It’s based on the amount you are billing Medicare, not on the dollar amount you spent on the software. It’s based on 75% of what you billed to Medicare, but paying you a maximum of $18,000 in 2011, which is the first year that anyone will receive such payments. Then in 2012, the maximum is $12,000. The maximum that a doctor can receive in total reimbursement is $44,000. You might have only spent $10,000 on your software, but they also recognize that there was also money spent on your training, hardware, and implementation and that you might have lost some income because you had to slow down for four weeks when you first implemented EHR. But if you don’t implement in 2010, you won’t be eligible for the 2011 payments. You’ll have to wait until the following year. And the amounts get reduced each year, so you can’t get the full $44,000. Again, these rules are not set in stone but this is the framework that they are leaning towards. Early adopters have the financial edge.

So that’s an incentive to implement early.

By the time 2014 ends, there’s no expected reimbursement at all. After that, starting in 2015, they will start reducing your Medicare payments by a little bit more each year if you don’t have it implemented. Also, it’s not just that you bought the software. You also have to show that you are “meaningfully” using it, based on individual reporting measures. For example, chiropractic physicians currently qualify for three individual reporting measures in the PQRI program (Physician Quality Reporting Initiative): pain assessment, functional outcome assessment, and use of a qualified EHR (defined as one that is CCHIT certified or includes searchable laboratory reporting, a medication list and a problem list). So chiropractors will have to report on their claim forms on every visit that they are using a certified EHR.

Based on these criteria, our software is Medicare qualified in the current PQRI program and we are now in the process of becoming CCHIT certified by the end of this year. My prediction is that there will be approximately four or five chiropractic software vendors that will become CCHIT certified between now and the fist part of 2010.

How much does EHR software cost?

I can give you figures for a chiropractic “qualified” EHR system. Again, this is much more than just a digital note generator. It should have the ability to communicate with or retrieve data from other computerized systems outside your clinic and also with any digital systems in your office, such as a digital x-ray or computerized inclinometry systems. It would need to be able to accept, for example, an MRI image from the local hospital into your EHR system. CCHIT also has requirements for administrative controls and security settings for each document, and requires controls for who has the right to view certain documents. For example, does your staff need to have access to certain documents? All of this must be compliant with HIPAA regulations.

For the initial software, you are looking at somewhere between $12,000 - $14,000 for a true EHR and then when you buy hardware and go to the cost of training your staff, you are probably looking at an additional $5,000-$10,000. So for the average chiropractor, it’s in the $20K range, assuming they need some new hardware.

The average chiropractic office has 2.5 office staff and one chiropractor. They are working out of two adjusting rooms, and we recommend putting a work station in each room. Walking around with a tablet has been proven to be sexy but neither practical nor efficient. Having a simple, reliable $450 work station in each room will work, and then you’re networked within your office so you control your own data. From a survey we did in May 2008, 76% of all chiropractors want the patient data in their own office and to have control of it, as opposed to using a 100 percent web-based application, with the data stored somewhere else. I do believe that we’ll start to see that change over time, since the younger generation is more comfortable with the web hosting their data and trusting the outside world with their data. In either case, you would have off-site data backup.