Thursday, June 20, 2013
The patient is a gagger. The x-ray shows a hooked MB root with calcified canals and a ginormous radiolucency. The perfect embodiment of why endodontists were invented.
The referral starts with a scramble through the drawer looking for the right form, followed by an attempt to copy or print an x-ray (that is diagnostically useless) finishing with a pat on the patient’s back and instructions to be sure and call the other doctor for the root canal.
Despite advances in digital records and communication, the majority of specialist referrals still follow this old paper-based system. However, paperless digital referrals are possible, have already progressed through two generations and promise to be even better in the near future.
First generation attempts to create digital referral slips simply recreate the paper form in a digital format, usually pdf. The referring dentist needs to download and print the form from the specialist’s website then fill in the information (patient name, practice information, tooth number, diagnosis, etc.) by hand. The patient takes the form to the specialist where the information is again typed into a computer. Although there is a digital version of the referral form this method is really a paper system that requires the redundant input of data.
Sometimes the referring dentist will attempt to e-mail the information including a copy of the radiograph. This is better than a pdf but still requires data entry at both ends and has security and HIPAA privacy issues.
Second generation online referrals can be created online, no paper. However, the referring dentist still needs to fill in the information by hand using a keyboard and mouse. Once the information is uploaded the specialist office could access it from the Internet and create a new patient record with no additional data entry.
Third generation digital referrals will be automatic, secure and interactive.
A third generation system will upload all the appropriate patient data from the paperless record to the online referral forms automatically with no additional typing. In other words, the patient name, the tooth and the treatment would not need to be re-typed but would be extracted from the exiting digital record.
But that’s not all. With a digital referral you are not limited to the minimum information we used to scribble on the paper form. You can automatically upload all the patient information the specialist’s office will need such as address, employment, contact numbers and the other things needed to create a patient record. The system will upload the patient’s insurance information with plan, group numbers and benefits. The system will upload the patient’s health history with areas of concern noted.
All the information a patient usually needs to spend time writing onto a paper form on an old brown clipboard is sent automatically before the patient even arrives for the first appointment.
You are not limited to patient information. You also will upload diagnostics such as photos, x-rays, CBCT scans or even digital models. These will be available to the specialist before the patient arrives, and they are the same quality as the originals (unlike a conventional copy of a model or a radiograph) and they can be enhanced with diagnostic software.
What about HIPAA?
As dental professionals we have an obligation both ethically and legally to protect our patients’ private medical information. E-mail, especially generic accounts such as Gmail or Hotmail are not private. The best way to ensure privacy is to transfer the information using a secure encrypted website. Every dentist does not need to invent his or her own system, there are several services available to act as a HIPAA-compliant web based service to transfer referral and other information. These include Dental Sharing for images and RecordLinc.
That is the automatic and secure part. However third generation referrals also will be interactive. Here is how that could work.
When you log on as a referring dentist, the system will recognize you and automatically know all the basic details about you and your office, such as address and phone number. As a referring dentist you will have access to an online appointment book showing open appointment times available for new patients over the next several weeks. If you are a preferred referrer—Gold Elite status or above—you can secure an appointment for your patient immediately.
Next you will be prompted to fill in details using a decision tree. A decision tree is a smart interactive system that guides the user through various selections with each new decision based on the previous answer. For example the system could ask, “Is the patient experiencing pain?” If the answer is yes then a new and different set of questions is launched. “Is the pain constant?” “Is the pain mild, moderate or severe?” and so on. If the answer to the first question is no, then the system jumps to a completely different symptom, “Is there any swelling?”
Complete interactive third generation systems are not yet available, although RecordLinc comes close. One of the major obstacles holding them back is interoperability, or more accurately, lack of interoperability.
At this time many of the bits of data stored in a dental system are stored in a proprietary fashion. That means the data is not accessible to another system. This is especially true of images such as x-rays but is even true of some basic data such as insurance plan info. There is no industry standard for the collection, storage and transfer of dental chart information. This issue was addressed in more detail in a previous Emmott on Technology article Opening the Industry to Open Technologies.
If you are a general dentist, you have a professional duty to refer a patient to a specialist for diagnosis and treatment as needed. With a paperless referral we can do it better and faster. The future is coming and it will be amazing!