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Dynamic Chiropractic Canada – November 1, 2008, Vol. 01, Issue 02
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Going Paperless: A Summit That Demands Preparation

By Steven Kraus, DC, DIBCN, CCSP, FASA, FICC

Moving mountains - to switch a paper-based practice to an electronic health record (EHR) practice can seem to be an insurmountable task, like moving a mountain. This perception can be so strong that it stops many before they start.

It robs them of the productivity and satisfaction that comes with a completely integrated digital practice. It also postpones their shift to EHR, keeping them one step behind the rest of the profession.

Switching to the digital practice should be more like conquering a mountain rather than moving one. Yes, it takes work, but it's not impossible. And the view from the summit is incredible. The key differences between conquering a mountain and being buried under one is how you prepare for the journey and the experience of your climbing guide. You need a partner who knows the trusted trails, the potential dangers and how to get you ready.

I've learned this very truth by helping hundreds of chiropractors make the switch to the digital practice. It's also a summit I experienced myself; a summit for which I had to prepare. I was powerfully reminded of this truth as I prepared to reach another personal summit, the top of Mount Kilimanjaro.

Kilimanjaro Ahead

I'm part of a group of 16 that is climbing Kilimanjaro to raise awareness about prostate cancer. Our team includes some real pioneers in our profession, including Reed Phillips, DC, PhD, past president of the Southern California University of Health Sciences; and Thomas Hyde, DC, the renowned sports chiropractor who was instrumental in helping chiropractors become a part of the Olympics. Our efforts will draw attention to the need for more prostate cancer research and education, as well as raise more than $1 million for the Hap Weyman Memorial Prostate Cancer Fund.

Mount Kilimanjaro is called the Roof of Africa. Its summit rests at over 19,000 feet. While the elevation isn't as high as Everest, the actual ascent distance from bottom to top is greater than all of the Himalayas. We're told that 65 percent of us might succumb to the altitude and have to turn back before reaching the summit. Pulmonary edema and increased cranial pressure are a real risk. We need to pay attention to what our bodies are telling us. Thankfully, Dr. Tom Hyde is our point man and internal guide for this trip, having done Kilimanjaro and other notable climbs before.

A Guide to Change Perspective

They say that once you go up Kilimanjaro, you come down a different person. To reach the summit is a life-changing event that transforms your thinking about human strengths, weakness and what's possible in your life. It's an experience I'm looking forward to. Yet I've gotten a taste of that transformation by witnessing the change I've seen in chiropractors, many of them friends and colleagues, who have "gone live" via digital clinic integration. Climbing that clinic mountain and making that shift to paperless can change your perspective on your own clinical strengths and weaknesses, and what's possible in your own practice. It's like seeing practice fresh again, much in the same way climbers experience Earth's features when they finally reach the top.

I know that I'm not going to have that summit experience on Kilimanjaro, however, without listening to our guide. And I submit to you that you're not going to have summit experience in digital management unless you find an experienced guide to push you toward the summit. A guide knows every climber is different and no climbs are identical. There's no cookbook to being a good guide, and no credible "Do It Yourself" text on mountaineering. The same can be said for the guidance you get in making the transition to EHR and digital documentation.

Mental Preparation

There's no one who has made it to the top of Kilimanjaro who did it on sheer physical strength alone. If you want the summit, your head has to be in the right place. This climb isn't just physical, it's an exercise in human will. In order to get us ready for this, Dr. Hyde has been in contact with our team, telling us of the challenges we'll face, warning us of the dangers that have been encountered before and helping us think about our task properly. He's let us know that we need to be there 100 percent as a team, and has encouraged us to do what we need to do to get ready mentally. My kids have been busy recording encouraging messages on my iPod so that I can listen to their voices when I hit the wall, mentally and physically.

This mental preparation is similar to what a clinic must go through if a practice is to successfully leave paper behind and "go live" as a digital office. Everyone from the part-time weekend secretary to the full-time office manager must be working together 100 percent as a team. Not having complete mental preparation causes confusion, breakdown in accountability, and sometimes sabotage by employees who don't understand their new role. Everybody needs to be fully briefed and on board. That requires mental preparation.

Mental preparation is best with a guide who knows the pitfalls of "going live" and who counsels you through managing your people. This experience and leadership doesn't just come with the system. Do your research; find an EHR company that knows it must partner with you for both of you to get the most out your climb up the digital mountain.

Physical Preparation

Getting your head right is more than half the work, but there's still some physical preparation needed for Kilimanjaro, specifically changes in workouts and nutrition. Dr. Hyde has counseled us to get out there with rucksacks on our backs and start hiking. While there aren't any mountains in my home state of Iowa, the pack workouts are educating my body on how it's going to move over Kilimanjaro's terrain while carrying my supplies. The workouts have also given me an idea on what equipment I'm going to need to stay comfortable through the climb and help me get familiar with the unique tools of mountaineering.

To get your practice in shape to make the digital shift, your practice need as much physical preparation as I do to climb Kilimanjaro. "Going live" effectively and sustainably requires the right equipment. Not purchasing the right tools can disrupt a seamless transition to digital management and cost you thousands of dollars in lost time and wrong equipment. We're talking about the network servers, wireless devices, handheld documentation devices, desktop and laptop computers, flat-screen displays and even the proper hardware to properly interface your diagnostic devices with your EHR.

You need about as much gear as I do to go up Kilimanjaro, so you need to get familiar with the unique tools that make a digitally integrated clinic possible. You also need a guide who can skillfully advise you on what hardware you need immediately and what you can purchase in the future. I'd rather not bring something to 19,000 feet that I don't need or, conversely, discover I don't have something I can't live without. I'm taking my guide's equipment advice seriously, and you should, too.

Mountain Simulations

If you want to really prepare for a real-life scenario ahead of time, you have to create a simulation. That's what soldiers and professional athletes achieve in their practice drills and trainings. Simulations connect your physical and mental preparation and help you learn which needs improvement before you perform. So, our guide has asked us to step up our workouts for Kilimanjaro. Likewise, we've been asked to mentally toughen ourselves for the demand of the climb. There are the rucksack hikes, but there's also visualizations and placing yourself at the scene of the climb.

This kind of guided simulation is just as important for "going live" digitally as it is for soldiers, athletes or mountain climbers. You need a guide in simulating the transition. We've already acknowledged that every practice is different. Therefore, every practice responds differently when it gives up paper and moves to digital-based management. Patient, doctor and staff movement around the office can change dramatically as sign-in kiosks go in, as doctors document on the fly, and staff work from one screen instead of three or four.

The digital practice is a different level of efficiency and movement that requires simulation before it's used with live patients. It's as different of an experience as climbing a mountain in Africa. You need simulations that can help identify where you need improvement in physical and mental preparation before you get there. You need simulations by a guide who knows the actual conditions that you're going to encounter as you "go live" - someone who, like Dr. Hyde, has already been up the mountain.

The Summit: The Practice of the Future

I hope to make it to the summit of Kilimanjaro. While there are going to be other personal adventures on this trip, and some humanitarian work in Tanzania, the summit is what's driving me forward. I want to be able to tell my patients with prostate cancer that I made it all the way to the top. I have to trust that the mental, physical and simulation training I've put into this is going to help. I have strong trust in my climbing guide.

I believe this is the same kind of trust that you should have for your own shift to the paperless practice. You're going to need some mental and physical preparation and simulation in order to "go live" as a digital clinic; especially if you want it to be the practice summit it should be. So, if you want the best in the integrated clinic, you need a partner that's going to do more than just install and watch you struggle through the learning curve. You need a partner who is going to help you prepare, one that will help you create the clinic of the future.


Click here for more information about Steven Kraus, DC, DIBCN, CCSP, FASA, FICC.

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