Jeff Carter, DDS
Many articles have been written about what can be accomplished with dental "high-tech" wizardry and at what cost. A lot of speculation exists about the merits of individual "information-based" dental technology systems available now, including:
> Practice-management software
> Intraoral cameras, extraoral cameras, and imaging software
> Digital radiography
> Patient-education programming
> Patient entertainment/relaxation programming
> Diagnostic adjunctives
> Internet/e-mail/online services
The purpose of this article is basic: What can you get, at what cost, and what is it going to do for your practice? As you read this, you may also want to know where we get our information.
T.H.E. Design staff members take informal polls at our monthly design conference. Keep in mind that our conference attendees are not a representative cross section of the 100,000-plus licensed practitioners in the United States, but rather a sampling of many of the most productive, high-end practices.
We frequently request input on a wide variety of technology questions at the conference, such as:
"Does your practice have intraoral cameras?" Approximately half of the doctors attending our conferences have an intraoral camera.
"If you have intraoral cameras, are they on a cart?" Approximately half of the doctors have them on carts, and approximately 100 percent of the doctors that have intraoral cameras on carts frown when they answer that question.
"How many of those who have intraoral cameras connect the video feed to a computer?" Approximately 10 percent of the doctors that have intraoral cameras connect the video feed to a computer.
"Who has Caesy, ADH, or some other type of patient-education programming?" Approximately 20 to 25 percent of conference doctors utilize patient-education programming.
"What practice-management software are you utilizing?" The three most popular packages - in no particular order - are Dentrix, Practiceworks, and Softdent.
Based on these kinds of questions and interactions, we, at T.H.E. Design, feel that there are two distinct system trends developing in most practices.
Let`s design each system based on a general profile of a doctor that we will name Dr. X (no, not the professional wrestler, if you are old enough to remember). Dr. X is a solo practitioner with one full-time hygienist, working out of four operatories. Dr. X`s monthly production is $30,000 to $45,000. He has a low case acceptance of comprehensive treatment by patients. He has an existing patient base with a predominately low dental IQ, and his new referral patients have an even a lower dental IQ than his existing patient base.
What follows is a description of each system with the associated costs.
Technology system Rx for Dr. X:
INTRAORAL CAMERA
> analog, networked intraoral cameras, accessible in all operatories
> freeze frame
> print capability
> digital-image storage
> imaging software
PATIENT EDUCATION
> specific procedure presentations accessible in all operatories and consultation room
> generalized multimedia presentations for waiting/ reception area
PRACTICE-MANAGEMENT SOFTWARE
> accessible on a client-server digital network in the following areas:
x three workstations in business area
x one workstation in consultation room
x one workstation in doctor`s office
System One
In this example, we are combining an analog operatory configuration with a networked digital-computer system. The intent is to keep costs down for the entire system, but when you read the system`s estimated price tag, you may wonder what costs are being kept down. Individual technology-system components may appear reasonably priced, but an integrated and highly functional system always generates significant costs.
Let`s walk through the basic functions of System One as it might relate to a new patient in Dr. X`s practice. A little background information on this particular new patient is helpful. Several years ago, this hypothetical patient, Mr. Noway, was overheard telling a doctor, "I really don`t like the way my teeth look, but there is no (expletive deleted) way you are mowing my teeth down into those `little pegs.` "
(1) Mr. Noway enters the facility for the first time and checks in at the reception area. While seated in the waiting area, Mr. Noway`s attention is directed towards a ceiling-mounted monitor displaying generalized information on the latest advances in cosmetic dentistry, including veneers and bleaching. He anticipates images of teeth being "mowed down" by miniature industrial-strength jackhammers and mouth-sized Sears Craftsman routers. These objectionable images never appear.
(2) Mr. Noway is seated in the operatory and a new patient exam is conducted, including intraoral camera images. A quadrant of intraoral camera images is displayed on the operatory patient-view monitor. Noway remarks, "Look at that. My teeth look worse than ever!" Dr. X and his staff briefly discuss Mr. Noway`s dentition with him and then schedule a consultation appointment to present a comprehensive treatment plan.
(3) A staff member digitally records Mr. Noway`s intraoral camera images onto a disc through an analog-networked recorder.
(4) Dr. X (or a trained staff member) takes the disc to the doctor`s private office and downloads intraoral camera images into a networked computer with imaging software loaded on the computer`s hard drive. Dr. X (or a trained staff member) cosmetically images Mr. Noway`s dentition and creates "before-and-after" images in a PowerPoint presentation. This presentation also outlines the proposed treatment sequence, costs, and financing options.
(5) Mr. Noway returns for the presentation of his comprehensive treatment plan in the consultation room. Dr. X displays (on a high-quality 17" SVGA computer monitor) "before-and-after" cosmetically altered images to Mr. Noway, saying "This what we can do for you." Dr. X selects a specific patient-education presentation on veneers and bleaching and then shows it to Mr. Noway, emphasizing, "This is how we will do the procedure." Dr. X or the treatment coordinator then discusses the overall treatment plan - including costs and the time it will take to do the procedure - with Mr. Noway.
(6) Mr. Noway returns for his first comprehensive treatment appointment. Seated in the operatory, he views a specific patient-education presentation about veneering on the patient-view monitor. He is reassured that there will be no mowing, no miniature jackhammers, and no routing (OK, there may be a little "routing" today).
(7) Thanks in part to technology, comprehensive high-quality treatment for Mr. Noway is now on its way.
In this example, Mr. Noway interacted with information-based technology at four points in the process before a syringe or handpiece entered the picture. Do you have any doubt that other patients, similar to Mr. Noway, are more likely to accept comprehensive treatment and attain a higher dental IQ through the use of integrated technology systems? We know how much fun it is to draw sketches on the backs of tray covers and napkins for case presentations, but that method is often incongruent with a $10,000 comprehensive treatment plan.
"(Expletive deleted), I am not spending this much!" you think. "What is that other technology system trend you mentioned earlier in the article?"
The other trend is actually an upgrade to System One and more costly. The main difference between the two trends is the answer to one critical question: "Do you want computers in the operatories?"
If you think your answer to that question is "yes," may we introduce you to another technology system Rx for Dr. X:
INTRAORAL CAMERA
> digitally networked intraoral cameras accessible in all operatories
> freeze frame
> print capability
> digital-image storage
> imaging software
PATIENT EDUCATION
> specific procedure presentations accessible in all operatories and the consultation room
> generalized multimedia presentations for waiting/ reception area
PRACTICE-MANAGEMENT SOFTWARE
> accessible on a client-server digital network in the following areas:
x three workstations in business area
x one workstation in consultation room
x one workstation in doctor`s office
x one workstation in each of the four operatories
System Two Description
All technology-system components are linked electronically in a fully integrated digital network. In System One, our interface between analog and digital was a hand-carried magnetic storage media (disc).
If we contrast Mr. Noway`s experience with System One and System Two, there is no difference other than possible appointment-scheduling from the operatory versus the business area. Therefore, in System Two, Mr. Noway also will interact with information-based technology at four points in the process before a syringe or handpiece enters the picture. The significant difference is for Dr. X and his staff. System Two is a much more efficient and flexible configuration. In fact, there is mounting evidence that computerized scheduling from the operatories is becoming so efficient that large increases in production and patients treated can occur without the hiring of more business staff.
An established practice probably already has at least a few - if not several - of the components of System One and System Two. Therefore, the actual cost in both examples can be significantly less. Equipment pricing can vary wildly in many cases. Computer hardware and software often can be purchased as component packages with significant savings. Regardless, based on our data, the estimated total cost for each system is "in the ballpark."
Is either system a wise practice investment just to increase case acceptance and raise patients` dental IQs? How might you evaluate this type of investment? Assume you do not want to pay cash and choose to finance the entire cost. A typical equipment loan would be in this range:
"So, you`re telling me I have to produce $1,289 (System One) or $1,656 (System Two) each month just to cover the cost of the system? I am trying to be more productive and profitable. How is this going to help?"
To justify this cost and turn it into a profitable investment, a return of at least 10 percent (stock market average over the years) is required. (Of course this is an active investment, which also means you have to work at it.) That translates into an additional $1,417 (System One) or $1,821 (System Two) each month to make this worth doing. Would you go to all this trouble to net an additional $100+ a month? Would you now like to change your name to Dr. Noway, a distant second cousin to Mr. Noway?
You know your practice and your ability to sell dentistry. If you had these tools, how much more could you sell and produce? If these tools were implemented successfully, could you gain two comprehensive treatment plans a month? How about four?
These technology tools work equally as well on your existing patient base to maximize acceptance of proposed treatment that already has been diagnosed. Historical tracking statistics are available on intraoral cameras, patient education, and other technology systems and their ability to create huge production increases. No real data exists on fully integrated technology systems working together to provide the best attributes of each individual system.
If you could increase your production $5,000 to $10,000 a month with either system, then that would be a pretty good deal. This increase does not require additional staff or time because you are doing the kind of comprehensive treatment you were trained - and continue to train - to do. You are no longer doing the less satisfying and less productive "drill, fill, pill, and bill" dentistry. After all, the only expense you want to increase is your lab bill.
For more information about this article, contact the author at (800) 444-4843. A biography of the author appears on page 8.
COMPONENTS AND ESTIMATED COSTS - SYSTEM ONE
OPERATORY COMPONENTS
Commercial quality video monitor.....5 x $350
Video monitor mounts.................5 x $150
Intraoral camera, stand-alone......4 x $4,000
CENTRALIZED ANALOG COMPONENTS
DVD player 1 x $300
Intraoral camera printer...........1 x $1,000
Video matrix switcher..............1 x $1,500
Digital recorder.....................1 x $300
DIGITAL COMPUTER HARDWARE COMPONENTS
Dedicated server with tape backup..1 x $5,500
Pentium III CPU....................5 x $1,000
DVD ROM drive........................1 x $300
15" CRT SVGA monitor.................4 x $200
17" CRT SVGA monitor.................2 x $350
Network interface card................5 x $50
100 base-T network hub...............1 x $250
Back-up power supply.................6 x $100
Keyboard and mouse....................6 x $50
Laser printer........................1 x $700
Ink jet printer......................1 x $300
SOFTWARE
Practice-management software.......1 x $6,000
Imaging software...................1 x $1,000
Patient education DVD (2 discs)........$2,200
Windows NT network software..........1 x $650
Windows 98 OS........................5 x $180
System design and engineering fees.....$5,500
Wiring, supplies, misc.,
and installation.......................$7,000
COMPONENTS AND ESTIMATED COSTS - SYSTEM TWO
OPERATORY COMPONENTS
Commercial quality video monitor....5 x $350
Video monitor mounts................5 x $150
Intraoral camera, stand-alone.....4 x $4,000
Pentium III CPU...................4 x $1,000
DVD ROM drive.......................4 x $300
Video capture card..................4 x $200
Flat screen LCD monitor...........4 x $1,000
Ergonomic positioning arm...........4 x $700
Infection control input devices (2).4 x $100
Backup power supply.................4 x $100
Network interface card...............4 x $50
DIGITAL COMPUTER HARDWARE COMPONENTS
Dedicated server with tape backup.1 x $6,500
Pentium III CPU...................5 x $1,000
DVD ROM drive.......................1 x $300
15" CRT SVGA monitor................4 x $200
17" CRT SVGA monitor................2 x $350
Network interface card...............5 x $50
100 base-T network hub..............1 x $350
Backup power supply.................6 x $100
Keyboard and mouse...................6 x $50
Laser printer.......................1 x $700
Ink jet printer.....................1 x $300
SOFTWARE
Practice-management software.....1 x $6,000
Imaging software.................1 x $1,000
Patient education DVD (5 discs)......$3,300
Windows NT network software........1 x $650
Windows 98 OS 9 x $180
System design and engineering fees...$5,500
Wiring, supplies, misc.,
and installation....................$10,000
