How to Go Paperless In the Dental Office Technology Guide

Technology Guide
How to Go Paperless
In the Dental Office
By: Dr. Larry Emmott
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Steps to going paperless:
•
•
•
•
Create the System
Stop Making Paper
Scan the Incoming
Pull Charts for 6-12 Months
Create the System:
To create a paperless electronic chart you must first examine what you are now storing on
paper. Generally the items in the chart fall in one of four categories, personal, financial,
treatment or diagnostic. You will need a system to create all of these items in a digital
format. The leading practice management systems like Dentrix or Softdent are designed
to do just that. They will create and store most of the items in the personal financial and
treatment categories.
To create digital diagnostic information, the practice will need a digital x-ray system, a
digital camera with image management software and a digital perio probing and chart
system like the Florida Probe.
The only paper items left are what the rest of the world sends. That is paper from
insurance companies, specialists, dental labs, other dentists and finance companies. How
the heck can you have a paperless office if the world keeps sending you paper?
Simply scan it. When some paper arrives that should be kept in the patient record such as
a follow up letter from a specialist, the office administrator opens the letter, puts it on the
scanner and within seconds the letter is copied into the patient record. The original paper
is then shredded.
Scanning is a good solution for now. However it won’t be long before we will be using
the Internet for all the bits of paper we are still sending and receiving.
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What does digital mean?
In the most literal sense to digitize something means to turn it into digits or numbers. In
a more practical sense it means turning something into the electronic language a
computer can understand.
A digital record is now possible because we have technology to convert everything we
used to store in a paper folder to a digital format. This includes data; that is information
in the forms of words and numbers. But it also can include pictures and radiographs. We
can digitize sounds, movies and even solid objects.
Digitized information can be stored, transmitted and manipulated electronically.
Dead Wood: It is probably a useful exercise to evaluate your paper system and
see what you are doing now that can be eliminated or streamlined with an electronic
system. For example many offices find they have a process in place that was set up years
ago that made sense at the time but is now no longer useful. However it is still being done
because that’s the way we have always done it. Other processes are no longer needed
because an electronic record is more efficient. For example it isn’t necessary to make
multiple copies of documents needed by many people; the original can be accessed from
any computer at any time.
It is possible to turn dead tree (paper) information into electronic digital information.
There are four ways to create digital information.
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Create the System
Enter it: What this refers to is the process of directly
typing or clicking in information.
Capture it: Digital capture refers to a process that
creates or captures information (usually images) into an
electronic format. In dentistry the best examples would
be digital photographs and digital radiographs.
Scan it: A scanner is a hardware device that converts
hard copy papers into soft copy digital information.
Import it: Data import does not create new digital information. It is a function that
allows users to add already existing digital information to a patient record. The difference
between scanning and importing is that scanning starts with a piece of paper. Importing
never goes through a paper phase.
This concept is a leap of vision for many dentists; who have viewed
technology as an endless and unwanted expense that often causes more trouble than it's
worth. However if dentists start looking at their technology as not just a local machine
but as a component in the big picture; then computer technology and information
integration makes more sense. The computer and digital information are essential not
only for making internal operations run smoothly but to provide crucial interaction and
commerce with specialists, suppliers as well as the patients
Guide to Creating Digital
Charts
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Software
Hardware
Process
Alternative
Personal Information
Name Address Phone etc.
Practice Management Sytstem
Keyboard and mouse
Type information into patient
record
Outgoing Paper Correspondence
Word Processing
Keyboard and mouse
Incoming Paper Correspondence
Practice Management System
Scanner
Electronic correspondence
e-Mail application like Outlook
Keyboard and mouse
Forms, Medical Consents etc
Practice Management System
Keyboard, mouse and scanner
Type in letter, print it for mailing,
then import it to the patient
record. Do not keep a paper
copy.
Scan the letter, import to patient
record and then shred the
paper.
Type message and send via email with copy or link to patient
record. Copy incoming to patient
record.
Have the patient fill out a paper
form, then click or type in
essential data to the patient
record. Then scan and import
the form with a signature to the
record.
Import information from an
electronic source such as a
web page or a tablet PC
Fill pre-formatted letter from
template with data exported
from patient record
Diagnostics
X-Rays
Digital Radiography Specific
Direct Sensoror and/or Digital
Panoramic
Place the sensor like a film and
directly capture a digital image
into a specific electronic record
attached to the patient record.
Capture a digital image with a
phosphor indirect sensor and
scan it into the software
Photographs
Image Management either dental
specific or general photographic
Digital Camera, a Card Reader and
possibly a video capture card
Take photos and download
them to the image management
software. Either link the photos
to the patient record or store
them as part of the record.
Capture a digital image from
an intraoral video camera with
either a capture card or direct
USB digital connection.
Perio Probings
Practice Management System or
perio specific charting software.
Electronic Probe like Florida Probe
Capture probing depths directly
with the probe and foot control.
Speak in the probing depths
with voice activated perio
charting or type in the
numbers with a keyboard
Treatment Information
Tooth Chart
Practice management System
Mouse and keyboard
Speak in conditions with voice
activated charting.
Treatment History
Practice management System
Mouse and keyboard
Click in tooth conditions and
restorations with an on screen
chart
Chart notes are entered
automatically when procedures
are completed. The dentist edits
the notes as needed
Treatment Plans
Practice management System
Mouse and keyboard
Lab slips
Practice Management System or
Lab specific software.
Mouse and keyboard
Prescriptions
Practice management System
Mouse and Keyboard
Specialist Referrals
Practice management System
with word processing or e-Mail
Mouse and Keyboard
Re-Call Information
Practice management System
with word processing or e-Mail
Mouse and Keyboard
Financial Information
Insurance Forms
Practice Management System
Mouse Keyboard and Internet
Insurance EOBs
Practice Management System
Scanner
Payment History
Practice Management System
Mouse and Keyboard
Click in proposed restorations
and other treatments with an on
screen chart. Display selected
treatments for patient
acceptance.
Type in lab procedure or click in
data from patient record. Print
and send with case.
Prescription is linked to patient
record choose from menu, print
and sign.
Note referral in patient record
then transfer diagnostics such
as radiographs and photos to a
word document then print and
send with patient
Note re-call interval and track
automatically within patient
record. Create and mail cards as
reminders.
Select completed procedres
from patient record and send eclaim
Scan EOB into patient record
and shred the paper
Enter payments
Extract data from electronic
record to fill pre-formatted emails and send automatically.
Use a tablet PC to directly
capture the patient data with
electronic writing and import
the inofrmation including an
electronic signature to the
patient record
Speak in notes with voice
recognition software.
Send lab Rx via e-mail or
through lab web page with
attached photos.
Rather than printing send the
clinical data and diagnostics
to the specialist via e-mail.
Rather than printing cards
software automatically
extracts re-call data and
sends e-mail.
Print and mail claim
Import EOB from e-mail or
web page
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Stop Making Paper
Once the system to create all the digital information is in place, you simply stop making
paper. Everything new is electronic; everything from the past is paper.
If we don't change direction soon, we'll end up
where we're going.
Professor Irwin Corey
One of the common mistakes dentists make with electronic charting is that they only go
part way. Sometimes we miss the obvious, it is the old “can’t see the forest for the trees”
(dead or alive). In this case the trees are the individual processes that can be used to
create digital information. The forest is the paperless record. If all you see are trees then
you might use an electronic chart for treatment planning but make progress notes on
paper. You might install a digital radiograph system and not link it to other records. You
might have a computer up front for finances and scheduling but don’t have computers in
the back for charting.
The tendency is to concentrate on individual processes or technologies without
integrating the process into the whole.
For example: The office may use a paper chart in the treatment room during diagnosis to
mark future treatment. Then they take the paper chart to the computer and enter
everything again. They will use the computer to create an estimate, insurance forms and
schedule. Then they will go back to the paper chart to enter procedure notes, back to the
computer to take a payment, back to paper for a prescription, back to the computer for the
next appointment then back to paper to check the x-rays.
What the office ends up with is a mess. Everything is done at least twice, the paper chart
is still needed no one is ever sure if something is on paper or in the computer. As a result
the computer chart doesn’t save time and money it makes things worse.
Another mistake is to gather digital information, such as photographs, but store it in
separate software that is not part of the patient’s digital record. To be most effective the
digital information must be all part of the same record using either a fully integrated
system or linking each system using computer bridges.
Time and again the dental office has everything in place to go paperless but they still
make paper just because that is the way they have always done it. Overcoming the inertia
of change is frequently the most difficult task of going paperless.
There is also an element of fear. Often it is the dentist but it may be the staff; one or the
other is afraid of what they do not know, the future, so they hold on to what is known, the
past.
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Scan the Incoming
How the heck can I have a paperless office if the
world keeps sending me paper? I get paper from
insurance companies. I get paper from specialists,
I get paper form dental labs, I get paper from
other dentists. I get paper from finance
companies…
The answer is scan ‘em.
A scanner is a hardware input device that
transforms hard copy into digital electronic form.
To scan paper any old scanner will do. However
if you wish to scan an x-ray the scanner must
have a transparency adaptor. Many scanners have
a small transparency adaptor designed to scan a
single 35mm slide. This is OK for a single x-ray but useless for a panoramic or a full
mouth series. Look for a scanner with a large transparency adaptor priced at about $300.
Be warned; some vendors will try and sell you a special x-ray scanner for well over
$1,000.
Using a scanner you can digitize paper documents and then attach them to the patient’s
digital record. When some paper arrives that should be kept in the patient record such as
a follow up letter from a specialist, the office administrator opens the letter, puts it on the
scanner and within seconds the letter is copied into the patient record. The original paper
is then shredded. You can use this method to scan and capture x-rays and photos as well
as forms and letters.
Attention: Based on my experience I know right now some of the practice
administrators reading this are saying to themselves, “Oh great another thing for me to
do. Scan all the letters. I don’t have time for all this!” Calm down, think it through. What
are you doing now with all the letters and EOBs? You open the envelope, glance through
the letter, go to the file room, find the proper chart and insert the letter. That will actually
take more time than scanning into the digital record. But there is more. When the doctor
needs to read the letter he or she asks for the chart and again you need to get up and
search it out then take it where it is needed. The fact is using a scanner will not take more
time it will save time, lots of time.
Depending on the Practice Management System, documents can also be attached to
multiple sources such as labs, referral sources, insurance companies or doctors and
hygienists. You can then reference the letter from wherever you have a computer
running. There is no need to run to the file room and sort through the charts then locate
the letter stuffed in the middle of everything else. If you need a hard copy it can be
printed or it can be sent electronically via e-mail.
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Pull Charts for 6-12 Months
Going paperless is a process not an event. At first you will need the paper charts on all
your patients as you will be referring to the previous paper entries. As time goes on you
will need to refer less and less to the old paper records. After a year all the current x-rays
will be digital and all the patients recent entries and treatment plans should be digital. It is
now possible to stop pulling charts. However at first you will need to refer to the old
charts fairly often for entries or x-rays more than a year old. Eventually you will rarely
ever need to pull a chart.
Do not try and scan in all the old records.
Many dentists believe that in order to go paperless they must convert all their old records.
This is a huge, time consuming and expensive task with a very limited benefit.
At most you may wish to scan the most recent records of patients who are currently under
treatment.
Going paperless is a process not an event.
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Dr. Larry Emmott is one of the most entertaining speakers in dentistry and he is
considered the leading dental high tech authority in the country. He has over thirty years
of experience as a practicing general dentist in Phoenix, AZ. He has addressed hundreds
of professional groups and has been a featured speaker at every major US dental meeting.
This article is an excerpt from the technology guide “Going Paperless in the Dental
Office”. This is one of three books Dr Emmott has written on high tech in the dental
office. You can find the full guide here: www.drlarryemmott.com. For more information
contact Dr. Emmott at:LarryEmmott@drlarryemmott.com or 602 791-7071
The Future is Coming
and it will be Amazing!