Emmott On Technology: The Advantages of Digital Dental Treatment Notes

Thursday, August 15, 2013

Emmott On Technology: The Advantages of Digital Dental Treatment Notes

How many times in your life have you written or rather scribbled something like this in a patient chart?

Crown prep tooth number three 1 carpule xylocaine. Actually you scribbled this: scribbled text

It is amazing how many dentists will spend enormous amounts of time every day writing, editing and reviewing poorly scribbled, hard to read handwritten notes but will not do a little planning and take a few hours to create digital notes so they never have to write in a chart again.

Digital progress notes are more complete, easier to read take much less time to create than paper entries, and you most likely already have all the technology you need to start using them. You just haven’t taken the time to set it up.

Digital chart notes often are attached to a CDT procedure code. When you complete a procedure, the basic notes are automatically entered. However CDT codes are designed primarily to track fees for insurance purposes. In real life we work on appointments and cases not just codes. Many procedures require multiple appointments to complete. For example a denture requires impressions, then a bite, a try in and then a delivery. Then there are follow up appointments such as suture removal and bite adjustments that have no fee and no code.

The first step to creating electronic procedure notes is to set up additional appointment based procedure codes. These codes are just for your practice, to accommodate all the extra appointments that do not have an assigned CDT code. The most obvious being the delivery of a crown. When you do this you can create progress notes for each extra code. Take some dedicated time to do it right now and you will save hours of wasted time and frustration later on.

Once you have the extra codes set up, you can enter your notes.

The various Practice Management Systems handle progress notes in different ways. Check with your trainer for details. One common system adds pre-written notes to the chart automatically every time you complete a procedure. Pre-write your digital notes starting with what you usually hand write in the chart. Keep in mind that you can now add detail that it is impractical to include in manual notes.

Here is a sample procedure note for an onlay preparation:

ONLAY PREPARATION. Reason for onlay: remaining tooth structure is unable to support a direct restoration; the alternative restoration would be a full coverage crown not a direct filling. Discussed treatment with patient including alternatives, patient understands and consents to treatment.  1 Carp. Aritcaine 4% 1:100 epi, Shade: XX .RD Placed. Prep tooth remove alloy and decay. Flowable base, condition 8 sec. Optibond Solo Plus, flow. Light cured for 20  seconds. Laser troughing for impression. 0.8W Cont wv. safety glasses worn. Oppos. alginate imp. Bite regist. mousse. onlay Imp.PVS. Temp fermit. No complications. P.O. Instuc. rto prn. N.V. set onlay.

Compare that to: scribled text

The digital notes are far more complete than you used to do by hand. And…you can read them! Now all the dentist or team member needs to do is enter variable information such as the number of carpules or the shade, delete anything that does not apply (maybe you didn’t use the laser this time) and add any complications or unusual situations.

Notice that one of the last parts of the note says, “No complications.” If in fact there are no complications it is good to note that, however this phrase also acts as a reminder. If there was a complication this is your cue to delete “No complications” and type or click in the details of any complications that you experienced.

When the patient returns to have the crown delivered you use the personalized onlay delivery office code you created. The automatic notes could say:

SET ONLAY: Bonded 1 Carp. articaine 4% 1:100 epi, Temp removed, patient has had no symptoms with tooth. RD placed. Onlay fit and adjusted. Pt pleased W/ fit and color. Cleaned dentin, Etched for 8  seconds,  Optibond Solo Plus, Calibra -med. Complete PO Inst. RTO PRN Adj.

If you did not have an office procedure code for delivery of the onlay you could not create these notes in advance. Also scheduling the delivery would be much more time consuming. If the delivery is treatment planned using a special code, then making the appointment can be as easy as three clicks.

Just in case it isn’t clear. You create these great progress notes one time. They are stored in the computer and they are added automatically to the patient record whenever you complete a procedure.

Another commonly used approach to progress notes is to create a decision tree. This is a system of questions the dentist answers in order to create notes. For example the first question may be:

Anesthetic?

  • Lidocaine 2%
  • Articaine 4%
  • Carbocaine 2%
  • Mepivacaine 3%

You click the proper response and another question pops up:

Topical?

Y  N

After you click that a third questions pops up:

Number of carpules? (With a dropdown)

1

2

3

After three clicks the system could create a narrative such as this:

A topical was placed then 2 carpules of articaine 4% with 1:100 epinephrine were delivered via aspirating dental syringe.

And so on. This method works but is rather tedious if 90 percent of the time you use one carpule of Articaine, but have to choose this over and over again in the notes.

Decision tree options work well for things that are consistently inconsistent. For example, complications or emergency findings. They do not work well for things that are almost always the same.

As long as you practice dentistry you will be required to make chart notes. Will you be making hard to read out of date hand written notes, or will you be using your digital system? The future is coming and it will be amazing! 

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