503- Integrating Technology and Data: The Future of Chiropractic EHR

Welcome to the Evidence Based Chiropractor where each week we deliver the latest chiropractic research and marketing strategies, all in the time it takes to get to your office. Now here's your host, Dr. Jeff Langmaid.

Hello and welcome to the Evidence Based Chiropractor. I AM your host, Dr. Jeff Langmaid. On today's episode, I have an awesome interview with Gabe from Chirohd. Chirohdi has fast become one of my favorite EHRs because of how they approach things. I think you're going to learn a lot, whether you're in the market for a new EHR right now or you're not. Please pay attention to this week's episode with Gabe from Cairo HD where we dive into a lot of background history and thought processes that really can help you in your practice. So without further ado, here is my conversation with Gabe from Cairo hd.

Yeah, thanks Jeff. I appreciate it. I'm excited to be on here.

It is my pleasure. I was talking pre roll with you a little bit. We were talking, I was talking about a mutual friend, Dr. Eric Kowaki, with sked chatting with him earlier today and he has the unique insight of seeing when practices go from one EHR to another. And he mentioned that he sees a lot of docs moving over to Cairo hd. So I guess we'll just kick it off right there. Why do you think that is? What are some of the foundational elements of Chirohd that you think docs should really pay attention to?

I think if you look at what's happened to the chiropractic EHR market over the last five, six years, specifically the last five, six years, but really the last 10 years is you just see a lot of consolidation. A lot of people have seen companies like Chirotouch be bought and sold and companies that people sign up for disappearing and a lot of people not incorporating a lot of technologies. So you'll see you sign up for an EHR and then realize you have to buy another service for texting or another service for patient app management or another service for insurance. You know, there's just so many pieces. We see a lot of clinics that are paying for three or four distinct EHRs to manage their CRM, their EHR, their patient management, their texting, their reviews. So I think one thing that's really different about us is that we've always tried to pull all of that together as much as possible, you know, and that's, I think that's a really unique thing in the market where we really do try to do it all, I think that's a big piece of it. I also think like, we tend to, we try to be on what we call the bleeding edge of technology. Right. We don't want to sit in this place of 10 years old technology that feels the same. And we're always looking for new ways to incorporate things. You know, we're looking at a lot of AI options right now, a lot of ways to incorporate some of the bleeding edge technologies that are coming out. And so I think it's, I think all of those things are really interesting and then just our growth, right. You know, we, we, we're a homegrown company. We didn't start with a big fund and all that. And we've gone through a few fundraises now, but we've gone from a team of four or five people, three just three years ago, to, you know, coming up on 50 employees and growing. And we're, we're really one of the few that's really still closely tied to the chiropractic market too, where we are, we care a lot about what's happening in chiropractic and we're really mission aligned with the industry, which I don't think you see as much anymore.

There's no doubt about that. And that's something that actually came up in the conversation I had with Dr. Eric earlier. And I want to dive into something that I know also is important to you, which I think many docs might find a little bit surprising. And that's around the data and how that data can be used to highlight who we are and what we do. Often when docs hear of data in the ehr, they think of some important things, which is reporting on numbers, right? Revenue numbers and things like that, the financials of the business. But data can go a lot deeper than that. And I know that's been something that has had a high degree of interest at CairoHD over a long period of time. So maybe I'll just open the floor to you and just maybe speak into that a little bit. How does data fit into this? How do you hope to use potentially data in the future? And where does that fit into the mission driven aspects of what you previously described?

Yeah, it's a great question. And I think people who have been close to chirohd and kind of have heard some of these things, I will just openly say a lot of this we haven't gotten to fruition, but I think the next 12 to 18 months we're going to see a lot of this start to really click, which is really exciting. So I'm excited to talk about it. But when you look at the systems that have dominated the space for the last 15 years, I'll just use Kairotouch as an example just because they're obviously one of the largest. As a server based system, every single office has a different data set. It's very, very, very hard to align and what we would call like do a data mapping layer where we understand that you know, when you say a 1 to 2 region adjustment in this clinic, it's the same thing as a, as a one to two adjustment region in another clinic which is much more complicated than it sounds. But when you start trying to look at an industry and understand like what's happening on not just a single office or a single franchise or a single group, but what's, what are the trends that are happening in all of chiropractic and where are visits at and where are things trending up or down? What's price per visit? Like some of these things are really, really, really hard to understand when you don't have a true clean data set. And so I think when we look at that from day one we knew we were going to have a lot of people's data in our system. It was one of the first high volume cloud systems that was available. We knew we were going to have a lot of that. So we just put a lot of effort into making sure that we had a clean data set from day one so that when we got at a bigger scale like we could start looking at some of these things and, and with the immersion of AI, it's only become infinitely more important access to clean data. And so that ties into all kinds of things, not just the data that you're talking about reports and financials and visits, but how it ties into large scale reporting or not reporting research. We work with Life University's research center. We're trying to expand our imprint with the schools and colleges and figuring out how to feed that data into people that are doing research and analysis. So there's that big vision of like how can we use all this data that's in our system to inform the people that are doing the research and try to clean up some of the efforts that they have, which is really exciting. The other big thing that I think is really important is if you've looked at what's happened from a marketing perspective, 10 years ago there was a million chiropractic coaching companies and it's still down and there's a few good ones that are still out there, but they don't have quite the space. And so there's like this void of, of coaching that people are hoping like things like AI and data are going to help with. And I think we're really interested in using the data on a whole set to understand what's happening in your clinic. So you know, not to get too far ahead of myself but you know, maybe in a while instead of you looking for a particular KPI that you're trying to measure, we really like to use the word actionable data. Like if where the system can just say hey, this looks different than it did last week. Did something change in your clinic? You know those types of things where we can identify things before you're sitting down on a computer to try to figure things out. Can we get ahead of insurance? Like hey, this claim is definitely not going to go through based on what we see those types of things. Like there's so much tied to that it's hard to distill down into a short clip. But I will just say there's, there's a lot about data that's really exciting, especially over the next year and a half.

I love it and I think that this is a key component because there's so many docs that I speak to that are super frustrated with their current EMR EHR because of a lack of clean data. So I'm going to say at a system wide level, you understanding the importance of that and then the, then the individual chiropractor being able to benefit from the fact that it's been built there and hey we, we, we, we, we're always in that position of striving for better, cleaner but it's so important and I'm going to encourage everybody listening and watching as well. We're going to drop a link down in the show notes. So if you are somebody who has been on the fence about potentially making a switch, if you're one of the 90% of docs out there on an EHR that's frustrated with your current system and want to connect with team I'm going to drop that link down in the episode show notes so please click over have a conversation. A 15, 30 minute conversation could literally change the next 5, 10, 20 years of your practice as you build in efficiencies and see where they can go. So on that Gabe, I want to ask you about who's the ideal chiropractor? Chirohd There's a lot of different kind of docs out there. We have docs with different techniques, docs with different volumes cash insurance, if you look at it and you were able to cherry pick and say man, this is the type of practice we absolutely love working with and that love working with us. And you can give me a couple different archetypes if you love. But I'd like to know who are some of those ideal Cairo HD practices.

Yeah, I will gladly say that this is expanding every year. This evolves with us. When we started and we first built the system, there's one particular which I'm going to get to in a second. But as we've gotten more mature, built better systems, gotten further down the line that the, the number of people that don't, you know, fit a archetype is, is smaller and smaller. But I think historically our, our bread and butter was always high volume, mostly cash insurance or cash clinics. That was, that was where we, we started and that was partly it was what was driving people to switch to cloud. You, you, when we came out there was only one or two other cloud based systems and, and none of them could handle a high volume clinic. They, they got really clunk manage if you saw over 120 visits a week. So for these clinics seeing 3, 4, 500 visits a week, there just wasn't a cloud based solution out there. And a lot of those clinics that are seeing that volume are just by nature more cash heavy. So that was really where we focused our initial effort and we won in that space. Really, really. Well we love those clinics. We love being able to optimize their systems. We also see that those, those clinics are usually the most ready to switch systems and to switch. You know, they're looking for efficiencies and they're excited to find something about that. So, so that was like the initial effort and you can just see how it kind of would progress. The next piece was insurance became a bigger and a bigger and a bigger and a bigger piece. And we went through some big growing pains on insurance as we tried to kind of go from you know, high volume cash clinics to low volume heavy 90% plus insurance. And I think especially this year, maybe more than any other year in Cairo hd we really started to hone in on insurance fixes and, and improving our insurance product. And, and now we're, there were some people, and there's probably people that are listening that had been on a Cairo HD call that I personally said we're not the right fit for you because we can't handle the intricacy of your insurance situation. You know, my, my job is to make sure that we are solving problems in your clinic, not introducing problems. And I felt like we weren't the right fit. I was the first to call it out. I would say that probably by the end of this year, I will never have to say that to another clinic again, that we don't fit you because of our insurance profile. So that's an important one. You know, as far as technique, we've never run into any limitations on technique. You know, we, we work with every doctor, every technique. I will say, like, there's some techniques that we constantly get requests and updates for. Then we're listening to those, we're looking at the market, and there's always ways to work around some of those. But I wouldn't say the technique drives the product. It's more just trying to figure out ways to augment what they're doing. And also from our end too, we are also in a position where we try to encourage people to be more similar, which is chiropractic is a very diverse industry and it's hard when you're trying to drive a movement forward when there's so much difference. And so the more that we can help people, like, hey, we've seen this work for a clinic, like your size and the way that you're doing it, we've seen not work really well. We have a lot of those conversations and really try to drive uniformity where it makes sense, but also encourage diversity where it also makes sense.

Yeah, that's massively impactful. And I'm just going to go back to what you said and make sure everybody listening gets that. You know, when is the last time I've never heard anybody in any HR company describe ways that you're troubleshooting areas to make improvements in a practice and being able to help them understand how to streamline operations. And I think that that's massively, massively impactful. You mentioned insurance being a big update upgrade, benefits coming in, progress, already shipped, and more to come. If you look back, I'm going to have you look back in the way, way back machine, all the way back seven years ago, all the way to today. If you had to maybe cherry pick two to three features and benefits that you're like, these are things I think are super awesome. And I'm going to give you a little context. They might be things that are super obvious that everybody uses. And maybe you even pick one that you're like, we have this and like 90% of our docs aren't using it. And it's driving me nuts because it's so awesome. What are maybe two to three items that come to mind for you that are really keystones within Cairo HD where you're like, we, we got this right and it's awesome.

Yeah. I think the first one that comes to mind is integrated text messaging and it's become more common now. But I will say like when we first release that, there was no one that had a true two way integrated text messaging system. You had to have a system like Scad or Review Wave or Zingit or something else plugged into your system. And almost every time you had to log into that other system so you had your EHR open, you jump back and forth and some of them you'd get emails back instead of text messages back. So just like that, having it all in one place. The first time we demoed it like got literal gasps from everyone in the room. And it was one of my favorite moments because anyone that uses Kyrig is so standard now. It's not a special feature, but it was really special at the time. And that was just like when we send out text messages for appointments, we show some, a status indicator on the appointment with a thumbs up or a thumbs down or you know, something so as people text it in, you could real time watch, see that everyone's confirming their appointments for tomorrow. And I think that was just something that wasn't even remotely on anyone else's radar when we released it. So it was, that was, that was a really big feel good win for us and it became standard now, you know, now it's like as soon as, you know there's an issue with that and it goes down for a day, there's uproar, which there should be, but, but it's funny, it was something that was not even, even a consideration, you know, a few years ago. So I think that was really big. I think a lot of our reporting, our early reporting was, was revolutionary at the time. And I think we're having, honestly we're having to make that same revolutionary change where it was stagnant, like we rolled it out and everyone's like, oh my God, this is the best reporting I've seen forever. And then reporting evolved over the last three or four years. So now we're having to make another big push for it. But our early reporting dashboards, we, we have a feature called Health Check which tries to find common. We've talked about like being, making your clinic more efficient, being a partner in your practice and not just an ehr. That Health Check was like these, this is, these are mistakes that we see every clinic make. Putting in duplicate charges, marking appointments completed when charges haven't gone in, putting charges that are supposed to bill out to insurance on a case with no insurance profile. Or you know, some of these things that just are really common. We have this health check system that checks across all of those. A lot of times you'll see those systems just for strictly insurance what, what we, what we call green sheets in our system. But it's just the idea of like, oh, this, this can't build insurance because they don't have a date of birth. We take that further and we're like, this just is not being done right. You didn't complete a soap note, you didn't add charges here, you duplicated charges here. And I think that was something that was really new at the time and we're going to continue to expand on that. That's another feature I really love. And the last one I'll say was just bulk scheduling was also these again, all these are like, everyone is so used to them now that all people ask for are like updates to them. But at the time, I remember watching someone do bulk scheduling in another system. I don't remember which one it was. But you know, they'd scheduled out a year of care and they hit, you know, schedule, they had the capability and then they walked away from their computer and they came back 10 minutes later and it wasn't done. It's like, so it was just, it took, they could do it. It just took this long time. And you know, when we released it and you could schedule a year of care in a half a second, it was just like mind blowing to the people that came on board. So I think like looking back, like those are three things that are really obvious when we released them were like mind blowing to people that came on board.

Board. I love it. Now, now I'm, I'm not going to ask you to spill the beans, but I am going to ask you for a little preview. What are maybe one or two items on the horizon that, that, that you're excited about?

There's, there is a lot that we're excited about on the horizon. I, I, I, I'm actually gonna, I, I will, I'll openly comment on one. I don't have to spill the beans. I would say if you look at where we've struggled the most in reporting, it's around ledgers like financial reporting and not, not collections. But we get a lot of offices that want really intricate details of reporting that really no system can do. But people just want it anyway. Usually we see this tied to complex commission structures. They've got an associate doc who makes 30% on people that he brought into the clinic and 20% on people that, you know, like they've got all these different layers and when you get into that level of complexity, it's really hard to report on. And when you start getting into really complicated financials, you know, whether that's accrual based accounting or double entry ledger systems or integration with a software like QuickBooks. Most EHRs don't have a double entry accounting ledger system. It's, it's just, it's a very hard thing to do and it's usually like that's usually reserved for a financial software. And so I think we, we, we're making some huge updates to our ledger system to be able to do maybe not initially integrations with things like QuickBooks, but those will be coming. We are looking at ways to integrate with financial software and give you way more robust reporting around financial. I think that is very open piece. I already hinted at a couple. We are actively working on several AI initiatives. Those, I'll keep a little more quiet in terms of what those are going to look like and how they work, but you know, not a day goes by that I don't have five clinics bugging me for AI integrations and AI tooling. So those are, those are happening and we are looking at them. We're very cognizant of how AI is going to work in healthcare and what's going to come under regulation, what's not going to come under regulation, what's going to benefit your clinic. We're very attuned to a lot of that and really trying to find tools that really drive your practice to perform better is really important for us. And then the last one I'll just hint at is we're doing a lot with patient retention, patient reactivation. We've, we've started integrations with other CRMs that are really common in the space that we're getting ready to release to everyone. But we're also looking at internal tooling to manage those pieces a lot better. So I think those are three, three areas that are really exciting for us.

Love it. If you had to give a couple sentences for let's say there's a doc listening right now, I got a feeling there's hundreds that are in the position where they might be casually looking for a new ahr. Everybody understands that there's a lot of pain associated with that change, which is often the biggest Friction point. But what are some things maybe that you've seen behind the scenes, what would you say to that doc? Who knows they need to make a change. Who's out there potentially looking, but keeps putting it off to the next month, Being in the driver's seat yourself, what do you see behind the scenes and what do those docs need to know?

Yeah, I think first piece, I'll just clarify and I think you already kind of qualified it but, but it's understanding like why you need to make a switch. A lot of times I get people that, that are looking to make a switch but they can't really articulate what they're trying to do in their clinic, what problem they're trying to solve, which is where I always start with. And to my earlier point, if you come to me and you can't articulate a problem that you're trying to solve, I will tell people not now is not the time to switch to a different ehr because if you can't define your problem, then your EHR isn't your actual problem. Right. So, so first and foremost I'm talking, so not talking to those people, I'm talking to those people that have a clear problem they are trying to solve. I think the most important piece there is that you, you have to make it a priority is like the, is the short of it. We see this all the time where people hesitate. They hesitate and then they'll drag their feet for 3, 612 months and then they switch in every single time. They're like, man, I wish I would have done this six, eight months ago. Um, so, so you have to make it a priority. You have to get your team bought in. That's another huge thing from our ends. You know, we try to help people transition quickly. Um, and a lot of times what'll happen is you'll have a doctor who decides that we're going to switch EHRs, but he doesn't get his team, he doesn't get them hyped on it, he doesn't get them to understand why the switch is important. And then we run into a resistance when we're trying to onboard with the team and we can't get them to, to be as excited about the doctor in those changes. So I, I would just say as a key metric or as a key piece of, of getting your getting it switched, you have to get buy in from your team and you have to get them on board early. But, but the change and the, if you are trying to solve a problem that you think we can solve, like don't, don't delay on it. It's really, really important that you make those changes in your clinic because they're not going to go away.

No doubt about that. So everybody listening and watching. If you want to have a conversation with Gabe and his team at Cairo hd, please click on down below. Have that conversation. As he said, you know, kicking the can down the road ends up, you always end up regretting the time lost between now and then. So if you are out there exploring better ways to understand the business of your practice, better ways in the patient management day to day, better ways in your accounting and financials, I'm going to encourage you to reach out to Gabe and the Cairo HD team. Gabe, thanks so much for coming on and chatting today. Deeply appreciate it.

Yeah, I appreciate your time, Jeff. Thanks for having me on.

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