July 2007

DCs often resistant to electronic record systems

In the "old days," chiropractors worried very little about malpractice lawsuits. As low‑risk, non‑invasive practitioners, they were (justifiably) seldom taken to court by their patients. Today, the situation is completely different. Because of the growing popularity of chiropractic, the involvement of insurance companies, and the perception of affluence (and deep pockets), DCs are likely to face at least one or two claims of malpractice sometime during their career.

Ironically, most cases do not involve quality of care, but center around the quality ‑‑ or lack of ‑‑ proper patient care records. According to one report, medical‑record information is used as evidence in about three quarters of all civil cases and in about one‑quarter of all criminal trials. (Harold L. Hirsch, "Medical Records ‑Medicolegal Implications," Southern Medicine, Vol. 63, No.4 (August 1975), p. 11)

For this reason, almost all risk management experts stress the importance of good recordkeeping. The British company, UK Special Risks, Ltd., advises clients that "the importance of record‑keeping cannot be overstated... Patient records form the basis of any medical legal defence and there may be a presumption that if a patient record is incomplete then the examination was similarly incomplete, strengthening the claimant's case."

Another report discussed the "increasing use of medical records in judicial proceedings, especially in malpractice suits, where the content of a medical record is often the physician's only real defense. (Chapter 7, Personal Privacy in an Information Society: The Report of the Privacy Protection Study Commission. Emphasis added.)

This demand for though and accurate recordkeeping applies to all health care practitioners, including chiropractors. Yet, DCs have often been resistant to upgrading their recordkeeping systems. "We continue to see cases brought to court and before state licensing boards involving doctors who scribble a few notes on a patient card," says Timothy Feuling, president of Chiropractic Benefit Services, a popular malpractice insurance program. "Half the time, they can't decipher their own notes and the other half, the records are not complete enough to serve as a strong defense."

The obvious solution is automating the entire recordkeeping process with an "Electronic Health Records" system. The new computerized systems are considered so efficient that many medical malpractice policies actually offer premium discounts for MDs who use them.

Yet, many DCs are stuck in the pen and paper mentality. If it's any consolation, they aren't the only health practitioners who are slow to adopt the new technology. Earlier this year, John Glaser, vice president and CIO of the Massachusetts hospital chain Partners HealthCare System told the audience at a Massachusetts Health Data Consortium that "Fewer than one in four doctors nationwide have begun using electronic health records (EHR), and most who are using electronic records have done only a partial implementation."

Charles Safran, MD, of Harvard Medical School pointed to the same problem several years ago, when he wrote: "The promise of the electronic patient record is real and proven, but the reality for physicians in the United States has been largely unrealized. Perhaps the emerging generations of physicians with computer skills and consumers of health care who demand digitally ensured quality will spur adoption of a technology that saves lives and improves the quality of care." ("Electronic Medical Records: A Decade of Experience," JAMA, 2001;285:1766)

Part of this resistance stems from a basic fear of changes that could disrupt their practice. According to Claude Cote, of Platinum System, the solution is to find a system that can easily and seamlessly be incorporated into an existing practice. "If a computer system ends up being more complicated and difficult to work than the old system, it's not going to be useful for an office," he stated. "Doctors need a complete, integrated system that will be up and running smoothly in a very short time. It has to be so simple to use that it's actually fun!"

Making an electronic patient recordkeeping system "fun" is a challenge but some doctors swear they actually enjoy using it. Drs. Mike and Leslie McClellan of Rainbow City, Ala., for instance, admitted that "after 18 years in practice we were fearful of a computer change." After switching to electronic patient recordkeeping (Platinum System) they overcame their apprehension. "It makes high volume practicing more fun," they said.

Naturally, no practice change comes without any obstacles and switching to an EHR system presents several challenges, including initial purchase and setup costs, entering past data into the system, protecting patient privacy, and developing and training staff in new office procedures. However, a well‑chosen system saves time, reduces cost and can be the doctor's most useful tool in defending against malpractice lawsuits and board complaints.

For most doctors, the benefits clearly outweigh the costs in money and time. Dean McIntyre, DC, of Tenn.‑based Family Chiropractic & Rehab, who purchased a Platinum System, noted: "It took our office about one week to input the data, and it has been more than we could have ever expected. The stats it keeps will blow you away, it tracks everything and it is also a button away."

The doctors and staff at Kel Chiropractic in Edmond, Okla., had a similar experience. "Although we are still inputting some data, we're truly seeing how a paperless office reduces the workload of our cash practice," they stated in a letter to Platinum System. "We have now been paperless for three weeks and wouldn't return to our old system for anything!"

As the risk of malpractice suits and board complaints escalate, electronic health records will become essential, if not obligatory, for all health care professionals. By shopping for and switching to a high‑quality system now, DCs will gain an even greater advantage over other practitioners who cannot or will not adopt the new technology.

"Relying on old methods of recordkeeping is like relying on outdated research," said Cote, whose Platinum System is now used by thousands of DCs in 17 countries. "If you want to position yourself as a modern, scientifically based doctor of chiropractic, you need to use a recordkeeping system that ensures the highest level of patient care and can help protect you in court."

Platinum System recently demonstrated its dedication to the chiropractic profession, and to advancing chiropractic research, by partnering with RCS (Research & Clinical Science). Platinum will help clients participate directly in the research process by becoming RCS Authorized Clinical Investigators. RCS is developing the programming capability to compile and analyze patient data collected by doctors using the Platinum System.

(To learn more about Electronic Health Records, visit the Health & Human Services website at: http://www.hhs.gov/healthit and the Platinum System website at www.platinumsystem.com.)