March 2008

Here's where our enemies will strike next

by Dr. Terry A. Rondberg

There's every reason to be happy about the research report confirming there is no link between chiropractic care and an increased risk of stroke. I think all chiropractors should print the information and circulate it to every newspaper in their city, and make sure all their patients learn about it as well. Many people who were frightened away by the earlier stroke reports or ads placed by chiropractic 'victims' groups will be convinced that chiropractic is not dangerous.

But if you think for a minute that this one report is going to stop our enemies from attacking us, you're far too naive for your own good. They will continue to attack us as unscientific and dangerous, and continue to misuse outdated research results to "prove" their point.

In addition, they will continue looking for our most vulnerable areas and strike us there.

One of those areas is our patient record keeping procedures. Hard as it is to believe in this day and age of computers and electronic health records, many lawsuits and board complaints still focus on inaccurate or inadequate records. We go in front of a judge and jury, or a board, and pull out a bunch of travel cards with scribbled notes. Or, we bring in computer records with vague, generic 'template' entries that could apply to all of our patients, or none of them.

That's like giving the opposition a gun and shouting "SHOOT ME." Or, as one writer put it in an article for Medical Economics, "a plaintiff's attorney will look at a sloppy, incomplete, and possibly altered record and see a gold mine. Your liability insurer, on the other hand, will see an indefensible case ... if the physician's records are ambiguous, careless, incomplete or ‑‑ worst of all ‑‑ look as though they've been tampered with, a defense attorney can do little more than advise his client to start writing the settlement check."

Record keeping today isn't as easy as it used to be. Most states have laws stating that a patient's medical or health record must contain all clinical information pertaining to the patient. That means every test result, observation, finding, diagnosis, response, side effect, intervention, outcome and interaction!

Can you imagine trying to write all those notes by hand on the patient file, and make it legible to boot? If that's what you're doing, you're a lawsuit waiting to happen.

Which is precisely why so many doctors are adopting electronic health record systems. Some eagerly jumped onto the technology bandwagon early on while others are finally being forced into using it (kicking and screaming every inch of the way). But facts are facts. Right now, using an electronic health records system is strongly recommended. In a few years, it'll be mandatory. There's no sense in waiting.

Because Chiropractic Benefit Services (CBS) malpractice insurance program puts a great emphasis on prevention, it has long encouraged doctors to use electronic health records systems and pay close attention to their record keeping procedures. Recently, it endorsed Quixote Software as the most powerful program of its kind available to the chiropractic profession.

Using Quixote won't guarantee that you won't be sued or brought before your board. But if the complaints involve record keeping, the use of Quixote's computer record keeping system will go a long way toward providing the kind of "bullet proof" defense you're going to need.

With Quixote, you'll be able to improve your defense in malpractice cases and board complaints by electronically documenting every aspect of your interaction with the patient, including your informed consent procedures, patient health history, tests performed and test outcomes, report of findings, rationale for care recommendations, patient compliance, etc. What's more, you'll be able to quickly and easily produce a complete, legible record that can be made available to your insurance company for use in court or in case of board complaints.

But there's a potential downside to electronic records that we have to be aware of as well. In some instances, using EHR can actually lead to lawsuits and complaints, since there is always a risk of accidental data loss or destruction, inaccurate data entry, and possible privacy violation issues. Although these risks are fewer for EHR than for paper records, they still need to be addressed.

That's why, when choosing your EHR software, you need to pick one, like Quixote, that provides adequate safeguards against these risks. You'll need software that easily and automatically creates data backups, offers a simple data entry system that's virtually "goof proof" and is completely HIPAA compliant.

As CBS noted when it announced its endorsement, there are a number of good electronic office systems available to chiropractors and it isn't always easy to decide which is best for you. Personally, I agree with CBS that Quixote edges out the competition because of its powerful yet simple interface, its reliable support and service, and its dedication to chiropractic. By being the "Software with a Higher Purpose," Quixote lives up to its idealistic name. It is the only chiropractic software company that gives its clients the opportunity to engage in chiropractic research by contributing patient information to Quixote's global database (all in perfect compliance with HIPAA privacy rules).

Take a couple of days to bask in the sunlight of the new stroke study. But after that, start looking around to see what you need to do to shore up any vulnerabilities in your office, to remove any potential weak spots that could be the next target of attack. If it's your record keeping system, visit www.quixotesoftware.net  to learn more about how you can make the transition to the type of system that can "bullet proof" your office.