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Based on Meaningful Use Attestations Through February 2013: The chiropractic EHR market looks very different than most other medical specialties, with many of the top names in EHRs holding little or no market share, at least among users attesting for meaningful use. This has created an opening for smaller vendors that are more specialized to the chiropractic field (11 of the top 12 vendors serve chiropractors almost exclusively) and much more parity in the marketplace (the market leader holds only 16.3% market share).
ChiroTouch by Integrated Practice Solutions is the leader in this market, followed by Future Health, ECLIPSE® by MPN Software, and ACOM Health. These four vendors combine for almost half (49.7%) of the market. From there it’s a pretty big drop to fifth place, with the fifth-through-twelfth vendors accounting for 31.7% of the market.
Practice Fusion is the sole vendor in this top twelve list that isn’t chiropractor-focused. As a group, the other eleven vendors receive 96.7% of their business from this one field, while it comprises only 3.6% of Practice Fusion’s business.
|Vendor||Attestations||Percent of Attestations|
|ChiroTouch by Integrated Practice Solutions, Inc.||693||16.3%|
|ECLIPSE® by MPN Software Systems, Inc.||425||10.0%|
|E-Z BIS, Inc.||247||5.8%|
|Addison Health Systems, Inc.||218||5.1%|
|Midwest Software, LLC||204||4.8%|
|Mighty Oak Technology, Inc.||154||3.6%|
Interestingly, the Midwest represented a much greater market share of chiropractic attestations than elsewhere in the country. Wisconsin, Minnesota, Michigan, Illinois, Ohio and Iowa are six of the top eight states in this report, combining for 35.9% of attestations though they represent only 15% of the U.S. population.
Almost all (98.8%) providers were using complete EHRs, and all were in an ambulatory setting--not a surprise, given that chiropractors rarely see patients on an overnight basis.
The data used to compile this report came from data made publicly available by the Centers for Medicare and Medicaid Services (CMS). Data are up to date through February 2013, but market shifts may have occurred since that time. Although meaningful use attestations are not exactly the same as market share, they are nevertheless correlated: the vendors approved for meaningful use tend to be the top players in the industry, and if a practice is reporting data to CMS then presumably their EHR is doing its job. Therefore, we believe this is a valuable assessment to make for chiropractors looking to make an EHR purchase decision. However, practices not attesting to meaningful use are not represented in the data, nor does our report factor in user satisfaction or longevity.
Of the 171,226 provers who attested to meaningful use, information from 4,223 chiropractors was used for this report. The culled down data is available here.
Chiropractic electronic medical record (EMR) / electronic health record (EHR) systems will offer features such as ADAM diagrams to illustrate diagnoses and procedures, SOAP notes with customizable text, and custom reports for a chiropractor's office. Additionally, some chiropractic-specific electronic medical record software will offer an image storage and retrieval system to track patient images and X-rays.
Chiropractors should also consider the following when evaluating systems:
|Chiropractic-specific workflow||Customized templates designed specifically for a chiropractic practice facilitate workflow and increase efficiency by offering a clear-cut way to capture complaints, history of present illness, review of symptoms and physical examination.|
|Chiropractic SOAP notes templates||Example templates include neck pain, oswestry, carpal tunnel, disc bulge, herniation, fibromyalgia, car accidents, sports injuries, sciatica, scoliosis, and thoracic complaints.|
|Visual input||Some chiropractic EMRs use point-and-click anatomical diagrams for taking notes during diagnosis and treatment. This one feature alone can decrease documentation time by three quarters.|
|Chiropractic device integration||Ensure that any medical devices used in diagnosis or treatment—for example, computerized muscle testing or x-ray radiography—integrates into the EMR software. Images and data should automatically import into the patient record, making the information easy to analyze and track.|
|Chiropractic E&M coding assistance||The chiropractic EMR’s E&M coder should allow the practice to verify ICD-9 and CPT codes associated with any diagnosis and connect directly to the billing software, ensuring faster and more accurate payment. Associated features include claim scrubbing, batch posting, DME billing, and workers compensation billing.|
|RAND assessments||Automatically incorporate treatment data into RAND outcomes assessments, facilitating this and other quality reporting tools.|
|Best-of-Breed vs Integrated Suite||EMR software can be purchased on a stand alone basis (i.e. "best-of-breed") or purchased as part of an integrated suite with medical insurance billing, patient scheduling and more.|
For any buyer evaluating systems for managing a chiropractic practice, there are some things going on in the medical software industry you should understand. Here are three important trends.
Software as a Service (SaaS). More and more buyers are interested in web-based chiropractic EHR software. Developments in chiropractic management software--such as data security and encryption, server reliability, and data backup are driving wider adoption for web-based systems. Add to that such benefits as lower upfront costs, built-in IT support, and remote access, and it’s no surprise that more and more vendors are offering their solutions on a SaaS model.
ONC-ATCB Certification. Perhaps the most interesting trend in chiropractic software is the Health Information Technology for Economic and Clinical Health (HITECH) Act, which includes $19 billion to incentivize medical offices to adopt chiropractic EHR. To be eligible to receive $44,000 in reimbursements in the form of increased Medicare and Medicaid premiums, providers must show “meaningful use” of ONC-ATCB-certified chiropractic EMR systems. Guidelines for Stage 2 announced in 2012 detail penalties for those that fail to qualify, in the form of decreased Medicare and Medicaid payments. As such, buyers should be reviewing certified vendors to ensure early adoption.
Mobile device support. One thing many chiropractic practice management software buyers are beginning to consider is mobile device support. Practitioners and their staff are increasingly using mobile devices such as smartphones and tablet PCs for work. Mobile technology allows you to accomplish more from outside the office--and improves mobility within the office---vendors are increasingly offering mobile capabilities in chiropractic office software. Whether through supporting mobile sites for staff and patients or by offering native apps for various mobile operating systems (Apple, Android, etc), we expect to see more systems coming to market with mobile capabilities.