Controlling the chaotic STORM in paperless dentistry

How many times have you heard, "Why is it that when I get some order to my practice, something new comes along and creates chaos?" Digital technology and paperless dentistry are the new buzzwords in dental journals and at seminars. Patient charts, paper forms, X-ray film, and a myriad of other materials have been the mainstay of dental offices over the decades.

by T. Roy Nakai, DDS

Integrated technology, single-database software programs,

How many times have you heard, "Why is it that when I get some order to my practice, something new comes along and creates chaos?" Digital technology and paperless dentistry are the new buzzwords in dental journals and at seminars. Patient charts, paper forms, X-ray film, and a myriad of other materials have been the mainstay of dental offices over the decades. Although it is difficult to relinquish these tangibles, there appears to be a paradigm shift in dentistry urging us to follow industry developments in digital technology. These technologies have created an environment where we now can be totally paperless ... but less than 2 percent of practices are paperless.

As one pursues research in this area, it becomes apparent that the choices in digital formats create as much confusion as benefit. The programs change as rapidly as computer software operating systems. Realizing that dentistry is hectic by nature, certain aspects must be strongly considered when implementing a paperless digital office. Creating formal and practical protocols for every aspect of the practice is critical so patients can see that technology benefits their care. Providing a visual education, as well as caring for patients' special needs, increases treatment acceptance. Where is the starting point for this digital research, and how can the ensuing chaos be controlled?

Chaos theory, as it applies to dentistry, states that no two days unfold in a replicable manner. This is a natural part of modern dentistry. You can, however, manage a smooth flowing practice with few blips by streamlining various processes. The key is to start with your main information center.

Initial research is anecdotal. Learning from the trials of those who have made the commitment to running paperless can make our transition easier.

In 1999, Dr. Danny Tse, founder of Master Dentist Institute, made the timely decision to assist doctors in creating high-technology practices that were totally paperless. It was a monumental undertaking, but, being the visionary he is, the calculable benefits he foresaw were well worth the time, cost, and effort.

Realizing that digital formats were just evolving, Dr. Tse felt that he had to make sound decisions based not only on current knowledge and equipment, but on continued future stability and development. He believed that it was important to select an integrated, single-database software program as the focal point. Another requirement was that this program needed to be easily accountable and auditable.

Why is this important in creating a digital paperless practice? According to Dr. Tse, "This is a very costly investment, and one cannot afford to purchase products and programs that will be outdated or not supported tomorrow. I also selected a stable, single-database software program because I wanted operational simplicity and a program that easily integrated with a multitude of digital formats."

Most offices have very complete practice-management software that functions smoothly, thoroughly, and efficiently. The majority of those offices have added a clinical-management suite for basic charting, periodontal charting, clinical exams, and notes. This pretty picture becomes murky with the introduction of digital technology. The two most important words to consider when incorporating digital technology into your practice are interface and integration.

Scenario 1: Interface - In an attempt to end the chaotic world of film, developers, light boxes, and photos, an office adds an interfaced digital-imaging or cosmetic software to its system. Now, there are two sets of software, from two companies, sharing only limited data and requiring multiple steps, bridges, or dongles to mate the image to the information. When the patient's record is accessed in the main computer program, additional software programs must be accessed to view images. All enhancements must be accomplished in the proprietary imaging software. Beyond that, this office must maintain multiple databases, perform multiple backups, and must deal with a multitude of companies for troubleshooting, updating, and training.

Scenario 2: Integration - This same practice incorporates an integrated digital-imaging package into its system. All image procurement and enhancements are accomplished by the same software with all of the patient information attached to the images. This allows the office to easily and quickly produce images for case presentations and treatment plans. During a case presentation at chairside, the doctor can display a treatment plan, video, and X-ray images for the patient to view on the operatory monitor. Dr. Tse calls this presentation process "codiagnosis." The patient is able to view dental images on the monitor screen and participate in the visual diagnosis with the doctor and staff, and a codiagnosis environment is created. Dr. Tse experiences a very high acceptance of this type of treatment-plan presentation. More importantly, all of the images are stored in the patient's data folder within one software system, requiring only one backup, one database, and one company to contact for service and support.

A single database is important. It is the core software program to which the other digital technologies must integrate. It allows the dentist to incorporate a variety of digital formats without the cumbersome task of importing images or accessing bridged images. Recognizing where and when chaos creeps into our operational systems enables us to control and direct them more appropriately.

Dr. Claudio Levato has done just that. As a charter member of this new wave of technology, Dr. Levato not only loves it, he thrives on it! Understanding that the complexities of digital technology can introduce a degree of turmoil in any office, Dr. Levato is a proponent of the one-database, integrated concept. While his staff did an excellent job of maintaining a mixture of digital systems, Dr. Levato realized that this fragmentation of information was creating chaos in his practice. Even though each program came with its own set of bells and whistles, the confusion, frustration, and inefficiency inherent with using a multitude of platforms outweighed the benefits. Dr. Levato required the additional flexibility to utilize a variety of high-end digital programs. To continue to use SchickRegistered, PlanmecaRegistered, and Gendextrademark sensors/panoramic radiographs and DenOptixtrademark and ScanXRegistered phosphor plates, he had to select software that allowed for a variety of options as well as being fully integrated. Committing to a single-database program has made his office functions less stressful and more efficient.

Aside from obvious considerations like stability and longevity when purchasing software, the choice to add digital-technology software must be measured carefully. Dentists must evaluate the software itself and be assured that its manufacturer is going to support it in the future. Single, digitally integrated database programs are rapidly eclipsing the stand-alone units used in traditional dental offices. Drs. Tse and Levato are pioneers in paperless practices and provide guidelines to follow in the evolution of the digital environment. Today's dentist must judge from the growing number of options in digital technology to ensure that he eliminates disorder, rather than adding more. Integrated technology, single-database software programs, and a little organization are your keys to controlling the storm.

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