Big Data & How It Will Change the Future of Chiropractic

Hello, welcome to the Align your practice podcast is Dr. Joe Esposito. We're excited today to talk about big data in the chiropractic industry, and how it is going to affect the profession. And even granularly. Down to your practice. We have two guests today. The ChiroHD duo here Gabriel and Luke Doty How're you guys doing, guys?

I'm doing great. Thanks, Joe.

Doing well. Thanks for having me.

Awesome. Well, Gabriel, you and I have talked for years about this topic. I know it's dear to your heart. So this should be a great conversation. I'll talk a little about my background and how I got into this topic. And then I'd love you guys, not only talk about your dream, but also bringing Luke on the team and just the collective brilliance of what you guys see foreshadowing even get to dream a little bit here. Maybe three years down the road? What What can we be doing for this profession basically, I've always been interested in big data and becoming a chiropractor and seeing results. I got really intrigued going to in functional medicine 20 years ago, and hearing medical doctors on stage talk about how they were misdirected. And now they're learning about nutrients and how it impacts lives more than what they've done for 40 years, I would be running to the phone and call my parents like you don't understand. They're saying there's lies about this conventional process. And I was so shocked that no one knows about it. And then being a chiropractor, the results, everything from infertility to chronic migraines, everything else I was so shocked to tell everyone because I'm like, how do people know this? So I got intrigued with looking at research. Most of the studies were three people, three case studies, one person, six people, not really refined in the data. So being in the medical circles myself, having clinics in spine surgeons office OBGYN offices, I do work with hospitals, it's kind of laughed at the impact because they look at chiropractic on the industry on the research side, and there's really nothing to sink your teeth into. So it always made me feel not ashamed, but frustrated that we don't have the research. So anyway, I started a software company years ago, called biologics. And I'm proud that we published three studies with the ACA rock, most of the demographic studies, looking at who sees a Cairo that type of people. And it was good data. But my gap was clinical data I didn't have in the database capabilities to publish what I really want is clinical data. And then you and I met Gary, I'll let you take all that. That piece of the story of what are what is Cairo HD, have in store, but just for the guys and girls listening to this? How does this impact our profession from your guys perspective?

Yeah, thanks for that intro. I'll back up a little bit and give a little bit of my background. And why. To your point. Why? Why big data in Chiro is important to me and how it kind of drives a lot of our philosophy at Chiro HD. So my entry into the Chiro space really started with my son, who was never diagnosed with anything or colic or anything, but it was just the worst sleeper in the entire world. And he, up until the time, he was probably about 18 months, he probably slept through five nights, and most of the time just screamed his head off every single night, man. And so what happened is, my my ex wife was seeing a chiropractor do it due to an auto injury or personal injury case. And I had mentioned to the doctor there that our son was not sleeping through the night and tried to was like, Hey, you should bring him in and see if we can we can, I think he's probably got an ear infection or some ear ear issues that are causing it. I'm the biggest skeptic in the world and had no interest in bringing my son to a chiropractor for sleeping through the night didn't understand it hadn't zero context to it, and just just resisted every step of the way. But that at one point kind of gave up on all the other options. And he didn't respond well to antibiotics. And we didn't want to do tubes or anything like that. And so kind of in a last ditch effort, just wanted to see what the doctor had to say. And you know, within that day, I took him home and he slept for almost two days straight. And from that point on, every time he started getting agitated, I take him in and it was instantly resolved and so my that was my entry into the space in Chiro world in general I'd been there for lower back pain and in an auto accident myself but but as a as a wellness type thing. I had never really even thought of it in those terms. And so my very first thing as soon as that happened was to jump on Google and you know, chiropractic, tried to figure out like, what's the connection point what, what's the data, what's the science behind it? And I was very frustrated with it. there was almost nothing. You know, honestly, the what turned up was a lot of negative articles about chiropractic and quacks and all this negativity around it and nothing about what I had just seen happen and improve the life of my son. So that was kind of the I mean, that was that was probably probably about eight years before I started Chiro HD, but it was the initial seed of frustration there. Fast forward, moved to Georgia, if my wife went to school there, went to school at life, graduated, and and joined a franchise and they were looking for a new chiropractic solution. My background is in software development. I've been in enterprise software for the last, you know, this point the last 20 years almost, and, and saw an opportunity and kind of the idea was born. But when I started it, my my very first pillar of what I wanted was, was how do I, if I'm gonna go out and build an EHR? How do I use that as a tool to drive some large scale analytics and research and data driven projects? And so that's always been at the core of what we've been building here.

That's awesome. It's interesting how most entrepreneurial journey start with frustration, like you're just frustrated, right? My mind was frustration, I didn't want to create a nonprofit, I didn't want to create a franchise I didn't I wasn't trying to to, because I was just so frustrated that you take action, right? So that's, that's awesome story. So now, where you're at now, what do you see, there are gaps in our ability to collect data. We were I remember years ago, we were looking at and I know life was looking at trying to create a bridge between stand alones into one database, and they, they couldn't, didn't get the grants, and they couldn't pull it. So with the company that we owned, we pull data to be able to do that study. So we're really proud of that. But where you guys are going is actually my dream, which is the clinical data side of it. But what do you see the gap? I mentioned this when we talked before, I don't see even data about the profession about us. And like, what what is the average chiropractor do? Would it be revenue or average amount of visits or like any data about chiropractic as a business? If I was to join this profession, the only thing I've seen is chiropractic economics yearly Annual Survey, which very limited, I was shocked. But it seemed to be the only thing I could ever find that was like, okay, the how many are women and men? How many visits is average. So if I was joining the profession, I would want to see a little bit more depth to data. I don't even know if that's where you're going. But that was one piece that I saw a gap. The patient side, obviously we all see that gap. But do you feel that what you've created is going to be the future solution, and help us down that road.

So I'll jump in and kind of point to you and gave her talking very similar problems with what you saw, he gave gave jumped on Google and he saw, you know, the anecdotal opinion pieces about chiropractors, you couldn't find information about, you know, how, what do I expect entering this industry? How do I prepare myself and you're at the whims of, of what happens when you enter, I think the consolidation of data, especially into cloud, you know, as we've seen with with chiropractic software of the past five to seven years, we'll start to break down some of those barriers, and really allow people to get get real data and stop having to deal with a lot of the ambiguity or a lot of the opinion pieces about chiropractic. And we can really kind of start to understand what how, how effective it is, as a business for if you're a chiropractor, and you're looking to start a business. How do you how do you build a successful business? What do you expect in that journey? And then on the treatment, and being a doctor side is getting cutting through the noise that is out there about is What does chiropractic do? What doesn't it do? And be able to start backing that up with with hard facts and research and data that that we can kind of pull together and it's happening across the board? I think the hardest thing about data new, we're talking about it with the life study, trying to data integrity is really hard. Even if you have all the data in the world, it is very difficult to consolidate that into something meaningful across practices, a visit or a appointment type might be labeled differently, like what exactly are you measuring? And how are you measuring that? So I think for us, you know, being able to start bridge the gap, bridging the gap between letting people run their practices as individuals but also of standardizing enough to make sure that we can measure the same things so that we can provide real information to help people, you know, grow their practices, and treat patients in a more effective way.

Yeah, I'll let me I'll just piggyback real fast on there. I was, I was gonna say earlier, that the real problem isn't isn't collection of data. It's the standardization and the, and the, what we call in the software world, the normalization of data, right. So it's, and in order to do that, as a software company, we do have to take some hard lines in terms of how the product works, or how a particular feature works, or how something's assessed, because we have to pipe it back into something that's, that's universal across all of our clinics. Right? So. So it's definitely been a challenge at times, because that we've made some decisions that that officers didn't necessarily like how much control we replacing over a particular aspect of the system. Because it was so important to maintain that integrity of data so that we can get to the point where we can start pulling that data in a meaningful way. Yeah,

because the the art side of chiropractic Have you tried to get a bunch of artists together and ones doing oil paints and watercolor and finger paints and you're like, let's make a painting. Well, you could make it many ways. So chiropractic, even the way we talk. And I could, I could beat up my my own profession by talking about like what we call a new patient. Some people call it when they walk in the door, some people call when they accept the care plan, right? So the nomenclature, if we don't unify that, we're going to have a mess when we're trying to interpret data. So I think you guys, I'm glad you guys hold the light. So that's important. Very important. I'll talk a little about the future like what Chiro HD is doing. And I want to give you guys some, some credit, and, and gratitude, what you're doing with the database, the way you're segmenting data, the way you're building the software, it's just so cutting edge owning a software company. And myself, even though I'm not a programmer, I can really appreciate the journey, the hard work and and the way you're thinking from the beginning, you're thinking, we're going to publish data at the end, most people are thinking, I just got to create a scheduler, now I got to just create a building. Now I just got to create. And most software just for those you listening to understand a little bit behind the scenes, there's a lot of software out there was designed by just modularly, making different pieces, and then trying to get them to stick together. And you're really opening up different software every time you click a button, which slows the software down. I don't know if that makes sense to anyone listening. But her HD is built in an architectural platform that it's all one software little bit more streamlined. And I don't know if I'm speaking well guys with your knowledge base.

That's it keep going.

Yeah, it's not an a better architecture. Because I think to what I see what you are doing that attracted me to use you in our organization, and align life does use this software. And the reason we picked it is because of the foresight, the foreshadowing of what they're trying to create. So the architecture, kind of like if I was to build a website, I wireframe, the website, I make sure I know what I'm trying to do from one page to the next. Before I create the copy, before I put a picture on the site, what we used to do is find pretty pictures, first, put them on a site, get all emotional about it. And then it would mess up when we're trying to convert a patient right? 20 years later, it's all about architecture. And for those that are looking for software archive HD, did the architecture first. So you're going to see a better outcome in managing your patients, and then providing research. Let's talk about what research what you plan to do. I'd like to hear your dream a little bit. Let the listeners hear three years, five years, what do you see? Is there really going to be life changing research? You

know, I number one, I hope it's not three or five years from now, I hope we start seeing some, some good for them. But I think you're right. You know, I think we'd really love to start seeing what may be called micro studies in the next 18 months. And so give you just a really quick overview of just how I think if you understand kind of the functionality that we envision you'll get, you'll get a little bit of a taste of what what we're hoping to bring to the profession. And we are continuing to work with anyone that will work with us in exploring those possibilities. We're going to be launching a joint effort with life University here in the next few months. That you'll you'll hear a lot more about as that comes to fruition but but at its core, again, this goes back to the other conversation about that data integrity piece. So so if you look at how do we run a a proactive study in the Chiro space, which which is not really been done at all, almost every study that has been done has been done retroactively. Right. So you're, we're saying, Hey, this is the subject we want to take on, let's go see if we can comb through the last 10 years of data and find find data, there's very little, very, very little proactive, here's what we want to study. And now we're going to take the next six months and measure it and look at it across those. And generally, when those have happened, it's always been with one organization or group, right, so we've got these five clinics that are owned by the same person that can take on this project. And obviously, there's a lot of reason for that, it makes it easier to perform a project like that, and do training across those things. And, you know, it's hard to ask a group of disparate offices to all participate in a unified effort. And so, so what we're envisioning as, as, as the mechanism to use this is to leverage our online intake paperwork, that's part of Chiro HD. So again, talking about some of those lines, honestly, the the intake paperwork system has been one of our hardest pieces of our entire platform solely for this conversation here. Because every office does their paperwork wildly differently, but we still have to harness everything that we're putting into their paperwork and drive it back to a central database of normalized data. And so we've held the line on that, and it's hurt us a few times, because we haven't been able to move as fast as we want it to in that space. But this is required for what we're talking about right now. And it's always where we've tried to hold that line. And, and it has, it's been a business detriment to achieve a, a larger goal. So but with that being said, the idea is that we work with with a group like life University, their research facility, they come up with the criteria, obviously, Joe, you probably know more about this than anyone about the all the qualifications and things that have to go in place to be able to publish an article, right? It's it has to, you have to have all of these pieces in place that we don't have. And so that's why we leverage these relationships with companies and universities and groups that have that have already got these these pieces in place. So So life will, you know, come up with a criteria for what we're studying, whether that's, you know, a full demographic cycle of, you know, or a symptom. Composite, we can also do ABC testing, where we can say we want to study these three variants. But basically, the the initial trigger point is the intake paperwork that aligns to an active study with that's out so that that study is released into the system and applies to all Chiredzi offices that have opted into participating in the study, a patient fills out intake paperwork, and that office is immediately alerted to the fact that this patient matches the criteria that study, that patient comes in the whole office is alerted, hey, this patient matches Do you want to participate? Here's the criteria, this patient has to come in X number of times a week, we can again, talk about that a b testing, we can even specify that, okay, this group for this patient, this is only an activator patient, you have to be willing to only use activator on this patient, you can only use certain techniques. So we can help start segmenting groups and having more than one adjusting modality style attached to it. So we can segment the groups that way, the office agrees to it that patients now included in that study. And I think the real magic of it at that point is is what happens when that patient comes into a visit. Because now now we've got them hooked up. And in most situations, then at the end of this, you know, life might get a report of that, that that patient at the end of that study, in our implementation, what we plan to do is when that patient comes in the office, you know, with every doctor that I work with, has their own preset macros that they've developed and built over the years and used to, you know, be very efficient in their clinic. But as part of this implementation, those groups life, whoever we're working with will implement a custom macro for the study. And that will pipe directly into their data system. So basically, when when that patient comes into the clinic, your default macros will switch out for the life standardized macros. And that's going to have all of our measuring points inside of it. That means that every clinic across Chiro HD is going to be using the same set of macros, the same data points, the same metrics, it's going to be 100% unified how they're entering their notes. And that data will be real time piped into into the systems that we're working with. So it's not something that they have to sit on and wait for months and months, they can actually monitor in real time as data comes into their clinics. And they'll be able to see it, whether it's with you know, a line life or with 100%, chiropractic or whoever whoever is using the system, it doesn't matter. It's going to be a unified data structure that's getting piped directly into their their data streams.

So a lot of the front end work is what slows you down. But once you have this structure, it's probably going to move pretty fast right because now You have the researchers mining good data, and they can do their work right once like, once a life gets a hold of the data, that's

That's the hope. Yes. If you if you talk to their team or any team and Joe, you, you saw all this all the time is half of their job is is is normalizing data that form, right? So they get all this data, and they have to spend months, like pulling it all apart and putting it into a format that they can then actually use for their study. So so this should shortcut their cycles as well, because the data coming in from our system is already normalized for their stuff, and they can start using it immediately.

Awesome. Well, no, I hats off to that that movement, because it's needed in this profession. I want to talk a little about what the outcome, why do you care if you're a listener, if you're a chiropractor, I don't care about research. I just want to get people better. It's a waste of my time. And I just want to give some clarity on the excitement about whether or not you like the validation or not. This data can be used to the current healthcare landscape is outcome focused from hospitals, to clinics, insurance companies, its outcome based out like they're looking consistently at functional outcomes, which is very different than 20 years ago was just, you know, the profit they're looking for is how do we save dollars. So now we have data of looking at health outcomes, not just musculoskeletal. But if we crossed the line into what my dream is to validate visceral dysfunction in chiropractic, which is unheard of in the research world, we have one headache study that got some notoriety, but there's a lot more work to do on that side of the game. So I think what's going to happen is the utilization of chiropractic. In its full scope of impact, which is anything the nervous system controls, opens the door to take this profession to where it should be, which is outside of the back pain pigeonhole. So we're looking at, you know, for those listeners, we're looking at going from like 9%, utilization to hopefully an 80% utilization of chiropractic in our lifetime. And thanks for what you guys are doing thanks to life University, thanks to the groups that are contributing data. So I'm looking forward to seeing this profession, be in such a shortage of chiropractors, that they're gonna have to do a lot more schools, they're gonna have to do a lot more work because the need for chiropractic is going to in the next 10 years, exponentially grow. reimbursements should change, the insurance companies should go back to full reimbursement for chiropractic because of the impact is making. So those are the two things I see more and more need. And then more coverage. Any thoughts from you guys on what you think?

Yeah, I mean, so you the talking inspection, especially about big data, how it's gonna affect thing, and then bring up insurance, we've talked a lot about research, I think one of the things I think about a lot is how some of the advances in machine learning are going to impact your billing specifically. So for us, we see a lot of opportunity to improve, improve coding and billing, and really make that process easier and more efficient. And kind of reduce the overhead of getting into insurance billing and making it easier for chiropractors to see a wider array of patients just by just by virtue of the software that they use, kind of lowering the barriers for insurance billing. So I think we see a lot of potential there. Medical research, insurance, billing, I think, on the on the side of running your business, being able to find hidden, hidden signals in the big data of, hey, this is an effective way to run your business. We see businesses who we see Chiropractic Clinics who are operating in X, Y, and Z way, become more effective. I think there is a lot of excitement, there's a lot of things that can come out of what's happening in the world and kind of the consolidation and move towards the cloud. It's gonna be fun to watch.

Yeah, I think it's interesting on the billing side, we code and then we hope our notes support code. Machine learning can say this is what the notes support. So you're never in trouble. You're only backing what your notes say. So that changes. The chiropractic makes us more safe, keeps us in integrity. It's I see only good in the future yourself. Awesome. Absolutely. Awesome. Well, awesome. That was a great discussion. I hope those of you listening not only see the value of what these two gentlemen are doing with Cairo, HDX to me, one of the leading movements in in our field in the future of data management, but also be people that believe in what we believe. So thank you guys for, for getting on. And I look forward to maybe having another chat in another quarter or year when some of these data studies start coming out, we can get back on and talk to our, our, our audience about what's what's happening in profession. So really exciting. Any final thoughts on your?

No, I'm just very, very glad to be on here. Love talking about this and you know, a huge you know, we've done six, seven years of work just to get to this point. So very excited about the the next steps that we're able to take as a company. In some of the stuff that's going to be happening, love to talk excited about a future conversation. I know there's a lot of people asking about AI right now I'm sure we could we could spend another hour on AI and how that's going to impact the space. So maybe maybe maybe a future discussion point there. But yeah,

let's do that. Maybe in three months. I love that. So if you are interested in online life and you have been listening this podcast and you want to know about car HD, please reach out we'd love to engage you in touch with these guys. Or you can come visit one of our clinics and look at the way we manage patient management using software, the carriage the software, any way we can help you please reach out support at a line life.com Thanks for listening. And thanks, guys. Looking forward to talking to awesome thanks for your time.