Preparing for the transition to electronic medical records

Nov. 1, 2010
Electronic medical records will be required by federal mandate by 2015, says Mary Beth Swift.

By Mary Beth Swift, Office Manager

For more on this topic, go to and search using the following key words: electronic medical records, SNODENT, Mary Beth Swift.

What will be the most dramatic change in your dental practice in the next five years? Some of you might say the addition of an associate, a remodel, relocating, adding implant dentistry, or adding technology such as CAD/CAM. Certainly these are all major milestones that would be a significant change in any dental office.

It is safe to predict, however, that there is one change coming very soon that will affect how we all practice dentistry on a daily basis: electronic medical records (EMRs). An EMR is an online database that contains a patient's entire health history for medicine, dentistry, pharmacy, vision, lab tests, and all other health needs.

Many dental teams may not be aware that EMRs will be required by federal mandate by 2015. The American Dental Association (ADA) stated that although EMRs have not been widely discussed within its general membership, their development will likely be the most challenging and defining initiative that the organization deals with during the next five years.

ADA task forces have been working on a system called SNODENT, which stands for Systematized Nomenclature of Dentistry. This system will allow dental offices to communicate a patient's information to his or her EMR using a universal method.

The ADA is also working closely with some of the major companies that offer dental practice software, as it is generally understood that dental practices will access and work with EMRs through these systems.

Many of you are already considering the learning curve and efforts needed to incorporate this impending mandate into your busy offices. Even though working with EMRs will be a big paradigm shift, the benefits should be in equal proportion.

A patient's current health status and medications will be available at a moment's notice and will not need to be verbally updated at each visit. This will lead to increased patient safety and better care.

We will no longer have to chase down X-rays taken at another provider's office, but will be able to simply locate them in the patient's EMR. Information will flow freely between a general practice and a specialist without the current burden of referrals and correspondence. Patterns can become more evident by having a complete history of the patient, which will lead to more informed treatment decisions.

Prepping for change

As with any major transition, those who have prepared well for the change to EMRs will likely have a smooth experience putting them into practice when 2015 arrives. While many of the details of how these systems will work have yet to be determined, it is clear that dental teams who are already comfortable with technology will have an advantage in making this change.

I have been fortunate to learn from a dental practice that has embraced software technology for dental records since the early days. At my first practice, our digital charting for patients started about 20 years ago, even before Windows technology was available in the dental software market. We were not an office full of tech-savvy team members, and many of us lacked even basic computer skills. In fact, when our first system was introduced, some well-seasoned members of the team had never used a computer.

The dentists in the group, however, had a vision of efficiency that motivated them to wean themselves from paper charts. The introduction of computers in the treatment rooms was successful even without the capabilities offered by our current system, and the growing pains are but a distant memory.

In 1998, it became apparent that our original software provider was not developing their product fast enough to keep pace with current technology. By that time, there was a much wider selection of new (and remodeled) dental practice management systems on the market that could do wondrous things in the Windows environment, and we decided it was time for a change.

Because we had already realized the benefits that a basic digital charting program gave our dental practice, we were anxious to do more with this technology. We performed exhaustive research to select new software because we wanted it to be a profitable long-term relationship. We chose Patterson Dental's EagleSoft system in 1999 and have never regretted the decision.

Having the resources and backing of a company with a strong reputation was the most important factor influencing our decision. We wanted to choose software that would be here for the long haul and continue to develop with the marketplace and technology.

Now, having seen how some of the systems that we evaluated 12 years ago are no longer in existence or have gone through multiple mergers, we are very pleased with our choice. The system's ease of use for any dental team member is a big plus, and we have experienced steady growth and consistent service that gives us confidence for the future.

With the 2015 deadline for EMR implementation fast approaching, we are confident that our software management system will provide what we need to cooperate with - and benefit from - this new health care directive.

Integrating systems

Six years ago, when he was 55, one of the dentists in the group practice I was with invited me and a few other team members to venture out with him to start a solo practice. The new practice would fulfill his dream and vision for an ideal office.

When we opened the new practice, there was not even a question about incorporating any other practice management software systems. We knew that the software we had come to know and trust would be an integral part of a successful new practice, so we continued to use EagleSoft.

Even though he is not really a "high-tech" sort of guy, our doctor has forced himself to become comfortable with technology because it is an essential part of his vision for a low-stress, highly efficient dental practice.

This attitude has put our practice on ideal footing to incorporate EMRs, as our entire team is now familiar with technology and has seen the effects it can have on productivity and efficiency.

Using practice management software has allowed us to start the office with a very small team, thanks to the streamlining of many of our daily duties. Many of the administrative chores of days gone by, such as writing on charge sheets and posting the charges manually into the computer, are now automatically done within the charting system.

Creating treatment plans and presentations for patients can be done with a few keystrokes. Submitting and tracking insurance used to be a full-time position in some dental practices, but for us usually requires less than one hour a week.

Our patients often comment how efficient and high-tech we appear, and this translates into their having increased confidence in us as their dental care provider. Our technology also frees us to take the time to be highly personable with our patients and develop strong relationships.

We continue to think of new ways to be efficient with technology in our office. With five years of digital X-rays under our belts, we are no longer pulling charts for our daily schedule - nearly all existing patient records are electronic.

The only things we continue to use paper charts for are health histories and old X-rays. We are incorporating signature pads in all treatment rooms and desks to capture digital signatures on health histories and informed consents in our software.

One of the nice features of our system is that users can see a digital print of exactly what appeared on the patient's health history each time it was verified. If you were to look at a paper history, would you be able to state exactly what was and wasn't on that form a year ago?

We are also considering incorporating a digital patient education system, which integrates many features in our software, such as CAESY patient education. We know that this will streamline and improve our informed consent procedure, which should be a major effort for all dental practices today.

We also see a growing demand and interest from our patients to receive communications by e-mail. About half of our patients now prefer to receive their appointment reminders and other correspondence via e-mail, and we continue to look at and plan for other digital communication methods that will increase our presence before our current and potential patients.

With our existing tools and the confidence we have gained using our software, we have a "bring it on" attitude toward EMRs - we'll be ready. Our patient data is organized, automated, and digital. We are confident that our software management company will develop the tools we'll need to interact with whatever format the mandate requires.

My advice for any dental practice that does not currently use digital charting is to do it now - don't put off the rewards you will reap from this technology any longer! The year 2015 is just around the corner, and if you start now, you too can be comfortable and confident (and even a little excited) to see this monumental change. It is truly an exciting time to be in dentistry!

References available upon request.

Mary Beth Swift is the operational manager for Grandview Center for Dentistry in Edina, Minn. She has more than 20 years of experience in the "business side" of dentistry. She is also cofounder of Dental Practice Enrichment Coalition, which networks and educates other dental business leaders in the Minneapolis/St. Paul area.

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