Whether you’d rather put all the pieces together yourself or prefer a turn-key set-up, you need to consider some important questions first.
Digital technology in the dental practice has become a high priority. Many practices are now completely digital and paperless. How did they get there, and are they really paperless? Many issues need consideration, and without careful planning, you can end up with a mix-and-match system that performs marginally - definitely not what you envisioned. Let’s take a look at some of the steps in building a digital practice or retrofitting your existing practice.
Office design - Assess your needs. Decide up front what type of digital solution will meet your needs and expectations based on the number of operatories. The physical size of the office as well as the number of staff members can make some systems cost-prohibitive, so determine beforehand what will work best for your practice rather than attempt to “make it fit” later. Many doctors have not been advised of the costs of a computer network or a complete digital solution, but if it is planned well and fully implemented, it will perform beyond your expectations.
Initial design considerations - Two types of digital X-ray systems are available - direct digital sensors and indirect (phosphorus plate, or PSP) systems. Address this first, because the type of system you choose will dictate part of your office design. We’ll take a closer look at the features and benefits of these technologies a bit later. For purposes of planning, it is important to envision how both of them work. Typically, a PSP system is located in one spot, therefore you must set aside space in your design for a computer and the device that scans the plates. The location should be convenient for clinical staff and not compete for space in your prep and clinical areas. Sterilization areas may be enlarged to accommodate this technology because they are usually centrally located. This device requires certain other supplies, so plan for an additional shelf. Although the technology is digital, it is similar to a film processor. It is much faster, but images are captured in the operatory and then taken to the electronic processor to be digitized. Resolution is excellent, but they take more time to use than a direct sensor system. PSP systems are widely used in larger offices because the number of direct sensors required makes the initial investment much higher. Look at each system and compare it to the way you take X-rays now. Some offices use a combination of direct and indirect technology. This is the best of both worlds.
Direct digital sensors are completely different with no need for central processing. Each sensor can either be moved from room to room, or a dedicated set can be placed in each room. Most digital sensors plug into a USB port. Some office designs can include external USB ports built into the cabinetry and connected to the computer, so decide on your cabinet design after you have decided on hardware and type of digital solution. Some cabinet designers are not familiar with computer CPU sizes or their cooling air flow requirements. Adequate cabinet venting is a must for equipment longevity.
Let’s look at operatory design. Dentists ask me, “How many monitors do I need?” and, “Where should I place them?” Both are good questions. A dual-head solution is optimal. One scenario is to have a monitor for staff use and data entry by the doctor, and one for patient presentation, education, and entertainment. Where space does not allow for two monitors, one monitor can be strategically mounted for use by the patient as well as the doctor and staff. First, decide how a new-patient appointment would flow. In a paperless system where all data is entered into the computer, the assistant would be recording most of that information. The mounting arms for the computer flat screen can be pole-mounted (chair), wall-mounted, or countertop-mounted. The location and type of bracket used should provide viewing by the patient only when you wish to use it as a consultation/education tool or entertainment device. Its location and mounting bracket also needs to allow an adequate view for the doctor and assistant. Larger, high-grade flat screens work best for this task. Make sure your vendor has experience integrating this equipment into your plans. There are real advantages to a dual-head installation. If you have a fully digital system including practice-management software, integrated digital X-ray, cosmetic imaging, and patient education, you can multi-task saving valuable time -
› While showing a patient how she would look with anterior restorations, the assistant can be entering these images as a proposed treatment plan.
› A patient-education CD can be playing on the chair monitor while a presentation of the patient’s “before” and proposed “after” images are being set up for the doctor to perform the consult.
› Relaxation scenes on the patient monitor can be running while the assistant is recording progress notes, waiting for the doctor, impressions to cure, etc.
Computer networks - Many networking options are available, and several companies provide one-stop shopping. Be careful when choosing a supplier. Look for name-brand machines such as Dell and Hewlett Packard. These manufacturers provide excellent equipment with on-site warranties. Be wary of the price that is too good to be true. If it costs much less, then it probably doesn’t have the features you will need. First, make sure the operating system is up to date. XP Professional is Microsoft’s current operating system. Second, make sure the computer has a business-level processor. Most manufacturers are providing Pentium 4 processors as their premium offer. Also, make sure the computer has enough random access memory, or RAM. Most dental software companies recommend 512 mb of RAM. For a small additional cost, you can increase it to one gigabyte, or 1,000 megabytes, of RAM. We suggest your initial plan have a dedicated server if you’re planning on having more than four computer workstations. The dedicated server will allow you to grow without making any major changes. You may want to consider a redundant array of independent disks, or RAID, configuration for your server, containing two or three mirrored hard drives. A RAID will protect your data in the event of a hard drive failure. This inexpensive solution can ensure no loss of production time. On a single-disk system you have your backup disk, but it takes time to restore and may not be up to date like a duplicate drive. Newer software is server/client-based, operates better, and is less susceptible to crashes. The new system will allow you to multi-task when educating and treatment-planning your patients.
Be aware that some computer providers have never sold or implemented digital dental systems, and the requirements are different than for other types of businesses. Interview prospective hardware service companies and ask for local references who have implemented the same technologies you’re seeking. Remember - buy as much computer as your budget will allow. Your system will run better with greater longevity of the hardware.
The life of this equipment typically is three years. Good software companies are continually developing their products to provide cutting-edge dental management and imaging software. When looking at software, always ask to see some evidence of significant updates in the last 24 months. Planning this technology is like driving - you must always look ahead. Meeting needs before it hurts production is the goal. Keep in mind that paperless systems do not increase your production unless they operate correctly and unhindered with many simultaneous users. Select a software/hardware vendor who can help you plan and anticipate your future needs. With new, more sophisticated tools, your system can be monitored by qualified personnel as well as maintained and repaired when needed.
Evaluating the technology - The digital X-ray business has become very competitive. You must do your homework to get the latest technology for the best price. Seek out the most knowledgeable people and listen to what they have to say. Don’t buy a system without seeing clear evidence of its diagnostic superiority over film, as well as the expertise of the sales and technology representative who comes to your office to do the presentation. Ask about the specifications of the device and look for clear answers. Do not accept general statements such as “This brand has the best sensor” (or best Phosphor system) without some documented, scientific facts to back them up. Be aware that many types of this technology - still widely marketed - have changed very little in the past six years. The proof will always be in the final image.
Timothy N. McLaughlin is regional director for MediaDent, a division of MultiMedia Dental Systems, Inc. McLaughlin has lectured nationally on digital radiology and the digital office. He has extensive consulting experience on cosmetic imaging case presentation, as well as a background in the logistics of the “paperless dental practice.” He is a certified trainer on digital X-ray implementation. Reach McLaughlin at (877) 770-8514, ext. 331, or e-mail [email protected].
