Chiropractic EMR & Billing Reviewing the best and worst

I set out trying to find the best Chiropractic EMR for the best value. I wanted to utilize a system which would provide me with practice management software that would also accomodate my billing needs as a Chiropractor. The desired program would have to be affordable, efficient and easy to use. Current Chiropractic EMR and Billing software programs offer many bells and whistles that the average Chiropractor can neither employ nor economically justify and the search for Chiropractic EMR and billing programs often becomes as confusing and daunting of a task as passing the boards.

I have spent many hours evaluating and reviewing several Chiropractic EMR and billing programs in an attempt to find the most popular and easiest to use. This involved many demo conference calls, downloads and even a few purchases. Investing in a Chiropractic EMR or billing system involves not only money but valuable time and effort by both the Chiropractic doctor and staff who will be required to use the software.

The biggest problem I have found while researching Chiropractic EMR and Billing programs is inflated promises. Every company assumes that every doctors problems can be cured by a complex program instead of realizing that complexity is what we are trying to avoid. For decades, chiropractors have managed to get by through handwriting notes and dictating reports. It wasn't until the advent of electronic note taking that we all of the sudden NEEDED electronic note taking. Granted electronic billing is out of out hands due to the insurance companies, but SOAP notes are still able to be cultivated by hand.

The ultimate chiropractic software would, in my opinion. do the following:

• Be offered at an affordable price. When I say affordable I am referring to what I think the software is worth, not what a sales rep deems it to be. When an average insurance reimbursement is $50, a ten thousand dollar program better not only be fast and perfect, it should weed my garden, teach my kid Spanish and predict the daily number.
• Allow a wide range of flexibility while at the same time reducing repetitive and menial tasks. Software reps often like to abuse the term " flexible". Flexibility can range from altering programmed phrases to having to fill in all of the CPT or ICD codes. There are several programs available which appear to have been created by a single Chiropractor who believes that everyone else should practice only the way they do. Their programs provide little room for customization and given that no two Chiropractors can agree on the acidity of water, the chances that they will practice the same is remote at best. Conversely their are other programs on the market that fall just short of requiring that you get a degree in programming in order to complete basic tasks. These frequently are sold and handcuffed to "support" packages that are expensive and often under utilized once installation is complete but remain a requirement every year.
• Basic SOAP note reporting should be seamless and comprehensible. Most programs present with one or several screens that require a minimal amount of typing while relying on pull down boxes or check boxes to select information. These choices are then converted into sentence for to craft a note in paragraph form. It makes little sense to have to go back and edit the text due to a lack of confidence in spelling or structure. I will admit that I am no superstar when it comes to composition ( as I readily display my inadequacies throughout this post, but I am not charging you thousands of dollars!) and this is why I need (?) documentation software.
• Narrative creation from SOAP notes is a godsend. Many programs will, with the push of a button, generate a narrative report based on the patients basic information, history and SOAPS. This is a must have option. Without this feature, doctors are resigned to either wasting their time performing the task themselves or wasting their money farming it out to others.
• The ability to scan documents is overrated. I am not buying into the "paperless office" myth. There are always forms to sign, insurance documents, EOBS ect and having a chart with a few papers inside costs a lot less than paying someone to sit around scanning documents and putting them into an electronic folder. If this feature fits into the overall identity of the software, hooray! , otherwise it isn't a factor.
• Easy documentation to billing compatibility seems to be an issue. Sometimes I drift off into a fantasy would where I dream about cotton candy clouds, castle made of mint chocolate chip ice cream and chiropractic software programs that don't require me to enter in diagnosis pointers and CPT codes on every visit. How heavenly would it be to just click through the Subjectives, breeze past the O's, dance by the Assessment and slap down a Plan and have it jump right to a 1500 form without 6 other steps? Other than job creation, there is no need to have to go to another part of the program, enter in the same codes and link them to the same diagnosis codes that you have used 16 other times in the last month, with no change. We use a small number of codes over and over and over again, there is no need to make this step calculus.
• Freedom to use any billing clearinghouse should be a constitutional amendment. Most Chiropractic documentation suppliers let you use the clearinghouse of your choice but some force you to use theirs or an affiliate. This is risky not only because if one goes down the other may also but it leaves you with no latitude should a better option become available. While a documentation program may and should coexist with a billing program, the actual task of electronic filing should be independent of the two.

First and foremost you should be able to use a full functioning demo to evaluate a Chiropractic software program. Screen shots, testimonials and videos are misleading. The only way for you to get a working knowledge of a program is to use it for a trial period. This should not be a limited mode and it should allow you to enter real patients and findings. This is important because should you decide to purchase the software you can use it right away instead of having to reprogram all of the custom fields and patient demographics. A fully functional program will also allow you to document your patient visits and will not prevent you from printing or saving the information should you opt not to extend the trial. I have been hampered by several programs in which I entered patient information but was unable to extract it once the trial was complete.

Make an honest list of what you need and what you want. Do you really need a 3D model of the finger? Are you honestly going to run a report on how many of your patients are left handed? I learned a valuable lesson about technology years ago while watching an interview with one of the Apple executives. He stated that inventing new technology wasn't a difficult task, convincing people to use it was much harder. Pharmaceutical companies are reknowned for discovering a drug and than creating a condition for it's use. Software companies are no different. Bells and whistles drive up the cost and often lose their luster within a short time. Time should be spent with the patients, not in front of a computer sifting through endless pages of how to better document an SCM muscle spasm. 

Call the supplier and ask questions. Do not assume that because the president of the company is a D.C. that everything is perfect. As I said before, we all practice differently and you should feel comfortable with a softwares basic frame and optional functions. Be warned that sales reps will frequently steer you away to some glimmering rarely used feature rather than address difficult questions. Most of these salespeople are not Chiropractors yet profess an uncanny proficiency in how you should run your practice and it always seems to correlate to their one of a kind software program. 

Read the fine print! We are all guilty of just clicking the " Yes I accept the above" box without reading what is inside. This could cost you dearly should you decide to terminate early, require support or need to add additional doctors or terminals.

Be wary of " Review" sites. I have spent countless hours searching for Chiropractic EMR, documentation and billing programs and have found little to no honest objective information. It baffles my mind that I can not find a relatively recent forum or discussion board where doctors or staff can share experiences with electronic chiropractic software. Many of the so called review sites are just affiliate farms for software vendors which lack any substantial critiquing or evaluation of the services " reviewed" yet offer rating which are never subpar even when clearly deserving of such. 

I have downloaded and purchased several Chiropractic EMR Documentation and or Billing programs over the last year. Many have been deleted from my computer and several still remain functional. I had no intention of sharing my experiences and as such made no notes about the programs I disliked. I opted to write this article after several bad experiences recently with different programs. My honest motive is to prevent other Chiropractors from having to endure the financial and mental pitfalls that I have suffered in an attempt to understand, implement and utilize this new technology.

I encourage anyone to explore and discuss any of the products mentioned or to share their thoughts on any others. I will not permit any product endorsements by sales reps but welcome any addresses to posted concerns.

Chiropulse has been used by my father and sister for several years and seems to provide a great value. I currently have an expired demo copy on my computer because I keep leaning towards purchasing the full version. I found the documentation side to be slightly lacking but operable. I was deterred also by what appears to be a confusing billing process but this may be due more from my sisters explanation of the steps rather than the program itself. It provides almost all of the options you would want at a fantastic price. Support is somewhat lagging in response time but my experience with them has been favorable. I would recommend checking Chiropulse out first and again after being beat up by some of the others.

Update 11/21/11

I attempted to use Chiropulse as both my SOAP note program and chiropractic billing program over the last year and a half. The only good thing about it was that it was cheap. I say cheap rather than inexpensive because it really is an inferior product and the service sucks. The documentation side is full of inconsistencies and requires you to have to go back in and correct errors in almost every note. If you try to customize any of the few areas that allow for customization it ends up making things worse. The billing aspect requires you to either make a template for every conceivable combination of CPT and ICD codes or you will have to match the two on every visit...every time. Instead of simply adding an option that allows you to duplicate a previous visit, Chiropulse forces you to match each procedure with each diagnosis code over and over and over again.,

As of this writing I have had hundreds of dollars in recently submitted claims come back denied because the program failed to match the notes with the billing aspect. When I emailed tech support they told me I was vague and that my complain didn't add up. I then copied and pasted my notes and explained it to them. Their answer was that I purchase a support ticket so I can get trained on how to use the program. I've used it for more than a year. I suppose they want me to pay them to show me exactly how inept and shitty their software really is.

Stay away from Chiropulse.

Reportmaster does not have billing capabilities at this time but deserves a look. Reportmaster is a great report writing program but the soap note capability can be tedious. I imagine that after working with the program for a period that it would be easier, but I found there to be too many steps for everyday notes. As far as creating a narrative, the program is fantastic. A practice serving a majority of PI, WC or Auto cases may find this to be a great tool. Support and price make it to be worth the money if narrative creation is lacking in your current arsenal.

Update 11/21/11

I tried to use Reportmaster for a few months but it kept shutting down for inexplicable reasons. Back in '10 I was getting emails soliciting me to plunk down $600 for version 7, in advance of it being released sometime in early '11. I just saw an old email from April of this year claiming the new version is seven weeks away. On 11/17/11 I received another plea from RM to buy an advance of the program which is now expected in February. Don't these software companies care about perception? How many times can you lie to people or steal their money before it catches on?

Guardian EMR is one of the programs that prompted me to write this article.  After being burned by Econnect ( see below), I jumped at the next pretty face and it cost me. Guardian EMR looked like a good program but once the lights came on I was faced with an ugly Betty. Firstly it relies on two different programs. There is a program for the front desk and one for the doctor plus another for updates and some other icon on my desktop which I didn't even use ( I'll explain why soon).

The software requires you to enter patient info on the front desk program, then either open up or refresh the doctors screen to open the patient. This may make sense in an office where you have several portals, but not for my one man show. The documentation section is confusing and has a bunch of hidden pull down items that you would never find unless you called to voice concerns over other issues. 

The other issues were big for me. First, you can not enter a note or charge for any other day except the present day. This means you can not enter your notes later, or submit a bill unless you follow the recommendation of the owner which are:

• Change the date on your computer, enter in the notes and claims for that day, change the date again, repeat, change the date back to prevent everything else on your computer from getting totally screwed.
• or to change billing days to a previous day: enter in todays date, click enter, go back and open up the claim and change the date, repeat the whole process for any other claim.

Econnect by Future Health is advertised to be a free program. That right there is enough to keep clicking, but guess who bought into it? I had explored Future Healths original program and found it to appear to be a nice working option but was priced slightly out of my needs. When the email came touting the new program I was all over it. Econnect is supposed to provide a basic software that according to the website " t—virtually every DC with a PC and an internet connection now has access to complete, integrated, quality EHR/ practice management software … free."

There is that word....free...it is free, but it is not complete. I must admit that I have not spent plentiful time evaluating the software for two reasons:

1. It is slow, inconsistent and I keep getting an error message.
2. It is not complete

One thing about hand writing SOAP notes that is annoying is copying the same things over and over. One thing that makes a documentation program is the ability to repeat the documentation. The free version of Econnect does not provide for the duplication of notes. Let me repeat for those of you that are hard of reading...the basic "complete" version of Econnect does not replicate your notes. This requires the purchase of an app for somewhere around $200 and some dollars. While this is not a huge amount of money, it pretty much kills the whole free concept. A base model Kia comes with a steering wheel, a base model SOAP program should come with replication abilities.
Additionally Econnect has no billing functions at this time. I was told that in 90 days their would be billing functions added. So I assume that I am expected to pay nearly three hundred dollars to make my free basic program actually usable and then wait three months to see how much the next free software would cost me.
Oddly enough, signing up now I get three free months ( there is that word again) of data storage to store of of my SOAP notes I can't write until I shell out $200 + and then I have to pay a small fee. So I can't bill for three months which is okay because I get free data storage.
I do not expect Econnect to continue to be this undesirable based on the company's past. I believe they rushed out their product and despite having a noble concept are perpetuating the appearance of a bait and switch.I will remain vigilant.

UPDATE!!!!!!!!!!!!!!!!

See the reviews about Econnect here....obviously there seems to be a trend.

 Click here for Capterra

MyEMR is free. Kind of like the good witch and bad witch, there can be good free also. MyEMR provides a free documentation program which has some pitfalls but overall is a great value because it is free and actually does work! While it is limited as far as extremities go, there is options available to customize templates and verbiage. The sentence structures frequently need editing but this is a frequent problem in all of the programs.

MyEMR has been my old reliable. I stray from her but soon am drawn back simply due to the simplicity, functionality and affordability of the program. There are several options to upgade to but actual upgrades to the program seem needed.

Update 11/17/11

MyEMR.is no longer free.

As I explore  available Chiropractic EMR Documentation and Billing software I will update this review. I welcome all comments and detest any gushing product placement.

Dr. David DeFries is a practicing Chiropractor in Boothwyn Pennsylvania.