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 has actually been an enlightening experience, not just on finance, but also on how the insurance industry still views chiropractic.

Although many insurance companies pay for some degree of chiropractic, there still is a bias that leaves one feeling much like an ethnic mintority in a racially homongenous land. The funny thing though, is that even while chiropractic is being pushed down in subtle methods by insurance companies chiropractic is becoming ever more popular.

The patients are the force that ultimately will drive what will happen in the future. Our new improved billing deparment will be helping our patients take even more responability in their billing, and helping patient to help insurance companies pay what the patients need to restore their health.

I am proud of what we have done, and if you are one of our California chiropractic patients, you will feel the enhanced power that we are going to give you!

In terms of the earth, depending on your religious bent, the earth has been around a very, very long time. Where my wife comes from in Norway, a house isn’t really even beginning to look old until it has been there a hundred years, and really old things were things that happened over 500 years ago. San Diego did not even exist 500 years ago, and I am not sure if the local natives even hung out here 500 years ago.

In San Diego, if it is 100 years old, it is truly ancient. If a house was built in the 1930,s it is a historical landmark. If a was built in the 50’s or 60’s it is really old!

We watched the Al Gore movie tonight, and I loved his focus on the big picture, time wise and geography wise. I also made the comment to my wife that he totally ignored the fact that the earth will eventually fall into the sun and none of what he was talking about would matter any way. It all depends on the perspective of time. I love the idea of being around to enjoy San Diego, the sunny February days like today at the beach, as long as possible. If I am really lucky, I will get to come back again another 1000 times and enjoy it again! I would hate for this life thing to be a one shot deal.

Either way, the farther back of a perspective I take a look at everything, the the better decisions I tend  to make. It also makes one a little braver, and willing to put ones neck out just a little further to improve things for all of us.

In the future, after this new billing system is fully perfected, I will have to find out within the laws of the land, a way to begin to tell more of the truths I know about regarding health. Some of them may not be very popular, but are important stories worth telling.

By the way, the Cleaning the Cords title is dedicated to cleaning the power cords and printer cables that everyone ignores which become unbelievably dusty given a long enough period of time.

For purposes of this blog today a case is simply a group of financial transactions that are grouped together for a given patient.
As I am becoming more involved in the whole process I have realized that Medisoft lacks a very specific report that I think most chiropractic offices would love. That feature would be a report that tells you exactly for a given case, how much the patient has paid, how much the insurance has paid. That way you can make sure you recieved exactly what you were supposed to.

Medisoft seems to still reflect what has been called the bill and pray method. That was when a doctors office would see a patient, send a out a big bill, pray they got something, and then adjusted off the balance of whatever the insurance did not pay. For decades many if not most medical offices worked this way. The reason was simply that the insurance paid well, and if you billed that way, medical doctors would still end up making many hundreds of thousands of dollars per year in profit.

Chiropractors in California have not had it that easy the past few decades, so we need to keep track of our individual dollars much more closely.

I am currently having a custom report written so that for a given patient at any time you can pull up a case and see exactly how much the patient paid to date, how much the insurance company paid to date, and how much if any adjustments were applied. I think it will go a long way in saving time in our accounts receivable area in the future.

At the same time we are switching over the software we are also training Roseanna and Cheng Cheng on the Accounts Receivable, and training Cheng Cheng on everything. The result is nothing less than the best organized accounts recievable department I have ever seen. There are still many parts to it that I am learning for the first time, and getting organized. Hopefully by this Sunday it will be done and documented. I still have quite a bit of studying and working to do.

Patient care is still operating at a high level as always. Yesterday we heard a story about a little boy who last week got adjusted in our office, and then on the drive home exclaimed to his mother that the page he was looking at in the book looked clearer.

I will publish the full letter from the mother in our letters section next week.

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!

I created the computer on the site in San Diego, while Atkins followed along on his computer. We were both able to see the price as we go along. The site is easy to use, the cost at the end was absurdly low for two top of the line computers and I got the high end 3 year warranty at the end. Atkins was amazingly knowledgeable. He steered me away from high cost money wasters, and pointed me to many small things that will make a huge difference.
We ended up on using a duo processor on both machines. The computer I am using as a server is 1.5 GB ram, and way over 250 GB on the hard drive. I did this so I would have plenty of room for the future for scanning documents. I figured the 120,000 or so documents I have so far, will take up around 40 GB or hard drive space. This was a very rough estimate. We are using a regular 1000 dollar computer for the server.

The client will simply be a laptop with a gig of ram, and a sixty gig hard drive. We decided to use DVD’s for the backup system. I will try it and see how it goes.

So thanks to David Churbuck for the great introduction to his crew. I am a happy customer who just came back for two more. Thanks to David, Maria, and Atkins.

By the way David, Atkins did not know who you were so I pointed him to your blog to learn who his bosses boss is.

Maria, thank you again for incredible customer service. Your team is well trained and top notch. It is great how quickly you guys take care of me!

By the way, the two computers came to about 2500 bucks total, for both of them. Such a deal!

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!