, approx. $22) allows you to place the monitor on top of the SEMG, not only making the monitor more visible, but saving space.
5. POWER:  AC when available (call ahead to secure it).  The next best thing is a deep cycle marine battery (120 amp hours) with a 400-watt power inverter (available from West Marine, or auto parts stores).  You will also need a part from Radio Shack which provides a cigarette lighter adapter wired to red and black alligator clips (to connect to the battery).  Plug the inverter into the cigarette lighter adapter, and you have power!  Don’t forget, you need a charger for this.  Honda 1000 watt generators are also good, but ONLY if you can place them far enough from your screening to avoid the obvious noise problems.   
6. PRINTER:  I am very impressed with the new HP 450ci printer ($299).  It is fast, rugged, and small.  Set it to draft mode for the greatest speed.

Instrumentation makes screenings not only more efficient and effective but, also, more fun.  Don’t forget to have a positive attitude, and remind each potential patient that results are not as accurate as they would be in the clinic.  This not only is the truth but, also, provides motivation for them to visit your office for a complete exam.
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. TAC

The author, David Marcarian, MA, is founder and president of Precision Biometrics, supplier of the MyoVision SEMG and Thermoglide systems.  He has worked for NASA, and was awarded a $450,000 grant from the NIH for developing the MyoVision.  He lectures for Palmer College of Chiropractic, and his course is endorsed by all U.S. chiropractic associations that mandate SEMG training.  He has personally instructed more than 6,000 chiropractors on proper SEMG use.  Mr. Marcarian can be reached at 800-969-6961, by email at [email protected], or visit his company’s Web site at

New Year’s Technology Rules-olutions from a “Techno-Geek” The Importance of the “Preemptive Strike”

OK, so I’m powering by Bill Gates’ house in my boat (no joke, he’s right there on Lake Washington), and thinking, “Wouldn’t it be fun to do to Bill what Tony Soprano did to his new lawyer-neighbor in the last episode of “The Sopranos?  Set my sport yacht right there in front of his house, with speakers blasting—but, instead of Frank Sinatra, pipe in the nasty tech support calls which come into Microsoft over it’s most recent ‘new and improved’ software?” 
So we have the topic of my January 2003 set of “David’s Rules”. 
 Remember, the key is to live a stress-free partnership with technology.  That means OUTSMARTING it.  “Preemptive Strike” is the key phrase.  Get it before it gets you.

New Strategy for 2003:  Instead of buying your new computer, or upgrading your current computer with a software CD, and finding out the hard way that there are problems with the operating system itself, do the following BEFORE you install any new application software or peripheral devices:

  1. Preemptive strike with Brand New Computer setup or upgrade to Windows XP:  Contact Technical support or the website for a new product you plan to install.  Find out what changes have occurred with your software installation, and follow the new instructions, if there are any on the website.   In other words, take a few moments to check out the website for last minute changes in the installation process, which may not have been documented in the installation software.
  2. XP is notorious for having multitudes of little gremlins running around your machine from the day you get it.  Thanks to the internet, Microsoft now provides automatic updates to your system which should “kill” as many of those gremlins as possible.  These days, the FIRST thing you should do when purchasing a new computer, or upgrading your computer to XP is to perform a “windows update” immediately after the upgrade or setup finishes.  It is relatively simple:
    – Setup your new computer or upgrade to XP.
    Get online.
    – Go to Start, Help & Support, Pick a Task, Windows Update.  Follow the relatively simple instructions, and your system will actually “heal itself”.  Be aware that it could take up to several hours, so plan for this.  Your input is not required for most of the process, but you should be around, just in case the computer needs a decision from you.
  3. Preemptive Strike with installation of new software applications:  Most software manufacturers get a huge discount for creating a huge number of software CD’s at once, so the software on your CD may be months old.  RULE:  The Software CD in your hand is an illusion.  The real software is sitting on a website somewhere for you to download.  When installing software, first, download the most recent upgrade from the software company’s website. Next, install the software CD.  Then, install the update you downloaded.  Reboot your computer, and now you have the latest software prior to working with it and finding out there are serious bugs.

I just installed ACT 6.0 on my system.  Believe it or not, the instructions on their website are totally different than the software’s own installation program would suggest.  If there had not been technical support there to help, the program would  never have worked.  Note that I waited for them to release a software “fix” on their website prior to purchasing the upgrade.  I wanted the other less suspicious (and probably less experienced) users to experience the pain required for the new update, first. 
I find this so unacceptable that all software produced by my company is beta tested for months prior to releasing it.  The new release of the our 2k3 software is in its 36th revision PRIOR to being released.  Most marketing companies ship products and THEN figure out how to get them to work.  Engineering companies like ours, create thoroughly tested products and THEN ship to customers.  I’ve noticed that doctors who become more technologically savvy almost always choose products with great engineering over the ones with slick advertising. 

Windows 98 Essential Technical Tips:

  1. If still using Windows 98, make certain to reboot the system once daily, as there are problems with Windows 98 machines getting “messed up” from sitting too long.  If you even noticed Windows 98 getting unstable, this is the most common cause.
  2. Backup up the system entirely once yearly, and run the computer’s recovery CD (if you have it) once per year to restore Windows 98 to its optimal working order.  Windows 95/98 has a tendency to develop something similar to arthritis over time, and the only true fix is to restore to original setup, and re-install your software applications yearly.  If you start having trouble with the system crashing, this is the time to perform the recovery.  The hardest part is reinstalling your software applications, so make sure you have them all,  prior to this process.

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. TAC


The author, David Marcarian, MA, is founder and president of Precision Biometrics, supplier of the MyoVision SEMG  and Thermoglide systems.  He has worked for NASA, and was awarded a $450,000 grant from the NIH for developing the MyoVision.  He lectures for Palmer College of Chiropractic and his course is endorsed by all U.S. chiropractic associations that mandate SEMG training.  He has personally instructed more than 6,000 chiropractors on proper SEMG use.  Mr. Marcarian can be reached at 800-969-6961 and via email at: [email protected], or visit his company’s website at

The Rules For A Stress-Free Partnership With Technology From A “Techno-Geek”

I’ll admit it.  I’m a techno-geek.  I have internet access on my Pocket PC, two cell phones, four notebook computers, internet access on my boat, and anyone who has asked me to solve a computer problem knows that I know what I am doing.  I love technology; and, just like your passion is the spine, my passion, and the passion of my company is to keep ahead of the technology curve, so you do not have to.  With twenty-one years’ experience in the “Silicon Valley”, including research at NASA and IBM’s ergonomics labs, I have learned quite a bit about technology and making it easy for people to use, e.g., people like doctors, who need to spend time with patients, not fixing computers.
If you want to utilize technology in the most stress-free manner, here are  “David’s Rules”:

  1. Never purchase any technology unless it has been around for at least six months.  The reason IBM is rated the highest in reliability is because they do not release technology until others have worked the bugs out first.  I believe in this philosophy fully, and it shows in my product designs.
  2. Always purchase “name brand” computer hardware.  There is a significant difference in reliability with an IBM, Dell or Gateway, as compared to a “clone” which was custom built with all the quirks that brings.
  3. Purchase high quality printers and displays.  The public is more likely to be drawn to a doctor that is higher tech.  There is nothing worse than doing a screening with a slow printer.
  4. If upgrading from Windows 98 to Windows 2000 or XP, have a professional do the installation.  You may never figure out how to get it to work properly.
  5. Purchase quality backup hardware (tape drive, or backup drive).  Use five backup disks (media), one for each day of the workweek.  Take the tapes off site daily in case of fire or theft.

When evaluating which chiropractic software and hardware/instrumentation products, always ask technologically savvy friends in your profession, who own AND USE a technology you are interested in, the following questions:

  1. Does the software crash?  How often does it crash?  If Tech. Support has not been able to resolve crashes, avoid the product.
  2. Is the instrument reproducible?  Have a “well-trained” friend perform two tests in a row.  Print them out for an objective comparison, if the software does not do overlays.  Don’t worry about hurting the feelings of the owner.  If the product is not reproducible, this will affect your credibility with your patients and your community.
  3. How reliable is the product?  How often has it required repair?  How is the technical support?  Having a great concept for a product is great, but avoid products that have poor reliability or technical support.
  4. Do you have to purchase specialized supplies from the manufacturer?  If the supplies are available from multiple suppliers, it means cost savings for you. 
  5. Is the software fast, easy to use, and simple?  Simplicity is the hallmark of a great product.
  6. Is your machine capable of performing the types of test you need?  For example, if the cervical spine is of interest to you, make certain your machine is capable of doing a complete cervical measure.  If you are interested in Standing Neutral SEMG tests to correlate with your X-ray, and follow in the tradition of chiropractic itself, find a product which uses a button press on the probe.  The button press is optimal, as it allows you to stand in a neutral posture when testing.  If possible, test a system prior to purchasing it.
  7. Does the technical support include the ability to remotely access your computer, via modem, for problem resolution?  It is the next best thing to having a technician right in your office, and a service you won’t want to live without once you experience it. 
  8. What are the details of the warranty?  Get the warranty statement in writing so you can see the limitations.  If, for instance, you get a three-year warranty, does it include all components?  Less comprehensive warranties may cost you thousands in repairs.

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. TAC

The author, David Marcarian, MA, is founder and president of Precision Biometrics, supplier of the MyoVision SEMG  and Thermoglide systems.  He has worked for NASA, and was awarded a $450,000.00 grant from the NIH for developing the MyoVision.  He lectures for Palmer College of Chiropractic and his course is endorsed by all U.S. chiropractic associations that mandate SEMG training.  He has personally instructed more than 6,000 chiropractors on proper SEMG use.  Mr. Marcarian can be reached at 800-969-6961 and via email at: [email protected], or visit his company’s website at