The Paperless Dental Practice – Start Today!

New practices are in a unique position to start fresh. Here’s how.

There is no doubt that the modern dental practice has changed rapidly over the past fifteen years. Dentists have come to realize that with new technology, they can create a practice that is more efficient, costs less to run, and allows for decentralization of the front office. While the process is easier for a start-up practice, with proper planning, existing practices can achieve this goal as well.

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

1. Dental 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. For offices that want to eliminate the paper, you’ll need to consider every paper component of the dental chart and try to find a digital alternative. For example, entering charting, treatment plans, handling insurance estimation and processing with e-claims, ongoing patient retention and recall activation, scheduling, and about 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, it will have to look at more modern practice software. It’s also important to understand that as much as we would all prefer that our practice management software programs can handle all of these functions, most fall short of this. Fortunately, there are a number of third-party programs that can provide functionality where the practice management programs cannot. We’ll explore many of these programs and services in a future issue, such as programs that allow you to digitize forms that require patient signatures and programs that can reduce the process of entering progress notes down to a few mouse clicks.
2. Dental Image and Management Software - This is probably the most challenging decision for any office. Most of the practice management programs will offer an image management module. These modules are tightly integrated with the practice management software and will tend to work best with digital systems sold by the company. For example, having an integrated image module makes it very easy to attach images to e-claims with few mouse clicks. However, there are also many third-party image programs that will bridge very easily to the practice management software and offer more flexibility and choices, although with slightly less integration. There is no perfect system: It really boils down to paying a premium for tighter integration or paying less for more flexibility. Some of the better known third-party 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, such as the daily schedule or other information that you would prefer that the patient not see. Windows has built-in abilities to allow you to control exactly what appears on each screen. 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 as well as having the necessary horsepower to run the network. The server is the lifeblood of any network, and it’s important to design a server that is bulletproof, has redundancy built-in for the rare times that a hard drive might crash, and can easily be restored. The workstations must be configured to handle the higher graphical needs of the office, especially if the office is considering digital imaging. 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. An often-overlooked consideration is that the smaller the computer, the more heat it generates. Heat is the number one enemy of computers, and since many dentists will place their computers inside a cabinet at the 12 o’clock position, having proper ventilation is absolutely critical.
5. Digital systems - The choice of image software will dictate which systems are compatible. Digital radiography is the hot technology at this time, due to the many factors. All systems have pros and cons, and dentists will have to evaluate each system based on a set of standards that are important to that practice. For some dentists, it might be image quality. For others, it may be the cost of the systems, the warranty of the sensor, the company’s reputation, or the compatibility of the sensors with their existing image management software. Keep in mind that Intraoral Digital Cameras are still an excellent addition to any office since they allow patients to see the things that typically only a practitioner could see.
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, 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 and can be restored in a quick manner.

For new offices that wish to be chartless or paperless, it’s crucial to evaluate all the systems that need to be replaced with a digital counterpart, and to take a systematic approach to adding these new systems to the practice. Most offices would be well advised to replace one system at a time, and get comfortable with this new system before adding new technologies to the practice. The typical practice will take nine months to 18 months to transition from a paper-based office to a chartless one, so, if you’re opening a new practice, the time to go paperless is now.