The plusses and potential pitfalls of bringing new chiropractic technology into your practice
Technology continues to change at a rapid rate as we constantly upgrade and trade in the old for the new, from cell phones and laptops to big-screen TVs. This is also true in health care as new products and new chiropractic technology are developed and launched on a regular basis. These products often show great promise for improving health, while others overpromise and fail to deliver their hyped results.
Many new products, especially “digital health” products that are in the news frequently, are not providing the clinical outcomes they originally projected. A study released June 20, 2022, provides an analysis indicating this shortcoming: “Assessing the Clinical Robustness of Digital Health Startups: Cross-sectional Observational Analysis.”1
How does a health care professional cut through the clutter of an increasing barrage of new medical products and sales pitches? There are a number of key considerations to use when evaluating and purchasing new medical products. Time spent properly researching and evaluating each product can save a practice from future losses of time, money and unforeseen liabilities. Medical practices should include this criteria in the overall risk management program of their practice.
Plusses for adding new chiropractic technology
Some of the positives for adding new technology products include:
Better outcomes — Properly implemented in a chiropractic practice, new technology will not take away the core business of providing chiropractic adjustments but will actually position and support it synergistically. Patients will benefit from better and longer-lasting treatment results and clinical outcomes. Patients are seeking the best results, and the combination of technology and chiropractic can provide this. Technology can provide “evidence-based medicine,” as many products were involved in clinical research and published studies.
Recommendation: Ask the product manufacturer for the clinical research and published studies their product was involved in. Make this information available to staff and patients.
Practice Differentiation — Adding new chiropractic technology can position a practice to be cutting edge. Marketing new technology can be a powerful tool to not only attract new patients who come to experience the new technology, but can also provide an opportunity to learn about the benefits and advantages of chiropractic care, resulting in exposure to a broader group of patients in the community.
Recommendation: Request the product manufacturer to provide marketing tools and resources that can be customized to your practice and be used to both retain existing patients and to attract new patients.
Early Adopter — Often when new technology is launched publicly, there is a limited window of time to purchase and become an early adopter, where the practice may be the only location with the new technology for a period of time. Failure to purchase at this stage may mean that other types of medical professionals will purchase and promote the new technology.
Recommendation: Discuss with the product manufacturer opportunities to be the first and only provider in your area or community, and how long you can have this status.
Empty Space — Many new technologies are “unattended” and ideal to use in rooms that are empty space or acting as a storage room. There may also be open areas in the office. Technology can be added to these rooms without adding staff.
Recommendation: Repurpose one or more rooms or remodel an empty space, creating room for new technology that can become a new source of revenue.
Passion — Many new technologies are exciting to use, operate and see results with, especially when combined with chiropractic care. Practitioners often have a personal interest in a specific type of technology and can turn that interest into a passion by becoming an expert in a specific technology or medical application.
Recommendation: Find a technology you believe in and can be passionate about. As you become an expert, you will find new patients who are seeking your expertise.
Personal Health and Career — Practitioners will benefit from personally using new technology to become healthier. When combined with their patients using the same new technology, it can offer a real solution to the physical wear and tear from doing daily manual adjustments. Technology can actually extend the personal health and career of a chiropractor.
Recommendation: Create a plan for scheduling time to receive treatments personally, and also include staff and family members (where needed).
New tech pitfalls
Some of the pitfalls to avoid when adding new chiropractic technology to a practice include:
FDA Registration — All companies that sell medical products must register their company and products they sell on an annual basis with the FDA.2 Any company currently registered with the FDA can be found in their database.3
Recommendation: Ask a company for their FDA registration status or search the FDA database. Do not purchase products from companies if they or their products are not currently registered with the FDA.
‘FDA Approved’ versus ‘FDA Cleared’ — If you see a medical product that advertises that it is “FDA Approved,” you can know that it is not, as the FDA does not approve any medical product. Medical products are cleared for specific indications for use that are stated in an FDA document called a “510k.” For example, a product may be “cleared to provide temporary relief for the symptoms associated with arthritis.”4 Any product that has a 510k with the FDA can be found in their database.5 There are medical products that are exempt from a 510k; these are listed in a database with the FDA.6
Recommendation: Ask a company for their 510k clearance number, or, if their product is exempt, search the FDA database. Do not advertise medical claims for a product that is outside the indicated uses of the product’s 510k. There can be serious consequences for doing this.
Consumer versus Professional — Many products have consumer and professional models. The consumer models intended for home use are often less powerful or have reduced features and will not generate the clinical outcomes a medical professional needs in their practice (example: treating a migraine headache with baby aspirin).
These products may be classified with the FDA as “OTC – Over the Counter” medical products.7 Products for medical professionals are classified with an “Rx” designation under one of three classifications.8
Recommendation: Always ask a manufacturer for the professional model. The professional model is usually much stronger than the consumer model and will generate better clinical results. The costs may be higher, but well worth the increased clinical performance and outcome.
USA versus International — Many products are listed for sale on the internet from a growing number of countries. They may be listed on websites that include eBay and Amazon (USA), and Alibaba (China). It is important to determine if the company selling the product has a location in the USA with on-site inventory and a direct customer service center. A product from China may be listed for sale at a fraction of the price of competing products in the USA. However, purchasing these products can be a gamble regarding quality and performance (usually low quality). In addition, products shipped from other countries (that are often mislabeled to bypass U.S. Customs) can result in seizure and forfeiture at the U.S. Customs borders when they enter the USA. The FDA monitors these companies and will issue notice of placement on the FDA Import Alert List when they are in violation. Companies on this list can be searched on the FDA link.9 An important fact when purchasing products from outside the USA is that it can be challenging and almost impossible to get these products serviced or repaired when they break down, and often any warranty they issue will not be supported.
Recommendation: Do not purchase a product that will ship to you from outside the USA, despite their email claims that “We ship to the USA all the time without any problem.” Most of these products are not currently FDA registered and lack required FDA 510k clearances, in addition to other required reports (example: electrical safety testing reports).
Residential versus Commercial — Medical companies are required to meet an extensive and expanding list of quality control and safety requirements, referred to as “current good manufacturing practices (cGMP),”10 and are listed on the FDA website.11 Despite these requirements, there are some medical companies that operate from a private residential home versus a commercial location. There is no federal requirement against this — however, it is challenging for these companies to operate without proper warehousing for product management and offices with full-time staff. Any address can be web searched, showing it to be a residential or commercial address.
Recommendation: Exercise caution with purchasing products that are not located at a commercial address. It is best to purchase products from a company with an established office, warehouse, full-time staff, product and clinical training, marketing support and a comprehensive warranty.
Scope of Practice — Some technologies may be outside the scope of practice of a state’s licensing board requirements.
Recommendation: Check with your state’s licensing board if you are questioning a specific technology or product. Some states have not kept current with all of the changes happening with medical product technologies.
Federal Trade Commission — The Federal Trade Commission (FTC) monitors the advertising, promotions and claims of all businesses, including medical products and medical practices. Violations can result in severe fines and penalties.
Recommendation: Review all content of your website, social media, advertising and print items on a regular basis regarding medical and financial claims that are outside the rules and regulations of both the FTC and the FDA.
New chiropractic technology to consider
This list of new technologies is not meant to be comprehensive, but to generate new ideas and strategies for creating a future practice today.
Remember to review the list of plusses and pitfalls and the specific recommendations. Discuss with the manufacturer their specific products sold only to medical professionals or for use in clinical settings. Inquire regarding opportunities for first-product rights or exclusivity within your zip code or community.
Virtual Reality Systems (VR) — Virtual reality is moving quickly into many aspects of medicine. The FDA has cleared a VR system for low-back pain. Multiple published studies have been completed for VR showing efficacy for a growing number of therapeutic applications for home and clinic use. Progressive VR companies are incorporating complementary technologies with their VR System. An example is the integration of VR with static- and motion-plate technologies for use with balance training programs.
Cryotherapy Full-Body Chamber Systems (unattended) — Many communities already have a number of businesses offering full-body cryotherapy, often owned and operated by non-medical professionals. New technology using electric-based systems are entering the market and will replace the existing nitrogen gas systems of all current cryotherapy businesses. The electric units are much easier to install and manage, and are more cost-effective. Options for purchasing include product-only purchases or turnkey cryotherapy franchise opportunities in some areas.
Photobiomodulation (Light Therapy) LED Full-Body Systems (unattended) — Full-body systems, sometimes referred to “light beds” or “light pods,” are now available with advanced innovations of multiple power levels (low to high), multiple wavelengths and multiple frequency (hertz) settings. New advancements in light-emitting diode (LED) technology are providing improved treatment options and outcomes. These systems are superior to lower-cost and less effective “red light (only) therapy panels.” Treatments are synergistic with targeted laser therapy and also full-body cryotherapy or full-body hyperbaric treatments. The unattended aspect of this technology provides high usage and a quick return on investment (ROI).
Hyperbaric Oxygen (HBOT) Full-Body Systems (unattended) — There are a wide range of product models to choose from, and new advancements include multi-space units that can handle more than one person. Additional developments include vertical systems. The unattended aspect of this technology provides high usage and a quick ROI.
Pulsed Electro-Magnetic Field PEMF Therapy Full-Body (unattended) — There is a wide range of product models to choose from, and new advancements in technology are increasing usage and outcomes. Treatments are synergistic with full-body light therapy (photobiomodulation) LED systems and also with EWOT (oxygen therapy) systems.
Compression Full-Body System (unattended) — Full-body compression therapy systems are moving from high-end spas to use in therapy, recovery and rehabilitation.
Exercise With Oxygen Training EWOT (unattended) — New developments in the original EWOT technologies have been launched into the market. Treatments are synergistic with full-body PEMF and full-body light therapy (photobiomodulation) LED systems.
Additional emerging technologies
Other technologies to research and consider for your practice include dry float full-body (unattended), halotherapy (salt therapy) full-body (unattended), external counterpulsation (ECP) therapy full-body, blood flow restriction (BFR) therapy, lymphedema electronic cupping therapy, and hydrogen inhalation therapy.
Wearable technologies to consider include wearable light therapy glasses, wearable whole-body neuromuscular stimulation and wearable vibration therapy.
Wearable and portable diagnostics include wearable QEEG (brain), wearable sensors, wearable motion testing, wearable remote physiologic monitoring RPM, wearable metabolic testing, eye-tracking technology, portable neuropathy screening and portable microvascular testing.
Where your practice wants to land on the cutting edge of new chiropractic technology lies with your passion and the patient base it can serve.
CHARLES E. VORWALLER is a 35-year veteran of the medical device industry. He has traveled the world meeting with doctors, scientists and researchers in pursuit of better technology and medical outcomes. He is the president and CEO of Aspen Laser, an FDA-registered manufacturer of photobiomodulation lasers and LED products. He can be reached at [email protected] or by visiting aspenlasers.com.