There is a sea of software programs designed to help
dentists better operate varying degrees of "paperless" - or
"chartless" - practices. Dentaltown Magazine reached
out to leading dental practice management software
companies to discuss why transitioning to a paperless
practice isn't a trend - it's vital.
What are the advantages for dentists transitioning
to a paperless practice?
Andy Jensen, CMO, Curve Dental: The practice
with less paper realizes better organization and security
of patient information.
Jason McKnight, Coaching Manager, Dentrix: The
efficiencies gained by having all the information stored
within a single software solution are tremendous. A big
fear of having a paperless office is "what if my computers
crash?" This is a non-issue when an office follows the recommend
back-up protocols of having multiple backups
and storing them offsite. Literally, with a laptop and access
to the offsite backup, the dentist can be up and running
instantly. The bigger fear should be for those offices that
have not transitioned to being paperless. What if there
were a fire or flood? If you are relying on paper charts to
store all clinical information, or worse yet, business information,
what would you do then? If you didn't have the
information stored digitally, the information is gone.
David Arnett, Co-founder, DentiMax: There are
so many benefits to be gained from going paperless that
it really is hard to list them all. For example, sending
claims electronically is going to result in much faster
insurance payments, using digital X-rays to educate
patients will result in higher patient compliance with
treatment plans, texting appointment reminders to
patients will dramatically reduce the no shows, electronically
sending prescriptions is faster and reduces the
chances for drug and allergy interaction issues, etc.
Allen S. Jorgensen, Co-founder, Lighthouse 360:
Katrina? Sandy? A "digital office," having all digital
charts, X-rays, etc., is a protected office. This office can
be "inconvenienced" by even the most major tragedy (we
had an office burn down the other week - and saw the
next day's scheduled patient on time thanks to being all
digital!) but will not have any records lost. Now, if we
turn that question around and ask about the advantage
of keeping a wall of charts: How often is that entire wall
"backed up and replicated" to be taken somewhere else
and re-created "just in case"? Why is it that with a wall
of charts - hundreds or thousands of them sitting there
looking at you - that the one that you really want is the
one that cannot be found? When a chart is "digital" it is
always locatable and the entire office can (and should) be
duplicated every night.
Jana Berghoff, Technology Marketing Manager,
Patterson Dental (Eaglesoft): The biggest advantage is that
it's easier to communicate about patients. In the past, there
was a separation and lack of information sharing between
the front desk and the clinical group. But with a digital
patient record, what the clinical staff knows is right there
for the front desk to use anytime the patient calls, without
having to go pull that patient's paper chart. Now we truly
can better serve our patients because their information is
right there on the monitor.
Jordan Sparks, CEO, Open Dental: It can save a
tremendous amount of time not having to hunt down
misplaced charts. That alone is a good enough reason to
Andre Montgomery, Vice President, XLDent: If it's
done right, the advantages include improved productivity
and workflows, better job satisfaction, better data accuracy,
improved patient outcomes and improved patient experiences.
In addition to all of these things, there is a big cost
savings. Some experts have stated $25,000+ savings per
year depending on the size of the office.
Can you offer some tips for dentists who are
attempting to transition to paperless dentistry?
Dentrix: Invest in the right equipment the first time,
and then re-invest as time moves forward. Skimping on
scanners, operatory equipment, computers and networking
will cause frustrations and decrease the options you
may have for going paperless. The paperless office is only
more efficient when the right equipment is involved.
DentiMax: I have much different advice depending on
whether or not you are starting a new office or already have
an established practice. For the new office just opening its
doors, I recommend going as paperless as you possibly can
from the very start. You've got a clean slate and a real
opportunity to establish habits and systems for your staff
that may be hard to unlearn later on - better to do it right
from the get go.
For the existing office that is crazy busy with patients,
my advice is don't do it all at once but rather take it one
step at a time. If you just have a front desk computer, you
might consider adding computers to your operatories so
that you can electronically create treatment plans chairside.
But if you are already treatment planning with software,
then look at adding digital sensors and auto clinical notes
to your workflow. If you are already doing that, then look
at adding digital document software.
Lighthouse 360: Take your staff on field trips - go
visit someone that is "living the life" you are trying to
imagine or explain. When you spend a day in the life of a digital office then you can begin the mental preparation
and acceptance. The transition is not and should not be
expected to be instantaneous. To do it properly, it needs
to be planned, mapped out and phased in. The wall of
charts did not appear one morning - nor should you try
to make it disappear in a day.
Eaglesoft: Dentists should first stop and assess if the
practice management system they have is going to take
them where they want to go. The practice management
system is really the foundation for everything, so it is
imperative that it is sound. If it's not working now, it's not
going to work in the future. I tell people, "Don't settle for
just good enough." Make sure you have that right foundation,
and if you have that the rest is easy.
Open Dental: Don't try to do it all at once. Going
paperless involves dozens of little steps that move you
towards a more paperless office. The staff needs to learn
each technology before moving on to the next one.
XLDent: Prepare your team, plan your strategy and
be patient. Preparation and good planning are the keys to
success. Follow-up training is also a key to success. Keep
in mind that old habits die hard and it's not just about
learning how to use the software. Going paperless is
about getting rid of paper-centric mentalities and implementing
point-of-care solutions. Scheduling on-site follow-
up training 45-60 days after the initial installation is
a good idea. Yearly refreshers to have your paperless workflows
assessed and get up to speed on new software
enhancements is an even better idea.
There are many companies our there that offer
helpful practice management software programs
to dentists. What, specifically, are the
unique, above-and-beyond features of your
company's practice management software?
Curve Dental: As a web-based system, we eliminate
the hassles of keeping the software up to date and the
worries of backing up the software. Moreover, patient
information can be accessed from anywhere without purchasing,
installing and configuring additional software.
With Curve Dental a server is not required, saving the
doctor all of the maintenance and costs that come with
Dentrix: Dentrix Electronic explanation of Benefit
Statements (eEOBs) and the Dentrix Web Site Manager
- Patient Kiosk. eEOBs eliminate the delays created by
mailing documents and the hassle of managing paper.
With eEOBs, your practice will reduce manual data
entry, streamline insurance claim reconciliation, speed
up patient billing and secondary claim submission and improve accounts receivable accuracy. The patient kiosk
feature revolutionizes your patient form completion
process for increased productivity and better overall
patient experience. Now patients can update contact,
insurance, medical history and other information easily
from an in-office kiosk.
DentiMax: DentiMax allows you to electronically
send prescriptions for all classes of drugs. This feature
tracks the medication your patients are taking, giving you
instant access to drug, allergy and disease interactions.
This electronic prescription tool will even inform you if a
patient is receiving pain relievers from multiple locations.
Another "above-and-beyond" feature is the built-in ability
to send text and e-mail messages to patients reminding
them of their appointments. Patients can even respond
electronically and have their confirmation results displayed
in the appointment book. And if you are truly
going paperless, you'll need a software replacement for all
those Post-it Notes. The DentiMax "electronic sticky"
notes will keep you and your staff organized and on task
by allowing you to record "to do" items for yourself and
Lighthouse 360: Our recognition of almost every practice management software's power and capability
(we currently enhance over 30 and list continues to
grow) to be beneficial today - as is. While many of the
software company's try to "churn" and push "the grass
is greener" to offices, the reality is that the functional
capability across the board on all is very similar, and
they can and do run offices day in and day out. With
the addition of Lighthouse 360, we can inject the
best practices that are coached and shared with experts
via an automated solution that will consistently do the
Eaglesoft: One feature of Eaglesoft Practice Management
Software that is key for paperless offices is
SmartDoc. This lets dental teams easily convert paper
documents into electronic versions and efficiently store
them. One of the things that makes going paperless difficult
for offices is that paper is always coming in,
whether it's mail, product documentation or other
materials. So even if those offices aren't generating
papers on their own, paper still shows up, and they need
an easy way to scan and store it. Not only does
SmartDoc give offices a way to convert and store papers
regarding a patient, it also lets them do it for employee
documents or insurance documents. It's a digital filing
cabinet for all of those purposes. Additionally, the
upcoming Eaglesoft 17 will give offices a customizable
medical history so that no matter how the office likes to structure the patient's medical history, they can do it in
a paperless manner.
Open Dental: Online patient forms that are completely
customizable, good bridges to many other software
programs, many choices for clearinghouse, support for
touchscreens and signature pads, and fully EHR certified.
XLDent: XLDent offers a complete suite of products
designed for mobile, tablet PC technology. We deliver
solutions at the point-of-care. Our digital integrations are
open architecture solutions that offer a choice in any
number of X-ray manufacturers. We also deliver a completely
paperless solution by using a unique combination
of web and ink-based forms. We are the only PM software
out there that offers an integrated ePrescribing solution.
Progress Notes are another feature of XLDent that
offers above-and-beyond functionality.
What trends are shaping the direction practice
management software development takes?
Curve Dental: An online society is dictating a new
revolution in dental software. In the early 1990s, dental
software transitioned from the DOS operating systems to
Windows because Windows provided a more beneficial
platform, both for the software developer and the end
user. Today, practices are transitioning from Windows to
the cloud for the very same reasons.
Dentrix: Cloud-based practice management. "Smart"
software that provides a workflow for staff members.
DentiMax: Practices' almost universal use of a high
speed Internet connection, the quick adoption of smartphones
and tablets by consumers in general and advances
in the quality of digital radiography are having the
biggest impact on shaping the direction of practice management
Lighthouse 360: The marketplace is a very competitive
environment with new innovation being copied and
mimic as soon as it gets a toehold. Combine this with the
technology in general evolution cycles that then allow
non-dental tools to be applied to the environment -and
things change even faster. There is also government regulations
and other attempts at standardization to move us
towards true information exchange regardless of original
source or target destination.
Eaglesoft: We're obviously heading more and more
toward the cloud space, making it easier so offices don't
have to maintain software. There are some things that
might be a challenge to transition right now, but certainly
with everything we're developing at Patterson,
one of the questions we're asking is, "Is this something
that can be in the cloud space?" It's definitely where
Open Dental: EHR certification mandates for 2014
include secure digital communication between patients
and their providers as well as between providers. This will
first affect the physicians, where all software is EHR certified.
It will then trickle into the dental industry, where
certified EHR adoption is still very low.
XLDent: Last week Eric D. Schmidt, executive
Chairman for Google, commented that the future of
software was in one word.... mobility. Obviously, we
agree with that.
What minimum, absolutely essential features should dentists seek out in a practice management software program?
Curve Dental: The essential features for a practice differs from practice to practice. When looking for dental software, a practice would do well to create a list of what's important to them the most; otherwise they risk being sidetracked by other features that may be attractive and impressive but not essential to their needs.
Dentrix: The features essential to becoming a paperless practice are patient check-in, charting, treatment plan presentation and patient education, patient check-out, scheduling, billing, insurance management and reporting.
DentiMax: If you are looking at just the absolute minimum "paperless/chartless" features, then I am going to have to go with what I will call the "Big Three":
In today's ultra-competitive environment, if your software does not offer these three basic features, you are putting your practice at a tremendous disadvantage.
- The ability to create treatment plans
- Tightly integrated digital X-rays
- Digital document software
Lighthouse 360: Dentists should not "seek out" anything that is not already available and in production use - the state of the technology now is far better and more powerful than it was in 1996... and in 1996 we had chartless offices running with no problems.
Patterson Dental: If dentists are making the switch to a chartless system, they will want a software they can keep for life, and that means they need to look for a system with sound technology support and a commitment to future development. These features mean the software will continue to grow and be enhanced, and dentists can have confidence that it will keep up with trends and technical requirements over time.
XLDent: It is essential to capture and retrieve clinical data at the point-of-care. In addition, it is essential to have a single chart that doctors and staff can work from without having to go into additional input panels. Keeping the chart clean and easy to use is extremely important for point-of-care functionality. It not only improves clinical accuracy, it also lends itself to clinical decision support and improves clinical workflow.
Open Dental: Automatic procedure note generation for completed procedures; ability to scan documents into organized folders by patient; electronic claims; integration with digital radiography.
Are there practices out there currently operating completely paperless? Is there any form of paper in dental offices that you don't foresee becoming digital?
Curve Dental: I've been told by several doctors that their practice is paperless, but I've not been able to independently verify. All aspects of the practice can be digital; however, for the software companies to provide that feature there needs to be an apparent return on investment.
Dentrix: Yes. Personally, my dentist runs a completely paperless office. I sign credit card payments, health histories and consent forms digitally. The last holdouts were the health history and consent forms. Now that those have become digital, there is no reason that, by the end of the day, any paper correspondence should not be stored digitally, even by scanning.
Dentimax: Yes, there are practices that have gone completely and totally paperless. Dr. Ryan Brown's pediatric office in Prescott, Arizona, is just one example. Dr. Brown used the paperless features of the DentiMax practice management software as well as its openness with technology of other companies in order to make his practice completely paperless. All forms of paper in dental offices can go paperless - they already have!
Lighthouse 360: Dr. Bridgett Jorgensen's office - North Gwinnett Dental Care - became 100 percent "chartless" when her husband Allen Jorgensen became the full time front desk staff and "Czar of Lazy." Coming from the business world with a technology background, and knowing that no other business in it's right mind would ever visit a medical/dental office to learn and model itself on this "chart" concept - we stopped creating them in 1996 and never looked back.
There is still "paper" in the office - but it is temporary, managed and made obsolete by the end of the day. Offices should focus on the workflow and efficiency aspect and not on whether a "pen" is being touched by someone. Over the years (past and future) there is less and less paper product needed because of the easier paths that are being enabled - but using the absolute of "no paper" to be the measure is entirely wrong and holds offices back.
Patterson Dental: There are certainly chartless offices that only have digital charts. But most offices still get mail every day, and still have to print and mail materials to vendors or patients that haven't gone digital. So there are still times where offices have to work with paper. I think it's going to be pretty difficult to ever be completely paperless, but being chartless is definitely possible. However, I don't think there's any form of paper in an office right now that can't be a digital record, and I've trained more than 500 offices so I've seen a lot of documents.
XLDent: Within the scope of practice and clinical management, yes to the first question and no to your second. There must still be considerations for other business systems in the office. It's just a matter of whether or not the dental office is purchasing and implementing these paperless solutions.
Open Dental: There are very few that we're aware of that are completely paperless. They are in urban settings where all the patients are professionals and who already live paperless lives. Those patients are completely comfortable doing everything electronically, but many offices can't be completely paperless because some portion of their patients are resistant to technology.
How does a paperless dental office enhance the patient experience?
Curve Dental: Being paperless doesn't necessarily mean the patient experience is enhanced. If the patient finds the chore of completing a medical history form just as tedious as completing a paper form, then the objective of becoming paperless may have been missed altogether. A digital practice should be a more efficient practice, both for the staff and the patients.
Dentrix: The image of an office that is paperless is a very professional, modern practice. Patients are so used to the digital world that it can seem archaic to walk in to a dental office and have to check boxes on medical conditions. Or to have to wait for an X-ray to be developed. Every industry is becoming more digital, and when a patient is considering whom to trust their dental care to, image is everything. That is how the practice gets the patient in the door.
The case acceptance goes up within an office that uses digital radiographs and intraoral cameras. When a patient is able to hold a tablet in their hand that shows a pocket of decay in an X-ray, or it has a photo of a cracked tooth, the patient is always more likely to accept the recommended treatment and begin immediately.
DentiMax: Electronically captured information is easier to access and lends itself to a better office workflow. And a better office workflow means your patients will spend less time filling out forms, waiting for their appointments and getting their questions answered (quickly and correctly). It really is a beautiful thing to watch the smooth flow of information between the back and front office as treatment plan, perio, clinical notes and other data is shared to create claims, statements and new appointments. The end result of this smooth workflow provides a superior patient experience.
Lighthouse 360: At the base level, a "digital-charted" office has less stress, more efficiency, can be much more personal and professional, and always has whatever is needed within a keystroke or two reach. Can you imagine calling Delta airlines to make a future plane reservation and wanting to ask about a past flight and being asked to "hold while I go get your chart...."? How comfortable would you feel going to the airport to take that flight and see them push up vintage 1940's technology (which a paper chart is) and hand-prop the engines while giving you a leather helmet and goggles to wear? The difference from a patient experience level in a digital office is amazing - and once you are transformed you would never go back.
Patterson Dental: A paperless system really helps patients simply because it makes their information readily available to the whole team. If a patient calls and says, "I have a toothache on the upper right," the person at the front desk has access to any history they've had in that area, and they can respond with, "Oh, the doctor looked at that last time you were in and we saw the beginnings of a cavity, so why don't you come back in to have it checked." All of us know what it's like to call an office or business and talk to someone who doesn't have a clue who we are, and we have to start at the beginning and explain our entire situation. No one today has time for that. We expect people to know, and so a chartless system makes that a reality for the dental practice.
XLDent: It enhances the patient's experience through perception, convenience and flexibility. When patients see that their dentist is using digital X-rays, it gives the impression that the office is current with technology and concerned about providing the best in health care. When the doctor and staff engage patients by showing areas of concern and including them in the treatment planning process using point-of-care technologies, they perceive not only the need for proposed treatment but also the value in the patient/doctor relationship. Paperless enhances the patient experience by offering flexibility in completing registration and health histories online from home or office. Paperless offers convenience with email and text appointment reminders. These are all things that make coming to the dental office easy and convenient. That equates to better patient experiences.
Open Dental: Paperless offices are going to be more organized, and that translates into a smoother patient experience. The atmosphere of the office is also enhanced by having less clutter and by coming across as more advanced.
What does the future of dental practice management software look like? What can our readers look forward to?
Curve Dental: Dentists can look forward to instant collaboration with their colleagues, dental labs and specialists over a current case, being able to share patient history and digital images in a secure environment and in real time. Software will become more "intelligent" in that it will be able to identify long-term trends within a particular patient's record, or compare a patient's current oral health condition against many other databases, find anomalies or similarities and bring these to the attention of the dentist. New technologies, such as digital impressions, will become a part of the patient record.
Dentrix: Cloud-based practice management software is making a big entrance to the dental industry. The ability to manage the practice from a smartphone is revolutionary. Practice management systems will continue to make running a dental office even easier. Gone will be the days of having that one person in the office who knows everything. Now the management of a practice's daily routines will become more automated and directions will be provided to each staff member, based on position within the office, on how and what to do throughout the day. The facilitation of communication between a doctor's hand and the computer's data will continue to become more efficient.
DentiMax: The future involves even tighter integration of the best ideas of today. For example, digital imaging and practice management software will become so integrated that the lines between the two will become blurred. We will also see further integration of practice management software with all the various popular hardware devices, including smart phones, tablets, Macs and PCs, etc. And we will see further use of the Internet to not only communicate with patients but to allow them to be completely involved in their whole dental experience.
The future also involves new ideas that include the enhanced ability to share information with patients and other practices, more automation of treatment plans where the software suggests possible treatments from digital X-rays, to completely automated processes like the payment process where the patients are billed and pay without any human involvement (think of driverless cars). The successful software will accomplish this with screens that are easy-to-use and understand.
Lighthouse 360: Practice management software will continue to evolve and exploit the hardware present at the moment. Just as a few years back it took a flight crew of four professionals to take an airliner across the ocean - and now the planes can literally take off, fly and land by themselves - with more efficiency and less cost. Any and all tasks that the computer "can do" should be done by the computer (hardware/software) because it will be done consistently and to a higher standard. This does not make the office staff redundant or obsolete - it enables them to be more focused on the tasks that are "people-centric" and they can better shine in performing them.
Patterson Dental: Readers can look forward to software that is easier to use, more robust and helps to support what they want to do and how they want to run their dental practice.
XLDent: Greater mobility and an evolution to and interoperable EDR.
Open Dental: In five years, when a new patient walks in, you will be able pull their demographics, medications and allergies from the health information exchange. There won't be any forms for the patient to fill out. You will be able to get an instantaneous pretreatment estimate from an insurance company, and when the work is done, the insurance payment will go directly into your bank account.
What else should our readers know about going paperless?
Curve Dental: What about platform? Web-based applications are the current standard in nearly every other industry, rapidly replacing client-server applications. The cloud is the current development standard, not the future. How many of the current dental software vendors continue to provide software written for a decades-old platform?
DentiMax: Whether we like it or not, there will continue to be government mandated items that will need to be incorporated into the software. For example, electronic health records that comply with the government standard of "meaningful use," the new ICD10 requirements and possible future mandated insurance claims standards will all need to be incorporated into practice management software.
Fortunately, government mandates can come with government incentives. If 30 percent or more of the visits to your practice are from Medicaid patients, then you are eligible for a total of $63,750 in government incentive payments (per licensed dentist). To qualify, you need to purchase and use a certified electronic health records (EHR) software program and demonstrate a standard known as "meaningful use." DentiMax is the technology leader in this area and offers such a certified EHR system - we call it "DentiCharts."
Lighthouse 360: Only the cliché that "attitude determines altitude." If you think that it is not possible to do, then usually you can prove that to be correct. By dreaming of the better solution and knowing that others have done it (and would not go back) you can make it happen whenever you want - there is nothing that has to "be created" for you to get there.
Paterson Dental: Dentists should also be considering integration with every piece of software and hardware they're looking at. It's important to choose products that support the philosophy that everything should be integrated, so you don't have piecemeal solutions. Dentists don't want to spend time going to multiple vendors when they have an issue; they want it all in one place. So a truly integrated, full-bodied, we-can-do-everything software is really important for them.
XLDent: I have a question for your readers: Do you feel current state and federal government mandates regarding use of "ONC certified" EHR software is a step in the right direction or wrong direction when it comes to "productive" and "useful" advances for the field of dentistry?
Open Dental: One disadvantage of going completely paperless is that you must be very rigorous about making and validating backups. Companies regularly go bankrupt when they lose their data.