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Paperless is NOT the New Black by Krista Houstoun, Associate Editor, Dentaltown Magazine

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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 go chartless.

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 high-end hardware.

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 team members.

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 tasks recommended.

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 software.

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 we're going.

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":
  1. The ability to create treatment plans
  2. Tightly integrated digital X-rays
  3. Digital document software
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.

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.

Paperless Practice Products

Curve Dental
Curve Dental provides a bright, innovative solution to managing your practice. It's cloud-based software sports a super-clean look and a refreshing amount of flexibility. With eight years of cloud-development experience, it delivers a comprehensive solution that includes native digital imaging, sexy charting, powerful scheduling, super-tight accounts receivable and more. More than 1,000 dental professionals rave about Curve Dental's responsive customer service. Customers enjoy continuous, no-hassle upgrades, worry-free and secure data backup and access-from-anywhere convenience. Call 888-910-4376 or visit www.curvedental.com for more information.



DentiMax
DentiMax is a technology leader with the knack of making software that is extremely easy to use. The software tightly integrates with digital X-rays, allowing you to easily view X-rays and treatment plans from the same screen. And DentiMax flows just like your dental office. From checking in a new patient, to electronically prescribing medication, to scheduling additional patient visits, DentiMax mirrors your practice's actual workflow. These easy-to-use but powerful features make DentiMax an easy choice. For more information, call 800-704- 8494 or visit www.dentimax.com.



Dentrix G5
Dentrix G5 provides the foundation for the digital dental office. Featuring a new SQL-compliant database, software integration tools and encryption technology, it's a secure, expandable platform that is designed to integrate more deeply with eServices and third-party products. Combined with the industry's most complete set of electronic services and offering the richest selection of third-party solutions, Dentrix G5 has both the scope and the flexibility to meet the unique needs of any dental practice.



Lighthouse 360
Lighthouse 360 is the most automated, most comprehensive patient communications system in dentistry. It is the only system that can reach 100 percent of your patients with e-mail, text messages, automated phone calls, postcards and letters. It reminds patients when they need an appointment, confirm existing appointments and ask patients to post online reviews - all automatically. Your team's efficiency goes up, broken appointments go down and patient satisfaction soars. Call 888-427-5454 or visit www.LH360.com for more information.



Patterson Dental - Eaglesoft
Eaglesoft Practice Management Software from Patterson Dental is designed to offer increased functionality and adaptability in a practice. To simplify daily tasks within dental offices, Eaglesoft includes functionality such as a user interface allowing for more personalized use, and line-item accounting, which allows the user to apply a payment directly to a specific line item. By fully utilizing these tools, practices can equip themselves with the software needed to make their office run more efficiently and increase revenue. Visit www.eaglesoft.net.



Open Dental Software
Open Dental Software is a secure practice management software used by dentists around the world. Features include a customizable appointment system, 3D tooth charting, easy recall scheduling, comprehensive billing system with e-claim support, flexible queries and reports, and integration with X-ray, scanner and digital camera services. It also offers data conversions, full technical support, remote and on-site training, simple installation and frequent updates. Open Dental is EHR-certified and HIPAA compliant.



XLDent's Wireless Tablet PC
Wireless Tablet PCs are becoming mainstream and XLDent is built from the ground up to work with this new technology. Many dentists are frustrated with the limitations that desktop computers, the keyboard and mouse have in the treatment room. Dusty cables and keeping everything clean adds to this frustration. With XLDent there are no cables, because of its wireless design plus it is totally mobile. Together, the intuitive, turnkey system gives you the power to dramatically streamline workflows. To see more go to www.xldent.com and see how XLDent is improving clinical workflows.



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