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.