I recently received an urgent midday call from my wife to
find out if I would run down to our local physician's office to get
my flu shot (my wife is slightly health obsessed – she carries a
bottle of Purell with her wherever she goes).
"There's only one other person here waiting and they just
got their supply in," she exclaimed. So I joined her, and even
though 30-plus years of patients breathing in my face has given
me almost Superman-like immunity, I surrendered my arm for
the vaccination. What I noticed most about the visit were the
charts the assistant carried into the treatment room. We have
been patients at this practice for 20 years and our charts were as
thick as New York City's Yellow Pages. My wife commented on
the assistant's biceps from having to carry those charts around all
day, but all I could think about was the nightmare of storing and
accessing all the information in the limited storage space I had
in my own office, not to mention all the trees sacrificed for the
sake of keeping medical records.
Then I smiled, because five years ago I enacted a plan to digitize
my office files, and thanks to my chairside assistant, Kim,
who has spent the better part of her office downtime for the last
several years scanning old charts and X-rays, the paper beast is
no longer a problem for us. I dealt with this issue, as well as others
in my dental practice, by embracing technology, and
although there has been aggravation at times (e.g.: "Dr. Z, the
computer crashed and I have no access to the appointment
scheduler!"), technology has been a terrific friend to me, an
extremely dependent "employee," and the source of many comforting
nights' sleep knowing that another challenge has been
dealt with successfully.
Utilizing technology demands careful planning, budgeting
and the ability to foresee which technologies make sense to
deploy for an individual situation and which ones are better left
for others. I think digitization of patient charts is the granddaddy
of technology in the dental office, requiring a reasonable
level of experience with computers (or a readily accessible tech
geek), but it can prove to be one of the most satisfying and efficient
deployments of technology to date.
My journey began in 1984, just five years into private dental
practice. I had almost no computer experience, except for the
Atari 800 personal computer which I purchased a year or two
earlier. I taught myself some basic programming and played
around with online banking with a 300 baud modem and a
green monitor. Paying a
handful of bills online
back then took about an hour, but
I envisioned the computer being a useful tool in the future and
felt it was a time investment that would be worthwhile.
When the IBM product center opened in my town in 1984,
they advertised a turnkey system for dentists for under $10,000,
and I jumped in headfirst and immediately put to use my first
office employee. Mind you, the ORD-Systems software package
– which was half the investment – was awful. The last straw
came a year and a half into using the system when it locked up
on a weekend when we entered our thousandth patient.
Other systems were hitting the market as well as new computers
that were two to three times faster than my PC-XT with 512K
ram and 10MB hard drive. One that caught my eye was Three
Star Dental by Dr. Jeffrey Tiefer. I liked that he was a dentist and
he offered the full version of the system for a free trial with a purchase
price of $1,000 if I liked it after evaluation. The software
was a big hit. I'm happy to say that 25 years later, I still use Jeff 's
software, now Diamond Dental Systems (and yes, he has been
there for me on weekends when I have needed support).
In 1995, I wired my home office and my three-operatory
practice, for networking and added PCs to the operatories. This
gave me a problem-solving tool I never had before. It seemed
extremely counter-productive to me to have several staff members
answering the phones to make appointments when there
was only one appointment book. The book was constantly being
moved around and, "Who's got the book?" was a familiar cry in
the office. I urged Jeff to look into online scheduling and he
came through. The staff was extremely resistant as you would
expect. Of course they quickly adapted to the search features
which enabled them to do things more efficiently. Even better,
the "appointment book" was now in every room of the office at
the same time. Within a short time they laughed at their reticence
in giving up the book and agreed the computer was
indeed a good friend.
My next biggest technological embrace was the conversion
to digital radiography. I hated waiting five minutes for the peripro
and another few for the assistant to mount the X-rays, and
presenting a treatment plan to the patient with tiny films on a
view-box. Let's not mention the cost of film, chemicals, cleaning
bills and new uniforms for staff whose clothes were ruined
by fixer, and the wasted time that could be used more productively.
Although many of my colleagues refuted dropping $15,000 for something they "can already do and can't charge
more for," for me it was a no-brainer. We had monitors on each
chair and the look on the patients' faces when you blew up their
decayed tooth to the size of the full screen made selling treatment
plans easy. In addition to better case acceptance, film and
chemical savings, this freed up staff time. The convenience of
electronically sharing radiographs with colleagues and insurance
companies, as well as the intangible "wow" factor should
not be overlooked.
Over the years, my patients have looked up to me as a technological
"Inspector Gadget," but they appreciate the technologies
I have embraced because I have selected ones that I think are
most practical and that will make my life easier and my patients
more comfortable. Along those lines, we added D4D
Technologies' CAD/CAM system, E4D Dentist, last year. The
ability to deliver same-day restorations is something any dentist
would drool over, but most consider to be too pricey an investment
for their practice. A closer look reveals that using the
Section 179 tax credit and putting the machine into service in
December makes this toy wonderfully affordable. I saved almost
$50,000 on my 2009 tax bill without laying out a cent until
June 2010 and the savings in my lab bill easily offsets the
monthly lease payment. Let's again not forget the "wow" factor.
Even patients who don't need a crown get to see one being made
and the virtues of the system are displayed on the 42-inch
plasma in the waiting room while they wait.
When it came to digitizing the patient charts in 2005, it was
less about "wow" and more about "how," although the "wow"
was certainly not lost. Rather than having a new technology
thrown in my face and evaluating its worthiness for my office,
digitizing charts was different. I recognized a problem for which
there was no easy technological advance to solve. I looked at
each item in the patients' hard chart and each had its own challenges
for the conversion. Although we had been taking digital
radiographs almost exclusively since the late 90s, we had many
patients of record from the 80s and records from previous dentists
were almost always film. It took a lot of research to find a
scanner with a large enough scan area to handle scans of full
series or panoramics in one pass. The Microtek Scanmaker 9800
XL was up to the task and it has scanned thousands of X-rays for
us over the last five years without once going out of service. We
still put it to use when patient records come over from other
dentists that are on film.
For paper scans we use Canon's DR-2010C sheet-fed scanner.
We have two of these babies in our administration areas.
They take up very little room and do a great job of converting
single sheets or stacks of sheets into PDF or JPEG files for photos
and printed X-rays. We have a simple folder system with a
main patient charts folder and 26 subfolders for each letter of
the alphabet. Within the subfolders our patients have their own
folders and within each patient's folder are subfolders for things
with multiple entries like explanations of benefits, referral notes,
scanned X-rays, photos, insurance benefit information, medical
history forms, perio charts, etc. Folder privileges are set so that
employees can add patients and folders but only a few, myself
included, can delete or move a file.
An external raid-compliant backup drive attached to the
server updates every hour to constantly back up office data in
the event of a power outage or heaven forbid, server failure.
Daily incremental backups are automatically uploaded online
using Amazon's S3 online storage system at about $20 per
month. In the event of a local catastrophe, records are always
retrievable from an offsite location.
New patients now complete their medical history and
information forms on our Web site and submit them to us
electronically via e-mail. We then use a PDF-creating virtual
printer like CutePDF to electronically save their files to their
respective digital charts.
You don't have to lose the paper all at once. Start slowly with
new patients at first. Most practice management software systems
now accommodate treatment notes. Buy the sheet-fed
scanner first and stop creating new patient charts tomorrow.
After a short while you will realize the benefits and start converting
your old charts one by one as patients come in for their visits.
Non-returnees don't get scanned and eventually their charts
get discarded after seven years. Benefits include smaller storage
requirements for charts; never "losing" a chart again; quickly
finding one item you are looking for in the chart without shuffling
through pages; easy transferability of patient charts to other
dentists, specialists and insurance companies; and of course, the
I'd be remiss if I didn't admit that there were times that it was
a good thing there wasn't a sledgehammer around. My wife has
had to put up with my bad mood on plenty of occasions when
the technology didn't perform as it was supposed to. All in all,
my journey with technology in the dental office has allowed me
to be more productive, have more fun in the office, and attract
and maintain a patient base with confidence in their practitioner.
It has helped me arrive at a stable solution to the difficult issue
of record-keeping that is becoming ever more of a challenge for
dentists both today and going forward in the digital age.