The Paperless Dental Office, Part Two

The Paperless Dental Office, Part Two

Why should you transition to a Paperless Dental Office? As I discussed in my last post, there are several reasons to begin using EMR (Electronic Medical Records). As a recap, I see basically three reasons.
1. Save time and money. Getting rid of paper billing records and charts, as well as film and development costs for imaging records, will undoubtedly save lots of time creating, filing, storing, and retrieving these records. You will also save the large cost of the paper and film supplies necessary for these non-EMR records.
2. EMR also yield large savings whenever you need to send copies of your records to either the patient or another provider who may not be located near you. EMR copies may be instantly made and transferred at no cost for supplies or courier charges.
3. Within the next couple of years, all healthcare providers, including dentists, will be required to use Electronic Medical Records in order to fulfill the government mandate that all patient medical records must be able to be added to an aggregating HIE (Health Information Exchange) where EMR from all healthcare providers may be collected into one overall EHR (Electronic Health Record). This overall EHR must be accessible to the patient as well as any healthcare provider needing that information to better serve the patient’s needs, enhancing coordination of treatments between all providers.

If you have decided to transition to Electronic Dental Records, the question now becomes, “How do I do that with the least trouble and the best results?”

The first step you must take is to evaluate your needs and wants since there is no “one size fits all” method or path to a paperless dental office. You have to decide which of the stages of “paperlessness” you want to achieve.

There are three areas in your office that require attention: the administrative area, clinical (charting) record keeping, and imaging records.

If you wish to transition to electronic records in all three areas, you then need to prioritize the order of the transition unless you want to jump in with both feet and move to Electronic Records in all three areas at once.

Most dentists have at least acquired some system of electronically managing the administrative tasks of the office. Almost all dental practice management software solutions available today are focused on the administrative tasks. They are designed primarily to keep electronic billing records and scheduling patient appointments. They can file insurance claims electronically, keep track of patient account balances, and bill the patients for your work. Many have some extended functionality and are able to organize treatment plans and even some patient notes. Many dentists, as well as many practice management consultants, focus their attention on this aspect of the paperless office. There are many dental practice management software products available ranging in cost from free to several thousand dollars that are perfectly adequate for these administrative tasks, and most dentists start their path to the paperless dental office with one of these products.

Unfortunately, most dentists who start toward a paperless practice by using one of these products to attack the administrative aspects of the practice will find themselves unable to progress forward to the second stage, clinical records, easily without having to buy a new dental practice management system. The administrative-focused software they initially bought probably won’t give them the clinical capabilities necessary to advance to the EMR clinical records effectively.

Back in the MS-DOS days when the dental software industry was young, a company named Chart-It produced a rudimentary add-on product that could work with the administrative-focused applications of the day to add a sort of charting capability to the software that had no charting. It was an interesting product with a good idea as its foundation, but Chart-It was actually only a graphic representation of the administrative information necessary for filing insurance claims. It was not able to let the dentist actually draw on tooth representations exactly what he was doing as he was able to do with a paper chart and his red and blue colored pencils. All other software in those early days, and even the vast majority of all the software available today that provides some kind of graphical “chart” suffers from the same problem.

Why is that? No one saw any need to record anything beyond what was necessary to file insurance claims or other billing purposes. All most software is concerned about is recording the ADA codes for insurance billing purposes, and perhaps generating a graphical “chart” with generic representations of the affected teeth and surfaces involved with those codes. There was no attempt to record the exact size, shape or location on a tooth of any restoration since those details were irrelevant to the insurance coding necessary for billing. Since all programs were administratively focused, and those details of your dental work were totally irrelevant to billing functions, no software made any attempt to record those details. Almost all dental software to this day still does not record those clinical details.

What about the clinical needs for a paperless office now that we know most all programs can meet the administrative needs? This is where things get much more complicated than the simpler tasks of the administrative side of the practice. You must decide if you want a simple “chart” or if you want a real Electronic Medical Record or EMR system. I’ll discuss what is necessary for a real EMR system in my next post, so let’s move on to the third area for electronic records, imaging, for now.

Dental imaging systems have been around for quite a long time now, probably 20 years or so. I remember when Trophy brought in the first dental digital x-ray system in the early 90’s, and, as is the case of all the currently available imaging packages, it was possible to link it to any practice management system willing to provide the bridge, or integration software, to make the connection. Today, there are numerous digital imaging systems available, all of which can be linked to your PMS system provided it is willing to allow it. Most of the major dental practice management systems today are unfortunately unwilling to provide bridges to imaging technologies they do not also own. You must be careful of what you buy for a Practice Management System if you want to preserve your choices of ancillary products like imaging instead of surrendering your choices to the dictates of the Practice Management Software.

With this background on the three areas of your dental practice that must be addressed on your path to the paperless dental office, my next post will deal with the order in which you do things most efficiently as well as the criteria necessary for a clinical software product that will enable you to truly have Electronic Dental Records (EDR or EMR) in your practice.

Certified Dental EHR software

Before beginning a discussion of certified dental EHR software, it is important to realize exactly what the terms EHR and/or EMR mean.  EHR stands for “Electronic Health Record” and EMR represents “Electronic Medical Record.”  Are these two acronyms different designations for the same thing, or are they actually two different items?


Although many people use the two terms interchangeably, it seems to me that there is a difference between an EMR and an EHR.  As I understand it, an Electronic Medical Record, or EMR, is a complete record of a particular medical exam or event.  That would then be a record for a specific office visit, encounter, examination or treatment that included all the medical clinical information to completely describe the event or exam. It would not be just the accounting information necessary for charging the patient and billing the insurance carrier for work done at that event or exam.


An Electronic Health Record, or EHR, on the other hand, is more an aggregation of multiple EMR records along with other health related information such as medical histories and historical records over time of medications prescribed and taken, vital signs, immunizations, and health problems or complaints.  In other words, an EHR would be a complete history of many aspects of a patient’s overall health rather than just a small subset of those items restricted to just one phase, event or type of health status such as dental, mental, visual, or specific internal medical category.


Software has been designed for many areas of healthcare to electronically record the information making up your medical or health issues and status over time, and that’s where the terms EHR and EMR come from.  In the past, as we all know, physicians and dentists have traditionally kept these health records in paper based charts which are hard to keep updated and especially hard to share with other health care providers and facilities like hospitals.


It is the great need for sharing and portability of a patient’s medical and health records that has prompted the push for all Electronic Health Records.  Government mandates that all healthcare providers and facilities move to electronic records that can be shared among disparate providers and facilities to improve the quality of care delivered to the patients have resulted in the creation of an independent, non-profit certification body, CCHIT (Certification Commission for Health Information Technology), to define the criteria as well as to test software products for compliance with those criteria in order to “certify” them as capable of producing and sharing such electronic records.


So, a “Certified” EHR software product is simply a software product that has been designed to record medical, including dental and other health related information, electronically, and has been examined by CCHIT, the Certification Commission for Health Information Technology, for compliance with all the criteria that have been set out by the U.S. Department of Health and Human Services and found to be capable of meeting those criteria.


Unfortunately, when developing the criteria for certification, hospitals and other large medical clinical facilities were the main targets, and all the criteria are based on the perceived needs of those facilities. Dentists and other specialized healthcare providers working from small offices were not considered.  This has resulted in all specialty software products, like dental software, optician’s software, etc., having to meet the medical recording and reporting requirements that were designed for the hospitals and large medical facilities.


That is why dental software must meet all those criteria for hospital grade medical software, at least at the current time, in order to be designated as a Certified Dental EHR software product.  That is also why none of the mainstream dental software products is currently certified.  They would have to program in all the medical functionality required for the certification status, even though it is of no real importance to a dentist for his patient records.  In fact, if they did write all those additional medical tracking functions into their dental software, the dentists would not use most of it.  All that extra functionality would accomplish would be to complicate the dentist’s record keeping and add significant extra work to every patient visit.  Even though one dental program, The Complete Exam®, was developed around the year 2000 specifically to create electronic health records for dentists before the terms EHR and EMR became popular, it is not certified at this time since it was not designed to record and track the medical information required for certification.  It was, and still is, the first dental EHR system and still has the most advanced clinical charting capabilities in the industry.


Fortunately, Health and Human Services has recognized the problems with requiring all programs, regardless of specialty or area of healthcare, to be certified to large medical facility criteria.  They are currently working with the American Dental Association to try and develop separate criteria for dental applications, and they are also working on criteria for some other specialized areas of healthcare such as ophthalmology and mental health.


There currently are a very few “dental” software products that are certified, and they are predominantly medical software that has been adapted to handle the different coding and procedural aspects of dentistry.  These applications are seriously deficient in the charting capabilities needed by dentists, and are really not much more than accounting and billing systems with the medical tracking capabilities necessary to achieve certification.

How to Live With Insurance Companies and Still Have an Efficient and Enjoyable Dental Practice

Have you ever felt like the insurance companies own your practice and you just work for them?  If so, you aren’t alone.  In fact, many dentists simply work for insurance companies and don’t realize that they have subjected themselves to that role voluntarily.

Many practice management consultants and continuing education institutes constantly preach that you can have a practice that does not depend on insurance by concentrating on and appealing to only those patients who want only the best and can afford to pay for it.  However, I am sure there are lots of places where those philosophies are a little difficult, to say the least, to put into practice. Read the rest of this entry »