Things to Consider When Buying A Practice Management System

In both of these cases, dentists need to consider changing or, at the very least, upgrading their current software. While it might seem like an easy process, there are many potential pitfalls. This article will explore a number of considerations that should make the process a bit less painful.

Do you make the change?
Often this first decision is the most difficult. If you are using a program that is not being supported, my advice is that you make the switch now. You will have difficulty getting technical assistance if a problem develops, and your software will not have updates, such as new CDT codes. The tough choice comes when your current software has simply released an update. In many cases, dentists pay for yearly support that includes any updates released. Dentists need to know exactly what updates provide and evaluate for themselves if the change is worthwhile. Keep in mind that PMS programs are complex, and new versions will almost always have bugs or other issues that need to be worked out. So sometimes, keeping with your current, stable version will make more sense.

The importance of backing up
If you go ahead with the update or new software, there is nothing more important than backing up your data. It’s been my personal experience that more than half of all offices back up either too infrequently or their backups are corrupted and would not restore the data in the event of a catastrophic loss. The best way to test this is to install the program on a separate computer and import the backup data to test for integrity. Even when not considering a software upgrade or installation, offices need to develop systems of consistent, reliable backups that will involve having the data at another location. The backup won’t do you any good if it is in the office and the office is vandalized or affected by some disaster like flood or fire.

Backup options
Dentists have many established and easy methods for backing up data. The most popular for years, tape drives, has fallen out of favor recently. The tapes are easily damaged and the drives are very costly. Newer options include re-writable CD-ROMs, called CD-RW. Each disk can hold about 650 MB of data, which is plenty of room to store program and data files. It’s difficult to buy a computer today that doesn’t have a CD-RW already installed. You can also consider using a portable hard drive to back up data; these come in all shapes and sizes and many of them are larger than the hard drives you currently have. A newer option, for offices that have broadband connections, is online backup. Data is sent over the Internet to secure off-site servers. Backups can be scheduled during lunch or after hours so that they don’t interfere with the practice schedule. Don’t even consider this option if you only have a dial-up Internet connection, as the data backup would take days to complete.

What to back-up
The basic rule-of-thumb is to backup anything that you could not easily replace. In many cases, it’s not necessary to back up the PMS program files, since all that you need to do is re-install the program with the original discs (you did keep the discs, didn’t you?). It’s usually not enough to just make a backup of the folder containing the software, since Windows programs install files over the place like Windows\system32 and other difficult-to-find locations. You should also develop a system to archive digital images. CD-RW isn’t necessarily the best choice here, as images can easily fill up many gigabytes of storage. To conserve space, you can archive and remove images for patients that are rarely used, such as patients no longer in the practice.

Avoiding a “gotcha”
One problem that can often happen is when a program changes its main file name. In a networked office, the typical setup is to have a main server and the workstations “map”, or point to, the folder or filename on the server. In some cases, updating or installing new software changes the name of the file or folder. In this case, all the network mapping would be lost. Dentists should check with the software company before upgrading and work with a networking specialist if necessary to minimize their down time.

Pointers for a “clean” install
In order to try to get as clean an installation/upgrade as possible, you should close down any programs that might be running in the background. Many computers have anti-virus programs running (and if they don’t, they should!) and these are usually easy to close down. But what about programs that are running in the background that you might not see? Here’s how to find them. In most versions of Windows, go to the Start button, click Run, and then type in “msconfig” (without the quotation marks). In the window that opens up, select the “Startup” tab. Every item that starts when your computer boots up will have a check mark next to it. In many cases, these programs can and should be turned off. Some you cannot, so look up some of the programs online or work with a computer consultant before you start unchecking random boxes. As an added bonus, depending on how many programs you turn off, you should see that Windows boots up much faster. The other factor that will help this process is to defragment your hard drive (typically found under Programs/Accessories/System Tools/Disk Defragmenter). When you write data to hard drives, it often becomes fragmented as different parts of the same file are spread throughout the hard drive. Defragmenting will reconnect these files and speed up the system, and allow your installation to be written to one contiguous area of the drive.

When to start
So, you’ve cleaned up the hard drive, made a backup and verified that the backup can be restored. Are you ready to proceed? (This is not something that you want to attempt on Friday afternoon at 4:30 p.m.) Although most of the PMS programs have taken pains to develop installation routines that are easy to follow, they are hardly foolproof. Many doctors found out the hard way that software compatible with Windows 98 or 2000 didn’t work properly with XP. Keep in mind that you typically have many integrated programs trying to function together, such as PMS, image manipulation, databases, Microsoft Office, Internet browsers, and many others. The point being, upgrades and installations are not always as smooth as they were designed to be. And when things go wrong, you need to have someone to call. Make sure that the software company is available to help in case of a problem. Make sure that your computer/networking consultant knows your plans and can offer assistance if necessary; you might even consider paying an expert to do the install and give yourself some peace of mind! I would certainly recommend that the install occur on your day off or a day that the practice is closed during the week.

Training the staff
Your staff can be a great resource to assist in this process. Many doctors I’ve spoken to are surprised to see the level of knowledge that the staff has when it comes to computers and the software. If you haven’t done software training for your office, now is the time to consider this. These programs can be extremely complicated, and the more they know about the software and how to troubleshoot, the better off you will be. All of the major software companies offer various levels of training, from telephone and video/CDROMs to on-site training. Find the method that will give you the best level of training; it’s one of the smartest investments you can make. And don’t limit the training to just one or a few staff members. Everyone in the office should become proficient in all aspects of the software, whether or not they have “clearance” to perform all the functions. You never know when a staff member might leave the office, and their knowledge and training will leave with them as well, so be prepared.

What can go wrong?
In a word, everything! Murphy’s Law was practically invented for computers and software! You could corrupt the data. You could make your operating system unstable and prone to frequent crashing, if it even boots up at all. Your digital cameras or radiography systems might no longer function, and if they do function, it won’t be with the same software you’ve used for years. You could lose your ability to see other computers on the network, your ability to use the modem for e-claims, and too many other problems to mention. Make sure that you have ALL the discs that came with your computer systems and the components handy: the operating system, driver files, installation discs, and manuals. The better prepared you are, the easier it will be to recover from a problem.

Fixing it right
Even with the best of efforts, some offices will get into trouble they cannot fix on their own. Some good advice is to have phone numbers available for people who can help. The software company should have a toll-free support number. Some are better than others at having technical support representatives accessible in a timely manner. If you worked with a computer company to build and install your hardware and software, make sure they are available. Keep manuals and software nearby for all the components in the systems. There are many online resources as well, such as the DentalTown message boards (my personal favorite!) at www.DentalTown.com/.

Software upgrades and installation shouldn’t be a difficult process, although it often turns out this way. The office that properly evaluates reasons for upgrading and prepares for all eventualities will find the process to be smooth and rewarding. Software is constantly evolving, and dentists shouldn’t have reasons to hesitate with an upgrade if the newer version will increase their ability to run a better practice.

Any dentist who has considered an upgrade of his or her technology systems has encountered the concept of integration. Technology systems are often multi-faceted and consist of software, hardware, networks, digital cameras, intraoral cameras, digital radiography and a host of other systems. In this article, we will explore the concept of integration, determine if it’s something that we need to achieve, and look at how some of the large software companies have started to achieve integration of the various products.

What Do We Mean By Integration?
Most technology consultants and experts would not necessarily agree on the exact definition of integration. In most cases, we are talking about the ability to take multiple divergent systems and find a way to make them work together. For example, taking a digital radiography system and having it work within your PMS software is an example of integration. However, I believe that we need to go one step further to define integration as it applies to the modern dental practice. When you talk to vendors and software companies, the ideal of integration is to have multiple systems that appear to be part of one large system. In other words, it’s not enough to have the digital radiography sensors work with the software. Instead, we want to be able to see the images on the same page as the patient charting which is on the same page as other patient data. So, in reality, when discussing integration, we’re really talking about seamless integration, which is certainly more difficult to achieve.

Do We Need It?
The first question that needs to be answered, then, is whether this goal of seamless integration is really necessary. I would suggest that it’s really a matter of personal preference, since there are pros and cons on both sides. There are certain advantages to having seamless integration. Many dentists prefer to have as much information on one screen as possible. They find it inconvenient to have to open a separate program for the PMS, digital radiography, digital images, cosmetic imaging, charting, etc. By putting all that info on one screen, they can get a “snapshot” of the patient that gives them x-rays, charting, photos, and treatment plan information at once. This scenario also makes it easier for the dentist and staff to learn the software, as the program navigation will be consistent and easier to learn on one software program vs. many programs. In most cases, an integrated suite of programs is easier for the patient to understand, which is an important component of co-diagnosis.

Some would argue, though, that the concept of integration is overblown. Although having all the images on one screen is handy, in some cases, you cannot do any manipulation to the thumbnail-sized images. Double-clicking the image will launch a separate software program, which isn’t truly integration in this case. I do feel it’s important that images be stored in a format that is standardized, such as JPEGs for photos. More importantly, you might not want an image to be fully integrated with the PMS software. If you decide to change PMS programs down the road, the question becomes how easy is it to extract these images and transfer them to your new software. For this reason, there are many software programs that are used solely for image management and manipulation. They interface directly with the major PMS programs, but keep the images in a separate database. So, if PMS programs are switched, the images are unaffected, as long as the new PMS has a “bridge” to the image program.

Another reason to consider using third-party image programs is the concept of open architecture. In the past, software was designed to work with one product only. If you purchased a Trophy digital radiography sensor, the accompanying software worked only with Trophy sensors. But what would happen if you decided that you wanted to buy a Dexis or Schick sensor as well? How could you use two or more different sensors without having to use multiple software programs? This is the concept behind open architecture. The goal of an open architecture program is to allow bridging and compatibility with not only existing components, but to be easily adaptable to any new technologies or systems that appear in the future. A truly open architecture software program will interface with any digital x-ray sensor, any video capture card, any digital camera, and any intraoral camera. There are some very good image programs on the market. Some of the better ones are Mediadent, Apteryx Xva3, SciCan Image F/X 4.0, and Vipersoft.

As there has been a huge amount of consolidation and change in the dental technology field, I would like to illustrate where the level of integration exists in what I call the “Big Four” PMS software products, which are Dentrix, Eaglesoft, PracticeWorks, and Softdent. There are certainly many other PMS programs out there that are quite capable and worthy of consideration. I choose to look at these four programs because combined they account for the vast majority of all new PMS software purchases. They are also owned by large dental companies and there is a strong possibility that these products will continue to evolve and will not disappear from the dental landscape anytime in the near future.

One caveat to keep in mind is that consolidation is a double-edged sword. While the goal of the software companies is to allow dentists to work with one company, this does tend to limit your choices unless you are willing to work with third party applications. The different software vendors will support their own products out-of-the-box, but it will often require some bridges and expense to get the software to work with another company’s products.

Dentrix
Of all the major PMS software programs, Dentrix was truly the first and still the most advanced in the level of seamless integration. Dentrix is owned by Henry Schein, which has a long history in the dental field. Dentrix has always had a very popular management program, which is now on version 9.0. A few years ago, they recognized not only the future role that digital images would play in the dental office, but the need to have the different products appear to work together seamlessly. They developed their integration package and called it DDO, which stands for Digital Dental Office. Rather than develop products from scratch, they chose to re-design one of the better image management products, Vipersoft. The Dentrix-branded Image 3.0, and ImageCam are based on the Vipersoft and ViperCam products. As Vipersoft was routinely regarded as the top product in the field, this was a wise decision! While Dentrix does have a truly integrated package, dentists should be aware that they do have the option of using any intraoral camera and any digital radiography sensor within the Dentrix program. In some cases, dentists will elect to continue to use their existing image management software. This will necessitate the use of a bridge, which is a software program that will allow patient demographic information to be transferred to the image management component of the camera or x-ray unit. This bridge typically costs about $1000, but is a good investment for the practice that already has sensors or cameras that they would like to continue to use in Dentrix’s PMS software. Of course, if the practice elects to use the Denrix image management software, then a bridge is rarely needed.

Eaglesoft
Following the lead of Dentrix and other companies, Eaglesoft, from Patterson Dental, has also developed a truly integrated solution for their customers. Recognizing the need to give their customers a one-stop shop for technology, Patterson also took over the marketing and distribution of Schick, which makes a well-regarded digital radiography sensor and also has released an USB-based intraoral camera. They also handle Gendex Denoptix, which is the most popular phosphor-plate digital radiography system. In the past, Eaglesoft had a bridge that would allow you to have the Schick or Denoptix VixWin software open up from the patient screen. While the Schick software is still highly regarded, Eaglesoft has now incorporated their own Advanced Imaging module; it does require an additional purchase. With this module, digital camera and radiography images can be directly captured, manipulated, and stored. The program works best with products from other companies that are part of the Patterson family, including Gendex Denoptix, and Planmeca.

PracticeWorks/Softdent
While PracticeWorks and Softdent are still two very distinct and separate products, the same company owns them and their clinical integration is following a similar path. Like Dentrix and Eaglesoft, PracticeWorks recognized the need to incorporate various vendors’ products to create an integrated solution. They are now the main distributor for Trophy digital radiography. While PracticeWorks has a rudimentary image management program, they recognized that the folks at DiCom had a far superior product, and they bought the DiCom program. Softdent has a built-in image management module, Softchart, which is relatively good, compared to other software products, but PracticeWorks is still encouraging customers to move up to the PracticeWorks DiCom Imaging 2.1 package. DiCom can handle any digital camera image, and works best with the Trophy digital radiography system.

All of the current PMS programs can handle digital images and digital x-rays, although at various levels of integration. The challenge that faces the dentist is to determine if the products of one specific company meet his or her needs. If not, then further research is needed to find third-party programs that can allow for full integration and flexibility.

Dr. Lorne Lavine has more than 10 years private practice experience, specializing in Periodontics and Implant Dentistry. He has written for and been interviewed by numerous dental publications. He lectures nationally on technology in the dental practice and is president of Dental Technology Consultants, which provides full-service consulting and integration to dentists who are upgrading their practice management systems. He can be reached toll-free at 866-204-3398, by email at dtc@dtc4u.com, or on his website at www.dtc4u.com.