304- Compliance, Documentation, and Your EHR

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Now here's your host, Dr. Jeff Langmaid.

Hello and welcome to the Evidence Based Chiropractor. I am your host, Dr. Jeff Langmaid. And on today's episode we are talking about an incredibly important topic for your practice and that is documentation and compliance and how it ties directly in to your ehr. I was fortunate to sit down with the team from Echiro EHR and break this down in detail. That's today's episode. Before we get started, I want to say a few words about Novopulse. This is where recovery meets performance. You need to check out this technology. Believe me, it reduces pain and inflammation while improving function. Novopulse.com Novo Pulse.com I'll drop that link down in the show notes as well. Yesterday I chatted with their founder Ali and I don't think I've spoken with anybody who knows more about the inflammatory process than this gentleman. So look forward to an interview coming up soon. But on today's episode, documentation, compliance and your ehr. What are the things you need to know? Here we go. How would you describe Echiro ehr? Because I think your description of how you guys have thought about the product and service you deliver is a little bit different. I alluded to it, but I'm going to start right there. How would you describe ECIRO to an EHR to, to a doc that maybe is not familiar with you guys yet?

Yeah, absolutely. Well, you know, the beautiful thing about our EHR was. Excuse me, Dr. Munsterman does a lot of auditing of chiropractors records and found that we just didn't have an EHR that could kind of, kind of service our needs as a profession. He went out, found a major medical ehr, a hospital grade system, kind of negotiated a phenomenal price for chiropractors because we can't afford a medical EHR and basically white labeled it and was able to layer chiropractic documentation right over this really robust engine. You know, it's essentially become the backbone of our ehr, if you'll kind of pardon the pun there. And so it's really allowed us to create this just rock star EHR experience in a chiropractic office that typically would not, we would not have the ability to have.

That's so critically important. I want to talk a little bit about that compliance because we're going to talk about practice Management. We're going to talk about some of the marketing, but. But Scott, I know that you've had a passion for compliance and documentation for a long time, and that's one of the big tenets of what ecairo brings to the table. When you were thinking about, you know, creating, putting together an EHR and utilizing it, what were some of those pitfalls you saw chiropractors consistently making? And how do you think docs should consider stepping up their compliance and documentation in regards to their ehr?

Well, I mean, that's a, that's a great question, Jeff. And the things that we saw initially that led us into this relationship with Ipatient care had to do with some major deficiencies in terms of the flexibility of being able to document accurately that specific patient encounter, making sure that the structure of the node is actually laid out in a compliant manner to make sure that we cover all the bases, essentially. And those are some key features that just weren't a part of it. The other side of it from compliance. I mean, you mentioned documentation, but as we take a look at HIPAA requirements and what we need in our practices in terms of encryption and login monitoring and just a number of security, meeting a number of security rules, there's a number of EHR systems that frankly fall short of that. And it was astounding to me. And so it brings, as Steve talked about, just a very robust engine through the iPatient Care platform and we tailored it to meet the chiropractic needs.

I love that. And Steve, I know you've spoken with probably thousands of docs at this point in terms of, you know, EHRs, their needs, what's going on? What are maybe those couple items? Obviously, compliance is critical, you know, as Scott touched on. But what are maybe those two items or those two things when you have conversations with docs in the field that really Kairos should be on the lookout, we all should be on the lookout for when we're choosing an EHR or that we need to take a look at with the one we're using right now. Maybe what are those two criteria that docs really need to think hard and fast about?

Yeah, absolutely. And really it comes down to ease of use. And that's really the one answer I'm going to give you is just ease of use. Because whether that's ease of use for the doctor, front desk staff, biller, it's got to work. You got to be able to get through something with 50,000 clicks. It's got to work fast and be compliant but ease of use, also the technology front, you know, you want to be in a cloud based environment, you don't want to be using technology from a century ago and be stuck on a server. You know, that's just invites all sorts of problems into a practice, whether it be IT headaches, ransomware demands these days, really just a whole host of things that you know, as a doctor, I don't want to have to deal with, I don't want to be an IT person, I just want to have a computer, Internet access and get into my ehr. So ease of use, whether it be on the user experience or really on the technology side, being in a modern day cloud system.

The cloud system is what I've heard so much about that over the last few years and I know there's still a little bit of a gap between what some systems do and what others do break down for those docs that might be somewhat unfamiliar with the difference between a cloud and a server based system. And what really are those benefits of the cloud?

Yeah, absolutely. For one, with cloud based systems you don't have to worry about backing up your data. So especially right now with things being in the news with ransomware, you're not susceptible to that. You don't have to protect your own network in your practice and in fact you actually with cloud software you don't need a network, you just need a computer and you just need Internet access. And the best example I have really for that, the power of the cloud and really the value of having your data backed up that way is years ago I had a good friend of mine practicing in Alabama, he was on a different cloud based system at the time, but got the tornado warnings. He and his practice members got out of there about half an hour later, tornado went through, leveled the place. He went back to his practice that night. There wasn't even one brick left. He did get a phone call about a week later from a woman that found his sign, the big one above his building in her tree about 50 miles from his practice.

Oh my gosh.

It actually has a good ending for him though because he never liked his office location to begin with. Six days later he found a better office space, had a bunch of old equipment in his basement, brought that over, went to Best Buy, picked up a new PC, went to the, you know, into the office, downloaded the software, put in his credentials. Five minutes later, all of his records were intact, all of his billing was there, all of his X rays. It was all protected in the cloud. It wasn't if it was Server based. It might have been in that lady's tree 50 miles away. And well, gosh, that's probably a whole nother HIPAA problem there too, Scott. But that's, you know, that for me, that's just one of the best things of the cloud. And then certainly into other things, whether portability, being able to check your schedule from home. Not that you want to be finishing notes from home, but if you ever find yourself in that situation, you can, you know, once I had an associate covering my practice and I was literally halfway around the world, I was in Beijing, able to log in and actually walk that doctor through a few patients from literally halfway around the world. So very, very powerful. If you haven't had cloud software tips before, it really kind of allows you to go beyond the four walls of your practice.

That flexibility is so important, especially with the dynamics of practice today, as you spoke of. Sometimes, you know, you're finishing notes, you know, at home, sometimes stuff happens. I mean, the ability to have flexibility with your documentation is key. And I want to talk to Scott a little bit on the documentation side of things. You know, I know that you take that, you know, seriously and it's been your life's work to a certain degree, really ensuring that docs have adequate documentation. That's complet. I'd love to talk about how you think about building that in with Echiro, because there's some docs out there. It's like, well, my, you know, my templates are friends of a friends of a friends and I happen to be using it and you know, I hope it's compliant. I hope the documentation is there. When you think about utilizing templates and really installing ways to be more efficient in the practice, how do you balance that with also being as effective and compliant as possible? Because I know you've seen some good, bad and ugly on the documentation and compliance side.

Yeah, exactly. Well, I think the key word that you mentioned there, Jeff, is balance, you know, and the bottom line is that notes need to be encounter specific. Medicare has laid out the blueprint exactly what needs to be in a note, whether it's the initial visit or subsequent visits. And so it's all right there. And so it's a matter of building out the proper structure of the note, like we kind of briefly talked about earlier, and then be able to put it in a manner that will allow fewer clicks, as Steve talked about, and yet giving much more flexibility as to what can go inside the node. And I know that's a very general statement, but as you take A look at the system. It's a very logical system, as Steve will attest to. It's a top down, left to right system and it just allows you to not miss anything that you need to have within the note itself. Now, the other option that we also have to the desktop version, which has proved to be very helpful, is that it does come with an iPad app. And that certainly adds just a total different dimension of experience to documenting.

I love that I used an iPad for a while in practice and I could tell you the dynamics of how I was able to communicate with my patients. And just really, it made a world. It made a world of difference. And when we think about where EHRs, it's about documentation, it's about compliance. You want to have those things dialed in. But there also is sort of a communication and a practice management component. I'd love Steve to have your thoughts on where does practice management fit in with an ehr and what should docs be on the lookout for? Because it really is kind of the heartbeat of your practice.

It is. And you need to be able to have, you know, you know, the thing that stands out for me, and I know for Scott, it is the documentation and it is awesome documentation. But when you start to look under the hood, when you look at things like reporting, you know, you to your point, if you're going to run a business, not just a practice, but a business, you need to have good analytics and they have to be accurate. And I say that kind of ingest because a lot of unfortunately, the chiropractic EHRs, you could run the same report 10 times and get and different answers. The data is typically not terribly reliable. In our system, it's kind of the opposite. We get over 300 reports. So it's too many reports. In fact, in the beginning, we have to get to know our clinic so we can say, hey, for what you're looking for, it's these seven or eight reports. It's not the 300 that you're never going to get into, but it's also, you know, can those reports show you things that are useful? And can you. Do you have the ability to drill down? So, for example, in hours you're able to do that level of a deep dive where you have. And it's not just getting a strict column and row report. These are in dashboard format. So you've got bar graphs and pie charts and things that are a bit more visually stimulating. And then as you click on that pie chart, you can actually drill down further and further into the report. To get some more and more finite pieces of data. So whether you have a large practice with multiple providers and you're at this point literally sitting at home with your feet up with your laptop out, checking on your practice stats, and you can do that with a good 30,000 foot level, or you can sit down and look at your own provider stats and drill down really deep and find out exactly, you know, where you are over utilizing one particular code, things that will make you stand out. So you'd be a lot more proactive as a business owner.

I'm sorry. One more piece to add to that too would be the patient portal. Very robust patient portal. And as we see the new regulations with the information blocking that's come up from hipaa, I mean, getting information in the hands of our patients is critical and that creates that opportunity for the dialogue and for the connectability that patients have with the practice, establishing with the practice. It's just one more piece that builds that interface with the portal.

A lot of our providers found that very helpful over the past, you know, year and a half, as so many patients were doing. You know, having to do things from home and even having to do things differently. Maybe patients had to wait in your parking lot and had to call in to sign in, when in fact, through our patient portal, they can actually go sign in from the parking lot if they needed to. So it does give quite a bit of flexibility. You know, the hope is that we never have to utilize something like that again. But it is nice to have it sitting there in your back pocket should you need it. That was really the nice thing about the system. It's so robust that it did allow you to change how you did things on the fly.

That's cool. You guys both jumped in right where I was going on the patient portal. So great job. I love it. What are those big items? I had this on my list to ask you both about the portal in terms of what are those items that the portal allows? How does the typical doc interact with their patients through it? And maybe what are some best practices that you've seen along the way for using a patient portal in practice for a doc? That's unfamiliar, right?

Well, you know, the biggest thing right off the bat is that you can give, when that patient becomes a patient, you can give them access immediately to the portal, right over the phone. You know, it's collecting their information, some basic minimum information about themselves, their email address. It sends that, that activation notice. They can log in. And then from the get go, Jeff, you can have your patient Intake forms on that portal for them to fill out prior to them coming into the practice. You can put on their patient education. Just a wide number of things that can be provided direct. It's just like an extension or an arm of the practice. And they can have access to anything within the ehr, their record that is that you allow them access into. So it has a wide degree of flexibility.

I love it. I love it. I think that the ability to communicate with a patient, you know, sort of at, you know, on their terms, at their level, you know, through multiple avenues is just so important and part of a modern practice. And I'm interested on Steve's take on this. Speaking with so many docs out there, what are maybe one or two items that you cringe when you hear other docs talking about a system that they're using and you hear X, Y or Z, what are those items? Again, I'm going to say that doc should really be on the lookout for those cringe worthy items that you knowing really the ins and outs of the software, the hardware and how it can actually work in a practice where, you know, docs are actually kind of, you know, hurting themselves by using a system that might have X or Y feature.

Yeah, absolutely. Right off the bat we kind of, I think we've hit the whole server and cloud based thing there. So I think right off the bat, if you're in a server, you're, you're probably doing yourself a disservice when you look at the pricing structure. A lot of these companies, you know, a lot of people have kind of cheap entry points for software that they nickel and dime you on the back end, you know, and that's one thing I love about E. Cairo is it's just kind of one price per provider. It does get a little cheaper, you know, when you add additional providers and part time folks. But we're not going to go ahead and say we're going to charge you, you know, 20 bucks a month for your intake form or you know, 40 bucks a month to do text messaging or you know, X amount of money per gigabyte of backup clearinghouse, all of these types of things that on the surface when you look at the price of an ehr, you don't really factor these in and all of a sudden the software that might cost you, you know, 250amonth balloons up to 400amonth because you didn't realize there's all these add ons. So that's kind of one thing to look out for as well. And then Certainly just can you run your business, you know, everywhere from doing your notes to the front desk to the biller, can everyone have a good, smooth experience in the software? At the end of the day, the EHR is supposed to help you. It's supposed to be a valuable tool to help you get through the day easier, not have it be an anchor that kind of weighs you down. That's what I find, unfortunately, with most of them because they were built in pieces. It started out as a billing software. Oh, let's add on this component and this component and this one. And that's why so many of them look jumbled, because they were literally put together with, you know, band aids in the background, kind of connecting everything.

I like what you touched on there. And it's, it's again what I had. You guys are, you guys are on it because I wanted to ask about, about billing because, you know, insurance billing still, for many docs out there is really, you know, necessary, you know, to how they run their business and their practice. And I know that, you know, documentation and compliance, you know, it matters with every patient, don't get me wrong. But when you're billing third party payers, you need to make sure that you have that really, really dialed in. And Scott, I'd love some of your insight in terms of, you know, how you think about the integration of insurance billing within an ehr and maybe a tip or two for docs out there to ensure that they're doing the best job that they could.

Yeah, well, hand in hand documentation and coding go together, you know, hand in hand. And so one of the biggest rules that I have for my clients, my compliance clients, is that they need to get their documentation done and signed within 24 to 48 hours period. And that a claim should not leave the office until that documentation is done, technically when that claim is out the door. And if you're still, still sitting there with chicken scratches on a napkin, you know, that you haven't put into your EHR system, guess what? That is your documentation. It's not any elaboration off those chicken scratches. And so at the end of the day, that's a very key piece. Now with this system, as you work through the system and get your documentation done, it rolls right into what we call charge capture. And that's where we bring the diagnosis codes together and the procedure codes that have been already embedded in your notes. So when you say that, you know, I'm going to document that I did manipulation 98940 or one or two regions and where I did it at and all that, that code automatically goes right into charge capture for us. And so it's all sitting there waiting. And so it all becomes a part of the process so that we make sure that whatever we've documented actually is going to get coded in the system correctly. And so that interface between the documentation and the coding is pretty critical. And then once it leaves that and enters into the billing environment, Jeff, then what's absolutely important is to make sure that you're monitoring the revenue cycle process of that claim, the life cycle of that claim. This system is so anal when it comes to that. On the billing analysis side of it, you know, every step of the way where you're at, it's integrated into a clearinghouse which comes with the price of the product. That was one of the things we were able to negotiate with Ipatient care in the whole process. And so, yeah, start to finish, this actually takes it completely through the process without a hitch.

It's so critical because I know so many docs out there who their data's a mess, right? And they don't really know what's going on. And being able to have a system that integrates from a patient portal practically on the front end all the way through to those that detailed reporting, if you want to dive into those weeds on the revenue side, is, is I think needs to be appreciated by every doc out there because it's really how you can build and grow and scale your business. And at the base level, you know, do the best job for your patients, communicate in an easy manner and continue to run your business and not feel like it's run ragged all the time. And where you're putting on all of your notes, all your documentation, all your patient encounter, AKA your ehr, is so important. And I can tell that you guys, I love having these conversations because you have such depth of knowledge around the products and the service. I know we barely even scratched the scratch the surface on today's episode, but Steve, I'd love to know where can docs out there? I'm sure there are quite a few who are saying, okay, I'm ready to learn more and see what the scoop is, because we probably identified some holes that they're dealing with right now in their own practices. Where should docs go to learn more and connect with you guys?

Absolutely. You go to, to our website, which is just echiro ehr.com and go ahead, there's a link there. You can go ahead and request a demo and you'll most likely hear back from me and we'll go ahead and kind of take you on a tour of the software and answer any questions you have. Or even if you wanted to schedule a quick 15 that called me, you'll be able to do that as well.

Yeah. Well, thank you. I'm going to drop that link down below, so I'm going to encourage everybody listening. Click over, see, see what's going on. Take a few moments because even if you are pretty comfortable right now, there might be some things it's always worth it to hop on with an expert, get a better understanding of what's out there. And I appreciate you guys offering those demos for everybody that's listening. Again, that link will be dropped down below. Hop on over there. Ensure that your patient journey from front end to back end is as streamlined as possible. Please make sure that you are documenting in a compliant fashion. And don't forget about the revenue collection side. I know that Eciro can help you with that. And again, hop on that link down below. Hop on with Steve, do a quick demo, see what's going on and see if it might be advantageous for your practice to make the change. Gentlemen, I really appreciate having you guys on today. The information was awesome. Thank you and I look forward to catching you soon.

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