Paperless Practice

Most dental practices have come to realize how quickly technology has become part of everyday life in the practice. Nowhere is this more evident than with practices that are trying to become completely paperless.The challenge for most 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. 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. 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, they will have to look at more modern practice software.
  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. 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. It’s important to realize, though, that there have been many changes in ownership of these programs over the past few years. So, your investment in these programs may not be long-term. 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.
  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 privacy-sensitive information, such as the daily schedule or other information that you would prefer that the patient not see. Windows and other software 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 both 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.
  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 many factors. For those that can afford it, cone beam 3D systems are all the rage. The dentists who have digital radiography report more efficiency by having the ability to view take and view images more rapidly, better diagnostics, cost savings by the elimination of film and chemicals, and higher case acceptance through patient co-diagnosis of their dental needs. 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.
  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. Online backup is now a reality and a very viable option for many practices that want a true set-it-and-forget-it system for their daily backup.

For 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 6-18 months to transition from a paper-based office to a chartless one, but the journey will be well worth the reward at the end.