by Ekram Khan
Aside from the decision to install a computer network in your office, selecting and deploying your practice-management software is the single most important technology decision you will make. There are numerous questions that arise when automating your office work-flow processes via software technologies:
- "Where do I start?"
- "What should I plan for?"
- "What do I buy?"
- "Will I see a return on my investment?"
In order to address these questions, I suggest you take a proactive approach — as if you were building your dream house. First, you must profile your practice type, identify a list of work-flow bottlenecks, consider the evolutionary track of your practice, and assemble a functional wish list for the practice. This may seem like a monumental task, but when approached methodically, the process can be extremely manageable as well as revealing. I will attempt to provide you with some tools to guide you through this process, and profile a few dental practices that have successfully implemented computer-based solutions — solutions that have made direct, positive impacts on their work-flow efficiencies and profitability.
Let's begin by quickly dispatching the ever-present issues surrounding computer hardware specifications. At the very least, you will require a dedicated server with mirrored hard drives, workstations with the fastest processors available, and the most memory your budget will allow. The processor speeds and storage capacities change so quickly that there really isn't a way to ensure against obsolescence. Therefore, buy computers with the best components possible. If you think that saving a few dollars by buying lesser equipment is a "value" decision, consider an article in the July 2001 issue of Smart Business magazine titled, "5 Technology Mistakes Smart Companies Make and How To Avoid Them." The article reports that the time saved annually per person by upgrading from a 4MB video card to an 8MB video card is 110.2 hours. If we assumed a conservative $15 per hour per employee, then 110.2 hours would amount to a staggering savings of $1,653 per employee for the cost of a $150 upgrade. Now that's what I call return on investment! Your computer network is the nervous system of your office's digital infrastructure, and the software that runs it serves as the neurotransmitters — firing off a variety of functions that will streamline your work-flow. Invest in the best hardware, and you will reap the best performance from your software.
Whether you extend the basic network into the operatories will depend on your practice profile and its evolutionary track. Profiling your practice type is a revealing exercise. Although there are common links across practice specialties, the software and technology requirements of each practice are determined by the desired functionality that must be achieved.
Let us consider a general dentistry practice with the objective of growing the patient base and expanding cosmetic dentistry services. My clients, Drs. Glen and Marci Beck of Tallahassee, Fla., chose PracticeWorks as their management software and initially deployed it on administrative computers only. Their objective was to master each technology that was introduced into the office before adding others. Soon after mastering the administrative functionality of PracticeWorks, the doctors decided to dive into operatory computing and master the clinical functionality of charting and intraoral cameras. Finally, they recently added the DICOM Imaging Suite for cosmetic imaging and a high-speed scanner for digitizing paper records and existing X-ray films. They phased in this transition over the span of approximately two years and can track a direct gain in productivity with the completion of each phase.
A phased implementation of software and technology is the most common course, but there are instances where offices have gone from having no computers to having every software and imaging technology on the market in one step. The direction you choose depends on how well you outline your objectives, and the "technophobic" or "technophilic" tendencies of your staff. To profile your practice, answer these questions:
- Does your practice have a high, moderate, or low daily patient load?
- Is your office a solo, group, or multisite practice?
- Do you currently use or plan to use digital X-ray equipment?
- Do you currently use or plan to use intra- or extraoral cameras?
- Which tasks require the most staff involvement?
Now that you have your answers, you are probably wondering what to do with them. The table below can be used as a guide to the primary features that you should evaluate in a practice-management software package. It is intended to provoke thought rather than be a definitive guide to features.
There are several good practice-management software packages available. I have clients who have PracticeWorks, Dentrix, Softdent, and Dentalxchange's PracticeConnect Application Service Provider (ASP) solution. My clients completed extensive in-office evaluations of each package before making their choices. There was even an instance where I was asked to fully integrate the practice-management software with my client's cameras and digital X-ray systems before he made a purchasing decision. The fact that my clients chose and successfully deployed several different software packages goes to show that the software/technology needs of each office are different. The offices that chose to implement PracticeWorks were impressed with the look and functionality of the appointment book and the automation experts who eliminated the tedium of many management tasks. The Dentrix offices focused on the depth of overall features that the package provided, while the Softdent offices focused on clinical and third- party integration features. Of the clients who have signed up for the PracticeConnect program from Dentalxchange, most of them are former clients of UNIX-based systems that charged a monthly fee for the use of the program. PracticeConnect is a hosted application, which means that the program and all of its data are hosted and backed up online. The point is that each software package has its own strengths; therefore, your choice of packages should be based on those particular strengths that address your profiled needs.
At this point, you are probably asking, "How does utilization of software translate into a more profitable practice?" The answer depends on what work-flow tasks you decide to automate with the software. Question number five of the practice profiling questionnaire asks you to identify the tasks that require the most staff involvement. Once you have done this, you can search for technology solutions that reduce or entirely eliminate human intervention in completing those tasks. One of the most staff-intensive tasks is printing and mailing bills to patients. A familiar solution is electronic claims submission and outsourced billing services that are tightly integrated with your practice-management software system. My clients use these services and are prepared to migrate to new services available on the Internet that are more cost-effective and provide better service than the dial-up claims and billing services of the past.
Another common staff-intensive task is handling inquiries by patients or other third parties that require searching for paper documents in the reams of manila folders that exist in your office, or even duplicating X-rays for insurance claims. We conducted an informal study at several client sites and found that the time it took for a staff member to answer a call from an insurance company and find and fax the appropriate records took up to 10 minutes. The time it takes to handle these inquiries can be reduced by 50 percent or more if your records are in electronic form. Imagine a staff member handling the same inquiry by searching a database and directly faxing the records from the computer she is using, while still on the phone with the insurance company! Although it is obvious there would be a significant increase in staff productivity by digitizing paper records, it is still one of the least implemented technology solutions. There are several reasons for this. Digitization of paper records is often overlooked, because the process of digitizing paper records is misunderstood; a certain fear factor exists regarding electronic records. It is often thought that the scanning of paper records involves someone standing in front of a painfully slow scanner and placing sheets of paper on it one at a time. This scenario is far from the truth. If you want to digitize your paper records, you can either elect to do it in-house or outsource it. There are several industrial-grade high-speed scanners with multipage automatic document feeders that can scan at the rate of 20 or more pages per minute.
If you outsource this task, there are service companies that will take your paper records and scan them into a searchable database for about eight to 10 cents per page. Your technology consultant then can take this database and bridge it to your practice-management software. There seems to be a perceived higher risk attributed to potential loss of electronic records due to hardware failure. The risk involved with losing your electronic patient records in the event of a hardware failure is less than the risk of a fire or natural disaster damaging your paper records. The Texas Medical Center in Houston lost groundbreaking data from research into treatments for asthma and cardiovascular disease, because paper files stored in the basement of the center were destroyed by flooding. With advances in digital signatures, watermarking, and encryption technology, and the passage of HIPAA legislation, electronic records will be considered legal documents. Soon, the act of maintaining paper records for legal purposes will become obsolete. Fortune 500 corporations have proven the productivity gains of going paperless. Therefore, implementing a software solution to digitize your paper records should be on your technology plan and will positively impact your bottom line.
I have noticed a few emerging trends in practice-management software technologies that predict more productivity and ease of use. The leading programs are using the handheld computing platform to extend the reach of your computer network beyond the confines of your office by allowing you to synchronize your practice-management data with Palm Pilots and Windows CE devices. This allows you quick, portable access to appointment and patient data after hours. The Dental.com software was the first to provide access not only to appointment data, but also to clinical data and images on Windows CE devices.
Imagine getting an emergency call after hours and being able to see a color picture of the patient, as well as recent radiographs with relevant clinical information, on a handheld device. Before this technology was available, you would have to use your laptop to dial into your office network over a slow dial-up phone connection to view the same information. PracticeWorks, Softdent, and Dentrix have synchronizing capabilities with Palm computing devices without color display capabilities. With the recent introduction of new color Palm computing devices, you can expect these software companies to extend the capabilities of their portable applications.
A significant new trend is to have Web-browser-based access to applications and data over Internet connections. This is now possible in dentistry using Dentalxchange's PracticeConnect ASP product, which is a practice-management program available online for a flat fee of $199 per month per location. The monthly fee covers support and all upgrades. Most major software companies, including the likes of Microsoft, will be providing software via the ASP model rather than selling traditional licenses. Aside from the obvious cost benefit of the monthly subscription model, there are several functional benefits. Rather than being just a practice-management software solution, PracticeConnect is an overall data- management solution. Since the program and all related data resides on the central servers, your data is backed up nightly onto centralized redundant systems. Having centrally located data accessible through a Web browser allows anytime, anywhere access to your office database as long as you are able to establish a connection to the Internet. Multisite practices can deploy this solution easily by installing basic Local Area Networks (LANs) at each location with Internet access. All locations can have real-time access to the same database and have centralized management reporting across practices. Practices that currently use antiquated, expensive UNIX-based systems should seriously consider PracticeConnect as a more cost-effective and intuitive solution. With expanding availability of high-speed Internet access, I strongly believe that the industry will be moving toward providing software via the ASP model. Dentalxchange is the first to provide a viable product that can be deployed easily and quickly increase staff productivity.
The key to profiting from software is to add functionality that increases productivity and decreases staff intervention in work-flow processes. Your practice-management software is the foundation of your software platform. The objective is to extend its functionality by integrating third-party software programs that eliminate identified work-flow bottlenecks. Products with a proven track record for increasing productivity are imaging packages like DICOM Imaging Suite, Vipersoft, and ImageFX. These products will integrate the management of digital images seamlessly into your practice-management system. All of these programs have scanning functions to digitize and archive your paper records.
The integration of additional hardware devices can extend the functionality of your practice-management software. Devices like digital X-ray systems, electronic periodontal probe systems, and intra-oral/extraoral cameras all generate digital data that needs to be managed. A fully integrated system will automate data-management tasks, freeing you to concentrate on running your practice rather than managing technology. Dentrix recently acquired Vipersoft and integrated imaging technology directly into the Dentrix package as Dentrix DDO. Its next step toward seamless integration is the addition of a digital X-ray sensor that will capture X-ray images directly into the software. Any office that does not have a full or partial technology solution in place should consider the Dentrix package as a solid starting point.
Achieving seamless integration of a plethora of technology products into a system that transparently supports your daily work-flow and increases your profitability can be achieved with careful planning on your part and guidance from your technology consultant.
