[00:00:03] Speaker A: Welcome back to Chirocast. I'm doctor Stephanie Brown and joining me is my co host, Danielle. And we're excited to bring you another valuable episode packed with insights for your chiropractic practice.
[00:00:16] Speaker B: We're thrilled you're tuning in today because we are covering something that every chiropractor should have in place. Disaster sops. This is an essential topic for ensuring your practice can handle any unexpected challenges.
[00:00:30] Speaker A: That's right. So whether you've been in practice for years or you're just getting started, having a solid disaster plan is really, really critical.
From natural disasters to cyber attacks, we're going to walk you through some practical steps to protect your clinic, your staff, and your patients. Danielle also just said Sop, which before I came to Chirotouch, I had no clue what that meant. So standard operating procedure, I guess, which mentions a point, I think, before we even jump into content, you really should have an operations manual where you have the rules of how you guys run your practice and the way you do stuff written out. And even if you're just going to institute something with this, with some of the content that we're going to cover today, really important to have all this written down and it should be part of your employee training and accessible for anyone if they ever have any questions.
[00:01:26] Speaker B: Yeah, and the best part is, it's not as complicated as it sounds. We'll break it down for you so that you can easily start building or refining your plan right away.
[00:01:35] Speaker A: We'll also share some key tools and strategies that successful practices use to minimize disruption and keep operations running smoothly when things get difficult.
[00:01:44] Speaker B: So grab your notepad because by the end of this episode, you'll have clear action plans for protecting your practice. So let's dive in.
[00:01:52] Speaker A: All right, so let's talk about why planning is important in today's chiropractic world. So the first thing that you want to consider when you're putting together your plan is just your own practice. So where are you located? What types of things could influence what happens in your office? What about the neighborhood you're in? Do you have a lot of foot traffic? Is it more of like a city where there's a lot of people around and you want to be careful of locking doors more? Or are you located in the middle of nowhere and that's not something that you have to worry about? So just kind of doing an analysis on your office, your location, what your needs are.
Are you all paper based? Maybe you're still paper charting.
You're going to have different needs to think about and plan for compared to an office that isn't using paper charts. So you want to look at your practice and figure out what you need to plan for based on some of those factors.
[00:02:48] Speaker B: Is your office right off of a freeway, or are you a part of a strip mall? I feel like I see those more and more where you're sharing your space with other businesses. And I think that's something to consider as well, because if they're targeted by something, there's a solid chance you might be as well.
[00:03:05] Speaker A: Yeah, absolutely. Um, so first up, let's talk about just, like, natural disasters. So, uh, that's been kind of a hot topic lately. It is currently hurricane season, and we've had a lot of offices that have been impacted by hurricanes by chance. But say, for example, you're not in a hurricane zone, so you may have to deal with tornadoes. I'm further up north. So we have to deal with snowstorms and have contingencies in place to deal with those kinds of things. So, you know, also, maybe you're in an area that's prone to earthquakes. I don't know. I don't get earthquakes. But you know what? We are on a major fault line, so who knows? Someday we might.
But, yeah, you need to have a plan in place. And some of this goes along with, like, even just if there was a fire in your building, how would you get out of your building? What are those evacuation routes?
So depending on how complicated your building is and where your office is located inside of it, that might be super important to review with your employees so they know how to get out of this is important too, because they're going to be instructing the patients probably, too. I mean, you might be there as well, but depending on how big your practice is, the staff is going to be helping with that.
So just announcing that you're evacuating and making sure everyone knows how to get out and then where you're going to meet once you're outside, if that's something that's going to happen. And then you want a system in place to account for everyone, to make sure that, you know, you're noting that everyone got out and you can check on them.
[00:04:45] Speaker B: Yeah, I didn't go too deep into research on this, but now that I think about it, you know, there's like, when you go into a hospital or, you know, a large department store, they have evacuation routes posted throughout their establishment. That's something to consider. If you're perhaps an office that's on the third floor of a building, or somewhere that it's an intricate layout with lots of offices included. I think an evacuation plan that's posted somewhere with the visuals, I think is also beneficial for staff and patients.
[00:05:18] Speaker A: Yeah. And this might vary by state, but the office that I worked in, well, we had two offices. One was more of a commercial space. The other was an old house. But even so, that old house with all its character and old layout and doors and whatnot, we were still required to have emergency exit lights that were illuminated at all times and a commercial fire alarm that monitored the space that had live monitoring. So if something ever happened, then it would call fire department immediately. So there may be some things, like, in that regard that you have to do no matter what, because they're required in your municipality, but if they're not, there's still really good best practices so that you've got exits marked and having a. Some kind of system that can call the fire department. I mean, even just that alone, I don't know what the statistic is, but having. Having an alarm that I'll call out is it, like, reduces your loss and financially or something? Because obviously, we'll get the fire department there faster. Obviously, if you have sprinklers, that's even better. But that might ruin some of your equipment. So something to think about.
[00:06:26] Speaker B: Yeah, I would say it doesn't hurt to, I mean, talk with your local fire marshal, get them to come in and do a walkthrough and give you advice or, you know, input on when you're building, if you are in the process of building your practice.
[00:06:41] Speaker A: Yeah, absolutely.
So beyond what you would do physically, there's also the idea of having some emergency supplies. So we used to have a little collection of, like, band aids in the office because there's nothing worse than having, like, a little cut on your hand and then you have to adjust all day. Um, but you should probably have more than that just because you're dealing with the public and you never know what's going to happen. God forbid you get, like, trapped in the office. You know, I'm not saying you should have three months of water in your back room preppers, not maybe at the office, but your emergency kit in the office probably should be stocked with just some basic emergency items so that you could just provide basic first care, you know, if you're waiting for an ambulance, God forbid, or something like that were to happen.
[00:07:28] Speaker B: I'm the kind of patient, my kids come with me everywhere. No matter where we go, they're going to request a band aid for the slightest inconvenience. So I know having those first aid kits on hand, it helps whether you need a band aid or for your patient's children that love band aids.
[00:07:43] Speaker A: Yeah, exactly. Also unrelated, but make sure you're staying stock of children's chiropractic stickers is fully loaded so that they have something to do if you all get trapped in the office. No, just kidding. Hopefully that would happen. Let's jump into slightly related, but a little bit different is just power outage. So certainly if you have, like, a big storm coming that you know of, you're probably not going to be at your office when the power goes out.
But if. If it's whatever, just like a thunderstorm rolls in or there might be a car accident down the road that takes out power lines or whatever, something that impacts your office while you're open, you know, what should you do? So, I don't know. We're old school.
My dad would tell me to go unplug the computer. So make sure your electric equipment is on some kind of surge protector.
We had a automatic flexion and distraction table, and we did buy a surge protector for it, just in general. But I actually opened the little pamphlet that was inside the surge protector at the store. You know, it's like a tiny piece of paper folding into like 10,000 pieces or folds. And it has, like, actual information on there on how to register the surge protector to make sure that you actually have protection for whatever's plugged into it if something would happen. It did also say there was like a dollar value attached to, like, how much they would reimburse you, like, up to a certain point should the unit fail and then your equipment is damaged. But there were, like, steps you had to take to make sure that you had that protection to register with the company. So don't just buy a surge protector at the store. You might want to check the documentation that came with it. Or, like, if you're my dad, just go unplug everything if your power goes out. The problem, though, is that that won't help you if it goes out overnight and then comes back on and there was some kind of surge or something.
But, yeah. Any equipment in your office, whether it's your table, x ray suite, computers around the office, all of that stuff should not be plugged into the wall. You should definitely have a, like a surge protector or whatever on it to protect that equipment.
[00:09:59] Speaker B: Yeah. And I know when it comes to surge protectors, like, I know I'm the type of person, if I need an extension cord, like, I'm attaching extension cords to extension cords and, you know, so on and so forth. And I know that's a no no. So reading those pamphlets, it's. It's crucial because there are some that might not be compatible with how much power those devices. I know x ray machines, the foot leveler type things, those are huge machines that they're going to need a level of surge protection that my smaller monitor at home is going to need when, you know, power outages or lightning strikes and things of that nature. So something to consider when you're looking for those. You probably want an industrial powered type of surge protection.
[00:10:44] Speaker A: Yeah, definitely. So what do you do if the power goes out? And like I said, you can run around and unplug all your equipment if you really want to, but after that, like, what if there's patients in the office? So I guess at that point, it's really a judgment call. Like, do you stay open? You know, what are you. What are you gonna do?
This has happened to me before, and we just stayed open. It was the middle of the day. Nothing in particular was going on, you know, but that being said, we, at that point in time, we did still do this after that, but we were in the habit of. We would print out our appointment list every day, and it would have the patient's phone number on that list. So we at least had a list of people who were supposed to be showing up that day.
One particular time this happened, we were still on paper charts, so we had everyone's folders ready to go. We could still document. We pretty much just saw whoever showed up that day and then obviously made note if someone didn't come in. And then we contacted them later. But at that point in time, our phone system did, like, plug into the wall. So we had no phones. We couldn't call anybody. We could not call receive calls in. And so it was definitely just, well, I guess we're gonna sit here and see who shows up.
I think most people came because they didn't. It wasn't like a widespread thing. Thing or a weather situation. So most people are still coming for their appointments because they didn't know we didn't have power, because we didn't have a way to tell them. And we also wanted them to keep coming in because we honestly, we were fine. But that being said, some of our treatment rooms didn't have any windows, so, like, what are you supposed to do? So we. I had actually drove home and just grabbed a bunch of candles that I had at my house and brought them back to the office. So we were adjusting by candlelight and that just, I mean, whatever, it got the job done, people got taken care of. We weren't doing a lot of therapies or any really at all. So it didn't matter. We had our hands and our mechanical tables if we needed it, and we were able to continue adjusting and see our patients. And it wasn't a big deal.
Certainly we couldn't take any money, so no credit card machine.
Obviously, we could take cash. And then some people still carry checkbooks. There was actually a lot of people that wrote us checks that day because they didn't want to leave without paying. So that was really nice. Otherwise, we just made a note and those patients caught up with us next time they were in the office. So you do kind of need a contingency plan in place, especially just, you know, either keep taking payments or how are you going to make sure, you know, that. That you get those payments?
[00:13:26] Speaker B: Question how? What about, I don't know how long it was that you're, that you're speaking of, but how would you notify patients that don't know the powers out that maybe want to walk in? If you offered walk ins, what does that look like as far as contingency plans go?
[00:13:42] Speaker A: Yeah, we didn't do walk ins, but I just would probably have done, if anything, you probably could accommodate more walk ins at that point because it's possible somebody would have needed to canceled, so it would have felt like a no show and you couldn't do anything to fill that gap because you can't call anyone on your waiting list.
So, I mean, if that had happened, though, we would have just said, hey, walk in. Thanks for coming by. Either. Sure, we can see you in this many minutes or, you know, really sorry, we can't. We're full and we don't have power and. But we can call you later, like capture their information and contact them if they weren't a patient and they need to become one, or if just to, if it's an existing patient, maybe contact them to schedule once things are back up. That's what I would do.
That being said, though, like, our cell phones still worked, and a lot of people have VoIP or voice over Internet protocol phone systems now, and most of them have an app on them. And so nowadays, if that were to happen, you could probably have the app for your phone system. Right on your phone. I mean, that's what I have on my cell phone. So even if my power is out, I could still use my cell phone, assuming that's all powered up and working still, and you could still contact patients that way. Or I could go in and maybe I'm not available, or maybe I'm the business owner, so I do have it on my phone, but my associates in my office with staff, maybe I go into that app and I can forward it to one of their cell phones since they're in the office running things.
So that would be a really great thing that technology has allowed us to do. In the event that you do have a power outage, you might be able to forward or utilize your mobile devices to keep the office at least partially going.
[00:15:31] Speaker B: What about generators? I know for residential, I see a lot of houses when we're in a snowstorm or their power gets wiped out from a car accident. Is it standard practice for businesses to have generators that would keep them running or is that a no?
[00:15:46] Speaker A: No, because I would say probably not. Just because like, you're running a commercial space and if you truly have a generator, that would kind of be up to the landlord probably to put in and manage because it's like their property, their electrical system and stuff like that. So I don't know how prevalent a generator would be in an office. Certainly if it was a standalone building or you're the landlord because you own the building, you know, that would be a decision that you could look at making. Uh, personally, I would just suggest buy a candlelight or I'm not open.
But I mean, that is a good thing to consider. Like what happens if it is winter? There is, it is an extended thing and maybe you can get by without lights, but like you can't be cold and you need at least need heat. So I don't know what you might do in that circumstance. So definitely something to think about and consider if you own your building or have that conversation with your landlord, you know, what do they do in the event of a power outage, especially if it's something that might be an extended power outage, depending on maybe what part of the country you live in and different things that tend to happen by you.
[00:16:52] Speaker B: Yeah, I was thinking like, I know my chiropractor, they have a lunch room and there's refrigerator, there's freezers. And if you're not there when the power goes out, you don't know the power has gone out. You could walk into, you know, days worth of not smelling great food in the fridge or freezer that has melted something. Something to consider there. Or I know you mentioned you're in an area where it's huge snowstorms, like water tanks, hot water heaters, if the pipes, I guess, freeze, like those can burst and cause other types of disasters. It's just like the domino effect and flooding things out and causing nastiness.
[00:17:32] Speaker A: Yeah. So that's a great example why that's a good conversation to have with your, with the landlord.
In the event of, like, heat loss, what do, what are they going to do to protect the rest of the building and the assets in the building against like, pipe spreezing?
Because it doesn't, I mean, that could just be the regular water lines that freeze. It doesn't have to be the hot water tank.
And I've dealt with a flood before in a residential situation, and it sucks. And it was just, in that instance, it was like the tiny line that feeds fresh water into, like the tank of the toilet. I had probably been going, if we had a guess, by the time we found it, it was probably going for four or five days. But just that little tube that feeds water, it just, it mean there was like a foot of water in the basement. Like, it was bad. So. And that was just that little tube of water. So, yeah, that's a great question. What do they do in an extended no heat situation to, to protect the building? I mean, it should be as simple, I think, as shutting the power off to the building and having everyone, like, flush the toilet and run the faucets to empty out the lines.
And this brings up a great question, though. Who is responsible for damage, if there was any, depending on, like, was it someone suite above yours that damaged yours? If it came from within yours, are you only responsible for your space? Or like, would your business insurance have to cover someone else's losses? So these are all really good things to talk about with your landlord to find out and understand how they have the building insured, understand those clauses in your lease with them, and also probably talk to your own insurance agent. And that sounds boring and, like, kind of lame, but you have to play the what if game. Like, what if this happens? What if that happens? What if this happens? Otherwise, you might end up getting surprised. Like in a, like a bad surprise.
[00:19:23] Speaker B: Where you think it's covered, but there's an exception. I recently had to comb through our homeowner's insurance and just the number of subsections and exclusions. It's like, if this, then this, the logic there is insane. So I can imagine it's tenfold when you have a business. And I know in our first episode we talked about the importance of having an attorney I think having an attorney to reference in these situations is also, I mean, it can't hurt having them help you navigate who's responsible because you are renting the space, especially if somebody's up top and everything comes down.
[00:20:01] Speaker A: Yeah, definitely. The other component to this, while we're on the topic of power outage, is going to be like your computer. So if your power's out, you're probably up the creek in terms of entering transactions, writing notes. So we have a lot of offices. Almost all. I feel like at this point, offices want to be as close to paperless as possible or they're charting electronically. But that being said, I mean, you probably still have a printer and you've got to make sure you have at least some paper in the office and things to write with. So that's one thing.
But yeah, if you lose power and you're going to stay open, I mean, I'm just writing notes down on paper so that I can go into my EhR later and do my documentation. So there's that. If you want to get really crazy and take it a step forward, I probably would have one sheet of paper per person with like date whatever I'm writing note and then like literally sign and date it just to cover myself. Because what if you can't get into your EHR for a few days? When you get into your EhR, go ahead and enter your note like you would normally, but personally, like, I would scan that handwritten note that I had done that day and put it in that patient's document sections or wherever. You can do that.
And if it ever came someone gave you a hard time because you signed the note three days later or something, I would, I don't know, you just have that handwritten thing and hopefully some kind of documentation we actually get.
If I lose power, I get an email from my utility company. So you could just, I don't know, have that as backup. But this brings up a really good point. If you have a cloud based program like Hyrule touch has, I can sign into that on my phone. And so if my power goes out, as long as my phone is charged and there's still cell service, I can still get in and do most of what I need to do. Likewise, if you have a tablet, certainly it can't be on your internal office's Wi Fi. You would have to have.
Yeah, I don't know how to use those either. So figure out how to use a hotspot.
[00:22:03] Speaker B: Everybody on your phone, it's right there on your phone.
[00:22:07] Speaker A: No, I'll look it up tonight so that I'm prepared in case my power goes out. Okay.
I don't know. Everyone talks about these hotspots and I'm like, I hope I don't have to figure that out someday.
Just for fun, I'm gonna do that. So, yes, figure out how to use your phone as a hotspot. Great. Or if you have a tablet that does have, like, Verizon or, like, it's on like, a cell network or whatever, you're still gonna be able to use that as long as it's charged into your. Your cloud based program, like, with how Chirotouch can. And that way you. At least someone, whoever's got that tablet is still gonna be able to, you know, keep documenting or making appointments. That's really the big thing, is those next appointments. So if you're writing down what people paid and that they showed up and stuff, that's great, but you're going to also have to write down, well, when do they need to be seen next? Probably, or check and make sure they have an upcoming appointment. But if you have a tablet and you've got a cloud based system, you're probably going to be able to do it right then and there and you won't need to worry about, gee, I can't turn the computer on right now.
[00:23:09] Speaker B: Yeah. I feel like with the cloud based systems, the most you have to worry about in the power outage is the lights on, being able to see and navigate through the office.
Other than that, I mean, your tablets, your phones, hotspots nowadays, it makes it super easy to function when there's a power outage.
[00:23:27] Speaker A: Yeah. This goes along with what we started with, assuming that's a short term situation. So if it's a longer situation, of course there's just going to be other challenges there to deal with. So.
[00:23:38] Speaker B: So, you know, snow isn't Snowden. Yeah. If you can't physically get into the office or anybody can get in, I feel like that's another layer of contingency plan.
[00:23:51] Speaker A: Yeah, definitely.
Okay, so we just started talking about computers. Let's talk about cybersecurity situations. Honestly, like, this is not my forte.
I have heard of offices who their system was hacked, and they had. I'm not going to say they had to pay a. I mean, maybe they did have to pay a ransom. I don't know. But, like, they had to do crazy stuff to, like, access their system. So I'm just going to say this, like, just because even if you have a cloud based system, I do still feel like you should have a local IT professional, help you set up your network and help you secure it and make recommendations for how to keep your stuff safe because you still have Internet, you're probably still have like local storage of, maybe you still have local storage of files that are being shared between computers so that everyone in the office can do their job and stuff.
So you still need those machines to work, but you also need to make sure they're secure.
[00:24:54] Speaker B: Yeah.
[00:24:54] Speaker A: And not just from a HIPAA standpoint, it's from a, you know, so the, the prince in Zimbabwe isn't holding you ransom for 10,000 bitcoin. Like that's going to be a bad situation even if your patient records are not on your computer. Right. Yeah. Um, so hopefully don't ever let that happen.
[00:25:15] Speaker B: Yeah, I think a piece of that, like with a contingent, not even a contingency plan, but training, internal training for staff so that you don't have a front office that is just opening up emails or personal emails on the work computers or downloading things, downloading apps to those computers that house EHR. Cause I mean, if you think, I mean, hopefully this doesn't ever happen, but in the event that there's litigation or something of the sort where those computers need to be seized as evidence, you definitely don't want anything that is your private emails or any files. You don't want those stored on those computers. You definitely just want to keep it work related and, and HIPAA compliant.
[00:25:58] Speaker A: Yeah, definitely. So have a local it person still help you set up your network. Um, this is a great example. Oh, I forget what brand it is. Let's just pretend it's netgear. But like when you buy a netgear router, it's like the, um, the regular, like the admin name is like admin and the username is, or the password is password or something like that. Um, it's like basic right out of the box, like from store. And I'm not talking like the Wi Fi password to get onto the Wi Fi. Like those are all custom typically, and they're pre assigned and it's like on the bottom or whatever. But like if you were to try and to sign into those router settings, it's that username and password that are standard. It's every single router you buy from the store, they have the same username and password. So if you are like just starting out from school maybe, or out on your own, and you set up your own network and you don't change that admin username or the password.
Any person can just drive up in front of your office if you have Wi Fi on and potentially, like, get into that. So your it person that you're gonna hire would help you figure this out, but you should always change that.
That like, what's the word I'm looking for? It's just like the basic password that comes with all of them. You've got to change the password that you would use to sign into the settings of that physical device.
So please do that, no matter what. Yeah. Also on cybersecurity, check with your business insurance and also check with your male practice insurance. Some of them are going to have information about that and possible extra policies that you can riders rider, as I was trying to come up with. They may have an extra rider to give you, like, more cybersecurity, or it could be just built into your current policy that you have with them, but that's a really important thing to find out about as well.
[00:27:52] Speaker B: Yeah, I was. As you were talking, it made me think of PCI compliance. So a lot of offices are taking credit cards. They're running cards day in and day out. They're storing credit cards in the event that somebody hacked into your network. They now have access to all of that, and that opens up a huge can of worms. I mean, I ended up helping a client a few years ago that his office was vandalized. It was broken into all of the computer docking stations. They were a huge Mac office. Everything was taken. And it not only involved the board, it involved like law enforcement, like far and wide. And I want to say to this day, it's still going on with all of the attorneys and insurance and whatnot, but that is something that they don't take lightly. So keep that in mind as well, especially with storing data on the computers. I know you never want to take somebody's credit card number down and just kind of leave it on a sticky. I experienced that at a hotel once upon a time.
But, yeah, I know that's a huge no no, especially in healthcare.
[00:29:03] Speaker A: Yeah, you don't write down credit card number ever. And I don't care what computer system you use and how good your antivirus is, and you have the best local it guy ever, no one's getting into your system. That's fine. But you're not ever, ever, ever, ever allowed to store a patient's credit card information in your computer system, ever. Not in a word document, not in a password protected Excel spreadsheet, not in your electronic health record system. In this section, that just says, note like, you are not allowed to do that. Don't do it. Because not only if you have, like a cybersecurity incident could it be lifted then, but, you know, God forbid you have a rogue employee that has access to all of that information. They will have no problem going on a shopping spree. I don't know how easy it would be able to prove that it was them and not you. I mean, probably not that hard, but I mean, that would be a big problem. And so even if you're not the one that went and spent the money on that person's credit card, you're going to be liable because you were the business owner and you are the one that was letting that information be stored in a non secure way, and you're probably going to be on the hook for it somehow.
[00:30:14] Speaker B: Oh, that's terrifying.
[00:30:17] Speaker A: So don't do that, please. I see it all the time, unfortunately.
Don't, don't do that. Very bad. Bad. No, don't do it.
[00:30:27] Speaker B: Yeah.
[00:30:28] Speaker A: Okay, great.
On that note, since we're talking about computers still and stuff, just in general backing up your data. So, you know, we have customers that like to come to Chirotouch cloud, and maybe they're coming from our server version of the system or they're just coming from another software, that's fine. But every so often we have a customer who is coming to us very urgently because their last system crashed, because the hardware failed. And they usually, when they get to us, they have nothing. They have no records, they have no ledgers, they have absolutely nothing. Their entire, we'll just say, like, career, life's work, all proof that they've ever done anything is gone.
And that's bad. It's really bad from a lot of different reasons. So I don't know if this is profession specific, if this is only chiropractors that are inflicted by this, I'm going to guess probably not. It's probably anyone who might be a small business owner. But it is ridiculously important to plan ahead and replace your hardware on purpose before it breaks. Do not keep a server for ten to 15 years. It's not designed to live that long. Now, if you have a local it guy or girl who's really good at things and keeps an eye on it and is monitoring it and replaced a part in it, I don't even know if that's a good idea either. Like, if you have someone monitoring your system, that's one thing, but if you just pay someone to set it up for you, and then, you know, they kind of go away and they're not actively making recommendations on when you should be replacing your hardware. Or, look, your server's twelve years old, it's probably on its last leg. Like, if you don't have someone advising you of that, a, find that person, and b, if your stuff is old, replace it, okay?
It's just, it's bad. And then even if your stuff isn't old, everyone should be backing their data up. So, like, there's something can fail at any time, it might be brand new and your server could fail, or your front desk computer could fail, or, you know, whatever the computer is in your office where you have your office files, like your intake paperwork or whatever else you use for the practice, that stuff can fail any time. So it boggles my mind that there are practices that don't back up their server that has their patient records and ledgers on it. And it boggles my mind that people don't back up just their local computer files. So, I mean, this could be as simple as having an external hard drive and you plug it in, and even if it's just once a week, even if you're just doing something like that yourself, once a week, so you find out where's all my stuff saved on the computers, put it on that hard drive, and then if you can work with your vendor to find out, what files do I need to be backing up that are on part of my EHR? If it's on your computer, maybe your EHR hosts a, like a backup thing to keep your stuff secure. That's great to have them do it too.
But I have talked to these people before. He won't mind me saying this, but the practice I used to work at, this happened to them in July. There's a number of factors that went into it happening, but, um, it happened to them and it, it, you know, I don't work there anymore. So it wasn't my patient notes that were gone, but it was my patient notes because I had been at practice my entire career and everything was gone.
Um, so even though I don't work there anymore, like, I still had this weird pit in my stomach. Like, oh my God. Like, everything I've ever done is gone. Oh my God. What if somebody needs their notes? Oh my God, what are we gonna do?
[00:34:12] Speaker B: Yeah, so another reason cloud is important, it's less maintenance, I would say, because you mentioned a lot of, like, servers get old, you have to replace them. So that's an investment. But then you also have to have somebody, I would say somebody on payroll that you can go to at any time, that if a server had some type of malfunction, you don't want to try to navigate it yourself. I know I wouldn't know what I'm doing at all and don't want to run the risk of corrupting anything.
[00:34:40] Speaker A: Exactly. So it's not like back in the day when you just had like to hook up your VCR to the tv, like the red, white and yellow wires, right. And you just plug them in and then you plug them into the tv and then it works like that's not computers anymore.
So. Yes. So fortunately though, my former employer, he did have relationships with people in town and he was able to find someone to recover the data off of the server and I, and put it onto a different machine for him so it was accessible. And then he did come to Chiro touch cloud, so we were able to import, you know, whatever, all the things and then, you know, so he has his records.
But still, that is incredibly stressful. And like the littlest amount of planning can really help you. So even if you have backup, it's not a bad idea to know, like, because you're going to be panicking and stressed out, probably you should just have written down somewhere. Okay, if this happens, okay, what am I going to do? It's on the red external hard drive in the top desk drawer. Or, you know, here's the phone number I'm going to call to my computer company, my software vendor and the it person to help me like restore this info or what have you. But yeah, even understanding with your vendor, like what goes into restoring my data, what does my downtime look like? Because it's not going to be like that. In most cases, they probably get you up quick, but you probably are going to want to be prepared at least to work on paper for at least a couple days. Hopefully it will end up being down less time than that, but better to prepare for that ahead of time. And then if it's shorter than bonus. That's awesome.
[00:36:18] Speaker B: Yeah. With documenting on paper, are there specific guidelines that you have to follow? Is there a form that you have to use or you can just grab a scratch piece of paper, make as, you know, thorough notes as you can?
[00:36:29] Speaker A: Yeah, basically just like they taught us in school.
[00:36:33] Speaker B: That's awesome.
[00:36:34] Speaker A: So a and p. Yeah, it's the same rules. It's just handwritten, so.
Yeah. And this is a great question, though. I would check in with like a compliance person if you're ever in that situation, if you have to, like, if you're usually in an EHR, but you have to chart on hand for a period of time in the middle. What do you do with those notes? Like I said before, I just hand write, sign and date, and then I would say scan it in. But that's a great question. What's the recommendation on how you would maintain that handwritten record, if you should and how scanning it might be good enough? But it's a great question to ask a compliance person, for sure.
[00:37:09] Speaker B: Yeah, because I'm already thinking, let's say, you know, you documented, you signed off on it. But let's say a not so nice employee finds that note and decides to go and write all kinds of things on it. You know, as long as you've scanned in the original, I imagine you're okay. But, I mean, there's always a what if scenario.
[00:37:27] Speaker A: Yeah. I mean, that would be the equivalent of an employee pulling someone's physical file and scribbling in it. So I don't, yeah, I guess it's the same risk. And you, you should, like, we'll get this question a lot, too, you know, well, how do I prevent someone from deleting this or deleting that? And it's like, well, correct. So you, like, you can't control what everyone does all the time, but you do. You lay out the rules and the guidelines. You should have an employee manual that says you're not allowed to alter the doctor's notes.
You're not allowed to alter X, y or z. You can't erase or delete this. It's right up there with, you can't steal cash out of the drawer. Like, all of that should be written down. And then your employee comes on board with you. They get trained and they sign and acknowledge and, you know, check with an attorney in your state and whatnot. But, you know, you have to set those expectations and it should be in writing. So if something were to happen, like in your instance, you explained before with that example, if your state board came in, at least they would see, oh, this person does have an operations manual and a compliance manual where it explicitly states that staff is not allowed to alter chart notes. So this doctor is not going to get fined or be in trouble for this because you did whatever you reasonably could to prevent that problem from occurring. So, yeah, you should have an employee manual with all the stuff in it, for sure.
[00:38:47] Speaker B: Yeah.
[00:38:48] Speaker A: So here's one. So we had a section in our manual that covered what to do if a patient ever has a medical emergency in the office.
And that included the example of, if I'm in the adjusting room and I yell out to you to call 911, you don't say why or what or who. Like, you don't ask. You do immediately. Don't ask questions. Don't keep listening to the patient story who's sitting at the front desk. Like, you just call 911.
[00:39:16] Speaker B: Right.
[00:39:17] Speaker A: And then, like, we'll figure it out thereafter. Um, but that's in our manual. Like, just do, don't ask, just do. Just assessing if someone has a problem when they're in the office. But I'm going to say this. If someone has a problem in the office after you adjust them and this wades into malpractice territory, um, don't lay them back down and adjust them again.
You don't know what happened. You don't know what's wrong with them. Could have absolutely nothing to do with your care that you might have just rendered, but the last thing that you should do is adjust them again. I'm just going to say that. Don't adjust them again. And then depending on what's going on, don't tell them if you think someone should go to the hospital, you don't tell them to go to the hospital. You call an ambulance.
Don't take all the steps.
[00:39:59] Speaker B: Yeah.
[00:39:59] Speaker A: You don't say, oh, you need to go to the hospital. If it's that much of a problem where you truly think someone needs to go to the emergency room, you're calling them an ambulance. When the ambulance gets there. If the patient refuses to get in and refuses care, it's on the patient. But you still did what you had to do to protect that person. That's what it comes down to, trying to make sure that you're protecting that patient. Don't feel weird calling 911.
Just do it. Who cares if they get into the ambulance? Yes, they probably have to pay for that ride, but that's not what matters. Like, you're getting them that emergent health care that they, that they might need. So don't adjust somebody if they get hurt or they think they're hurt or they're having a problem after an adjustment, and if they're hurt, call 911. Like, do not tell them to go to the hospital or there's significant others in the waiting room and says, I'll drive them. Also a, no, I don't care. I don't care if you've been my patient for 20 years and we have dinner together every Friday night because we became best friends. I'm still calling 911 for that ambulance to come take you you can deal with the ambulance when it gets here if you're going to refuse it, but you got to do what's best to protect that patient.
[00:41:08] Speaker B: And you. That's a CYA situation. You're probably also going to document that interaction for that encounter, because it was part of that patient's encounter in the event that anything came back on you.
[00:41:20] Speaker A: Yeah, I did send someone to the. To the hospital once, but it was not an emergency. Like, it was not a life threatening thing. I mean, they probably thought they were gonna die, but they weren't.
That's good. And that scenario, he did come with a significant other. He had already been to the hospital that weekend, you know, back in leg pain. They blew him off and told him to take painkillers, whatever. He comes into my office, the guy's basically. He's on a. This is a 40 year old man using a walker, basically dragging his feet behind him. Could hardly stand on his own. He basically would just lean forward with as much momentum as he could, supporting his upper body weight with, like, with his arms and, like, his feet were just dragging behind him. He was pouring sweat. He couldn't even fill out the paperwork because he was sweating on the form. I mean, he couldn't think clearly anyway. But he was sweating on. I mean, it was also August, but he was sweating on the form. And so I'm just like. I mean, we were in the waiting room. I didn't even bring him back. I just did a couple, like, nerve tension tests and, like, checked his reflexes. And there were no other patients in the office at this time, and none on their way in. And I was just like, you gotta go back to the hospital.
So his girlfriend was with him, and they brought him back. But if you are in an emergency and you have the awareness to do this, I mean, if you're calling an ambulance, you know, you just be prepared to tell them what you know about that person. They're gonna call ahead to the hospital. In my situation, it wasn't an emergency because. Life threatening emergency.
But I called. I literally. I mean, this was many years ago, but we had a phone book. I got a phone book out of our filing cabinet, and I'm not that old, but I still got that phone book out. I looked up the hospital. There was literally a phone number for the emergency room, and I called it. So they answer, and I'm like, hey, I'm basically. This is doctor Stephanie Brown. I'm at blah blah, blah chiropractic. I have a patient I'm sending back who I just saw, and I just wanted to talk to somebody before he got there because he was already there that weekend. So she was very nice, you know, what's going on? And I just told her, like, he is telling me his progressive neurological deficits. He presented with x, Y and z. Like, I mean, he had an acute disc herniation, which we all know, depending on the situation, you don't have to have surgery for that. But I felt like his situation, like he probably did.
And so I said, you know, he was there this weekend. You guys gave him some medicine, but he needs something else than that. And so I think maybe they would have taken him seriously when he got there the second time. But I think me calling, I would like to think, kind of helped moving along, and he didn't end up having surgery.
[00:43:59] Speaker B: So you probably saved that man's life.
Like, you were that deciding factor between, like, him suffering and, like, him having a great quality of life, you making that call and being an advocate for him and his health care.
[00:44:15] Speaker A: Well, I just don't. You don't, you know, and that was the thing. He's like, well, I've been doing this in my lifting weights by himself in his basement his whole life. And I'm like, yeah, but if you're by yourself, you might not have had great form. And so he's probably doing it wrong his whole life. And that's, that's what it was. He lifted too much and it went down.
But, yeah, so if an emergency happens with a patient in the office, like, you should think ahead about what you're going to do in that circumstance. And as an owner, if you have associates in your office that should also be in, like, the provider and staff section of your employee manual where you're telling them, this is what you have to do if there's an emergency during your office hours in the event that you're not there as an owner, well.
[00:44:57] Speaker B: What about an emergency that happens to a staff member or the owner themselves if they're a sole practitioner and they just, they've got staff behind them having that process in place as well. Like, what are they going to do? They're going to have to shut the office down. They're going to have to notify patients somehow that, you know, doc is going to be out and, you know, God forbid that something truly devastating happens and they're no longer able to practice again. You've got to have those plans in place so that at least somebody can, can be an advocate for the practice in your absence.
[00:45:30] Speaker A: Yeah. And so not to bring up a bad topic. But, like, what happens if you die? Like, what happens to your practice? What happens to your family? You know, the family thing is fine. Everyone's like, oh, I'll have a will and stuff. That's good. But you need to look at like, the state laws in your area that are going to govern what happens to your business. You cannot assume that just because you have a will and all your assets are going to go to your spouse, that they're going to get to keep your practice. I don't think it works like that in every state. I think there's some states where they have to sell it within a certain amount of time if they are not a license chiropractor.
And so how are you going to help your spouse out when you're dead so that they can do that?
So talking to an attorney to do some estate planning about your business and then also, as uncomfortable as these things are, put it right up there with your health proxy. But, you know, have that conversation with your spouse so that they maybe have some resources that they'll be able to tap into or use so that they can get help. Either, you know, selling your practice, whether it be to the associate who's there already or, you know, if they have to work with a broker or whatever to find somebody to buy or practice, that's an asset. And so it needs to be protected for your family financially. And that's a conversation you have to have not just from an estate planning, but then helping your spouse from a practical standpoint, like, how would they sell your practice? So kind of a bummer. But just think about it now. Rip the band aid off, get the plan in place, and then you probably should revisit it every ten years or something. But then, you know, at least you did the heavy lifting in the beginning. So.
[00:47:06] Speaker B: Yeah. Yeah. Because you mentioned this, there are certain states, I know there are very few, but there are some that you can own a chiropractic business and not be a practicing chiropractor, but they're not, that's not the norm. And so I would say the overwhelming majority are going to need to have a plan in place for if something like that were to happen.
[00:47:23] Speaker A: Yeah. Or liquidating assets and where you sell things, if that's what the decision is. But helping them, you know, after you're gone, just having something down so they have a reference would be really great.
[00:47:34] Speaker B: Yeah.
[00:47:36] Speaker A: Also, so we just talked about people getting injured, but just also, God forbid, like you have a robbery or something. So we had this in our employee manual, too.
But what do you do? I mean, I think the general guidance police would say, like, give them what they want, because the last thing you want is someone to get hurt in the office. Overdose. A few hundred dollars or even a few thousand dollars, like, that's not worth someone's life, so you give them what they want. But I think having protocols in place for keeping doors locked, you know, doors are always locked unless you are literally open. Seeing patients, end of story. I mean, that's how I operated. I was a sole solo practitioner in my office, often without even any staff.
But that's what I always did. And it meant I knew what the sound was, where someone was at the door, because they showed up early when I was coming back from lunch. But then I just went and unlocked the door and let them in and it was fine. But you can't mess around with that. So if you're getting robbed, you need to tell your staff that you would give them what you want, whatever they want.
If it's a thing where there's patience there, when it happens, after that person leaves the bad guy, you know, I would ask patients to stay, stay calm, lock the door, and just call 911. Even if it feels, if it was insignificant or they didn't get something that's like, a lot, then it doesn't matter. You should still call it in. You don't know if they've hit other businesses in the area. You don't know if they're still outside waiting for your patients to go to the car. Like, don't go there. So just ask everyone to stay inside, lock the door, call 911, and have that written down so that your staff knows what to do. Certainly you're not going to hold people hostage. So if patient wants to leave, no matter what, then I guess they can go. But I think, like, your, your default should be, should be asking everyone to stay. If something like that were to happen, that leads.
[00:49:23] Speaker B: Yeah, that makes me think about cameras. Cameras in businesses, but also cameras in healthcare. You know, situations, you know, where can they be? You know, that's in your best interest, but also the patient's best interest. And I know you mentioned earlier panic buttons similar to like a bank would have.
I think those are a great investment. And I think it's also good practice for all business owners to practice under the possibility that you could have an internal employee that doesn't have your best interest in mind and orchestrates a robbery, because they do have access to certain information in your EHR, in your computers. They're seeing that cash flow, they know where it is. So they might not be the one that is going to hold everybody up, but there's no saying that they're not going to call and have it orchestrated and you might never know.
[00:50:19] Speaker A: Yeah, exactly. So, yeah, cameras are a hot topic for sure. If you want to institute cameras in your office, you definitely want to find out what's allowed. So video recording versus audio recording. The law might be different there. Um, and then location. Um, you need to check with a lawyer in your state. Like, I wouldn't even guess or hope for the best or assume, well, my waiting area is considered public space, so it's fine. It might be, but, like, I'm not going to be the one to tell you that. So, like, you should find out from someone who actually knows. Um, and then, yeah. Panic button. Uh, I don't personally know really where to get one. I do know though, like my personal house, I have a ring alarm system. I mean, it wasn't that expensive and the monitoring is like $100 a year.
I happen to have smoke and co detectors that will call out. So you probably don't need that if you're in a commercial space because you're a landlord. Or if you're the landlord, probably already has some type of centralized fire panel that is inspected by fire marshal or whatever every so often if that's required in your area.
But I mean, you could even use that to have an internal, like put the sensors on the windows and doors so you have an alarm system at the office.
I know ring does have a panic button that's built into it. So you could have one in an adjusting area. You can have one at the front desk.
So those are relatively inexpensive things that you might be able to institute not only from a security standpoint, literally like having monitoring and sensors on the doorste. Um, but also to get that panic button in there. Just quick note, if you are renting or you're leasing your space, if you want to put up an alarm system, you probably need to check with your landlord for sure.
[00:52:04] Speaker B: Yeah, and probably local law enforcement. I imagine it's a little different for businesses than it is for residential. Like, I know I have to. I have ring as well also. No, we are not sponsored by them. I just use them.
So I know that I have to pay them separately for any event that might lead to them coming out to my house. It's like a year, $10 fee. Like, hey, just in case we might come out, you have to pay for us. But having them come out also and kind of guide you on where you might want to have them and how often they're patrolling and what the protocols are. Those are always good to have.
[00:52:39] Speaker A: Yeah, absolutely. Quick. No, it's a good thing I don't have to pay because mine goes off all the time because I burn food and constant calls the fire department because I don't know how to cook, apparently. All right, anyways, on that note, it's a good thing I don't have to pay every time it goes. So embarrassing. Okay, so, well, let's close things out here. So, you know, as we've seen, like Hurricane Helene and Milton just came through. Like, natural disasters can strike any time. You know, in that instance, they had a little bit of warning, but to other parts of the country that did not. Um, and some of the other things we discussed today can literally happen anytime. So the key really is you've got to think ahead. You have to be prepared. Um, you're not being a negative nelly. If you're trying to think of, but literally sit down and think of everything that could go wrong in your practice and just pretend, okay, like, it's not happening right now. But what would I do if this did happen? And then just get some things written down so that you have guides in place that's going to help you know, what to do when it happens because it can be stressful, but it's also going to protect you potentially from a liability standpoint because it'll make sure that you have training in place for your employees.
And just in general, planning is going to help minimize downtime, ensure patient safety, and get you back to practice as fast as you can. If it impacted it.
[00:54:04] Speaker B: It's a peace of mind, too. And I think any therapist would agree that in this case, overthinking is, is required. And it's, it's, you know, they're happy to tell you to overthink in this situation for any possible scenario. Yeah, write it down, plan for it, and, you know, you have that peace of mind that your team is going to be able to function in whatever situation might pop up.
[00:54:24] Speaker A: Yeah. So we have a customizable, downloadable disaster preparedness checklist specifically for chiropractic offices.
So if you have any other tips or experiences you want to share, or if you just want a copy of that checklist so that you have a starting point, just reach out to us so you can email
[email protected]. i hope this was helpful to everybody. And, you know, like Danielle said, you just have to plan ahead and be prepared. So I hope that helps everybody and hope you guys enjoy your day.
[00:55:00] Speaker B: Bye bye.
[00:55:02] Speaker C: Thank you for joining us on this episode of Chirocast Insights for modern chiropractors, brought to you by chiropractic. Hosted by doctor Stephanie Brown and Danielle Havinas. Produced by Debbie Brooks. Editing from Matthew Dodge. Our theme song, house five is from Scott W. Brooks. If you enjoyed todays show, dont forget to, like, link and subscribe. We appreciate your support and well catch you next time.
