Dr.Michael A.Housman

excerpted from Today's Chiropractic/May1998 issue

Computerizing the Clinical aspect of Practice

Managing information efficiently in the Chiropractic office has many advantages and this is what the computer does best. The information that we are speaking of includes the patients financial transactions, SOAP notes, narratives, office forms and a myriad of data which needs to be quickly accessible. This article will focus primarily on how a database system can help manage the clinical realm of the practice as well as freeing up more time for the doctor.

Database Computing

A database simply speaking is a group of information organized in a manner that allows for quick retrieval, storage and printing. If you are currently running a software program that manages your patients financial records then you are already using some sort of database system. Database systems for the PC market were first popularized in the late 70's with a program called DBASE which served as the basis of much of the software in database management that you see today i.e. Access, Lotus 1-2-3 etc.

Ideal System

For a moment lets look at what the ideal database system could be for the Chiropractor. The ideal system would generate soap notes and narratives and store them in a common database so that information could be exchanged easily between files. This system would also let the doctor add to the data to customize the system as well as putting comments into the daily notes. The ideal system would also have an area for Chiropractic research articles and abstracts indexed under multiple headings so that the doctor could locate the articles quickly and easily as well as paste relevant articles into reports and narratives to substantiate care when necessary. Also diagnostic computerized information on xray, technique, diagnosis should be immediatly available so that the doctor could look to digitalized reference data when needed. Lastly the doctor should be able to add to the database by downloading research articles over the internet so that a library of data is constantly being updated rather than filed in some cabinet and lost in the paper maze.

Practical Application

In my office all of the Soap notes, narratives, Chiropractic Research abstracts, diagnostic data, and nutritional info is located in one database .. Each record is indexed under a subject and keyword for easy retrieval. So for example a patient narrative would have "Narrative" as the subject heading and the patients name under the keyword. Out of a 10,000 record database currently I can locate any one record in under 1 second. Within the database I can do selective search's so that if I desire to locate all of the research articles that pertaining to cervical sprain/strain I can do so quickly. I could also ask the computer to bring me up all of the patient records that had a diagnosis of SI subluxation that were female , age 40 that were treated in August of 1996. One of the main advantages of a well organized database system is the ability to retrieve the data in a variety of ways to suit your specific needs.

Internet

One of the great advantages to building a clinical database system is in the use of the internet. The internet provides access to an incredible amount of information relevant to the chiropractic profession. There are search engines available such as Medline and Medscape that allow the doctor to search for abstracts that substantiate Chiropractic and nutritional therapies. How you work with that information is most important. The concept of organizing and creating an in-office "intranet" is of great importance in moving your office from a paper based information system to a digital based information system. Simply having more information on the computer is not enough. Having it organized in a manner that is quickly and easily acessible is the key.

Often when browsing the internet I come across useful article's or research abstract's that I wish to add to my database. To do this I simply download the article from the internet and import it into the database after giving the article a subject and a keyword for easy retrieval. If I ever need to go back to that article in the future I can find it quickly and easily. Often times we are losing information in the computer as easily as in a filing cabinet. The reason for this is that the text files we save are often placed in directories that are not easily searched or accessible. By placing all of your clinical data in one database you can better manage and locate the information contained in the computer.

Interfacing with the Medical Community

The common argument by the medical community that Chiropractic is not "scientific" is falling quickly by the wayside in light of the current research data that backs up the credibility of our care. This research comes in many forms and much of it is now available on the internet in the form of abstracts and articles. I have a category in my database categorized under the subject "Research" where I place these articles. Each article is labeled with a keyword that describes it's contents. Often when dealing with the medical community I include various summaries from these articles to help enlighten other doctors as tothe validity of chiropractic. Having a library of chiropractic research is essential in my opinion to communicate with the insurance and medical community.

Software Attributes

When searching for a good database system it is important that the software has the ability to do the following.

a)Export:You want to be able to export the data to text files in ASCII format. This allows you to take a file and move it to another program or disc if you so desire

b)Import:The ability to bring data into the database is also important so you can add files that you already have to the database as well as files you download from the internet

c)Global search:One of the most amazing functions of a good database system is the ability to search the entire database for the occurance of a particular word or group of words. This involves having a good "Database Search Engine" built into it. For those that have used Yahoo or Lycos on the internet , these are essentially search engines that can scan a large amount of information rapidly for the occurance of a particulary keyword or group of keywords. This is a vital function for your in-office intranet as well. So for instance if you wanted to look at all of the files that have the words "Lower back pain" you could do that as well. I could also type into to the global search function the words "Chiropractic and Otitis Media" and come up with all of the records or files that have those words occuring in it.

Backing Up data

Enough cannot be said about doing regular backups. One of the potential drawbacks of digitalizing your clinical data is in possibility of losing all of it at the drop of a hat. One of the best ways to backup your data is with a zip drive. These drives can handle data from 100 megabytes up to multiple gigabytes. However you backup whether it be with floppy drives, a tape drive, a zip drive or to another hard drive develop a routine whereby you do it regularly. There is nothing worse that having your hard disc crash and not have an up to date backup. Don't learn the hard way ! Computers do fail ! Summary

There are many advantages to moving the clinical side of your practice to a good database system. Having the ability to import your soap notes, narratives, research notes and other relevant info into this database is like building a library that is at your fingertips and infinite in the ways it can be manipulated. Ultimately managing information in the office efficiently allows the doctor to spend less time shuffling thru mountains of paper and more time treating patients and enjoying the fruits of his or her very important gift to society.

Dr.Housman Graduated in 1980 from New York Chiropractic College and currently maintains a private practice in Searsport ME. He is also a database consultant and the founder and president of Windsong Software which markets Chirobase, a chiropractic database system. He can be reached via email at cbase@agate.net Demo's of Chirobase can be ordered at 1800-254-0958