First Impressions Magazine

by Laura Thill

Taking it Digital
Digital equipment and office EMRs take dentistry to a new level of practice.

It’s faster and efficient, and more of your dental customers are making the switch. From traditional paper files and bulging charts, to front office automated billing systems and digital X-rays in the operatory, dentists are steadily converting their practices to paperless, computerized businesses. If distributor reps don’t keep pace, they may miss an opportunity with these customers.

Of course, no dental office is completely "paperless," as Dave Steck, vice president and general manager of Sullivan-Schein (Milwaukee, Wis.), points out. But there’s no question in his mind that digital-based offices run more efficiently, with a substantially reduced workload for the staff. So, in spite of the cost of automating a practice and training employees on a new system, this may be one investment that dentists can’t afford not to make.

Obstacles
Indeed, implementing a new system can be overwhelming to many dentists. The cost varies, depending on the size of the practice and whether it already owns computer hardware or an electronic medical record (EMR) for office billing. Still, it’s never cheap to automate. "Even if the practice already has all of the hardware in place, the cost of upgrading the system could range from $15,000 [for an EMR] to $30,000 or $40,000 for a digital X-ray system," says Steck. "Then, there is the added expense of any additional hardware [the practice needs]." Often, a dental practice will purchase its computer hardware from a local vendor that provides networking and ongoing support, he adds.

"[A practice should] soak up the cost of implementing a new system," he continues. "It’s an investment a doctor must make in [his] future. Even if the practice spends $50,000, this costs about $1,000 a month in payments for about five years. In comparison, without an automated system, each month the dentist would spend between $200 and $300 for [traditional] X-ray film and another $100 to develop the film. Then there is the cost of maintaining the film processor." Steck says he believes a practice begins to see a payback on a new system after three or four years, although the improvement in office efficiency is immediate.

Even when cost is not a factor, a huge barrier to implementing a new system is "the fear of the unknown," says Mary Beth Humenik, who manages her husband Mark’s Northbrook, Ill.-based dental practice. "It was hard to get our staff to change its way of thinking," she says. "Not everyone was comfortable [with the idea] of using computers. They thought they wouldn’t have enough time to type in patient notes (instead of writing them in the chart)."

Dental hygienists are perfectionists, she says. Their patient charts are meticulously organized and they hesitate to change anything that may get in the way of this. Bringing staff on board with a new system was "a matter of learning new skill sets," she continues. In the end, it took two days of training to bring everyone to a point where they could use the system. "Most software programs and diagnostic equipment are fairly simple to use," she says. "And vendors are usually open to helping out with [system interfaces] and ongoing support."

Not that it’s easy for every dentist to close his or her practice for a day or two to train staff. But, the dental staff accounts for the greatest office expense, says Steck. "The staff is much more efficient when the office is automated, with greater accessibility to patient charts, records, scheduling [and more]," he says.

However, the staff is only as efficient as the system permits. "The average dental office today is automated for scheduling and billing," adds Steck. "Only 20 to 25 percent of dental practices in the United States have [transitioned] to digital films and X-rays." If the operatory is not digital-based, or if it is not integrated with the front office, the staff at the front desk cannot access patient records. A "paperless" office refers to digital equipment together with an automated record keeping system, notes Steck.

Well worth it
When Dr. Mary Verardi started a new dental practice in 2005, she couldn’t imagine anything but a high-tech, digital operation. She purchased a complete package: Dell computers ordered to spec, a practice management system for the front office, and digital radiography for the operatory. It took the vendor two days to load the software and another two days to train the staff to operate the system.

"I wouldn’t encourage any practice starting up to use anything but a digital system," says Verardi. "Still, this process requires a lot of communication [to run smoothly]. There really should be one individual who comes in and coordinates everything."

Verardi is convinced that a practice can recover the cost of a new system relatively quickly. Regardless, the advantages for dentists and staff are worth every penny.

"The greatest advantage of [going] digital is having less work for the office staff," she says. For example, digital X-ray systems do not require traditional developers and processors. "At the practice I formerly worked at, there would be a fight over who would have to clean the developer," she says. In the end, it was never put back together quite properly, she adds.

Humenik agrees. "After using digital X-ray, it would be so hard [for the] staff to take an X-ray, run it through a processor and then put it into a plastic viewing envelope," she says.

Digital X-rays provide immediate results, decreasing X-ray times by as much as 10 to 25 minutes. "With the old, hard X-rays, we never knew if we needed to retake them until they were developed," says Verardi.

In addition, digital X-ray can be enlarged for better viewing and more precise diagnostics. Digital intra-oral cameras enable patients to see actual pictures of their teeth on a chair-side monitor. "Being able to see [his] mouth encourages the patient to ask more questions and have a dialogue with [the dentist]," says Verardi.

Humenik finds that voice-activated, automated periodontal charting has also enhanced office efficiency. "It used to be that [the hygienist] would rely on an assistant to call out numbers, which [he] would write down," she says. "Now, the computer is programmed for each hygienist’s voice commands." Using a headset, the process is hands-free and involves only one operator.

It’s not just the operatory that runs more efficiently using digital technology. The front office staff’s workload is reduced substantially by replacing paper patient files with digital ones and switching to automated insurance claims. "The office staff is the dentist’s greatest expense," says Steck. "When the office is automated, and the staff has better access to patient charts, records and scheduling, it is more efficient and more productive."

"We don’t have to assign individual staff to locate or pull charts," says Verardi. Fewer paper charts mean less clutter and less shelf space being consumed. A digital practice can also avoid many of the smaller expenses that accrue, such as purchasing paper, stickers for paper charts and postage (since mail is replaced by e-mail).

"But, really, the greatest savings with a digital office is that the staff is so much more efficient," she says. For instance, sending out insurance claims, which used to involve up to a 90-day turnaround, now takes five seconds to "click and send."

"We used to mail insurance claims and hope the proper person received each claim and ministered to it," say Humenik. "Now we [e-mail] claims, sending them through an automated clearinghouse." Claims are tracked from start to finish and, as long as the information is correct, they are automatically processed. Turnaround time on claims has dropped to several days, she adds.

Think bigger
Selecting a software vendor can be intimidating for some dentists. But, the process need not hinder a group’s efforts to transition to a digital operation. Trade shows provide a good starting point, but the best way to identify reliable vendor partners is by networking, suggests Humenik. "Get a feeling for what systems work best for other practices," she says. "Find out what kind of ongoing support they are getting."

"Be sure the software company will be around for a long time and that it has the capability to create ‘bridges’ that link new diagnostic devices and technology to existing software programs the practice is using," says Verardi. Dental technology is advancing quickly, she says. But, dentists are often hesitant to change with it. That’s an opportunity for distributor reps, who can help their dental customers stay current on the latest diagnostic devices and the most efficient office management systems.

"If I was a new dentist, I’d view ‘digital’ as a cost of entry," says Humenik. "First, there’s the patients’ perception. They want to know, ‘Is this someone who is current and using the latest diagnostic equipment?’" For dentists looking to add a new doctor to the practice, many computer-savvy practitioners will include in their curriculum vitae a list of software programs they have worked with.

"Dentists should think bigger," says Verardi. "In the long run, it is better [for them to] bite off more than they can chew. When I purchased my software system, I had to consider what I planned to do and how I wanted to practice dentistry. I knew I eventually wanted to own a second practice." Today, Verardi offers her patients a full cosmetic package and when she does open another office, her system will enable her to integrate both practices.

"My patients notice my office," she says. "When they have a choice of practices, patients will [invariably] select the updated office. I think having a digital office makes a big difference, both to patients and new staff a dentist would like to hire."

The paperless design

When Dr. Mary Verardi recently participated in the annual Dental Office Design Competition sponsored by Dental Economics magazine and Matsco, an Emeryville, Calif.-based financing company for dentists, she presented her plan for a state-of-the-art automated dental practice. The following includes highlights from Verardi’s proposal, which details the design of her Lake Mary, Fla.-based practice.

Practice Philosophy

Detail oriented
Attentive to patient’s physical and emotional needs.

Patient and Staff Flow

Handicap accessible
Wide hallways and rounded corners
Seven operatories
Patient flow pattern designed to eliminate congestion of incoming and outgoing patients.

Design Criteria

Mediadent intra-oral sensors
Sirona Orthophos XG 5 digital panorex
Mediadent imaging software
Multi-media LCD flat screens
Digi-Doc backpack intra-oral camera.
Canon EOS Digital Rebel XT extra-oral camera
Mediadent practice management system
Voice-activated periodontal software
Paper scanner
High resolution scanner for hard radiographs
Remote access to office database.

Benefits of Digital Practice

Clutter free (no space-consuming paper charts, documents and forms)
Increased staff efficiency (no searching for misplaced charts or cleaning X-ray processor)
More time to interact with patient
Patients take a more active role in their dental care (digital photos, X-ray and charting views better educate patients).

Verardi designed her practice to accommodate future growth and additional staff and doctors. Before converting a dental practice from "paper" to "paperless," she recommends drawing up a list of dissatisfactions with one’s current practice situation.