HOW TO PROFIT FROM... computers

Dentists typically devote much time and energy to staff training, office design, billing, case presentation ... and honing skills that improve the day-to-day performance in their practices. Some practitioners are beginning to use long-range management tools, such as strategic planning and patient-based marketing.

Wave of informatics will transform profession

Jeffrey C. Bauer, Ph.D.,

William T. Brown, DDS,

Paul R. Zimnik, DO

Dentists typically devote much time and energy to staff training, office design, billing, case presentation ... and honing skills that improve the day-to-day performance in their practices. Some practitioners are beginning to use long-range management tools, such as strategic planning and patient-based marketing.

Ironically, the dental profession`s historical commitment to practice management does not mean that dentists automatically are positioned for success in the future. The most important health resource of the 21st century - information - has not been a specific concern of dental-practice management in the past. Managing information will be the key to success in the not-too-distant future.

Dentists certainly have a lot to teach physicians about practice management. However, a few insightful medical doctors confronting managed care in the early 1990s were the first to recognize the importance of information applied to all aspects of clinical practice. They established a field of study called medical informatics.

Medical informatics has become an identifiable discipline with its own journals, institutes, and conferences. Because of its more distinct clinical focus, dentistry may offer an even better environment for perfecting this new field of study. Dental informatics is almost certainly an idea whose time is about to come.

What is informatics?

Informatics is the applied science of collecting, storing, and retrieving data to support informed decision-making. The health-related methodologies and applications of informatics still are being developed, but the foundations already are quite distinct and can be evaluated from the perspective of modern dental practices. Many dentists may already be headed in the right direction without realizing that they are early participants in an information revolution.

Foundations of informatics

The technological foundations for informatics are modern computers, networks, and digitization. Indeed, the full application of information science to health care, or any other field, would not be possible without the revolution in technology that has occurred over the past five years. Dentistry can and will be transformed as progressive practitioners and practice managers begin to embrace new possibilities created by these three major developments in information technology.

* Modern computers offer immediate access to unprecedented computational power. Today`s microprocessors and peripheral devices are brand new tools - not simple refinements of the mainframe-based systems that once defined computing. Advancements in storage capacity and processing speed empower us to think about using information in ways that were not possible just a few years ago. Best of all, the cost of computing power has plummeted to affordable levels.

* Networks, the result of combining computer and telecommunication technologies, allow information systems to be built and operated in new ways. Computers now can communicate among themselves to share data and software on a real-time (i.e., current) basis, achieving new benefits in the process. For example, several independent clinicians can pool patient information for large-scale studies of a new procedure, or the latest version of software can be downloaded via the Internet to identify and evaluate trends in practice economics. In other words, the modem - not the disk drive - is the key to the emerging power of informatics.

* Digitization, the process of transforming real-world data into computer language, is the third element in the revolutionary world of information technology. Digitization amounts to the storage and, increasingly, to the acquisition of all information in electronic form. Once various sources of information are stored in compatible digital formats, they can be analyzed and understood in ways that were impractical, even impossible, when the same information was stored on paper. Indeed, the world of informatics almost is paperless.

Integrated information

Integration of information is the conceptual corollary to the recent technological developments that make informatics possible in a doctor`s practice. The new technologies allow decision-makers to answer related questions from the combined perspectives of clinical, financial, and managerial databases.

Thanks to digitization and powerful developments in multimedia software, informatics can be used to create systems that span the boundaries between different types of practice information. Text files, spreadsheets, billing records, visual images (radiographs, photographs), and even sound can be brought together as needed to produce a new level of information about a specific patient, a group of patients, a single practice, or an organization.

Integrated digital information can be used to identify and schedule the "least-cost" combination of personnel for producing quality-controlled services that achieve the desired reduction in total expenditures over a defined period of time. In plain English, this means doing a better job and making more money. This type of comprehensive analysis is extremely difficult to accomplish when patient accounts, clinical charts, and personnel information are in different files that have nothing in common, even if one or more of the files is computerized.

Dental informatics

Dental informatics can be expected to experience explosive growth as a branch of practice management when dentists learn the value of using computers, networks, and digitization to bring information together for purposes of improving quality and lowering costs.

Dental informatics ultimately will expand far beyond the traditional concerns of practice management. Informational tools already used in medical practices suggest how much change is in store for dentists as these technologies are transferred to dentistry.

* Informatics will affect the way dentists communicate with one another. E-mail on the Internet, chat rooms on the World Wide Web, and "store-and-forward" or interactive real-time links to consulting specialists will redefine the relationships among doctors.

* Informatics will change the doctor-patient relationship. Recall appointments will be handled electronically for a growing number of patients. Follow-up care will occur over the Internet, creating documentation to minimize the problems of professional liability. Patient education will be accomplished through Web sites, mailing lists, and news groups.

* Informatics will change the way dentists learn. High-powered graphics and computer simulations will provide opportunities to evaluate and model new products, techniques, and support services. Continuing-education credits will be earned through on-line courses managed by dental schools and publishers.

* Informatics will change the way dentists earn their incomes. Electronic management of patient accounts will be the rule, not the exception, in the not-too-distant future. Verification of benefits, preauthorization of treatment, and patient charting increasingly will be accomplished on-line. Reimbursement will be tied directly to the use of information technology.

As noted, these examples simply apply some existing applications of medical informatics to the world of dentistry. All health professions will be changed even more by the ongoing transfer of information technologies from outside the health sector. Banking, communications, computers, transportation, and entertainment are far ahead of health care in harnessing informatics. The entrepreneurs who developed leading-edge information technologies for these industries are just beginning to turn their attention to health care. Some exciting developments surely will follow.

Steps in the right direction

Not surprisingly, some dentists already are positioning themselves and their practices for active participation in the evolution of dental informatics. Here are just a few examples of currently available tools using computers, networks, and/or digitization to produce boundary-spanning information that can improve dental practice.

* Digital radiography acquires the image directly on computer disk for archiving and retrieval, eliminating film-related costs and exposing the patient to 70 percent less radiation.

* Digital photography produces computerized pre- and post-treatment images to document the benefits of therapy for the patient, the dental record, and the dental plan (via a formal network link).

* Intraoral cameras allow the dentist to document physical findings in remarkable detail and allow patients to see their teeth and gums while they are in the dental chair.

* Computer-assisted design and manufacturing (CAD/CAM) devices scan a prepared tooth and fabricate a restoration in one visit, avoiding the cost and inconvenience of impressions and temporaries.

* Computer-assisted anesthetic delivery systems increase safety, assess risk, and reduce costs through the use of expert systems based on scientifically designed clinical protocols.

What to do now?

Dentists who want to prepare for the informatics revolution can get a head start. Put a very high priority on becoming computer literate and getting on-line as soon as possible. Learn how to use and integrate software that includes the basic office functions - word processing, spreadsheet construction, database management. Then, start using multimedia-presentation software to bring together images, text, and data. Above all, learn how to use a communications package for e-mail correspondence and Internet searches.

Competence in using networked computers will become very important as informatics becomes the new foundation of dental-practice management. Given the rapid pace of change in the 1990s and the high relative value of information in the 21st century, investing in the skills to use information technology will pay off sooner rather than later. Informatics may just be arriving in dentistry, but it is here to stay.

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