So it organizes this information and tells you how to proceed consistent with the guidelines you are choosing to follow.

Exactly. The software knows which classification the patient is in and it guides you through the procedures in that guideline. Now, the majority of EHRs today do not do all of this. And the majority of chiropractic software does not qualify as a true EHR.

Who determines what qualifies?

CCHIT, the Certification Commission on Health Information Technology. This is a nonprofit agency that has been endorsed and used as the certifying body by the federal government since 2006. Medicare and the ONCHIT [Office of the National Coordinator for Health Information Technology] reference CCHIT as the valid certifying body.

And you have developed software that you use in your own paperless clinic in Carroll, Iowa, and which is marketed to others.

Yes. Our company now has over 40 employees and we have over 1000 users in 48 states using the Future Health system called the Virtual Office Suite (VOS). I developed this company out of frustration that there wasn’t an existing system out there that met the needs of the chiropractor. I used to own four different digital documentation systems and billing systems and I was frustrated that they couldn’t manage the practice. They might have been able to manage billing, but they weren’t managing the overall integration of the clinic, scheduling, documentation, storage of the documents, and practice management information. We needed to take all these different components of a practice and integrate them so that alerts, reminders and tracking systems were in place so that the doctor could really manage his clinic. Also, it was all about speed. Previously, I couldn’t create a compliant note quickly enough. With the other systems I had purchased, it was actually taking me longer to document in that digital format than it was with my own customized paper system, with check-offs and circling of data. That’s what led me to dive into the software world several years ago.

Is your software now certified by CCHIT?

No, it is not. We are in that process now. As of January 2009 there was no chiropractic specific software that was CCHIT certified. It’s important to become certified, because in order to participate in the economic stimulus funds (although the regulations are not yet set in stone), it looks virtually certain that in order to receive payments from the stimulus funds, you will have to use a CCHIT certified system.

I understand that the federal reimbursement to doctors (including chiropractors) for the purchase and implementation of this software will only be available to doctors through Medicare.

That is exactly correct. I read the bill inside and out, and I also have information that’s not in the bill, straight from the Department of Health and Human Services, where I had meetings last week. The framework is there, but the specific details still have to be worked out. In a nutshell, the money will come through your Medicare check.

Does the chiropractor have to have a certain volume of Medicare billings to qualify?

This is not yet certain. We are likely to know the answer by end of 2009. Early information about the plan indicated that a provider would have to bill $25,000 annually to Medicare (in approved billings) to qualify for any reimbursement, but more recent information indicates the possibility that reimbursement might be available on a pro-rated basis for those chiropractors who bill Medicare less than $25,000 per year. Let’s work those numbers backwards. With the average Medicare reimbursement for chiropractic services at $33 per visit, that comes down to 63 Medicare visits a month, or 16 visits a week. If you have that many Medicare patient visits per week, you will likely qualify.