February 2008

The dream of the paperless office is still unrealized

Back in the mid‑1970s, futurists coined the term "paperless office" to describe their vision of a business environment that was completely ‑‑ or at least largely ‑‑ electronic, generating little tangible "paper" documentation. Such a system was predicted to increase productivity, save money and space, and facilitate information sharing.

Now, three decades later, we're still talking about paperless offices but generating as much, if not more, paper documents than ever before. Although computers are as common today as adjusting tables in chiropractic offices, most simply afford doctors and their staffs more opportunities to print out documentation. In fact, according to an article in the Christian Science Monitor paper sales rose six to seven percent every year during the 1990s. "The convenience of desktop printing allowed office workers to indulge in printing anything and everything at very little effort or cost," stated CSM reporter Matt Bradley.

Other experts note that the use of e‑mail in an organization actually causes an average 40% increase in paper consumption since users tend to read, then print, their e‑mails and attached files. Habits die hard and people who were raised or began work in the pre‑computer "paper" days have the most difficulty letting go of their paper copies and backups.

The CSM article relates a telling story of a business executive who, in 1993, decided to turn his entire advertising agency into a model paperless environment and removed all filing cabinets from staff offices. The trick didn't work. Employees simply "started storing paper in the trunks of their cars and hauling it around the office on toy wagons."

Only recently, as more "post‑computer" workers joined the workforce, has the trend toward paperless offices actually made an impact on the way we deal with documentation and information.

Still, many chiropractors lag behind the national trend and have been slow to adopt electronic systems. One California doctor posted a series of Internet messages chronicling his efforts ‑‑ just last year ‑‑ to find a software system that could help him achieve the ideal of a near‑paperless office. "I am sad to report that after extensive study and searching I was unable to come up with an Electronic Medical Records System that worked the way I do," he told readers. The blog entries express the frustration that many DCs feel when they attempt to make the switch to a paperless office.

For the most part, that frustration stems from five obstacles they encounter:

Cost: Full‑service electronic office systems aren't cheap. In addition to the software package, there may be expenses for additional equipment, training, support, and supplies. However, most experts say that the costs are recouped within the first few years and can, in the long run, save a great deal of money. This savings comes from increased efficiency in filing insurance forms (and the correspondent increase in claims payments), a decrease in past due accounts thanks to better payment tracking, better use of staff and doctor time, and even reduced expenses for paper, printer ink and supplies, and postage.

One other benefit of electronic office systems that could save many thousands of dollars is better risk management procedures. By facilitating proper record keeping procedures, a good electronic system could avoid a lawsuit that might result in a million‑dollar settlement.

Time: Switching to an electronic office is not accomplished in a day (or a week ... or a month). Many offices need several months to make the transition. You'll need time to set up the new system and train all staff members on it, input past information into the computer system, and revise office procedures to take full advantage of the benefits of the software you choose. Don't underestimate the time you'll need to make the conversion. "Initially, the conversion to EMR will not be easy. Nothing in life ever goes completely as planned, and you will almost surely deal unexpected glitches," warned Dwayne B. Baharozian, MD, in an article for Review of Ophthalmology.

That reality shouldn't deter doctors from making the change, though. "Everyone should remain focused and positive," Dr. Baharozian added. "Working through these problems will ultimately give you a deeper understanding of how the system works. This is no different from adjusting to challenges presented when learning a new surgical technique."

Expertise: Few DCs are computer IT experts, and the complexity of electronic office systems can be intimidating. Powerful systems can be overwhelming at first glance, and even information on the equipment can appear to be in a foreign language. Let's face it, how many of us really understand what LANs, dot‑net, Sql Server, integrated functionality, or ActiveX mean?

Unfortunately, many software sales people and company representatives, particularly those who specialize in the more technical aspects of the programs, tend to talk in computerese, that arcane language that should be reserved for tech seminars and Star Trek conventions.

The good news is that a well‑designed program offered by a good company eliminates the need to completely understand what goes on under the hood. Few people actually comprehend how pictures and sounds travel, but they watch television and use their telephones anyway. The same applies to computer office systems. You and your staff only need to learn how to use the system, not how it works. Knowing that you need little computer expertise will ease the burden of facing this obstacle, as long as the company you deal with provides adequate training and support along with the software package.

Confusion: The first step in going paperless is doing the research on which system to purchase. This is also, for many doctors, the last step since they can easily be buried under the avalanche of information. A Google search of the words chiropractic software resulted in 215,000 Internet references, more than half a million pages to choose from in your search for the details you need to make a reasoned decision. (Even combining the words into the single phrase "chiropractic software" produced nearly 50,000 citations.)

More than half of these pages are from vendors professing to offer the best available software package. Each claim is probably accurate, their software IS best for some doctors. For many doctors, the fear of making a wrong (and often costly) decision is enough to paralyze them into inaction. They adopt the "better the devil you know" attitude. Yet, once the switch is made, most are glad they did it.

You can eliminate part of the confusion by doing some in‑house research first. Take a critical look at your current system and determine exactly which jobs you want the software to do. Set appointments and send reminders? File and follow up on insurance claims? Enable accurate SOAP notes? Import digital picture of x‑ray into the patient's record? Display a photo of the patient on each record?

Talk with other chiropractors who have electronic systems. See what packages they use, any problems they've encountered, and advantages they've enjoyed. Ask if you can drop by their office and see the software in action. But keep in mind that their needs and preferences may be completely different from yours. A system that works in their office may be totally wrong for your practice. Still, you may be able to eliminate some possibilities this way.

Next, armed with a list of functions you want the software to handle, hit the Internet. Use a search engine to find information on applicable keywords. For example, you could enter the terms "chiropractic software" "private practice" (in quotes) to narrow the number of citations to pages that specifically discuss chiropractic software suitable for private practice (a total of fewer than 400 pages), or even include the word "billing" to narrow the field down to fewer than 300.

Check the basic information provided at the company websites and cross off any that are obviously not suitable. Keep whittling your list down until you arrive at the three or four best possibilities.

At this point, you're ready for some serious exploration. Call the company and ask for a demonstration of the product, which can often be provided via the Internet. Test drive the software to be certain it does all the tasks you want it to handle.

Ask detailed questions about the support you receive ‑‑ from initial implementation to training, ongoing assistance, program updates, hardware replacement, etc. Make sure you feel comfortable with the company's staff as well as the software itself. Make sure they provide both actual "classroom" and online training for all of your staff members.

This entire process will probably take several weeks before you're ready to make the commitment and buy a system. If you can resist the urge to throw up your hands and go back to paper records (which hits almost everyone about half way through the process) you'll be on your way to converting your practice into an almost paperless office. After a few months, your only regret will be that you didn't do it sooner.

(For more information on computerizing your practice, visit www.quixotesoftware.net )