One of the key things was simply that after every 12 visits, we re-check the patients objective findings, and make a graph of the progress. It is of course not a perfect system. It is not weighted as to whether one objective finding is more significant than another one. For instance if the top vertebrae is out of alignment, in my opinion it can cause massive changes to ones neurology, above and below the bottom of the skull. On the other hand a stuck toe joint would count on our system as just as significant.

Also of course I am not a perfect machine, and although I consider myself to be one of the better more conscientious chiropractors I have ever met, mine, and every other doctors ability to use our hands to determine which bones are out of alignment and stuck has some variability to it. For the record, my theory is that chiropractor to chiropractor there is a variance of skill in feeling asymmetry of the spine. There are of course bones that are asymmetrical from side to side that can throw one off. There also is another point that I have never heard brought up from chiropractors, and that is the fact that the greater the distance the bone has become fixed from its central position, the easier it is to feel.

I have discovered this after inviting people to feel their own misalignments and decide for themselves, or by having parents check their children or visa versa. Even for myself, the greater the degree the bone is displaced from its center resting place when it becomes stuck, the more certain I am of the result. As the bone becomes close to being perfect, it is harder to measure the fact that it is out of alignment, and more the fact that the bone simply does not move well.

Back to paperlessness!

After having Reagan who had been with us for half a decade leave and get married. Mazel Toff! (That is congratulations in hebrew) the patient treatment area has suffered in its following up on patients who have fallen off from their ideal treatment plan. As you probably know, we pride ourselves on getting results that often vastly exceed those of other chiropractic offices, so this problem is totally unacceptable. One of the required pieces of getting patients better is that they show up exactly per their treatment plan until they get to their peak recovery.

So after trying to get a few people in to replace Reagan, and so far failing, I have stepped in the past few weeks and taken on the job myself. Many of the patients have been very surprised to hear my voice saying “Hey, didn’t we have a visit scheduled for you today? What’s going on?”

I actually love my patients a lot, so it is fun to be on the phone with them.

I have found that the current software we use called Office Hours, misses many features that I consider basic in doing the job of hunting down wayward patients, and getting them back on the treatment plan that we agreed to at the beginning.

One thing is simply that it would be nice to see their face. I remember people by their faces, much sooner than I do by their names. I also want to have lots of room to write details about them, staying of course within all of the privacy laws. Also, when I look at the schedule, color coded appointments speak to me much quicker than any other symbol. Red means they missed. Yellow or Green means the patient showed. I also want colors that mean we called and reminded them and spoke to them and they confirmed they would be in, versus we called and reminded them and spoke to them and they said they would probably be in today.

I want this position in our organization to be super efficient and easy to do.

So I am currently looking at two different options. Both options involve getting custom made software made. None of the E.M.R. (Electronic Medical Records) software could even come close on this.

Option 1 – Have it made using FileMaker Pro. Thank you to Sarah for turning me on to this amazing software. It is pretty much moron proof. You open it up, decide what info you need on a page, and within seconds you have created a database. It took me around 10 hours of study to get the basics of what it is. It is simply a fancier and more customizable version of Microsoft Excel. It can have a big box full of a bunch of smaller boxes of information. You can customize how it looks. You can write little mini programs to tell it what to do with all this information. To create what I want will make our office almost paper free. So even though I understand the software now, I would like to higher a professional FileMaker Pro person to make our contact management/ scheduling / EMR / Coding / Patient Treatment software.

Option 2 – When I get done with writing all of the exact requirements of the software, I will ask Ray, my super programmer who I have hired here and there to see what it would cost him to  make the software from PHP or some other programming language. Easier? Harder? I have no idea.

So for the past three weekends, I have been carefully writing a technical description of what I want the software to look like and do.

Then I will hit up Ray, a few cool FileMaker pro sites I saw, and my favorite programmer swap meet Rentacoder.

Also after many years I was finally able to purchase purposeinc.com I will be getting that up and running for my internet marketing consulting and pearl tile business. I will probably put links on it that point to this and all my other sites so there is one central place to get to all the other ones.

That’s it. If you are a reader of this site, and you read this, please leave me a comment. I find that like one out of every 5,000 readers leaves a comment, seriously, and I would love to hear who is stopping by!

It appears that even with a fair amount of computer knowledge, it still requires a fair amount more of technical networking knowledge to get the whole thing to work. Not for the timid! On the other hand I also bought a very detailed book on Networking in the Dummies series, and it was still very hard to understand.

Here is a bit of recap of my saga to make our San Diego Chiropractic office paperless if you have not been keeping up to date.

Getting a tablet that you could write on the screen.

The decision to go paperless 

Paperless Research

The  computer that you can write on its screen

Medisoft and EMR

EMR Report and the Experts Uncovered

The Discovery about EMR and Time Saving

The search for great customer service

Creating a new body diagram 

Paperless, EMR and Medisoft info from a real Expert

The Choice on Medisoft Resellers

The Computer Decision

Setting Up a Router for Home

The surprise Lenovo purchase

So that leaves us where we are. This upgrade to the new machines and software should be done within a few weeks, and it will take our little San Diego chiropractic office, up to the next level!

First off, I found three guys who are absolute experts in Medisoft and also in Networking and programming. In a few years I expect networks and Medisoft and EMR to be as easy to use as Quickbooks or Microsoft word, but at the moment it ain so.

Mark Beans sounds like a real winner, with tons of experience, and a real expert on Medisoft. He has sold his business, is too busy with another job to take on clients, and recomends the new owners at MSR Technologies but I have no knowledge of them except that he recomends them.

The second guy who sounded seems like an absolute expert is Gavin Walker at Med Tech. He has a strong company, is very knowledgeable and has extensive programming and technical experience.

My final choice is to work with Shawn Barrett at ASI. He is my first choice, but if something falls through I will beg Gavin to help me.

After weeks of research on this subject, (and I am like a tasmanian devil when it comes to internet research) these two shined above the others. (Mark Bean would also be on the list but he is no longer in the game)

Both Shawn and Gavin have extensive programming experience, which is not technically necessary with Medisoft and setting up a network, but based on postings at other sites, Medisoft gets screwed up enough that I want someone who can get into the files and understands programming and data manipulation at a deep level. Both of these guys give you plenty of information upfront, before even charging for it, which leaves me in a personal debt to both of them. Both of them have worked with Medisoft for I believe over a decade. Long term stability is important to me, so that I know they will be there in 6 months. Both of them were very focused on honesty and ethics. I only know this about Gavin because he makes a strong point of talking about it on his website, and with Shawn I know it from experience.

Both got back to me relatively quickly. Gavin does not list an e-mail on his site, so just call him, and he will call you back.

Either of them would have been an excellent choice based on the data I have so far. I am going with Shawn first though because I have worked with him before, and because he is only a half hour $50 plane flight away from me in Vegas, and in the same time zone. Also I am out in Vegas a few times a year for conferences, so if I need to hook up face to face I can see him.

I would like to personally thank Gavin for the time he spent on the phone with me, and based on all of my evaluations of him, which were pretty extensive, I would be very comfortable having him set up Medisoft network.

Now the real test will be what happens when we set the whole thing up in San Diego over the upcoming weeks.

]]> http://www.bodyabcs.com/bwp/2007/01/the-paperless-office-in-san-diego-oneday/feed/ 4 http://www.bodyabcs.com/bwp/2007/01/some-great-medisoft-information-for-our-san-diego-office/ http://www.bodyabcs.com/bwp/2007/01/some-great-medisoft-information-for-our-san-diego-office/#comments Fri, 19 Jan 2007 22:41:31 +0000 dk http://www.bodyabcs.com/bwp/2007/01/some-great-medisoft-information-for-our-san-diego-office/ I have been e-mailing back with Shawn Barrett at Ability Software. I have known the guy quite some time, and he is quite bright and has been very helpful previously. I sent him some questions by e-mail, and if you have been following my steps in setting up billing and EMR, you may find the following interesting.

I have edited a bit of this for clarity, it is my e-mail with his comments embedded in it…

Hey Shawn,

I am hoping to get this set up within the next week.

I have a good relationship with David Churbuck one of the V.P.’s of Lenovo, so I predict I will get excellent customer service.

[Shawn Barrett>>] Yes, that is always very advantageous.

I still have some “confusions” on the difference between a server, and simply a powerful desktop computer. Perhaps they are the same thing these days, and the name only implies the difference of use? It is confusing though that I can not find any servers on the lenovo site. My guess after searching is that the term server is generally used for a machine that will handle a network much bigger than mine.

[Shawn Barrett>>] Server, has two meanings:

1. A computer, usually robust with plenty of memory and hard drive space, designed to share data (files and databases) and devices (printers, scanners, etc.) for multiple users on a network. This is a central location where everyone on the network should be storing their files and an automatic backup runs on a regular schedule to backup all the data. This can have either a desktop operating system (Windows XP Professional) or a server operating system (Windows 1123 Server) installed on it.

2. A computer that is setup as #1 above that is out of the way and not used by anyone directly. It is not designed to be used as a workstation, only to store and share files, etc. It also keeps the configuration for the network and the users providing proper security permissions and keeping sensitive data (accounting information, etc.) properly secure. This configuration is usually used for larger networks (8 or more computers) and/or higher demand (large databases, storage of scanned documents, office e-mail, etc.). A true server has the server operating system installed on it such as Windows 1123 Server. A true server usually has some redundancy built into it (extra hard drives, power supplies (should one fail), sturdier components, etc. This is why true servers are more expensive than just workstations. A true server is expected to last for at least 5 years with minimal repair.

For a small network like yours, you can use a good workstation as the ‘server’, especially if you only have Medisoft and some documents to store and share on it. However, you would want to make sure to have a good backup system in any case. Also, keep in mind some of the requirements under HIPAA are that a good and update to date anti-virus system is in place on all computers and that backups are done on a regular basis and then taken off site. You also need to have a backup computer and/or plan incase of loss or failure of the main computer(s).

In terms of actual use, our office currently sees around 40 visits per day, with each visit requiring being scheduled in office hours, and on average two procedure codes entered for each visit. After the billing system is up and running, I will be planning on adding in EMR, so I would like the system to be able to handle that info also. With the lower costs of computers, I am totally O.K. with getting machines that are a little cheaper, and then upgrading them as needed over time, in say 2 years.

[Shawn Barrett>>] I can definitely understand that. Just keep in mind that if you go paperless, you have to be able to still get to the patient charts to provide healthcare should the computer system go down. Going paperless provides a lot in benefits (reduces office space taken by charts, puts everything into the computer for better access – no more missing or misplaced charts), however, there are costs involved in making sure that the computer system (or some part of it at least) is always accessible in case of computer problems. This part is the main downfall to using any type of ASP (Application Service Provider) over the Internet for your EMR – if the Internet is down, then you have no patient charts.

Before you do the work below, could you give me some idea of pricing for your time helping me get everything set up, even if it is just the hourly rate.

[Shawn Barrett>>] I am putting those pricing together right now.

Then, could you take a look through Lenovo’s site, and recommend three computers for me.

[Shawn Barrett>>] I would be glad to do that, but do you want notebooks or desktops? Desktops are cheaper in price and have generally better performance than notebooks, however, notebooks are more mobile; essentially, you pay for the ability to be able to move the computer around (or take it out of the office) with notebooks. If you don’t plan on taking them out of the office, then get desktops. Notebooks are also more easily stolen and damaged (dropped or knocked off desk, etc.).

I have a 750 square foot office. In the front, in Div 3 is where I will have one of the workstations.

There is a large open treatment room with a small desk in the middle of it where I would like another work station.

In a small room in the back of the office, too crammed to work comfortably, I would like the computer to be where Medisoft will be installed. This machine will rarely, or never be used, except for administration of the network. This machine is the one that is right next to the cable modem, so can be hard wired. I was planning on connecting this machine hard wired to the router, and the other two computer connected to the internet via the newest Belkin wireless router. I have had excellent experience with Belkin in the past.

[Shawn Barrett>>] I reviewed the workstations to find you a workstation/server from the above website, and found “ThinkCentre A55 Tower 8705CTO” which seems that it would work. You would need XP Professional and 1 GB of ram along with a DVD R/W and some type of backup system.

I was thinking of this router,

http://reviews.cnet.com/Belkin_Wireless_Pre_N_router/4505-3319_7-30993672-2.html?tag=rate

[Shawn Barrett>>] I reviewed the router and it looks fine, however, this note on the specifications concerned me:

“This product uses the draft version of the upcoming 802.11n standard. Its compatibility with other and future products is not guaranteed, and it may interfere with current 802.11b and g products. “

I have it at home already and it works great.

Tell me your opinion of the above. If you would like to charge me for advice as we go along, that is fine, but I would like to know in advance. I would like to get your advice today if possible, so I can make my hardware purchases and get them sent to me quick.

Thanks!

dk

Things I learned.

As far as I know, there aint no software out there yet for medical billing and EMR that works as easily as say Quickbooks.

It sounds like around 30% of the doctors in the U.S. who set up EMR systems, end up uninstalling them.

If you are very smart, and can make very simple forms, paper systems can be faster than EMR systems.

Medisoft is still by far the most widely used Medical Billing Software in existence, but there are many warnings out there. One of them was that a few versions back, when it came out, somewhere between a few users, and a lot of them, had their data become unable to use. This reminds me that when upgrading to any new system, keep the old system running until you are absolutely sure the new one is working.

Medisoft took almost a week to call me back when I called about pricing and ordering.

The guy Mark I mentioned in this post,

appears to no longer own or work at that Medisoft reseller, so I do not know how good the new owners are. (No data good or bad)

For the Network version of Medisoft version 11 for 2 to 3 users with Office Hours Professional, I was quoted $3457.

For a single user with all of the above is about $1600.

They said if I buy the version 11 for a single user, and then upgrade to version 12 for some small fee, they will credit 90% of my single user price toward the network version.

Even so, I think I am going to continue my quest toward making the system as efficient as possible, even if it costs a little bit more money.

Our San Diego chiropractic office has long been one of the best, if not the best, because of us sparing no cost in anything that makes the office work better. Aesthetics have not always been the highest priority, because I feel the staff and location take care of that, but for technology or chiropractic knowledge, as they say, cost is no object!

Also, the expert Mark Bean with the business in Florida, it appears has sold his business, and I have no way to find him.

On the other hand, Shawn Barret from Ability Software in Vegas, emailed me right back, eager to help.

I still have been unable to get one of the EMR software demos to run on my computer. It is my brand new Lenovo, so I do not think it is the computer. I turned off my firewall. I think it must be a software problem, but I am not sure. I have sure learned though that a good demo, easy to downlod, is a quick way to sell software.

I also bought the 290 page report from the AC Group and I am glad I did. It was very comprehensive, and I still have more to read. It costs $129. I learned a ton from the report, and recommend it to anyone looking into EMR. I also spoke to Mark Anderson on the phone today, the CEO of the AC Group. Mark said that for a small chiropractic office that the combination of Medisoft and SpringCharts was a good match. He is the only one I have spoken to or heard about so far, that really has an overview of all or most of the softwares. It is a full time job to keep up on all of them.
I am getting the feeling that by simply using technology I allready know, such as Medisoft, excell, word, and windows, and simplifying my paperwork even more, I still may be able to have a system that is faster than the other softwares. I don’t think this is true for most practices though. Our practice, and everything about it, is so extremely simple and refined that it blows most M.D.’s and other chiropractors away when they see it.

It is absolutely top quality health care, I think the best you will get anywhere for what we do, done very, very efficently.

Our next step is to switch over to the new Medisoft. I would like to do that next week. This week we will catch up on all of our Accounts Recievable work, and then get the new software set up.

An important lesson I learned last time we updated software was as follows. The new system will have problems. We will probably have to take it down, and reinstall it a few times before it is all working right. The only way to do this in a working office, is simply to run the old system on one machine, while we install the new system on another machine. Then when the new system has proved itself for a few weeks, then we shut down the old system. 6 years ago when we let someone else take over our billing for a while without keeping our old system in place, it almost cost me the entire practice.

So this time we will do it like the airlines. We will keep our perfect system running. Then we will have a second system set up and running in parallel. Then we will turn off the old system. It just means we will do double work for a few weeks. The staff and I are used to working hard. We might as well just work a little harder!!

Whew!!! It has been an exaustive and exausting 48 hours of research on Electronic Medical Records (EMR) and Practice Management Software (PMS) for our San Diego Chiropractic office. Make sure you know the two previous definitions PMS and EMR, as they are used continuously below.
Here are the two most important links I have found so far.

The first one is  EMR Update. This site is the only place where I found any significant data on making our office paperless.

The main thing I have learned is that the opinion of a large number of doctors is that EMR and PMS software companies promote a flawless easy to use product, much more than they actually are.

It appears that Medisoft has been bought and sold 2 or 3 times during the past few years.

Medisoft is definately the most used software by small medical practices.

One of their recent version releases, I believe 10, caused at least a few if not quite a few practices to not be able to use their software for a while until the bugs were fixed.

This reminds me of why I made a decision years ago to never use, brand new technology for vital tasks, but instead to use technology that has been out for at least 6 months, if not 3 years so the kinks can get worked out.

One very interesting company and player in this arena is Mark Anderson of the A.C. Group.  The below is from memory, so I apologize if it is not 100%. He has a company that I believe every 6 months sends a 5000 question survey to every EMR company. The questions are about usability, viability of the company, number of users, and just about everything they or their customers could think of to ask. If the EMR company self rates themselves by their answers above a score of 85% then Mark’s team evaluates the actual software. They also claim that they get a lot of first hand data from employees and other people in the industry about the companies, and obviously feedback from the users themselves. They charge from $1,000 up to $150,000 or so for their services. In Mark’s interview linked to above he talks about one software vendor that he is having a little dispute with. The vendor claims that Mark is financially influenced by the Vendors in his recomendations, but Mark claims no such influence. If nothing else, the conflict actually draws attention to the two of them and serves a good marketing purpose as well!

Without naming names, I have consistent problems with downloading demos of many of these softwares. So far in fact only one demo out of the many I tried has worked.

I also found an old friend in my data base Shawn at Ability Software. and sent him an alert as to what I am trying to figure out. He sells Medisoft software for a living, and also helps people with their Meidisoft problems. He helped us out on a sticky point a few years ago, and I kept track of him. The research process is going well, and I predict I should have a good answer within a few days, or next weekend. I am sure I will have more to report.

One of the most important things to know in this is just what EMR is. EMR stands for Electronic Medical Records. It is not commonly used to describe billing, but instead for the health care records taken by the doctor.

To understand the below it is also helpful to know that Medisoft is a medical billing software, and Office Hours is a scheduling software that Medisoft makes that integrates into Medisoft.

I found the following link very helpful:

The only Used Forum on EMR and Billing that I was able to find.

The EMR organization for an overview of the industry

One of the most poignent statements of all was by Dr. Channing Bollock of Orlando, who stated in a Yahoo group (paraphrasing) Medisoft has a hundred thousand users, and most of the chiropractic software programs have a few thousand.

It reminded me that in order for software company to hire and keep good programmers and creative people it takes a lot of users or it just is not sustainable. Even if a software company sells a product for $20,000 and they only have 1000 users, it is just not enough money to put the time and energy into perfecting their software to the level that I have gotten used to. The standards set by programs such as Quickbooks, Turbo Tax (hello to Bill Harris!), Ultra Edit, and Word Press, some of the perfect softwares that I use has raised the bar of what I expect from a software company.
So I am leaning toward Medisoft. Originally I was hoping to find one software that could handle all of the information from scheduling, to visit documentation, to billing, all in a company with enough users to keep it running well.

I have given up for the moment on finding that.

I came across a few programs that claim to handle medical records seemlessly with Medisoft. One of them is Medinotes and the other one is SpringCharts.

The more I read, the more I liked SpringCharts website. Having spent so much time on building websites over the past few years, I can tell a lot about a company and the people behind it, not just by content and look of a website, but also about the set up and organization of the site.

I called SpringCharts a few minutes ago just on the off chance that they had sales people answering the phone on the weekend. To my surprise the president of the company Jack Smyth answered the phone. They were in on the weekend working on some projects. He answered my questions,

1. That the software was closer to a few thousand dollars rather than ten thousand dollars.

2. Information flows from Office Hours directly into SpringCharts.

I still have a little bit of concern about the fact that Medisoft, owned by NDC Health, Now Owned by Per-Se technology, who may have been recently bought out by another larger company. I have no idea about the focus of the current owners, and whether Medisoft is important to them or not, but with as many users as Medisoft has, I am sure hoping the motivation to keep the product good is there.

I am also going to ask David Churbuck one of the V.P.’s at Lenovo who sells a lot of tablet PC’s, if he has any opinions or recommendations.

In talking to my wife about this earlier, she just finally visualized what our office would be like without paper. The idea of this made her very happy, as she is an avid environmentalist, even more so than I am.

I will update this as the journey to become paperless unfolds. (Get it? Paperless? Unfolds?)

I recently made the decision that I want our office to go paperless. This is a promise made by computers 30 years ago that still has not taken place. This week, the city of San Diego sent us large packet on how to continue with recycling. It appears that our land fills are almost full, and when they are trash will become infinitely more expensive to deal with in San Diego.

Also by making everything electronic there should be less repitition of entry of information, which will make it easier to keep the 100% error free bookkeeping we aim for with patient records and billing.

I started my search with our current software, Medisoft. It appears though that Medisoft has been bought by another company, and it seems that other company may have been bought or is in the process of being bought by another company. When I called them this week, I was unable to get a hold of a person, and did not recive a call back, so I continues my search elsewhere.

Last night I worked from one of my favorite San Diego resteraunts, In and Out, and then later from the Star Bucks on Convoy, next to Comp USA. (Props to Comp USA again for changing my hard drive last month, when I almost lost a big chunk of my data, and yes I had backed it up!)

What I am looking for is a solution where I can utalize these new amazing tablet PC’s by Lenovo. I am absolutely thrilled with this thing since I got it. You can enter data right onto the screen with the pen that it comes with. This means that the patients, myself, and the staff can enter all of the info into the tablet, and then have it all go straight into the billing and records, saving all other data entry and filing. Everything would be caught up imediately, as soon as it was entered, or within a few seconds.

The hardware now exists for this to work easily. This is also an important step toward us being able to open the super efficient chiropractic offices here in San Diego that I want to. I am having difficulty finding the software. The software companies I have seen so far seem to make two or three different packages. One for scheduling, one for billing, and one for Electronic Medical Records. What I am looking for is a seemless solution that does all three. I am going to document in this blog my quest to make our San Diego chiropractic office paperless. It also has to be highly reliable, and I have heard and seen plenty of software that did not have very many users that was not reliable and crashed. For this kind of data the tolerance for error is 0.
My fear is that at the end of this in a week or two I will be talking about the compromise I came up with! So software writers, please read this, and make us a great solution.

Check back, and I will tell you what I find.

Added Note

This e-mail was sent to me from Tina Maxwell and has been edited. I do not know Tina, so can not vouch for her or not.