Part 7 of 9: Invisible: How Technology and Interoperability Influence Chiropractic and Physical Therapy Positioning in Healthcare

Introduction

Healthcare today runs on technology. From patient access and referrals to administrative processes and policy influence, every aspect of modern care delivery is powered by digital infrastructure. In this environment, interoperability—the ability of different systems to seamlessly exchange and use information—is the backbone of success.

Practices using interoperable systems benefit from more referrals, stronger payer alignment, reduced administrative burden, and greater visibility in healthcare decision-making. Those that remain disconnected are left behind—isolated from care networks, invisible to referring providers, and buried under administrative tasks.

Unfortunately, chiropractic and physical therapy have largely been excluded from this connected world. The EHRs used in these professions rarely integrate with Health Information Exchanges (HIEs) or offer open APIs, effectively cutting providers off from the systems driving modern healthcare. Furthermore, many of the most prominent intermediaries managing chiropractic and physical therapy PPO networks have also failed to leverage technology to deliver administrative efficiencies standard to medical specialties.

Interoperability: The Key to Modern Participation

1. Health Information Exchange (HIE)

Health Information Exchanges consolidate patient information—visits, tests, treatments, and outcomes—into centralized platforms. Providers with interoperable EHRs gain access to this data, offering a complete view of a patient's health history across providers and settings.

Chiropractors and PTs are rarely connected to HIEs, making them and the high value care they deliver, invisible to the broader care journey and limiting care coordination opportunities.

2. Referrals and Care Coordination

Interoperable EHRs assign a unique messaging address to each provider, enabling direct, electronic referrals. Literally, an easy button. These systems automatically notify the referring provider when the patient is seen, creating a closed feedback loop and improving continuity of care.

Providers on interoperable EHRs are receiving far more referrals. Clinics without this capability lose patients—not because of clinical quality, but because the process to refer to them is inefficient, and the feedback loop is a fax machine that creates work for the referring office.

3. Population Health and Policy Influence

Healthcare is increasingly shaped by population health initiatives and registries. These systems aggregate patient-level data—like outcomes, screenings, and quality measures—and inform policies, grants, and payment models.

DCs and PTs contribute minimally to these registries due to outdated EHR platforms and limited interoperability. Even in accessible programs like MIPS, representation is minimal.

Administrative Burden: The Cost of Disconnection

Interoperability isn’t just about referrals and patient records—perhaps the most important purpose is in claims processing and administrative workflows. Unfortunately, most intermediaries managing chiropractic and physical therapy networks have failed to modernize their technology infrastructure. Why? In part, because the EHR platforms commonly used by DCs and PTs are themselves outdated and lack modern integration capabilities. This creates a vicious cycle: intermediaries don’t innovate because the provider technology isn’t demanding it—and providers can’t advance because the intermediaries aren’t enabling it.

As we discussed in Part 6, these same intermediaries have contributed to stagnant, low reimbursement rates. But the problem doesn’t stop there. They’re also compounding financial strain by failing to deliver the administrative efficiencies that are now standard in nearly every other healthcare specialty.

Healthcare providers who contract directly with insurers typically use EHR-integrated Electronic Data Interchange (EDI) tools—such as 270/271 (eligibility checks), 835 (electronic remittance advice), and 837 (claims submissions)—to automate and streamline revenue cycle operations. These tools enable:

• Automated claims submission

• Electronic remittance (ERA) posting

• Real-time benefits and eligibility checks

• Faster and more accurate denial management

• Reduced manual data entry

• Fewer billing errors and payment delays

Yet for many DCs and PTs operating through intermediaries, these basic capabilities are still out of reach. Instead of leveraging integrated digital tools, providers are often forced to:

• Manually download remittance files

• Log in to multiple web portals

• Print and hand-complete prior authorization forms

This level of administrative burden would be considered unacceptable in most other specialties.

The irony is stark: those facing the lowest reimbursement and highest payment friction are also saddled with the most inefficient systems. Chiropractors and physical therapists are working harder to manage basic transactions—using more staff, more time, and outdated tools—just to keep up.

AI: A Missed Opportunity—For Now

Artificial Intelligence (AI) is already transforming healthcare. AI can streamline claim scrubbing, automate prior authorizations, handle scheduling, and provide predictive analytics for better patient management.

Yet, chiropractic and PT professions are missing out. Most of the widely-used EHRs in these fields are not built on modern infrastructure. Without open APIs or interoperability, AI tools cannot integrate deeply. Instead, they become clunky add-ons—limited in scope, expensive to implement, and offering only partial value.

Potential Impact: AI has the potential to reduce administrative costs by 30–50% in outpatient clinics, according to McKinsey & Company. For a PT or chiropractic clinic generating $750,000/year in revenue, this could translate to savings of $50,000–$100,000 annually through automation of claim processing, documentation assistance, and scheduling optimization.

Without better technology platforms, these savings remain theoretical.

Why It Matters

Interoperability is no longer just a feature—it’s a strategic necessity. Clinics with modern, connected technology experience:

• Higher referral volume from health systems and MDs

• Real-time care coordination with better patient outcomes

• Participation in payer data models that influence reimbursement

• Administrative efficiencies that lower cost and free up staff

• Representation in care models and public policy

Clinics without these systems fall behind—not for lack of clinical quality, but because they are digitally invisible.

The Path Forward for Chiropractic and Physical Therapy

To reverse these disadvantages, both providers and intermediaries must commit to modernization. Key steps include:

• Adopt interoperable EHR platforms capable of connecting with HIEs, clearinghouses, and referral systems

• Join clinical directories and national provider networks to receive digital referrals

• Implement automated feedback loops to track care coordination and outcomes

• Contribute to population health data registries, ensuring PT and DC perspectives shape policy and payment models

• Demand better integration capabilities from software vendors, or switch to platforms that support open APIs and AI integration

• Demand that intermediaries advance their technology to maximize administrative efficiencies

Conclusion: The High Cost of Invisibility

In today’s healthcare landscape, technology is no longer optional—it’s foundational. It shapes access to patients, alignment with payers, and a clinic’s ability to participate in care coordination and policy influence. The digital gap separating chiropractic and physical therapy from the rest of the healthcare system is not a small inconvenience—it’s a structural barrier to growth, value recognition, and long-term viability.

Interoperability is the gatekeeper to referrals, efficiency, payer collaboration, and influence in healthcare delivery. As other specialties advance with integrated, AI-enhanced platforms, the risk is clear: those without modern technology will be left behind.

For chiropractic and physical therapy, invisibility is no longer a survivable strategy. If we want to thrive—not just clinically, but economically and professionally—we must claim our seat at the table.

As this series nears its close, it’s time to introduce a real solution: a path forward that brings providers together under one unified, interoperable infrastructure—governed by providers, for providers.

Enter: A clinically integrated network designed to close the digital gap, amplify our collective voice, and secure the future of chiropractic and physical therapy within modern healthcare.