The Paperless Practice Chelsea Patten, Staff Writer, Dentaltown Magazine

— Chelsea Patten, Staff Writer, Dentaltown Magazine

The days of putting in orders to OfficeMax for thousands of manila folders are coming to an end. Dental practices have inched toward going completely digital for years by adopting technology like intraoral cameras, digital radiography and CBCT. Many offices now use computerized practice management software for scheduling and treatment planning, which can be viewed on computer monitors stationed in each operatory. As digitization of practices becomes more widespread, more and more options are presented making "going paperless" attainable for every dental practice.

As you watch the stacks grow at the front desk, the many sources from which an office accumulates paper are made evident. Even with just a few new patients in the waiting area, the desk is littered with initial patient forms – health history, consent forms, copies of insurance cards. You might have five to 10 sheets of paper on a single patient before the patient even enters the operator y. Then set off to the side, there are charts containing all the treatment paper work – treatment planning write-ups, X-rays and notes from various office visits. And in a basket designated for incoming mail you have insurance claims and treatment reports from specialists. All these documents are essential to treatment but do not necessarily need to be in paper form.

A Government Mandate for EHRs
Electronic health records (EHRs) help to improve the quality of care, efficiency and access, as well as safety and security. The Bush Administration Initiative, voted into action in 2004, requires streamlined electronic health records by 2014.

With a national movement to make health records electronic, the American Dental Association (ADA) has jumped on board to advocate the process. Since EHR guidelines were developed with physicians in mind, rules are more open to interpretation for dental professionals, so the ADA has taken a stance on the forefront of decision making for EHRs for dentists.

There are many incentives to help dentists go paperless. The American Recover y and Reinvestment Act (ARRA) will invest $19.2 billion in health information technology. This money goes toward implementing universal infrastructure as well as offers monetary incentives through Medicare and Medicaid to doctors and dentists who implement the technology.

Chartless Versus Paperless
If you are giving patients paper to fill out when they come into your office and then scanning those documents into the computer after they complete them – you are "chartless." Chartless is not paperless but it's definitely a step in the paperless direction. "Paperless" involves more than just scanning and shredding documents to be chartless. An office becomes truly paperless when the internal operations of a practice as well as the documents it outputs are all completed electronically. This would include charts, but would also entail electronic scheduling and reminders, the use of intraoral cameras and CBCT, and the correspondence with insurance companies and specialists. To get a better picture of a paperless office, see David Arnett's article "How Paperless is Your Office?" on page 104.

Practice management software is your primary paperless ally since it is able to do much more than just digitize patient charts. It can organize treatment documents including X-rays, and handle all your scheduling needs, including patient reminders and recalls. It can organize charts and can provide forms online to be filled out ahead of time. Technology is also available for electronic forms and signatures.

The Benefits of Going Paperless
There are many benefits of adopting any level of digital technology into your office. Here are some of the main advantages:

Cost Effectiveness
The cost of going paperless varies considerably depending on what infrastructure is already in place, and how comprehensive the database. There are some large initial costs, like storage systems and software programs, but the return on investment (ROI) for going paperless is evident, particularly since incentive programs can offset the initial costs. ROI can be seen in decreased administrative work since there will be no more "pulling and filing." You are no longer obligated to pay for the physical storage of charts or the means of securing them. By going paperless you are able to save on office supplies, including letterhead and postage.

Security and Legal
Between HIPAA and liability insurance, you are required to keep records and patients' charts under lock and key. Computerized systems have timely and consistent back-ups. With electronic records, not only will you be storing records in a safe place for confidentiality sake but you will also remove the threat of having records vulnerable to natural disaster, fire, theft or vandalism.

With practice management software, your records are cleanly presented, always legible and always complete. Worries about misfiling or misplacing papers completely subside, since all files are indexed with name, date and time. You have the ability to streamline accounts receivable, appointments including patient confirmations and reminders, progress notes, insurance claims, specialists' correspondence and radiographs all in one location.

By going paperless, you will never need to bear the consequences or the worry of a lost or damaged chart again. Not only do you have constant-backup but you can access your files from anywhere. You decide who gets viewing and editing privileges and you determine from where you can access files. Some dentists might only want accessibility in-office; others might appreciate having all the information accessible from their smart phone. You can adjust settings so employees can add new files but only admin can delete or move the files. This prevents accidental deletions or intentional sabotage by a malicious employee. Practice management software and storage systems work together to provide the level of accessibility desired by the dentist.

Convenience for Patients
As demonstrated by the use of the Internet and the movement of social media throughout the last few years, patients use technology every day. Moms and children alike have cell phones. Families get e-mail and pay bills online. Why should these avenues be treated differently in your office? Many practice management software programs allow you to send appointment confirmations via text message or six-month recare reminders through e-mail. Programs will even allow patients to make account payments online. By using a method of communication convenient for patients, you are retaining these patients.

The Steps to Going Paperless
With tips from the ADA and from dentists who have already gone paperless, we've put together a series of steps to implement a system in your office.

What is Your Motivation?
Determine your motivation for wanting to go paperless. Whether you're motivated by the ability to make your office more efficient, streamlined and cost-effective, by going green to save the environment, or by the available financial incentives, choose what is most important to you and adopt the paperless practices most likely to help you achieve that goal.

Make a Commitment
One of the first steps in going paperless is making the commitment. Although there is a specific destination in mind, going paperless entails quite a journey. Create a timeline with short-term goals and be the visionary for your office throughout the process. You must have both feet on board if you want your staff to take ownership of the commitment as well.

Find a Software Program
You most likely already have a practice management software program in your office. The chart on pages 102-103 lists the paperless features your software already has. If you don't already have one there are dozens of practice management software programs. Evaluating what types of documents you have, how you want to organize those documents and assessing access privileges (who, what and where) will give insight to narrow down the options.

Ensure Proper Equipment
Before you get started you need to make sure you have the proper foundation for digitizing such a vast amount of information. Some practice management software programs require in-house storage, while some store all the information online. Find out what type of storage you need, for both long-term archived files, and short-term accessible files, and get it in place before you begin. You will also need a durable scanner, able to handle the inundation of documents from your current paper files.

Train and Be Trained
For those who do not have a practice management software program in your practice, adopting new software is not intuitive, especially if you are weaning yourself and your staff off paper files. Not only is it not intuitive, but most offices will express resistance to the change. In order to fully embrace going paperless and to utilize a practice management system, you might need to enlist the help of an expert. Even if you already have a software program, schedule a trainer to come in and teach your staff about the features you are not currently using. In this case, knowledge is power. By learning what your practice management software can do, you have a better chance of utilizing it to its full potential.

Develop Rules for Consistency
Determine rules to avoid inconsistency in data entry, migration, purging and destruction of paper files. By keeping everyone accountable to the same set of rules, you are helping your office avoid mistakes, misfiled and misplaced documents, and ensuring security of documents. Who can access and edit the files? How will you ensure timely migration? How will you store information in the long-term? By determining your answers to these questions beforehand you are eliminating the risk of inconsistency and making certain all your information is indexed for easy and secure searching throughout the system.

Be Patient
Going from an office full of paper files to a paperless, digital office does not happen overnight. In fact, it can take anywhere from 12 to 18 months and it's easy to get bogged down with the stacks of paperwork needing to be converted to an electronic system. Keep staff up to date with the progress and celebrate when your office reaches one of your short-term goals. Entering years' worth of charts can be tedious, but it can also be rewarding when staff see visible results. Digitally input new patients first. Then convert charts as patients come in for their visits. You'll never need to waste your time scanning in data for old patients who don't return. And eventually their paper files can be discarded. Verify rules for destruction of inactive charts with local area officials.

Encourage Others – Patients, Insurance Companies and Specialists
Even if you have a digital system for logging paperwork in your office, you will always have a growing stack of papers on your front desk unless you encourage those you work with to go paperless as well. Many practice management software programs incorporate correspondence with insurance companies and specialists. Ask the specialists you work with on a regular basis to send you their treatment reports via e-mail instead of by postal mail. Also, make patient forms available online and encourage patients to fill them out prior to their appointment. This process not only helps efficiency but is also one more step toward paper-free. You might not be ready to go completely paperless, but since there are so many ways to drive your office in that direction, we encourage you to adopt digital, however extensively, at your own pace. Continue to be forward thinking, utilize the hundreds of resources available to you, and work toward the goal. It is within your grasp.

Click here to check out a list of some products that can help you in going paperless.

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