Why is documentation so important and how does EHR technology improve record keeping?
Steven Baker, president of the American Board of Forensic Professionals and investigator for the Arizona state board, cites one medical malpractice suit as an example of the value of EHR software, in an article by Nataliya Schetchikova for American Chiropractic Association.
A chiropractor applied heat to a diabetic patient's ankle under a certain number of towels. This number of towels was not recorded. The next time heat was applied, a Chiropractic Assistant used a different number of towels. This led to the patient getting a burn. Because the burn could not heal, the patient's ankle had to be amputated.
This example shows the importance of documenting every aspect of a patient's visit. Along with improving patient safety, appropriate documentation guarantees reimbursements from insurance companies.
How would EHR use improve documentation and help a medical facility run more smoothly?
EHR use helps doctors save time during patient visits. Also, handwriting legibility will no longer be a concern. EHR systems have improved the quality of documentation by requiring a chiropractor to include all necessary information via prompts.
"The template-driven health record reminds you of everything you are supposed to do. For example, some doctors will forget to do a pain scale. The automated record will give you a prompt, 'What is the pain rating?'" Richard Cole, a practicing chiropractor, told the news source.
Some common areas for problems with documenting in the medical field include billing and lack of documentation with treatment services. EHR solves these problems as this technology increases speed and efficiency in the matters of billing and documenting treatments.
When chiropractors search for a vendor to solve their office dilemmas, they should make sure the software they purchase has the solutions they are seeking. Purchasing useful chiropractic EHR software could lead to reduced time spent on documenting and increased efficiency.