Let's Add More

I’m in my office right now building connectors between software systems that should have never been separated in the first place. The EHR does one thing. The practice management system does another. The insurance verification tool handles a third piece. None of them speak to each other the way they should, so I’m writing scripts and customizing workflows to make them fit together. This is engineering work. It is not chiropractic work. It is increasingly what I do to keep the clinical work possible.

Documentation requirements have expanded continuously for twenty years. HIPAA added layers. The ACA changed how insurance justified payment. Risk management added more. Each addition made sense when someone required it. None of them are unreasonable individually. But the system is designed to only pile on. It never asks what can be removed. The onion keeps getting layers. Nobody takes any off.

This is not unique to chiropractic. Talk to a family doctor, a dentist, a podiatrist. They’re all doing this work. Watching the administrative time expand while the clinical time gets compressed. Engineering personal solutions because no infrastructure was ever built to handle the burden at scale.

Here’s what I notice: the system that created the problem is the same system that will not solve it. Insurance companies set documentation requirements but have no incentive to simplify them. Regulators add compliance rules but never subtract. Each stakeholder adds something because it serves them. Nobody has leverage to say enough. The accumulated burden is just the cost of operating. Practitioners absorb it.

The profession invested in EHR systems. Vendors built practice management tools. But the investment is incremental when the problem is exponential. So practitioners are left with software that was designed to help, not to solve. You buy the best available options. You customize them. You build the bridges between them. You maintain your own system. That maintenance work is invisible until you stop and realize how much of your day is consumed by it.

Systems designed to only accumulate do not naturally optimize for the people inside them. They optimize for the people who add to them. When the cost of operation lands on individuals instead of being solved structurally, individuals solve it individually. You engineer your own infrastructure because nobody built one that works.

I’m in my office writing scripts because that’s what happens inside a system that has not accounted for what it costs to carry everything it piles on.

Dr. Glenn Jaffe is a practicing chiropractor with more than twenty years in the profession. He served as president of the North Carolina Chiropractic Association and has worked at the national and legislative level on the profession's governance priorities. He is the founder of BoldAzure, a leadership platform for chiropractors. He writes about where the profession is, how it got there, and what maturation actually requires.

Learn more at boldazure.com