Meaningful Use Standards for EHRs/EMRs – Do They Mean $0 for Chiropractors?

If you are a glutton for punishment, go ahead and read the 136 pages of meaningful use guidelines on the Internet.   If you like technical documents full of doublespeak, this is for you.  Unfortunately, meaningful use may impact a chiropractor's ability to qualify for reimbursement promised by the economic stimulus package.  That is the bottom line.

As part of the ongoing governmental push toward EHRs (electronic health records), the government has designed a set of criteria that each EHR must meet in order to qualify for government reimbursement through the stimulus package being offered through Medicare and Medicaid.  Unfortunately, while the government has included the chiropractic profession as reimbursable practitioners, the guidelines for a certified EHR fall far outside the scope of the chiropractic practice.  At this point in time, there is no certifying agency for chiropractic EHR's.  In fact, if you call CCHIT - the one and only certifying agency so far (, they have no certification process for chiropractic EHRs.  If you look at the meaningful use guidelines, you can see why certification for chiropractic EHRs is lacking.  Let's take a look at the guidelines.

Computerized Provider Order Entry

The EHR must provide for computerized order entry for medications, laboratory, radiology and provider referrals.  While the chiropractic profession will order x-rays and may refer patients to other providers, they do not prescribe medications and usually do not get involved with laboratory tests.  A good portion of the guidelines cover electronic prescription and the ability to generate alerts for drug interactions and contraindications.  There are two or three pages of meaningful use guidelines specifically related to electronic prescriptions.  In addition, the EHR has to be able to order lab tests and receive the results as structured data.  Again, this information is not useful or even allowed in many states according to the chiropractic scope of practice.

Record Demographics and Changes in Vital Signs

To be certified, an EHR must enable the office to record and modify demographic data including preferred language, insurance type, gender, race, ethnicity and date of birth.  In addition, vital signs such as height, weight, blood pressure, temperature and pulse must be able to be recorded and modified.  The system must automatically calculate and display the body mass index based on the patient's height and weight.  An interesting addition to the requirements is the fact that the EHR must record smoking status for patients 13 years or older.  It must be able to indicate whether the patient is a current smoker, former smoker or someone who has never smoked.    It is an indication that prevention will be addressed by future guidelines.   Once the EMR or EHR has gathered this information, it must be able to produce lists of patients based on the demographic data and specific diagnoses.

Report Quality Measures to CMS

While the EHR is expected to be able to report quality measures to CMS (the governing body for Medicare and Medicaid), there are no specifications available. 

Interaction with Patients

As part of the meaningful use guidelines, the EHR is expected to be able to send preventive or follow-up reminders to patients based on demographic data, medications or diagnosed conditions.  In addition, the EHR must provide an electronic copy of the patient's record on request by the patient.  It specifically states that the EHR must “Provide patients with timely electronic access to their health information (including lab results, problem list, medication lists, allergies) within 96 hours of the information being available to the eligible professional.”  What all that means is this: the EHR must include the ability to communicate information directly to the patient after a service is rendered.  For a chiropractic office, does this mean that you need to make your office notes available to the patient online after each visit?  That seems to be what it is saying in this statement: “Provide clinical summaries for patients for each

office visit.”  Many of the chiropractic EHRs on the market are not equipped for direct interaction with the patient.  It would seem that much of this interaction will have to take place behind a secure patient portal.

Check Insurance Eligibility and Submit Claims Electronically

A small portion of the guidelines indicates that the EHR must be capable of checking insurance eligibility and submitting claims electronically for all carriers, not just Medicare and Medicaid.  Again, this is a departure from the normal use of an EHR.  It is usually the practice management portion of the software program that performs these functions, not the electronic health record.

Implement 5 Clinical Decision Support Rules

While the first portion of this rule deals specifically with medications and alerts regarding contraindications, the second portion reads as follows: “automatically and electronically generate and indicate (e.g., pop-up message or sound) in real time, alerts and care suggestions based upon clinical decision support rules and evidence grade.”  Once the alert has been generated, the EHR must track the number of alerts responded to by the user.  How does this apply to a chiropractic EHR?  I wish I had an answer to this one but its applicability escapes the author at this time.

Capability of Transmitting and Synchronizing Data

The EHR must be capable of transmitting and receiving data regarding medications, lab tests and results and immunizations.  In addition, the EHR must transmit immunization data to appropriate public health agencies.  Again, most of this rule falls outside the scope of practice for chiropractic.

Protection of Health Care Data

A certified EHR must display the ability to assign a unique name or number to each patient.  It must assign levels of security that allows access by users within a clinic.  It must provide for the encryption and decryption of health care data.  It must have a means of verifying that the user requesting data has met the criteria for accessing the data.  In other words, the data must be secured by passwords and encryption so the person who cleans the office cannot access patient data (unless the “office cleaner’ is the doctor!.)

The Dilemma Exposed

As a chiropractor, do you want to use a computerized electronic health record built for the medical profession?  You will have to wade through pages and pages of screens that do not apply to your patients to record your encounters.  Even more daunting, do you want to pay at least $40,000 for this capability?  The large medical companies offer financing for their higher priced models but do you want to pay for functionality that you will never use just to qualify for the stimulus reimbursement?  That is a question that you must ask yourself. 

Because the meaningful use guidelines are so stringent, many of the smaller companies offering chiropractic EHRs cannot afford to accommodate the medical guidelines concerning electronic prescriptions, lab tests and immunizations just to sell their chiropractic versions.  Quite frankly, they shouldn't be forced to.  If a company has built an EHR specifically for the chiropractic profession, there should be a path to certification if the government did, in fact, intend that chiropractors qualify for reimbursement.  Of course, maybe the language of the law was never really intended to be all-inclusive.  That is a question that I will leave you to answer.

About the Author

This article was written by Marilyn K Gard, MBA, CEO of ClinicPro chiropractic software and ICER-2-GO LLC.  Marilyn has been involved with the chiropractic profession for 30 years, conducting chiropractic insurance seminars, writing professional articles and running a software development company.  ClinicPro software currently offers an electronic medical record program which includes patient education in partnership with the New Renaissance organization.  Marilyn can be reached at or 928-203-0854.

Chiropractic software, or chiropractic practice management software, is specifically designed to run a chiropractic office.  It includes chiropractic procedure codes such as 98940 and 98941.  It includes chiropractic diagnosis codes for subluxation and neural muscular skeletal conditions.  It is HIPAA compliant and complies with the guidelines for Medicare chiropractic coverage.  In addition to providing chiropractic software, creative concepts in communication writes articles for local and federal chiropractic organizations and publications.  ClinicPro chiropractic software is committed to providing the best chiropractic practice management software in the industry along with the best technical support available for Chiropractic software.

As a chiropractor, the needs for clinic software differ from a medical practice.  Chiropractors primarily use two procedure codes: 98940 and 98941.  In addition, electronic medical records for chiropractic practices differ significantly from medical practices.  Chiropractors do not use electronic prescriptions, lab tests or immunization registries.  Chiropractors need to record x-ray findings, visit plans and functional limitations.  Chiropractic software by ClinicPro provides the best chiropractic practice management software in the industry.
In a chiropractic office environment, the use of chiropractic software streamlines the functioning of the office.  Chiropractic software should include an appointment scheduler that allows chiropractors to set up visit plans.  It should include chiropractic procedure codes for x-rays and adjustments such as 98940 and 98941.  It should include an integrated electronic medical record that allows chiropractors to record Medicare mechanism of trauma.  Using an EMR to record documentation notes and physical exam findings streamlines the overall functioning of the chiropractic office.