In Our Digital Era
- haileycrawford3
- Jul 30
- 7 min read
Steven Kraus, DC, FIACN, DIBCN, FICC, CCSP will provide a clinical perspective and a practice management slant on the digital x-ray field and how it can impact a chiropractic practice. His 34 years of experience and background as a CEO of an electric record company, Past Board Chair of the Iowa Board of Chiropractic, and the owner of over 18 clinics including interdisciplinary settings, along with buying and selling over 400 clinics nationwide, will give you a unique perspective in assessing the benefits and challenges of digital x-ray.
Episode Highlights
2:29 – Chiropractic maniac to serial entrepreneur. “Long story short, I went to Palmer College and turned into a chiropractic maniac. My first decade out, I opened up 18 chiropractic clinics and I just loved it. I worked Monday through Saturday for the first 16 years of my career and never took a day off unless I was going to continuing education. I then started Electronic Health Record Company, mostly because I had 18 clinics of my own. Back in the 90s and early 2000s, everything was a disparate set of software scheduling, billing, note taking, which was pretty janky back then. Before EHR was a phrase, we started creating an integrated system. After I had invested over a quarter million for my own 18 clinics, I realized I had to sell this nationwide because it was not going to be cost effective. Then, we became the largest chiropractic EHR. We got overtaken by ChiroTouch because I started a cloud system and it was just ahead of its time. Everyone was afraid of the cloud. Eventually, an investment company out of California bought us up promising that my software was going to be the software. Well, it wasn't, so I ended up leaving after that transaction. But it was a good day for me. I was working with a digital company in Canada where we were integrating with the EHR, and they called me to see if I wanted to work with them. As an entrepreneur trying to do my own thing, I declined. Then, they asked if I wanted to buy them. Well, I bought the digital x-ray company, moved it from Canada to Iowa, and built a huge manufacturing facility where we built the x-ray. I was going to turn this x-ray company into a software company, and part of my passion on that was owning 18 of my own clinics. I also brokered over 400 chiropractic clinic sales throughout the United States and the commonality inside of that was x-ray. As the world was moving to digital x-ray, I wanted to create a spine print, like a fingerprint. I want chiropractors to be able to do every kind of biomechanical measurement under the sun that they want to do and, before AI was AI, I wanted to automate this. We're getting really close to real AI, in terms of doing the biomechanical measurement of the spine. An x-ray is 2D, but 3D is where we want to be. Anyway, I'm in the digital x-ray world because I believe it's a major component in the practice. If we're going to be spine care experts, we have to know what the spine looks like.”
7:08 - Selling Future Health and never losing control again. “That's a heck of a story. There were really five key players with an investment group called K1. At the time, we had to sign an NDA. The majority of their money came from a lot of different investors, but their principal investor was Mark Zuckerberg from Meta. His money was part of the money that bought our company, and I wasn't allowed to mention that for a year and a half. They bought ChiroTouch and our company on the same day without officially telling us and then merged the number one and number two EHR companies together. But again, I was under the impression it was going to be my software that was going to rule the day. When the next year went by, it became evident that wasn't going to happen. It was out of my control at that point. I had no say so, but that's why I said any future company I do, I am never going to give up more than 50 % ownership, because I am not going to lose control again. It was still a great experience because, even if they were buying a $200 million company or a $20 million company, they put us through the same due diligence process as they would anybody else. It was a great experience. Then, I helped them with the acquisition of about five other EHR companies and I had a lot of fun. I don't regret it because I enjoyed it immensely. They brought in sales experts, software experts, customer service experts, people that were paying high-end dollars for consultants to evaluate us before they purchased us, and I applied those techniques and criteria to my current company.”
10:56 – Getting the government involved. “There was a whole bunch of EHR companies and some of them are still around, but a lot of them got swallowed up and acquired by these large conglomerate mergers. Back in 2007-2009, there was ARRA, the American Recovery and Reinvestment Act, where Meaningful Use was giving $44,000 to every chiropractor who would adopt EHR according to those criteria. When that started, I wrote the first paper on that, and I got so much hate mail saying there is no way chiropractors are going to be included in that, but I was 100% certain. I flew out to DC, met with the office of the national coordinator, and had three meetings with Obama. Do you know what his plan was? His plan initially was to have one EHR for the whole country. He was running for president at the time, but I told him that plan was going to kill over 100,000 jobs out there. There were so many EHRs are out there that employed so many people. I told him he had to allow all the EHRs to be a part of it. He paused, thought, and a year and a half later, when he was president, the rules came out that all EHRs could be in it - you just had to follow this set of criteria for Meaningful Use. I'm not going to take the credit for it, but just so you know.”
19:35 – Timely, simple, and technical. “My motivation wasn't really the hardware. Yes, I wanted to bring digital, but I wanted the software analytics, if you will, because I'm a big believer in spinal biomechanics. I'm not a specific technique guy. I know all these upper cervical guys use lots of line measurements to use their techniques on patients for their care that they prescribe. They rely on those measurements. I wanted to make those measurements fast, easy, and calculated automatically by the software. Then, the placement of the points – how many chiropractors, if you ask them if they remember where exactly to put the points, other than simple things, can do it? Our software tells you where to put it with a box around the general area and then you place the point. The calculations and the x-ray report is automatically created. The other thing that was driving me to create better software was every state law in the United States requires chiropractors to do an x-ray report if you're the one who ordered the x-ray. Now, if you refer out to a facility, the radiologist will do it, but if you're taking your own x-rays, chiropractors typically wait to do the official x-ray report until they're requested by the insurance company for the records. They need to be doing it right away in real time. Our software helps create that report in a minute or two. Through AI, you can rock this baby out and use it as a patient education tool. Now that's the other piece of it - justifying care for extended care. Because if there's complicating factors, I want to bring those to the attention into the report to help them justify their care. The thing that has always frustrated me is when we talk about evidence-based care in chiropractic, we have to remember it's a three-legged stool. It's not just the published research. It's the doctor's clinical experience and education. Besides the best research evidence that's published, it's also the patient preferences. So much of the academia out there forgets about the clinical experience and the patient preference. All they do is put 100% of the weight on published literature, which isn't right. It's important, but there's other aspects to consider. I guess that ignorance or forgetfulness drove me to want to push x-ray.”
30:48 – AI in radiology. “There was a 60-minute special, and they interviewed the head radiologist at Boston Mass Hospital, and he said he will not read a CT scan for breast cancer unless AI reads it first. They showed that the difference for catching it was like 98.9% for AI and it was like 96% for radiologists, but that 2% difference is two more lives.”
36:43- Loud and prominent doesn’t always mean true. “I'm excited to bring the research awareness to the profession because I do believe that people start repeating certain sentences over and over. Even in some of the published literature, those authors are repeating things that are outdated. I'll give you one quick example - many people, for the last 30 years, have been saying that 1 in 10 Americans go to a chiropractor, but that's false. The Gallup poll that Palmer came out with shows it's actually 1 in 7 or 1 in 8. We have to stop repeating things that just aren't true anymore. One of the things that isn't true is the x-ray is only used if red flags are present. It's just not true. There was a study of over 3,200 chiropractors and basically 9 out of 10 of them said you should use x-rays for more than just red flags. That's the opinion of the profession, yet the academia and the 5% group were yelling the loudest for the last decade. The rest of the profession thinks that must be the truth, but it's not. One way to help push that agenda that it's not true is we started RadEvidence.org, which is a website that has unbiased information in over 600 published research articles. I'm just excited about changing the profession and getting that pendulum back to the center. That's my mission right now. In order to do that, I have to make it easy for chiropractors to do their analysis and reports because all these fears and objections to taking x-rays is preventing them from doing it.”
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