Barry K. Freydberg, DDS, FAGD, FICD
This article originally appeared in the Journal of Contemporary Dental Practice, Summer 2001, Volume 2, No.3 under the title, "Connecting to Success: Practice Management on the Net" and is reprinted with permission.
New computer technology has profoundly affected the ways in which dental professionals interact with patients, undertake chairside routines, perform clinical procedures, and manage the business aspects of a dental practice. Your success will depend on how you choose to leverage that technology.
Communications with referral partners, third-party carriers, and dental patients can be expedited and streamlined when tools such as the Internet and World Wide Web are fully utilized. Dental professionals can watch clinical procedures for the first time via live satellite transmission, perhaps thousands of miles from the clinician who is actually performing the procedure. This newfound efficiency requires staff to be computer-savvy, thus expanding traditional roles of dental assistants, practice administrators, office managers, and front-desk personnel.
Digital and wireless communication
Digital and wireless technologies provide new ways for people to connect with one another. It is not uncommon for patients to give cellular or digital phone numbers, pager numbers, or email addresses as their preferred methods of contact. While many dental patients accept this means of information exchange, many dental practitioners continue to resist these new forms of communication.
These practitioners can no longer ignore technological changes. Consider these statistics: In 1990, only 5 million U.S. citizens subscribed to cellular or digital telephone services. Today, approximately 90 million use cell or digital telephones, and this figure is expected to approach 140 million within the next two years. With few exceptions, telephones currently being manufactured have microbrowser capabilities (the ability to access the Internet via telephone).
Dissenters from within the dental profession argue that connectivity is removing the human touch from patient care. On the contrary, email contact is less invasive than the telephone; although email is not necessarily more intimate, it is a more considerate means of contacting patients. This is because email does not interrupt either party, and users control the length of communications, as well as the time they choose to access and respond to messages.
By enhancing the digital information flow, dental professionals can increase the likelihood of quicker and more efficient communications and interactions with dental patients.
Ultimately, the use of digital information technologies will serve as the cornerstone of a successful dental practice. The flourishing practice of the future will use digital tools to revamp the practice of dentistry. At least two of the currently available digital tools are increasingly becoming essential: a customer-oriented Web site and a comprehensive, yet research-friendly database (the practice management system).
The government's word of caution
The intent of provisions of the Health Insurance Portability and Accountability Act of 1996 (HIPAA) regulation is to create administrative simplification to assure portability of health insurance coverage in a secure electronic environment. According to the ADA News, "HIPAA contains a statutory security provision that does not rely on publication of the final HIPAA security rule to take effect. The law already requires that each person who maintains or transmits health information adopt reasonable and appropriate administrative, technical, and physical safeguards:
- To ensure the integrity and confidentiality of patient information
- To protect against any reasonably anticipated threat or hazards to the security or integrity of the information
- To protect against unauthorized uses or disclosures of the information
- To otherwise ensure compliance among employees or officers"
It is anticipated that the security rule will be clarified over time. In the meantime, dentists who transmit patient information via computer networks should exercise caution to guard against a breach of patient privacy.
Technology evolution and revolution in dentistry
Nearly 20 years ago, filing insurance claims and preparing patient statements were among the first functions to become automated. Dental practitioners soon discovered the efficiency of automating general office procedures, and staff began tracking referrals and running patient recall programs on computer systems.
The next stage in the evolution of dental technology involved "decentralizing" data entry, or placing computers in dental treatment rooms. This diminished the burden on front-desk personnel because it allowed clinicians to enter patient data from multiple locations throughout the office and reduce error rates associated with more traditional business methods. This stage also placed computers in front of the dental care providers - requiring them to become familiar with computer hardware, practice and clinical management software, and computer networks.
Practice management software evolved from a narrow administrative focus to a more complete system as clinical and management functions became interrelated. Such systems involve the integration of patient care with treatment documentation including various imaging and charting functions along with all necessary billing, recall, referral, and external communications. The result of this integration has made it very cost-effective for dentists to add computer workstations in treatment areas that capture, synthesize, and store all data obtained from intraoral cameras, digital X-rays, and computerized charting.
Today's dental practice requires a high-quality practice management system that assumes the role of "mission control" for the office. A reliable practice management system, in its broadest sense, is now the "central nervous system" of the dental practice. Use of such a system obligates all staff members to learn and become proficient with it to maximize the benefits associated with computerized and automated practice management.
Clinicians must accept that computers need to be installed in every treatment room as soon as possible. Management (practice and patient) benefits are immediately realized when computers are installed in treatment rooms because the entire staff is able to share duties traditionally performed by one or two staff members at the front desk, thereby reducing the front-desk bottleneck and enhancing office productivity. Eventually, every office should also incorporate digital camera and digital X-ray capabilities, and have a high-speed Internet connection (such as digital subscriber lines [DSLs], T1, or Ethernet connections) networked into every treatment room and support room. This will facilitate the transmission of images from one computer to another inside the office and beyond.
Practice management: The next generation
Connecting and becoming comfortable with using the Web will be essential to preparing for the next generation of dentistry-targeted software. Intra-office practice management software systems depend on regular maintenance by dentists and other staff for upgrades, backups and reconfiguration for compatibility with new programs. This software now can reside on the Internet if the dental practice subscribes to an Application Service Provider (ASP), which would be responsible for this type of maintenance.
An ASP is a third-party company that manages and distributes software-based services and solutions to clients via a wide area network (a computer network that spans a large geographical area) from a central data center or location. For example, the Internet is the largest wide area network in existence.
Basically, dentistry-related ASPs allow clinicians to rely on another company to perform almost every task related to storing, maintaining, and supporting their practice management systems. The advent of ASPs in the dental community grants dentists the freedom to store, retrieve and access practice management applications and data online from any location. This permits offices to share records on the Web and create "virtual" group practices. Additionally, the move to an Internet-based practice management system - offered by an experienced, knowledgeable, dental-oriented company - places the dental practice's data in a highly secure environment and eliminates the need for a costly software package.
Using the Internet for practice management is a low-cost investment compared with purchasing, installing, networking, and learning an entire computer system. The use of an Internet management system essentially eliminates the problem of technology obsolescence. Many offices are beginning to recognize that employing an ASP is a powerful way to defer capital costs and reduce the risk of dead-end technologies. You don't have to go out and buy hardware, software or networking gear. You don't need to hire an IT (information technology) staff and worry about upgrades, security, and system performance.
The ideal ASP partner will be one with access to vast knowledge about dentistry, exceptional technological knowledge, and with the capital to invest in new ventures. This partner will be willing to serve dentists with cost-effective, valuable products, and relationships, as well as the latest and greatest technology. Most importantly, the right partner will have invested in its employees as well as its products, hiring and training customer-oriented personnel who understand the needs of dental practices and who keep abreast of new issues and technologies affecting the dental profession and patient care. Additional advantages will materialize if dentists learn how to make wise hardware purchasing decisions and select the correct ASP partner - a company that provides superior service in addition to the product.
ASPs specializing in web-based practice management systems for dentistry will offer users a virtual private network (VPN) to achieve connectivity. These VPNs will benefit from the use of data encryption and other security devices to ensure that only authorized users can access the network and that data cannot be intercepted. Such a provider uses what is referred to as an industrial-class ASP, a technology that is housed in a secure environment. "Server farms" boast special security features, in which the host computers are locked in "cages," limiting access to one or two people employed by the company offering that service; the cages reside in an earthquake-proof facility, which is guarded 24 hours a day, seven days a week.
Eventually, companies offering ASP services to dental practices will differ according to the levels of security they offer. When evaluating the company for its services, practitioners will have to research the server facility and its security options. Overall, most issues involving maintaining and storing patient records in the practice will be resolved with a secure web-based system. A practice-management ASP will not require a complex network of in-office computers, which minimizes hardware and software maintenance issues. Plus, the ASP will take care of all system backups.
The future of dental technology
At the 1998 annual meeting of the American Dental Association (ADA), Intel demonstrated appointment scheduling using the Internet in a manner similar to that proposed by ASPs. The demonstration focused on problems that have been proposed as stumbling blocks for progress with Internet electronic scheduling vs. interacting with a human dental office scheduler. One problem addressed was patient privacy and data security. This new Internet scheduler provides patients with a password to access their own information but not to other patients' information or to critical administrative information of the dental office. It is anticipated that Web-based appointment scheduling will be universal in less than five years.
The investment in computer hardware and software for dental offices will be reduced considerably, thanks to the advent of ASPs. However, fees for Web access likely will increase because we will be paying to obtain higher access speeds, and ASP costs will be assessed based on actual usage.
Dentists need to prepare themselves for these and other changes by attending lectures and technology conferences given by the ADA, local dental associations, and vendors. They also will need a high-speed connection to the Internet. In most communities, Dedicated Subscriber Lines (DSLs) or cable modem services are available and will continue to enhance the speed of Internet access in the future. More advanced fiber optic, cable, and satellite systems undoubtedly will be introduced that will provide even faster service.
It is likely that the early adopters of ASP-based practice management systems will be dentists who have not already invested heavily in technology. Although most dentists will probably move their practice management system to the Internet within two to three years, the lower technology users will be moving first, primarily because their technology migration needs are less pressing. In other words, they do not have the huge volume of third-party products to integrate. The higher technology users will follow en masse when Internet technology can easily handle these more advanced integrations.
The predictable and lower costs associated with implementation of an ASP also will enable dental practices that historically have not had the resources to invest in hardware and software the opportunity to take advantage of a feature-rich practice management system. These offices will not have to face many of the technology evolution updates that their computer-savvy colleagues have waded through over the last five or 10 years, but can jump right in to the Internet patient-management mainstream. However, it must be remembered that just as in the early days of the first incarnations of practice management software, these are the embryonic stages of the ASP, which may go through various stages of development before reaching maturity and sophistication.
Finding the time and resources to take full advantage of these powerful new computer tools remains a serious issue. For this reason, it is essential that dentists find the right technology partner to help them navigate these unknown waters. As with any technology, the product is only a small part of the purchase. The support and the people behind the product - that is, the connectivity among dentists and dental technology companies - ultimately will allow dentists to obtain the best combination of products and services available and have more time to connect with their profession and their patients.
Dentistry and the Internet
In addition to email capabilities, dentists can take further advantage of the Internet as a communication tool for sending patients reminders and practice news. Dynamic, customizable electronic newsletters are available via the Internet with interactive linking capabilities that can direct patients to a variety of services and educational and oral health resources at virtually insignificant cost to the dentist when compared with printing and mailing patient newsletters.
By building a Web site for a dental practice and submitting information about the dental practice to search engines such as Yahoo!, Excite, Lycos, and Google, and the digital Yellow Pages, dentists can turn the Internet into a valuable marketing tool.
The Internet also provides a powerful research tool. Dental professionals can access a number of journals, periodicals, suppliers and other sites for learning about case studies, sharing ideas with other dental specialists and gathering basic patient information.
For patients, the Internet provides access to information about clinical procedures and maintaining oral health, adding value to the care provided by professionals. However, dentists need to direct patients to quality Web sites with accurate information to ensure they access the appropriate educational tools.
From a practice management standpoint, the ability to share patient records with other dental professionals such as dental specialists and other generalists is paramount. Transferring patient records via email to referral partners is not ideal because of its vulnerability to viruses, limited attachment size, lack of security and privacy (even if encrypted), and because it's not interactive. It is more desirable to use a secure Internet server, such as an Application Service Provider (ASP), which is a type of system that stores the information on the Internet.
Some dental schools are beginning to incorporate using X-rays, charting, laboratory prescriptions, and other documents on the Internet instead of manually moving records from one department to another. This solution to enhancing efficiency is a low-cost investment compared with purchasing, installing, and learning an entire computer system. The transfer of files and patient records from one office to another, or from offices to insurance carriers, will likely become one of the dental industry's most essential uses for the Internet.
The dental profession has only scratched the surface in terms of capitalizing on the Internet's possibilities.