Southern California Solo Practitioner Finds RAPID EMR Key to Better, Faster Notes and Reports

 

 

When she opened her independent practice in Long Beach, California in late 2004, Dr. Michelle Zarzana had already experienced professional life in a large, multi-discipline West Los Angeles health care organization as well as in a busy Long Beach chiropractic partnership, and neither of these proved to be the professional experience that she wanted.

 

What she did want was the opportunity to practice her way – unpressured, spending time with patients, growing at a measured pace, enjoying positive relationships with the doctors, attorneys, insurance companies and adjusters she would deal with, and reserving enough time to herself to live a full and satisfying personal life.

 

She came to chiropractic later in life than many of her peers, having previously established herself as a marine biologist and researcher and as a teacher. A serious injury had placed her in extended, successful chiropractic treatment and it was so effective that she thought, “…this is where I can do some good….” She enrolled in the Southern California University of Health Sciences (formerly Los Angeles College of Chiropractic), finishing the five year program in three and one-half years and earning her D.C. degree in 2002.

 

 

Progressive doctor

Dr. Zarzana regards herself as a progressive chiropractor, with a mission of getting patients well and then maintaining that wellness with a limited regimen of visits for check-ups and reinforcement of her recommended exercise programs.

“I think this approach gets patients better faster and keeps them better,” she says. “Once they are released from treatment, I like to see them once a month for as long as necessary, but not longer.”

 

Like most of her peers, Dr. Zarzana often found herself bogged down in paperwork -- handwriting and recording daily SOAP notes and later composing and issuing reports to the various attorneys, insurance companies, regulators and referring doctors that required them. She tried dictation and outsourced transcription, but she found the process unsatisfactory and ultimately chose to be her own transcriptionist in preference to suffering the delivery and quality problems that she frequently encountered.

 

“These reports are legal documents, and they have to be right,” she says.  Nevertheless,  paperwork was adding the equivalent of a full day of additional work to her schedule each week, crimping her time with patients and seriously impairing her personal time and lifestyle.

 

 

Saving Time and Energy

Dr. Zarzana, early on, began looking for a way to save time and energy and in a serendipity moment, the solution arrived with a patient about six months after she opened Zarzana Chiropractic. An employee of nearby ACOM Solutions, Inc., the patient mentioned that the company had begun offering an automated clinical notes and reporting solution called RAPID Documentation that was specifically designed for chiropractic offices. The automated chiropractic software solution replaces the typical procedure in which notes from exams and office visits are hand-recorded on daily note forms with paper-based patient folders building from visit-to-visit.

 

Designed in consultation with successful, well-established chiropractors to meet the specific needs of the chiropractic community, the software resides on a tablet computer and features interactive intelligent graphics and checklists for diagnoses and patient progress.  The array of interactive screens include, among others, Patient Information, Chief Complaints, Range of Motion, Neurology Exam, Orthopedic Exam, Impairment Rating, Narrative Report, Outcome Assessment Reports and pictorial “Helper” screens for the entire body, the muscles, the spine, acupuncture, auriculotherapy and a genealogical tree. When the doctor taps on a diagram point or check-box, associated text within the RAPID system is generated and sent directly to the patient file.

 

Handwritten notes are entered using the solution’s “Inking” feature, and if desired, external documents such as photographs and accident diagrams can be scanned into the file, where they are automatically indexed.

 

 

Instant reports

At the conclusion of the patient’s treatment program or at an interim outcomes assessment point, the doctor selects the desired report and sends the completed file to be printed and distributed.  A Microsoft Word-based report generator that operates independently of RAPID enables creation of customized reports that reflect the individual doctor’s unique style and personality.

 

“I already had an interest in technology and as we talked about RAPID, I became very interested,” she says. “When I saw the solution demonstrated I was amazed. I decided to purchase it immediately.”

 

Dr. Zarzana was not disappointed, for she found quickly that she was able to recover the many evenings and Saturdays that she had been devoting to paperwork.

 

”Chiropractors’ first interest is health care,” she says, “but chiropractic is also a business. So you have to look for affordable ways to make the business side better while not negatively impacting patient care. RAPID was not complicated to learn and its many interactive features make it extremely easy to use. Its impact on patient care is actually very positive, because it frees up time from paperwork that can be devoted to patients or to building the practice.”

 

 

Patient self-registration

Within a few months of purchasing RAPID, Dr. Zarzana further streamlined the practice with the purchase of ACOM’s Patient Self-Registration kiosk. The kiosk eliminates the need for front office personnel to register patients and to open their files. When a patient calls for the first appointment, the file is set up over the phone with the patient’s name, address and associated information.  When the patient arrives for the appointment, he/she is handed a tablet computer with the open file displayed along with brief instructions on inputting the information that Dr. Zarzana needs to proceed with the diagnosis -- nature of complaint, type of complaint, degree and location of pain, and so on.

 

“This information starts the file for the initial visit, and all I have to do is clarify points as we go through the examination,” the doctor says. “On subsequent visits, the patient revisits the file and the various screens and updates his or her condition, continuing to expand the documentation of treatment progress. It saves an enormous amount of time. Reports can be generated with the touch of a few keys and while I may have to go back and look at the file occasionally before generating a report, that is a matter of a few  minutes versus an hour or more.”

 

 

Demonstrating treatment value

Before she sends a final report to a third party payer, Dr. Zarzana always asks the patient to review it to make sure that what she tells the insurance company and other interested parties is confirmed by the patient. The consistency, clarity and organized presentation of RAPID reports, help to support the prompt payment of claims, she believes.

 

“If the insurance companies can’t see the value of the treatment, they are reluctant to pay for it,” she says. “When you can document what you’ve done, you have a far better chance for uncontested payment.”

 

 

Patient volume, revenue growth without pain

When she purchased RAPID Documentation, Dr. Zarzana normally saw about 30 patients per day in her six-day week – a clientele heavily weighted towards sports medicine, particularly young athletes and their families, along with the traditional mix of personal injury references, workers compensation cases and wellness patients. She was (and is) the only chiropractor in the practice, but she also employed two massage therapists and an acupuncturist/herbalist.

 

Dr. Zarzana liked the way her practice is structured and the way she was able to work with her patients and apparently, her patients and referral sources liked it too. She has doubled her patient load and with it also doubled practice income. The practice has had to move a larger office with more examining and treatment rooms and to cope with the increased volume, the staff has also grown. It now comprises two massage therapists, the acupuncturist/herbalist, a personal trainer, two front office administrative/patient support personnel, and an accountant who also maintains the practice website (www.zarzanachiropractic.com).

 

“Automating clinical notes and reports allows us to get more work done in the same amount of time and the ACOM Health system has contributed to the development of a strong professional image for our clinic,” Dr. Zarzana  says. “The new reports we supply to referring MDs have positively impacted our credibility with them. Several have called after receiving their ACOM Health reports to say that the level of professionalism is not what they are used to seeing from chiropractors.” 

 

 

 

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