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.

The Paperless Dental Office

This is the first in a series of posts where I will present my thoughts on how any dental office can best move from the traditional paper-based charting and billing system to a full-functioning “paperless” practice.

There have been many “webinars” and industry magazine articles written on this subject, but most have been thinly veiled advertisements for some particular office management software product. Most of those dental software products are not really capable of creating accurate, legally sufficient and HIPAA compliant patient records in my opinion. I’ll get into the “why” of that opinion in a minute.

A lot of becoming “paperless” depends on exactly how you define paperless. You can consider yourself paperless by some definitions if you simply record all your patient transactions, appointment scheduling, and other administrative tasks in electronic form. I knew a dentist years ago who was about as paperless as you could get back in those days ten years ago. He did not use any special software that was designed specifically for a dental practice, despite the availability of several popular packages available back in those days ten or fifteen years ago. Instead of buying a dental specific software package, he used Quicken or QuickBooks to keep track of all the procedures he performed on his patients and the charges for those procedures so he could keep track of all his patient billings and account balances. He even created an invoice form in his QuickBooks that looked like an insurance claim form in order to file claims with the various insurance company payors he worked with. I have to admire his dedication and computer skills in setting that system up! For his appointment book, he used the standard Microsoft Outlook calendar and he used Microsoft Office to keep a series of documents for his patients that contained his clinical notes, referral letters, case presentations, and other such items for his records.

Remarkably, this New England dentist even made up a full screen sized drawing of a basic tooth chart similar to what was normally purchased in paper form for charting back in those days. He could then open up that basic, blank chart drawing with Microsoft Paint and then, using his mouse, he could draw on the chart with a blue or red “brush” just as if he were drawing on a paper chart with colored pencils. He would then save the chart drawing to that specific patient’s folder where he could look at it any time he wanted to. At the next patient visit, he would re-open the previous chart drawing and make any changes to it as necessary and then save the modified chart drawing as a new file in the patient’s folder. Over time, this would result in a series of chart drawings for any given patient, each dated for when it was created or last edited. This allowed the dentist to “go back” and look at a patient’s chart at any point in time in his history with the dentist, a capability that some current dental programs that do any kind of charting still can’t do today!

Dental office management programs were all designed to bring all the functions just described above into one overall program that should make those tasks easier and more efficient for the dentist. Most of those programs were either DOS based programs or Unix programs designed in the early days of the 80’s and 90’s to take care of the administrative tasks (billing and account tracking, insurance filing and appointment book maintenance), and they had no way to manage the clinical records.

Today, many programs are designed to keep at least a generic version of clinical records, and a few have even developed a graphical tooth chart of sorts.
With the advent of better programs, the question now becomes “How can I utilize some of the technologies available today to eliminate unnecessary paper from my office”. Before answering that question, you may ask “Why would I want to convert my office to Electronic Records,” or to put it differently, “Why would I want to go paperless?”

The answers to the “Why” questions are fairly straightforward. Becoming paperless saves administrative expense in several ways. You save money by not having to buy all those paper products, which can be significantly expensive. You also save by not having to store all that paper that can easily be lost or mis-filed making it difficult to find when you need it next.

To me, the biggest advantage of using Electronic Dental Records is their availability at any time anywhere in the office, and even in two or more places at the very same time. The elimination of the time required to file and retrieve paper files when needed is way more significant than most offices realize, especially when a patient file is not filed correctly whenever a user is finished with it.

Then to, there are the government mandates that all healthcare providers, including dentists, must implement electronic records within the next few years, so why not start now?

Given that long introduction to EMR (Electronic Medical Records) in the dental office, and assuming that you want to convert your practice over to all electronic records, how can you efficiently and effectively accomplish that transition?

That will be the subject of my next post following in a couple of days. Check back later if you are interested in my thoughts on how best to transition to an all-electronic patient records or paperless practice. I will also post a link to where you can download an ebook of the whole process at once.