Digital Tools to Improve Chiropractic Patient Retention
IndustryView | 2015

Research has found patient satisfaction levels are tied to practice retention rates, suggesting that happy patients tend to be more loyal ones. With retention a particular problem for chiropractic practices, Software Advice surveyed chiropractic patients to find out how tech-based resources (e.g., multimedia educational materials and patient portals) can enhance their experience. Chiropractors can use these findings to drive engagement and education efforts, encouraging patients to return to their practice for treatment.

Key Findings:

  1. Chiropractic patients prefer tech-savvy practices: 91 percent, combined, are “more likely” to select a chiropractor who uses multimedia patient-education materials (e.g., videos and digital images) over one who does not.
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  3. Mobile devices appear to be an under-used communication platform for educating patients: Only 12 percent say their chiropractors have used tablets or smartphones to explain medical conditions and/or recommended treatments.
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  5. Chiropractic patient portals are a largely untapped resource for boosting engagement among our sample: 51 percent of respondents have never been offered access to a patient portal, and 28 percent don’t know what a portal is.

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Introduction

It’s a tough task for any medical professional to turn a first-time patient into a familiar face, but chiropractors run into unique challenges when it comes to patient retention. This is partly because Doctors of Chiropractic (DCs) will often recommend multiple monthly or weekly visits depending on a subject’s needs. When a patient leaves their chiropractor for good, they’re not just causing one or two holes in the doctor’s schedule—they may be leaving a slew of canceled appointments in their wake.

What’s more, as patients begin to feel better, it’s not uncommon for them to cut their care plan short without fully considering the consequences to their long-term recovery. In fact, more than 40 percent of chiropractic patients discontinue treatment after 10 sessions. Practice management expert Dr. Drew Stevens has authored books and blog posts on this very subject.

“Patients come in thinking chiropractic [care] is like going to urgent care, where they get a shot and feel better the next morning,” he explains. “And a lot of doctors don’t let them know why they need multiple visits to correct the issue. Patients are just told, ‘Guess what—you have to keep coming back because it’s going to take a while to get rid of the pain.’”

The detrimental effects of this approach are evident in our research: 59 percent of chiropractic patients polled say they have stopped going to the chiropractor regularly. When asked why, one answered:

“I was displeased with the man I went to and no longer trust chiropractors. He knew there was something wrong with me and wouldn’t discuss it, yet he wanted me to come back three times a week!”

Industry experts say it is possible to adjust patient expectations so they understand and accept the need for continuing chiropractic care, but it requires the right mix of patient education, engagement and technology. The technology-based resources we highlight in this report can help DCs inform, engage and—ultimately—retain more patients.

Most Patients Would Favor Chiropractor Who Uses Multimedia Tools

According to a Simmons College study, a contributing factor to chiropractic patient satisfaction is the extent to which the DC explains the patient’s condition and treatment recommendations. Chiropractors have traditionally used anatomical models, posters or brochures to educate patients about their condition and how they can get healthier.

Today, however, more sophisticated visual aids are available: From 3D animations of a patient’s spinal column to interactive images of a herniated disc, entire libraries of both pre-made and customizable multimedia materials exist.

“Every chiropractor in some way, shape or form should use a visual aid,” Stevens says.

We asked chiropractic patients if they would be more likely to choose a chiropractor who uses multimedia educational materials (e.g., videos and digital images) in their practice over a similar chiropractor who did not—and a combined 91 percent say they would. Clearly, patients prefer tech-savvy practices by an overwhelmingly large margin.

Likelihood to Favor Chiropractor Using Multimedia Tools

Likelihood to Favor Chiropractor Using Multimedia Tools

According to the U.S. Bureau of Labor Statistics, demand for DCs is growing so much that a 15 percent increase in the employment of chiropractors is expected by the year 2022. As more DCs enter the field, it will become increasingly important for them to stand out from the crowd by establishing themselves as forward-thinking practitioners.

Our data indicates that an investment in patient education technology would go a long way toward achieving that goal. What’s more, a recent survey found that 58 percent of patients feel the use of technology in the exam room “positively affects” their health care experience.

Chiropractors have a few options at their disposal when it comes to implementing this technology. They can buy a stand-alone patient education system, such as 3D Practice, Speedy Assessment or ChiroCloser.

Alternatively, they can choose an electronic health records (EHR) system with a native or integrated patient education application. These applications can either be purchased individually or as part of a complete suite, depending on the DC’s needs and budget. (A more comprehensive guide is available here, and we’ll outline some popular solutions later in this report.)

Mobile Devices Are the Most Under-Used Patient Education Platform

Next, we asked patients which communication tools their chiropractor has used to explain their condition and/or recommended treatments. (Respondents were allowed to choose more than one option.) The greatest percentage of patients—36 percent—recall seeing their doctor pull out a pen and paper for this purpose. Only a combined 12 percent say their DC has used a tablet or smartphone.

Most Common Chiropractic Patient Education Platforms

Most Common Chiropractic Patient Education Platforms

Given that the use of mobile devices is only becoming more widespread, it’s discouraging to see them rank so low in their use by chiropractors to educate patients. The Pew Research Center recently found that 62 percent of smartphone owners have used their phone in the past year to look up information about a health condition. Since people are already pulling out their mobile devices to explore medical information, it makes sense for chiropractors to incorporate resources that are already so familiar to patients.


The way medicine was in 1929 needs to go away. We [need to] start using things patients today are using. Let’s use an iPad to overlay a patient’s picture on an anatomical image so they can better visualize their condition. Let’s use an Android device so patients can see immediately what’s wrong with them. We need to take advantage of these tools.Dr. Drew Stevens, Practice management expert

The type of chiropractic-specific technology Stevens describes is already in place: it’s just a matter of encouraging implementation. Software vendors, such as ChiroTouch, are starting to offer mobile-friendly, digital patient-education solutions. Some of these applications, such as the one pictured below, can even be customized to include hours, location and other information about a practice.

  • MyChiroTown app educational content

    MyChiroTown app educational content

  • MyChiroTown app dashboard 

    MyChiroTown app dashboard

No matter how the message is delivered, it’s important that doctors spend a significant amount of time and effort explaining patient conditions and treatments. According to the Journal of Ambulatory Care Management, there’s strong evidence that there are key benefits of providing personalized patient information, including:

  • Improvements in patients’ knowledge and understanding of their condition;
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  • Increased sense of empowerment;
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  • Greater ability to cope with the effects of illness; and,
  •  
  • Improved patient satisfaction.

The screenshots above show how patient education technology can help DCs better deliver these benefits to patients, and thus encourage more visits. After a patient reads a description or views a video about their condition, the option to make an appointment with their doctor is only a couple of taps on the dashboard away.

Ninety-Seven Percent of Patients Find Digital Educational Materials Helpful

Digging deeper, we set out to gauge whether the technologies patients want are the ones chiropractors actually use. We asked two questions: Which digital educational materials patients find (or would find) most helpful, and which ones have actually been used by chiropractors to explain conditions and/or recommended treatments.

A combined 97 percent of patients would find digital images, slide presentations and videos helpful in allowing them to understand their treatment/condition. However, only 73 percent say their chiropractor actually incorporates these types of materials.

  • Most Helpful Educational Materials

    Most Helpful Educational Materials
  • Most Used Educational Materials

    Most Used Educational Materials

While it’s encouraging to see that the use of digital images is matched by their perceived helpfulness, patients feel they could be better educated by more frequent use of slideshows and video materials than they’re currently getting from their chiropractors. Indeed, while 28 percent of patients would find videos helpful, only 9 percent have seen them in action.

A recent study suggests that videos may be a more effective way of increasing a patient’s comprehension of health information when that information is too complicated to explain through text alone. Software that helps DCs showcase educational videos therefore holds the promise of enhancing the patient experience.

One such product, ChiroCase from vendor VitaLogics, provides an example of how complicated medical diagnoses can become more accessible through sophisticated audio-visual animations.


Patient education video available on ChiroCase software

VitaLogics’ Technology Solution Specialist Nicole Cowley says that this kind of software is useful not only for patient education—it can also help drive referrals. She explains that patients will often share multimedia educational materials with curious family members, which can spread the word and spark interest in the practice itself.

Such compelling anecdotal and research-based evidence begs the question: Why aren’t multimedia patient education materials used by more chiropractors? Primarily, Stevens believes chiropractic colleges should step up efforts to promote the use of technology by incorporating mobile devices in lesson plans and educating future DCs about software innovations in the industry.

He also contends that many chiropractors are hesitant to spend money on health technology. This is partly because chiropractors typically earn less than other health care professionals, and thus, must be more strategic about their purchases. The median salary for a chiropractor in 2012 was $66,160 per year—only $690 more than the median pay for registered nurses, and $121,040 less than that for physicians and surgeons.

When Stevens advises practices, he says he often has to be firm to get the message through to thrifty DCs: It is worth it to purchase the educational tools needed to grow their business and move to the more profitable side of the industry’s pay scale.

Only 15 Percent of Patients Have Access to a Patient Portal

Patient portals—secure websites commonly integrated with EHR systems—are typically packed with engagement-driving functionality. Patients can log on and instantly view their test results, communicate with the medical team, schedule appointments, pay bills and more. Since these portals are a self-service technology, they can enhance the patient experience without adding much to the workload of chiropractic staff.

Unfortunately, our survey results show that a great deal of work must be done to raise awareness and adoption rates for chiropractic patient portals. Nearly 80 percent of patients, combined, have either not been offered access to a chiropractic patient portal, or are not even aware that such portals exist.

Chiropractic Patient Portal Access and Awareness

Chiropractic Patient Portal Access and Awareness

These results reflect a significant lag in chiropractic portal adoption as compared to other medical segments. In a previous Software Advice report on patient portal usage in the medical industry at large, we found that 32 percent of patients have been given access to a portal: more than twice as many as the amount of chiropractic patients with portal access.

However, this gap is not due to a lack of available technology. Factors such as chiropractors’ cost concerns and low overall technology adoption are more likely to blame. Indeed, many software vendors, such as Future Health, already offer chiropractic-specific patient portals.

patient portal educational content

Patient portal allowing access to educational content

The above screenshot is from Future Health’s EHR system, SmartCloud. Its portal allows chiropractors to provide patients with direct access to educational resources, in the form of digital documents that they can access through the portal and download at home.

Most Chiropractic Patients Use, or Are Interested in Using, Patient Portals

With such dismal rates of awareness and access for chiropractic patient portals, we wanted to see how patients felt about these tools in general. The results are encouraging, indicating that patients who can use portals largely do use them (60 percent), and those who can’t use portals largely want to (65 percent).

Chiropractic Patient Portal Adoption and Interest

Chiropractic Patient Portal Adoption and Interest

These results are in line with Stevens’ experience in his practice management consultancy: For doctors who have invested in portals, he says, “the patients are just eating it up.”

Our survey findings coupled with federal financial incentives for health information technology implementation should make DCs consider patient portal adoption even more seriously. As the American Chiropractic Association explains, some DCs are eligible to receive tens of thousands of dollars in government money when they prove “meaningful use” of health IT systems. And putting a patient portal in place is one of the rules set by the Centers for Medicare and Medicaid Services (CMS) to qualify for the funds.

Of course, DCs interested in taking advantage of this program must make sure they meet the necessary qualifications. As experts point out, only practices receiving a certain amount of Medicare patients are eligible, which might preclude some DCs from pursuing these incentives altogether.

Patients Want to View Health Records, Schedule Appointments on Portals

Digging deeper into the idea that patients find value in portals, we asked respondents what purposes they want to use a patient portal for, choosing from a list provided. (Respondents were allowed to choose more than one option.)

The below functionalities come standard in many software platforms that include patient portals, with the exception of the ability to view videos on follow-up exercises (while some vendors do offer this, it’s not as common).

Most Desired Patient Portal Functionality

Most Desired Patient Portal Functionality

The top three results are in line with the rest of our survey. When patients are given tech-based tools by their chiropractors, they tend to want to use them—providing opportunities to boost their education, engagement and retention rates.

Viewing their health records (chosen by 31 percent) can give patients a better understanding of their ailments; scheduling appointments (chosen by 25 percent) will keep them coming back and seeing videos on follow-up exercises (17 percent) gives them a way to engage with treatment recommendations long after they’ve left the exam room.

patient portal dashboard

Patient portal with dashboard to message care team, view health documents etc.

What’s more, all these factors combined can potentially lead patients to speedier recoveries and better overall wellness. After all, patient involvement has long been touted as a means of achieving successful health outcomes in chiropractic circles.

Conclusions

Chiropractic patient retention starts with open communication. Anecdotally, Stevens says that patients don’t often ask for the reasons behind care recommendations. This “don’t ask, don’t tell” dynamic—where patients don’t ask for details, so doctors don’t tell—is hurting chances for patient retention beyond the first few visits. Chiropractors have to be proactive about expressing their findings in engaging, easily understandable ways.

The right technology can help patients understand why continuous care is needed. The American Chiropractic Association describes patient education as one of the most important benefits for investing in an EHR. What’s more, our respondents express a desire for multimedia educational materials and access to patient portals from their chiropractors.

Based on our survey results and expert commentary, here are some parting tips on how to narrow down the best technology for your chiropractic practices:

Invest in a system with multimedia patient education materials. Posters and brochures can only go so far in explaining the inner workings of the human body: Patients surveyed believe videos, interactive digital images and slide presentations are helpful, if underused, resources for this. DCs purchasing a new system should look for one with a built-in content library. Budget-conscious DCs, or those with a system already in place, should consider purchasing a stand-alone application dedicated to providing multimedia materials.

Incorporate mobile devices into patient consultations. Our survey results indicate patients are not seeing many smartphones or tablets integrated into their care consultations, despite the fact that these are popular and familiar platforms. Chiropractors can use mobile devices to display visual aids while explaining a patient’s condition or to share videos explaining recommended follow-up treatments.

Prioritize patient portal access in your software selection. When a DC is ready to invest in an EHR or practice management system, they should choose one that offers access to a patient portal. Our findings show this technology is largely unknown or unused by patients, even though most express a willingness to give it a try. By responding to this demand, chiropractors can take a significant step toward increasing patient engagement and boosting retention rates.

Methodology

To find the data in this report, we conducted a two-day survey of 165 chiropractic patients consisting of 14 questions. All survey questionnaires undergo an internal peer review process to ensure clarity in wording.

Sources attributed and products referenced in this article may or may not represent partner vendors of Software Advice, but vendor status is never used as a basis for selection. Expert commentary solely represents the views of the individual. Chart values are rounded to the nearest whole number.

If you have comments or would like to obtain access to any of the charts above, please contact gaby@softwareadvice.com.


Gaby Loria

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