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10.07.05 Issue #187  
Six Steps to a Chartless Practice

Lorne Levine, DMD
President, Dental Technology

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There is no doubt that the modern dental practice has changed rapidly over the past ten years. Dentists have come to realize that with new technology, they can create a practice that is more efficient, costs less to run, and allows for decentralization of the front office. Records that were primarily paper and film-based are being replaced by digital radiography, electronic records, and a move towards a paperless, or at the very least, chartless practice.

The challenge for most offices is to develop the best plan on how to evaluate their current and future purchases to ensure that all the systems will integrate properly together. While many dentists are visually oriented and thus tend to focus on the criteria that they can actually see and touch, some of the most important decisions are related to more abstract standards. I have therefore developed a six-point checklist that I feel is mandatory for any dentists who are adding new technologies to their office, and I recommend that each step be completed in order:

  1. Practice Management Software. It all starts with the administrative software that is running the practice. To develop a chartless practice, this software must be capable of some very basic functions, such as the ability to enter charting, treatment plans, handle insurance estimation and processing with e-claims, ongoing patient retention and recall activation, scheduling, and about dozens of other functions that are used on a daily basis. It is also vitally important that the software provide security measures to address patient concerns over privacy. Many older programs do not have these features and if an office wants to move forward, they will have to look at more modern practice software.

  2. Image Management Software. This is probably the most challenging decision for any office. Most of the practice management programs will offer an image management module: Eaglesoft has Advanced Imaging, Dentrix has Image 4.0, and so on. These modules are tightly integrated with the practice management software and will tend to work best with digital systems sold by the company. However, there are also many third-party image programs that will bridge very easily to the practice management software and offer more flexibility and choices, although with slightly less integration. Just as with the practice management software, protecting patient privacy should be a key feature. Some of the better known image programs include Apteryx XRayVision, XDR, and Tigerview.

  3. Operatory Design. The days of a single intraoral camera and a TV in the upper corner are being replaced by more modern systems. The majority of offices are placing two monitors in the operatories, one for the patient to view images or patient education or entertainment, and one for the dentist and staff to use for charting and treatment planning and any HIPAA-sensitive information.. There are numerous ergonomic issues that must be addressed when placing the monitors, keyboards, and mice. For example, a keyboard that is placed in a position that requires the dentist to twist his or her back around will cause problems, as will a monitor that is improperly positioned. So, not only do we need to properly place the monitor, keyboard, and mouse, but there are a number of issues related to the infrastructure that must also be addressed. These include the dimension and ventilation of the 12 o’clock cabinet for the CPU, cable conduits in the floor and ceiling, and power requirements for all the devices.

  4. Computer hardware. After the software has been chosen and the operatories designed, it’s time to add the computers. Most offices will require a dedicated server in order to protect their data as well as having the necessary horsepower to run the network, and the workstations must be configured to handle the higher graphical needs of the office. The computers placed in the operatories are often different from the front desk computers in many ways: they’ll have dual display capabilities, better video cards to handle digital imaging, smaller cases to fit inside the cabinets, and wireless keyboards and mice.

  5. Digital systems. The choice of image software will dictate which systems are compatible. Digital radiography is the hot technology at this time, due to the benefits of faster times to view images, higher resolution, and the ability to easily enhance the image but intraoral cameras are still an excellent addition to any office since they allow patients to see the things that typically only a practitioner could see. Most dentists are using or considering use of a digital camera as well since these are superior to intraoral cameras for case documentation and lab communications. All systems have pros and cons and dentists will have to evaluate each system based on a set of standards that are important to that practice.

  6. Data Protection. With a chartless practice, protecting the data is absolutely crucial to prevent data loss due to malware or user errors. Every office, at a minimum, should be using antivirus software to protect against the multitude of known viruses and worms, a firewall to protect against hackers who try to infiltrate the network, and have an easy-to-verify backup protocol in place to be able to recover from any disaster. The different backup protocols are as varied as the number of offices, but it is crucial that the backup is taken offsite daily and can be restored in a quick manner.
Dr. Lorne Lavine, founder and president of Dental Technology Consultants, has over 20 years invested in the dental and dental technology fields. Dr. Lavine has vast experience with dental technology systems. He is a CompTia Certified A+ Computer Repair Technician, CompTia Network+ certified and will soon be a Microsoft Certified Systems Administrator.  As a consultant and integrator, he has extensive hands-on experience with most practice management software, image management software, digital cameras, intraoral cameras, computers, networks, and digital radiography systems. Dr. Lavine, also writes for many well-known industry publications and lectures across the country.  Dr. Lavine can be reached at 866-204-3398

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