Aug. 1, 2004
The progressive dental practice has evolved considerably since the late 1980s. Practices are moving toward a paperless or chartless concept, where records are kept in digital formats.

By Lorne Lavine, DMD

The progressive dental practice has evolved considerably since the late 1980s. Practices are moving toward a paperless or chartless concept, where records are kept in digital formats. The advantages of this type of system should be obvious to any practitioner. Data is easily available at any location, records never get lost, and clinical data can be manipulated to enhance the ability of the dentist and staff to diagnose and treat disease.

While dentists spend significant time choosing the best hardware systems, including computers, networks, digital cameras, and digital radiography sensors, many fail to realize the importance of software in this equation. Practice management software is designed to bring all facets of this data together; a poor software choice will lead to many hours of frustration. And — not to be ignored — image management software is critical for the clinical side of the practice. In this article, we will limit our discussion to practice management software and the process dentists may use to choose the best solutions for their practices.

Practice management software

While hardware infrastructure is important and provides the first steps in a technology system upgrade, there is little doubt that the practice management software is the one component that ties everything together. Every program has strengths and weaknesses. Dentists should try to choose a system based on two over-riding principles: features, and service and support.


The choices that face dentists are almost overwhelming. Recent consolidations have reduced major players in this area. The "Big Four," as they often are referred to in online forums such as Dental Town and the IDF, consist of Dentrix, Eaglesoft, PracticeWorks, and Softdent. Combined, these four programs account for at least 80 percent of the market, by my estimation. Nevertheless, there are many smaller companies that have been around a long time and continue to produce excellent products. The trick, however, is to find the program that best meets your specific needs. As different systems are compared, one will see that certain features are handled better on one program than another. In other words, there is no one perfect program that is best for each dentist. There is not now, nor has there ever been, an answer for the question, "What is the best program?" I recommend you review independent studies and comparisons and ask colleagues for their opinions. Surveys conducted by Clinical Research Associates and Dental Equipment and Materials recently evaluated the most popular programs and should be used in your evaluation process. When comparing products, there are a few things I recommend you keep in mind:

1) You must involve your staff in this decision. As most dentists know, staff interact daily with software. Many dentists have admitted to me that they barely know how to turn on their computers, let alone understand complex dental programs. Your staff will handle administrative functions that the software handles. If they find a program difficult to use, it will be disastrous to your practice. Many dentists are fortunate enough to hire office managers who have dental software experience; he or she may be invaluable in determining the advantages of particular programs.

2) Every program has numerous bells and whistles, but most dentists end up using only small portions of these features. Almost all offices use certain areas of practice management programs. These include—but are not limited to—patient registration, scheduling, treatment planning, insurance estimation and processing, recall patient management, and reports of practice parameters, such as production and collections. There are many elements of modern software that should not be discounted. Dentrix, for example, has a direct link to Care Credit in their software, so that offices almost instantaneously may determine a patient's ability to finance expensive treatment. Each dentist should decide what is important to him or her before researching programs. Make a list of what's important and compare every program using that list.

One method I have found effective is to take either an existing patient or create an imaginary patient and see how the software tracks this patient. In other words, create the patient record, schedule him or her, create a treatment plan, post treatment to the account, create an insurance form, re-schedule the patient, etc. In this case, you may compare apples to apples when evaluating how software handles this. You should see how well software adapts to how you prefer to see and treat patients. Poorly designed software will force you to change how you practice and process patients. You should avoid that software at all costs.

3) Although most dental software involves both administrative and clinical features, the administrative component will, in most cases, be most important. This does not mean, however, that clinical functions are not important. Integrating clinical data with practice management systems is outside the scope of this article, but it is important that the software you purchase is capable of working with software and hardware of high-tech products. Seamless integration allows practices to easily access both clinical and administrative data without needing to re-enter patient information in more than one location.

Training, service, and support

It is unfortunate that the most important factors are usually given the least amount of consideration when choosing a software package. Most dentists spend hours evaluating software, choosing features, and looking at program prices, but barely even think about training and ongoing support.

Let's start with training. There is no better way to ensure your staff never adapts to a software program than to bypass proper training. Many dentists try to save money by passing up on-site or classroom-based training. Don't make this mistake. Training is one of the best investments you can make. Dental management software programs are complex — don't let anyone tell you otherwise. Having everyone in the office (and, yes, that includes the doctor) up to speed on the software is crucial to ensure it is rapidly integrated into your practice.

Service and support is the other part of this equation. Many dentists look at software prices, but do not factor in costs of ongoing support. I have seen support packages that are as low as $200 a year to packages that are more than $5,000 a year. When choosing a support package, you need to ask a number of questions:

1) What are customer service and support hours?
2) What other means of support, i.e. email, Web-based, fax, etc., are offered?
3) Are different levels of support plans offered?
4) Is unlimited telephone support offered as a part of the package or is it on a per-minute basis?
5) How much support is included with the initial program purchase? What will it cost to purchase additional years?
6) Is on-site support offered?
7) What are the qualifications of the support staff?
8) How often is the program updated?

Ask how soon your call will be answered. Many practices have complained recently of the ever-increasing time that offices wait for return calls. You should test this out yourself by trying to contact support departments at different times of the week, such as Monday morning and Friday afternoon. Ask to see performance statistics, such as the average on-hold time and average length of call. This information will provide you with an insight into what's in store for you. As I mentioned earlier, independent surveys that rate customer support for many different systems also are available. Ask your colleagues for their experiences.

As practices continue to gravitate toward the chartless ideal, many dentists will realize their current, outdated software is not up to the task. Properly evaluating software from current and long-term perspectives helps dentists avoid costly, exasperating experiences.

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