Dr. Kraus has practiced chiropractic for over 20 years and serves as clinic director of a multidisciplinary clinic in Carroll, Iowa, which includes two chiropractic physicians, a family practice physician, a certified physician assistant, a physical therapist, physical therapist assistants, an athletic trainer, and two massage therapists. His clinic has been visited by Iowa Governor Tom Vilsack (now Secretary of Agriculture) and Senator Tom Harkin, who mention it frequently when encouraging the healthcare community to embrace the collaborative effort of disciplines working together and using EHR technology. 

He is a sought-after speaker on a wide range of health-related topics, including health electronic health records, clinical documentation, Medicare regulations and guidelines , integrative practice, and the role of chiropractic in the health care system.

What does an individual chiropractor gain by converting to EHR, both within the practice and when interacting with doctors or insurance companies outside the practice?

There are three main things that they gain: efficiency, quality of care, and financial incentives now or avoiding the financial penalties when this is mandated in the future. Number one is the efficiencies in the office, which range from overhead cost savings to streamlined communications within the different departments of the office, and the possibility of lowering other areas of overhead. One example: consider the time it takes to pull charts in the morning and then file those charts again. Assume that a staff member has to open the file, pull some papers out, two-hole punch another document, place it in the file and put the two prongs back. We’ve done time trial studies to try to measure the cost savings. We estimate that the average chiropractic clinic (which sees 140 patient visits per week), would save $2600 annually through staff time saved while accomplishing the same goals with electronic health records. So that’s one simple example of efficiency.

The second thing the doctor gains is better quality of care. The real purpose of an EHR is not just to digitize the notes. If that were the case, then technically you could argue that dictating your notes would be the way to go, because it’s all neatly typed out in a Word document. But that’s not the intent of an EHR. The reason they want a “qualified” or “certified” EHR, which is described with terms like “interoperable,” is because the purpose is to improve the quality of the care. That’s the reason they’re driving health care professionals to do this. It’s not just for your own office efficiency, but for improved quality so that there are logs, repositories, alerts and reminders for case management, and so that the information can be shared electronically with other health care providers.

Could you give a typical example related to chiropractic practice?

Let’s say you’ve given home exercises and nutrition recommendations to patients. What is the doctor’s method for following up on patient compliance with those recommendations? The beautiful thing about technology is that it can help us manage cases on a timely basis. It becomes overwhelming for the busy practitioner to remember exactly what he might have recommended to every patient. He might have to go back and look deep in the paperwork of the chart. The EHR will automatically generate lists or logs for certain types of patients and point to the kind of follow-up that they need. In the medical world, with diabetes, following up with certain medications and certain exercise regimens for these patients requires time. How does the doctor remember, with all 200 of their patients who have the diagnosis of Type II diabetes? With a chiropractor, it might be following up with MRI results. The EHR would alert you that the MRI result had come in. Maybe the patient isn’t coming back in until they find out if there is a disc herniation. This provides the reminder. It helps us to manage our cases better. This is just one of many possible examples.