Aug. 1, 2000
Today`s dentists are taking technology to the next level. Of paramount importance to this process is the decision of which management software to use to control information in the practice. Equally important is deciding who will work on the hardware for the network. Many companies have put together hardware systems for attorneys and accountants where only one or two types of software are used throughout the entire network. It`s much different dealing with today`s dental practice because of multi

Thoughts on software in the dental practice and an interview with Dr. Barry Freydberg

John Jameson, DDS

Today`s dentists are taking technology to the next level. Of paramount importance to this process is the decision of which management software to use to control information in the practice. Equally important is deciding who will work on the hardware for the network. Many companies have put together hardware systems for attorneys and accountants where only one or two types of software are used throughout the entire network. It`s much different dealing with today`s dental practice because of multiple softwares linked or bridged to the management software and the existing patient files.

Some basic questions have to be answered by the dental team. First, how does the practice intend to use this management software? Does your office intend to only use the software for business functions? Dentists often say they want management software strictly for business functions but, 30 to 60 days later, realize the need to expand into a network format and integrate other technologies. If the right decisions haven`t been made at that point, it`s an expensive mistake. Never underestimate what your practice can do with management software. Buy what you think you might use in the future, even if you know you won`t be using it today. Will clinical workstations be implemented? What about a network? These are important decisions that must be made when the management software is initially purchased.

It`s imperative that the entire dental team is involved in the purchasing of management software. Team members should help to decide where, ergonomically, the computer monitors should be located. Staff members will be the ones using the technology and they must have the optimal amount of training to use the purchased technology. When the management software is purchased, it is imperative that the dentist buys the training program that goes along with the software. It`s difficult for the staff to learn exactly how the software can help build the practice through osmosis only.

You must also communicate with the team how this integration of technology will take place. One of the most important things the dentist can do is to schedule "communication time" with the entire team so that everyone knows how to fully utilize this new investment and achieve the expected goals. Have a "brain trust" meeting with the entire team before and after purchasing the software. Here, the dentist can explain his or her vision for how the practice will use the software. With this information, the staff will be far less bewildered about this new technology.

Major decisions must also be made about the infrastructure of the management software. Basic research needs to take place prior to investing in software that will control every bit of data in the practice. Who owns the software company? Is it a new business or does it have a long-term track record? It`s difficult to maintain good support of the technology if the dentist calls an 800 number and no one answers. Be sure that the company that owns the software is in good financial health.

Once you`ve narrowed your decision to a few options, interview fellow dentists who actually use the software. Find out how well each company supports its product. Also find out if the software has a proven history with Windows and if it can integrate additional technology. The last thing a dentist wants to be is a company`s Beta test site.

As additional technology moves into the clinical area and clinical workstations become more integrated in the practice, the management software must allow the practice to link additional softwares to it. Some new Windows-based versions have a limited capability in this area, which can be frustrating for the dentist and the entire team. Be sure your software choice has the capability to add other components.

Implementation of the software must take place on a step-by-step basis. The entire team must know what the goals and objectives are relating to the new technology. Then look at what implementation strategy will be the most effective for your practice. Should there be changes in patient flow? Which persons within the practice will use the software? Will a learning curve be needed? If so, be sure that there is time activation on the learning-curve process. This will help the entire team avoid feelings of frustration and "working with too many loose ends." When the dentist evaluates the results, he or she must have a system in place to measure results and ensure that the new technology is being used to its maximum capability.

With proper implementation of this new information-controlling medium in the practice, communication with the patient is more effectively accomplished, as is the ability to educate the patient and present treatment plans at a higher level. Implementing technology that will enhance case acceptance and the bottom line of the practice will help the dentist and the entire team reach another level of excellence.

Following this train of thought, Dr. Jameson speaks with Dr. Barry Freydberg regarding dental-management software and Internet usage. Freydberg is a 1968 graduate of the University of Illinois College of Dentistry, where he taught operative dentistry and oral diagnosis and medicine for six years. He is a Fellow of the Academy of General Dentistry, and a Fellow of the International College of Dentists. A full-time practicing dentist since 1969, Freydberg has successfully utilized computer information to enhance the marketing and management of the general and multispecialty group practice of which he is one of the founding partners.

Freydberg maintains a Web site ( and can be reached by e-mail at [email protected].

Dr. Jameson: Why don`t more dentists make full use of dental-management software in their practices?

Dr. Freydberg: There are several big reasons why dental offices don`t use dental-management software. One reason is that staff members don`t envision where they want to be. They don`t know what information they want to use and what they want to manage. The staff members` job descriptions and the physical structure of the practice are not set up properly to use the information.

For example, let`s say you want to use automated data to reactivate family members into a hygiene program. Most of us have computers at the front desk. But, at the front desk, there`s a big line and we`re in a hurry. We`re trying to greet and dismiss patients, as well as make financial arrangements and schedule appointments. You can`t be in an environment like that and grow the practice. The office has to be set up where computers are in the operatories and certain tasks are kept away from the front desk.

Dr. Jameson: So, are you saying clinical workstations are mandatory in order to have total control of the necessary information in today`s practice?

Dr. Freydberg: Yes. It`s not even a maybe. I`m saying put the management functions on a computer first. Once they are there and everyone is comfortable using them, you can add clinical capabilities to the computer very inexpensively. You can add software and capturing instruments, whether it`s X-rays, cameras, or charts. You already have the computer and the network, so adding technology simply means adding the capturing instruments and having the system in the work area.

The title of my most popular lecture is "Technology Is the Tool, But Relationships Are the Key." We think of expanded duty time as time to not only cement the temporary or take an opposing impression, but also as quiet time to spend alone with a patient while the doctor or assistant is in another location doing something else. That`s where you can reactivate family members into a hygiene program, discuss incomplete dentistry, or show the patient a CD-ROM to explain what will be done and answer his or her questions. You can discuss financial arrangements or even look at pictures of the grandkids.

Dr. Jameson: So the clinical workstation becomes an empowerment tool for the team to become more interactive and proactive in case acceptance?

Dr. Freydberg: The staff can become more interactive and proactive in everything. What is the best way to schedule in a practice? It should be done by the assistant who just treated the patient, not by telling someone else that you need to see the patient again in two weeks. Miscommunication can happen by using a third party.

If you`re scheduling at the chair, you have total control over the appointment book and can negotiate with a patient. The assistant can say, "I know you really want to come in on Wednesday. We`ll see you at the end of the day. But if we`re running late, please understand that we`re doing you a favor. Bring a book with you." You also can tell a patient that you`re giving him or her the emergency time, but if an emergency comes up, he or she will have to wait. These are things that can be done by no one else but the chairside assistant. The chairside knows if this patient`s procedure will be quick or difficult, and he or she knows if the patient is a bleeder or a gagger.

Every patient needs two things: 1) a treatment plan, meaning a list of what will be done, how much it will cost, and the financial arrangements and 2) an appointment plan, meaning the length of time and number of visits. This information needs to be in the computer on the day of the consultation, whether it`s a young adult who needs an occlusal on #19 or an older patient who requires complex restorative treatment.

Dr. Jameson: What type of changes will we see in dental-management software that will allow us to accomplish these goals?

Dr. Freydberg: The software industry has consolidated dramatically. We also have seen management systems and networking expand, as well as the use of computers in the treatment room. Now we`re starting to see some incompatibilities among the different camera, X-ray, and charting companies and their software. These things have become a problem as companies change their versions of software. Suddenly, the links might not work. Now companies are acquiring each other so the programs will work better with each other. Shopping is another question; it will be easier, but there will be fewer selections.

Soon, all of this software will be on the Internet using application service providers (ASPs). Problems with compatibility will be gone because of the Internet. But at the present time, most high-tech practices use interoffice networks. Early adopters of the ASPs probably will be lower-tech dentists than we imagine. The high-tech dentists will wait for the Web to catch up with them.

I keep pushing software companies to have an option that would specify whether a patient wants to receive something by regular mail or by e-mail. They are working on that.

Dr. Jameson: Some of the biggest problems today seem to be finding support for computer hardware or software and having these problems resolved in a timely manner. Will the Internet provide an answer to many of these problems? Will there need to be a paradigm shift in the practice to use the Internet in this way?

Dr. Freydberg: The Internet and consolidations will help alleviate problems. The Web will eliminate or reduce the problems of multiple locations, security, backups, and updating software.

The paradigm shift will be big, but less expensive than what we do now. The world will be going this direction, but we, as dentists, probably will be one of the last groups to shift. We do things on the Web at home before we do them in our practice. How many dentists put their portfolio on or, instead of keeping them on their own computer? It`s always consistent, up-to-date, and much easier than working on your own machine. Let`s use the metaphor of the Internet being a watermelon and the straw being the pipeline or bandwidth in and out of your home. Right now, sucking that watermelon through the straw would be difficult, but the straw is getting wider all of the time. As they approach the same width, you will find that you will have no need to have a network within your office attached to anything except the Internet.

Dr. Jameson: So, there is a definite need for a dentist to have Internet access somewhere other than his or her home where the kids may keep the computer tied up, correct?

Dr. Freydberg: Absolutely! A doctor who doesn`t have access to the Internet today is missing a big opportunity. We recently surveyed 400 patients and asked them if they preferred to be contacted by phone, fax, or e-mail. We also asked them for their e-mail address, as well as how often they checked their e-mail and if they had a Web site of their own. We found that 71 percent prefer to be contacted by e-mail. There`s an office in Seattle that performs more than 95 percent of its communication by e-mail or the Web.

People want to be contacted by e-mail. It`s easier for them to respond to e-mail. There`s no need to pick up a phone and leave a message. Most everybody answers e-mail before they answer regular mail or phone messages.

E-mail is unobtrusive and can be used to send newsletters. I can send 71 percent of my patients an interactive, live newsletter for free. I`d be a fool not to do that. But there are still dentists who print newsletters and mail them and spend money they don`t need to spend. You can even send virtual flowers to these people. We`ve had patients who have printed the virtual bouquets that we have sent them and put the flowers on their cubicle wall. Co-workers have walked by and asked who sent the flowers. The reply was "My dentist." Our Web site address was on the printout. In one case, we received two new patients from that, and it cost us absolutely nothing.

My strongest advice to dentists is to begin collecting e-mail and Web addresses. In two or three years, you will be very glad you did.

Dr. Jameson: So all of this that we have discussed can create an image of a state-of-the-art practice to current and potential patients, correct?

Dr. Freydberg: That is so true. We tell people to go and visit our Web site and learn a little more about us before their first visit to our office. They go to our site and see our practice`s philosophy, our staff members` length of service at the practice, get to meet the staff, and see some of the operatories. When they walk into our building, the selling of the technology already is done. They know about bleaching and electronic radiographs. They see cases that we`ve done on our patients.

Not only does the Internet help our relationships with our patients, it also helps with the lab. One of my assistants got a case back from the lab. As he looked at it, he wanted the centrals lengthened and the cuspids shortened. He used the Internet to show the lab what he needed, and the technician responded that he now knew exactly what my assistant wanted. The pictures didn`t have to be mailed or delivered.

It`s not unusual for an endodontist, orthodontist, and a periodontist to be working together on a case. One of the problems we have had in the past is keeping up with the records. We`ve lost records, mailed records, and played telephone tag trying to find records. Now we can load everything on to the Web, using a secure ASP, and everyone can review the information on their own time.

Dr. Jameson: So should technology-motivated general practitioners be encouraging their colleagues to have the ability to access this information?

Dr. Freydberg: Yes. There`s one dentist in Ottawa, Ill., who went to specialists and told them that, beginning in six months, he would not accept any paper from them. Dental schools are now showing students how to use only the Web for transferring information to and from colleagues. That means that in six or seven years, a new dentist could walk into a practice and ask the dentist why he or she has records on the computer or on paper rather than the Web? Voice on the Web is coming into use. In two or three years, we could be doing voice records on the Web. It is the future.

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