Six Steps to a Chartless Practice

The modern dental practice continues to evolve. Records and data that were once paper-based are rapidly being replaced by digital records. The hot buzzword in 2006 is “paperless,” as many offices wish to eliminate paper in the practice.

While I don’t feel that removing all the paper is a realistic goal, many offices are able to completely eliminate the need for charts, thus becoming chartless. To achieve this requires proper planning and foresight.

The challenge for most offices is to develop the best plan on how to evaluate their current and future purchases to ensure all the systems will integrate properly. While many dentists are visually oriented and thus tend to focus on the criteria they can actually see and touch, some of the most important decisions are related to more abstract criteria. I have therefore developed a six-point checklist that I feel is mandatory for all dentists who are adding new technologies to their offices, and I recommend that each step be completed in order:

1. Practice Management Software: It all starts with the administrative software that is running the practice. To develop a chartless practice, this software must be capable of some very basic functions, such as the abilities to enter charting and treatment plans, process e-claims, handle insurance estimation, ongoing patient retention, recall activation, scheduling, and dozens of other functions that are used on a daily basis. Many older programs do not have these features, and if an office wants to move forward, they will have to look at more modern practice software. In some cases, there are third-party programs that can take over functions not available in the PMS program.
2. Image Management Software: This is probably the most challenging decision for any office. Most of the practice management programs will offer an image management module: Eaglesoft has Advanced Imaging, Dentrix has Image 4.0, and so on. These modules are tightly integrated with the practice management software and will tend to work best with digital systems sold by the respective dental supply company. However, there are also many independent image programs that will bridge very easily to the practice management software and offer more flexibility and choices, although with slightly less integration. Some of the better known image programs include Apteryx XRayVision, XDR, and TigerView.
3. Operatory Design: The days of a single intraoral camera and a TV in the upper corner are being replaced by more modern systems. The majority of offices are placing two monitors in the operatories, one for the patient to view images or patient education or entertainment, and one for the dentist and staff to use for charting and treatment planning and any HIPAA-sensitive information. There are numerous ergonomic issues that must be addressed when placing the monitors, keyboards, and mice. For example, a keyboard that is placed in a position that requires the dentist to twist his or her back around will cause problems, as will a monitor that is improperly positioned.
4. Computer Hardware: After the software has been chosen and the operatories designed, it’s time to add the computers. Most offices will require a dedicated server in order to protect their data, and to supply the necessary horsepower to run the network, and the workstations must be configured to handle the higher graphical needs of the office. The computers placed in the operatories are often different from the front desk computers in many ways; they’ll have dual display capabilities, better video cards to handle digital imaging, smaller cases to fit inside the cabinets, and wireless keyboards and mice. Most computers for the dental office have a three-year life expectancy.
5. Digital Systems: The choice of image software will dictate which systems are compatible. Digital radiography is the most requested technology at this time, due to the benefits of faster times to view images, higher resolution, and the ability to easily enhance the image, but intraoral cameras are still an excellent addition to any office because they allow patients to see the things that typically only a practitioner sees. All systems have pros and cons and dentists will have to evaluate each system based on a set of criteria that are important to their individual practices.
6. Data Protection: With a chartless practice, protecting the data is absolutely crucial to prevent data loss due to malware or user errors. Every office, at a minimum, should be using antivirus software to protect against the multitude of known viruses and worms and a firewall to protect against hackers who try to infiltrate the network, and have an easy-to-verify backup protocol in place to be able to recover from any disaster. The different backup protocols are as varied as the number of offices, but it is crucial that the backup is taken offsite daily, can be verified to be accurate, and can be restored in a quick manner.