Published August 2008, Chiropractic Economics

With the proper planning and right expectations, transitioning from one practice-management software system to another can be relatively trouble-free.

A solid practice-management software system can do the work of 10 employees. An outdated or poorly designed system can eat up time, money and energy. And making the transition from one system to another is rarely a piece of cake.

New software and hardware may be the answer to bulging file cabinets, concerns about HIPPA compliance and the dream of streamlining documentation and billing. The move from the old to the new can be exciting—as well as frustrating, expensive, time-consuming. But there is good news.

Dr. Tye Bratvold, DC, owner of Millennium Chiropractic in Puyallup, Wash., was overwhelmed by the stacks of patient files piled on his desk at the end of each day. It was time to expand his automated scheduling and billing system to include documentation. “We were getting busy enough,” he says. But like most chiropractors looking for help, this decision was only the beginning. More than two years later, Bratvold is still learning what his system can do.

That’s not a problem, though. Bratvold learned that slow and steady is the best approach. Setting the right expectations upfront can help a chiropractor avoid the minefields of new technology.

Look within

The first step is an introspective one: Why get a new system? Perhaps your practice is growing or its needs have changed. Maybe the insurance clearinghouse has instituted modifications that are incompatible with your current system. Or you are embracing the green philosophy of a paperless office. Whatever the reasons, you should know them upfront.

“What end-product are you looking to create?” asks Mark Lewis, senior sales representative and trainer for Platinum Solutions in Dallas. “You should always start with the end design. One thing you don’t want to do is fit your practice into someone else’s program.”

Stan Shapiro, DC, purchased his San Diego practice, Better Health Chiropractic, several years ago. The former owner had not upgraded, and Shapiro was looking at a $3,500 charge to update the out-of-date system. This seemed like a good time to look elsewhere.

First and foremost, Shapiro needed a system that would work in his open-adjusting room. “We wanted a very contemporary system,” Shapiro says. “I had read a lot about the paperless office. But computers aren’t my strong suit. I wanted something that would be easy.”

Shapiro is like most of the clients that Sara Colby sees at her Tulsa, Okla., information technology firm, Solutions Consulting Group. They want four things: functionality, reliability, accuracy and good technical support. She advises chiropractors to make software-purchasing decisions with an eye to the future.

“Many doctors think, ‘What are my needs today?’” she says. “But software is an investment.”  You can save money and time by choosing a program that will grow with the practice and keep up with industry changes.

“One reason we chose our system is because if we add a physical therapist or a massage therapist, we can add interdisciplinary practitioners to the program,” says Jason Westemeir, DC. His practice, South Tulsa Performance Health, sees about 25 to 30 patients each day.

Software is only as good as the hardware it’s running on, so a close look at the existing computer system is a must. Many expansive systems require a dedicated server, and some programs depend on touch-screen monitors.

“You’re automating an office,” says Ron McNeill, founder and co-owner of ChiroTouch, a practice-management system with headquarters in Seattle, Wash. “You need good reliable equipment. A really good program on really poor hardware performs badly.”  But you should not run out and buy hardware before you settle on a system. Each system has specific equipment requirements.

Window shopping

Since a new system and hardware can come with a steep price, it makes sense to kick a few tires before signing a contract. “Do your homework, that’s for sure,” McNeill says. “There are so many different things you have to be careful of.”

McNeill suggests talking with other chiropractors first. Software companies should be able to provide references—if they won’t, move on.

“Ask your colleagues,” says Colby. “Go to the practice management groups and see who they recommend.”  But beware of online reviews of products. “Some of the reviews are published by the software company itself,” she warns.

Price is another concern, of course. Some software companies sell their products, while others require a monthly fee to use the system.

Whether you purchase the system outright or pay a monthly fee, it’s important to feel comfortable with the company itself. “You’re establishing a relationship with a company that you hope will keep up with your needs,” McNeill says. “You’re getting into a business relationship with a company. The product is just what starts it.” Good training and tech support are as important as how the system functions.

Asking questions can help you feel more at ease with their decision. “Don’t assume that all of the things that you love about your old system will be in the new system,” McNeill says.


Buying a software system? Before buying, ask yourself these questions.

  1. Where do I see my practice in 5 years? Growth will always dictate the type of program you need. The system you purchase should be flexible enough to expand with your patient list and services.
  2.  Where do I want to be able to access patient records?If you want to do documentation during the exam, you’ll need a system that has remote access throughout the practice. If you’re happy updating patient records from a central location, satellite stations are unnecessary.
  3.  How much do I have to spend?  These systems are serious infrastructure investments, but you can cut down on costs by phasing in various parts of the system or by choosing a program that doesn’t require a hardware overhaul. Don’t cut corners with tech support or backup, however.
  4. How much data do I have? Small practices don’t need to convert one of their exam rooms to a server room. While bells and whistles sound great in a sales pitch, they may be difficult to pay for or may be more than you can handle. At the same time, bigger practices will naturally need a more robust system.

 

Settling in

If you think you can install a new program over the weekend and be up and running the following Monday—think again. Installing the program and transferring data takes time.

“The transition from one system to another is the biggest hurdle,” McNeill says. “The potential impact of doing that can be underestimated.”

First of all, there’s a certain amount of customization necessary to make sure that the system fits the needs of the practice. For example, medical claim forms vary from state to state and from company to company.

Then there is the data itself. Most software companies don’t advise a complete data merger of files from the old system to the new. In fact, a perfect merger is impossible. “The software systems work differently, so you don’t want to convert the data on Saturday and expect it to work perfectly on Monday,” Colby says.

“I was initially kind of scared, because we had a large database,” Shapiro says. He could have merged most of the 15,000 records from his old system, but he decided not to.

“I didn’t want to clutter my database,” he says. “I wanted to keep it fresh.”  So he took advantage of the opportunity to clean up his files. His staff was trained on how to input the data, which they did during downtime. After weeding out inactive and duplicate patients, Shapiro’s database has about 600 to 700 records.

All of this can feel a bit like flying the plane while building it. “That’s one of the concerns—keeping your office up and running while the software system is being installed,” Colby says.

For that reason, Dr. Christopher Pieda, DC, owner of Back to Health Chiropractic in Alameda, CA, has taken his time. “It took us a few months to install the system,” he says. “We didn’t just jump into it.”  He estimates that over the last three months, he’s gotten about 75 percent of his patients into the new system.

Back to school

“The majority of practices don’t hire a computer technician,” Lewis says. “And doctors, all they want to do is adjust.”

That’s why training is a crucial piece of the software buy. It’s also where customization comes in. “In-office training is always the best,” Colby says. “There’s a different comfort level in person.”

Westemeir took advantage of three to four training sessions that were at least two hours long. “By the time we were ready to start using the system, it felt like we had had it for a long time,” he says.

Lewis recommends a three-day training process. First, the office is closed for a full day of staff training. The office re-opens on the second day, and the trainer shadows the staff. That’s when gaps in information and customization show up most clearly. On the third day, the office is closed again, and the trainers can retrain or demonstrate more advanced aspects of the system.

“Our main goal for the training process is to get the basics down,” Lewis says. Additional training takes place remotely. Trainers and technical support staff can take over the computer screen to demonstrate the program in more depth.

A safety net

“Every software is going to have ongoing expenses,” Lewis says. Two of these continuing costs provide a safety net for the system and the practice.

First there’s technical support. “It really needs to be seen as an insurance policy,” McNeill says. Most companies offer a menu of tech support packages. You should choose the one that best meets your expectations.

But tech support is not only for emergencies. A software company should offer regular upgrades and be equipped to fix bugs in the system. Pieda has already had one upgrade in his months-old system.

Back up is another important consideration. “We highly suggest getting backup off site,” Lewis says. Off-site backup protects the practice against data loss due to structural damage in the office.

When it’s all said and done, a new system can be transformative for a chiropractic practice—from the front desk to the exam room.

“I can literally pull up a patient’s screen and access old x-rays and compare them with the new ones,” Shapiro says. “Besides looking really cool—patients notice that—we’re staying up to date.”

With time and attention, the transition can help even the busiest chiropractor juggle the daily duties of a busy practice.

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