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The Financial Wonders of Electronic Patient Communication

Aug. 1, 2004
Online patient access to your practice is vital to your future — right now!

By Dr. Kent Smith

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Much has been made over the years of how we should best communicate with our patients, and rightly so. After all, no dentistry is ever accomplished until a relationship has been established and communication has been successfully implemented. For some, this comes easily. For others, it always seems to be a struggle.

It has been well documented that the dental profession draws more than its share of introverts, and for these (count me among them), life is getting easier with each new century. As this new one gets going, communication has a new face.

You have probably noticed the increased number of patients who are checking their e-mail while they sit in your dental chair. This is not a fad. More and more businesses expect their employees to stay in touch when they go to the dentist. How can you use this new business shift to effect change in your dental practice?

A VHA ( survey a few years ago made an amazing discovery. Fifty-four percent of patients would switch their physician for the ability to interact with them online. That survey was done in 2000, and I feel quite sure the percentage has risen. Dentistry is different from the practice of medicine but not remarkably so. It is clear that the trend is moving in this direction, and if you want to attract new patients — and even retain your own — you must not ignore it.

I am reminded of this changing landscape almost daily. For example —

Last week, a patient took a digital photo of her tooth and sent it in an e-mail for a diagnosis. Although the photo was not high-quality, it helped us schedule the appropriate time for her next appointment.

Last weekend, I was on my way out of town and received an e-mail from the "Ask the Doctor" feature on our Web site. I was in the car, and because it was from a potential patient, I responded using my PDA (personal digital assistant — a Treo 600, in this case) and a relationship was created. She came in today for her first appointment, and lest you think this behavior is found only in the younger population, this was a 64-year-old woman looking for a new denture.

Earlier this week, while in the middle of treatment, my patient whips out his PDA/camera, takes a picture of his face, and e-mails it to a friend. He wanted his friend to see how funny he looked in a nitrous mask. Actually, this was much funnier to the patient on nitrous, but I wasn't going to spoil his fun.

If you have not seen this type of behavior in your practice, it won't be long until you do. I practice in a city with a median income of just under $45,000, but communication avenues are expanding regardless of the economic setting. Those of you with wealthier demographics might have noticed this even sooner.

How it works

How do we take advantage of this phenomenon? How about a few examples from my friends on the Internet Dental Forum? First, let's hear from Dr. David Dodell, a dentist in Scottsdale, Ariz., and the forum's founder —

"Several years ago, a patient of mine e-mailed me on the weekend about a fractured tooth. He clearly described the problem to me and asked me what to do. I logged into my office and brought up the radiographs, images, and clinical notes via PCAnywhere. It appeared that the tooth needed a crown, but I recommended he see a local dentist (he was in upstate N.Y. in a small town) to smooth down any rough areas and possibly patch the broken area until he could get home.

"I e-mailed him everything. Monday morning, he goes in to see the local dentist. He starts describing the problem and relays what I thought the problem was. He then proceeds to open his laptop in the chair with all of my clinical notes, photos, and radiographs. He later told me that the guy's mouth dropped open.

"He got home, told some of his co-workers, and I gained several new patients all because I answered an e-mail on the weekend from a patient across the country."

Nancy Hammel, with Clay Center Family Dentistry in Kansas offers the following —

"Often, we'll get e-mail messages from patients describing their dental needs and fears. It seems that for high-fear patients, communicating by e-mail is a great way to establish trust before actually having to walk in to a new dentist's office cold!"

Next, let's hear from Les Latner, a dentist in Los Angeles —

"A couple of summers ago, I had just started a case of Invisalign on a high-school teacher, but for the three months of summer, he was doing an internship in Washington, D.C. I gave him all the aligners he needed for the summer and he would email me every two weeks with how it went with putting in the new aligners. His case is now complete and everything went well."

Jeff Roy, a partner in our practice, offers this —

"I get lots of positive feedback from patients and nonpatients who appreciate my accessibility via the 'net. We have an 'Ask the Doctor' feature on our Web site, and I often spend more time answering questions from nonpatients (patients of dentists who are not connected) than I do mine. I'll never understand that one. I constantly try to redirect them to ask their own dentist these questions, but they keep asking me! I really don't mind giving back to the profession in this way, it is just weird that they often seem to trust me more than their dentist. Maybe my patients do the same thing — it's the free second opinion they like. Or, they've seen our pics and bios on the Web site and somehow think we're trustworthy characters ... who knows? I should be billing many of those dentists because I've sold so much dentistry for them via second-opinion confidence. 'Pay it forward,' eh?"

E-zines and e-newsletters

One way to effectively and profitably use electronic communication is through the creation and disbursement of e-zines, or electronic newsletters. Not only do they keep your office on the minds of your patients, but they can include links to your Web site where you can post something of interest for them. We try to have a monthly contest on our Web site, and the e-newsletter alerts them to what it is as well as the prize we are offering. Using the gifts we receive from dealing with Henry Schein, items such as DVD players are quite popular and cost us nothing to award.

A few months ago, we created an extensive survey for our patients. Knowing how much people abhor filling out surveys, we offered a $500 cash prize to one lucky winner and the survey return percentage was quite impressive. How much is it worth to know exactly how your patient base feels about your practice and what suggestions they may have?

As an added incentive, our phones ring constantly for hours after a newsletter is sent. These are patients calling to set up appointments because the e-mail was a reminder that they have been "meaning to make that call."

Another way we use e-mail is in a "welcome" message after a new patient comes in. In addition to our welcome letter, our practice administrator sends each patient a nice e-mail stating how much we enjoyed meeting them. This has the advantage of immediacy, because often our welcome letters are received up to a week after the patient's initial visit.

Don't forget Smile Reminder

I can't go much further without mentioning Smile Reminder. We have been using that service for quite a while, and feel it has an extremely positive return on investment. If you are unfamiliar with their software, it integrates seamlessly with your practice-management software (we use Dentrix), and sends reminders to your patients with scheduled appointments. You can have the software send these reminders via e-mail or through text messages to their cell phones. We send them both ways, but are always getting feedback to make sure our patients are not feeling overwhelmed with reminder messages.

Of course, I am assuming you are collecting e-mail addresses and mobile numbers from your patients because Smile Reminder is not the only reason you need these. It's hard enough to locate our patients these days and we need to take advantage of every option available. At this point, we have Smile Reminder set to send out both e-mails and text messages two days and two hours prior to patients' appointments. They also get birthday messages, and we never even know they go out until we get a return e-mail saying how much they appreciate the thought.

Maybe most importantly, your staff can free up some of the time they lose each day attempting to contact patients with appointment reminders. Patients can confirm their appointments now by merely clicking once inside the e-mail they receive, and they appreciate the fact they do not have to return a call you left on their voice mail. This message came today, but it is not unusual to get these — "I just want to let you guys know that I love your e-mail and text reminders on appointments — it makes it easy to do when at work."

An interesting addition coming soon is called "auto-calendaring." This new feature will automatically create an appointment in their e-mail calendar (Outlook Express and others) as soon as they click to confirm their appointment. This is just one more way to help those forgetful patients remember to come see us! I do not feel I can do the service complete justice in this article, but you can learn more from their Web site at Don't bother telling them I sent you, because they won't give me a dime, anyway!

Electronic communication is certainly possible without a Web site, but the benefits are exponential if you integrate the two. Much is written about Web sites, and there are some good sources out there to help you, such as Dr. Larry Barsh's book, "Dental Web Sites That Work" ( I'll let the experts guide you in design, but I would like to discuss the marketing side of your Web site. After all, if no one knows it's out there, it's not going to bring you much return on investment. Do not be led astray — the No. 1 reason to have a Web site is to increase revenue.

If you got it, work it!

As mentioned earlier, e-mails you send to patients should give them an excuse to visit your Web site, with links to various pages included. When your team are asked for details about certain procedures in a phone call, they can point the patient to that page on your Web site. This not only saves valuable time, but it makes sure errors are kept to a minimum and could provide needed imagery for a complete understanding.

A word of admonition or affirmation to many of you with Web sites: While visiting many dental sites, I notice that roughly two-thirds do not allow the patient a means to electronically communicate with the office. If you have a Web site (and if not, what is taking you so long?), but have no one in your office who regularly checks for e-mail, then something needs to change.

Other ways we choose to market our site include imprinting on our clinic jackets, letterhead, billing statements, lip balm, pens, welcome packets, appointment cards, and envelopes outside our front door and anywhere else we could possibly place them. In fact, every year, the Byron Nelson Golf Tournament has its front entrance across the street from our office. This means that the front of our building is seen 480,000 times over the course of the four-day tournament! We can't pass up this opportunity, so we hang a 30-foot banner every year that simply lists our Web site.

Patients expect it

Time out! Thirty minutes after typing the above text, I met a couple for the first time who were referred from our Web site. The wife did the Web search, so I asked what led her to our site. She stated she did a search with Yahoo! for dentists in the area, then typed their names into an MSN search to see who had Web sites. In her words, "If they didn't have a Web site, they weren't going to hear from me!" True story.

Whether you're a fan of electronic communication or not, it is here to stay. Learn to exploit it. Look to integrate it. Lastly, embrace it. Your patients are expecting it.

HIPAA considerations

HIPAA has created some constraints on the way we communicate with our patients. I am no alarmist, but at least familiarize yourself with some dos and don'ts. There are many Web sites dedicated to this, including,, and our own (do a search for HIPAA).

Actually, HIPAA falls under a larger umbrella called Risk Management. The RM guidelines you might keep in mind when using electronic communications are —

Develop a policy and procedure for electronic communications
Develop a written privacy policy
Adhere to both
Develop a method for ensuring e-mail addresses are current
Do not overlook patients who do not have electronic access
Have all patients sign the appropriate HIPAA forms
Ensure that e-mail is encrypted
Avoid any semblance of spamming your patients
Do not use e-mail for any time-sensitive issues
Include the text of originating message in your response (always a good idea)
Limit information you send to what was requested by the patient
When appropriate, request confirmation of message delivery
Be sure to include e-mail messages in patient's electronic chart
Avoid setting up any "routing" of e-mail messages

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