High-tech tools for your esthetic practice
Larry Emmott, DDS
Dentists buy two types of techno goodies: (1) practical, useful, and cost-effective tools, and (2) fun, amazing techno-toys. Techno-toys are bought not because you need them, but because you want them. Many dentists have shelves full of toys they "had to have," but never managed to use effectively. Its OK to buy techno-toys as long as you realize that`s what you are doing. On the other hand, to use technology effectively, you will have to buy with care and put some effort into setting up and using new systems.
Developing technology
Starting with the intraoral cameras introduced over 10 years ago, we have seen a steady advancement of high-tech tools for the esthetic and restorative practice. These include intraoral cameras, digital capture of intraoral-camera images, digital radiography, digital still cameras, image-management software, and cosmetic-imaging software. The developing technology in these areas is so remarkable that it is easy to get caught up in the excitement of it and buy without consideration for how to make it work profitably in the practice. Offices that profit from technology follow a logical sequence in its purchase and application.
Dentists are attracted to the visually exciting technology and often want to jump into advanced imaging systems without first developing the more boring infrastructure for the technology. However, few offices will see a true return on their technology investments if they don`t lay the proper groundwork. Steven Covey declared that the third habit of highly effective people is to "put first things first." If you want to profit from high tech, you will need to follow that advice.
The first step is to set up a good, Windows®-based, networked, practice-management system. The second step is to move the computers into the treatment rooms and start doing chairside data entry, electronic-charting, and chairside scheduling. Many people are skeptical when they first hear about using computers in the treatment rooms. It doesn`t seem right, and they come up with lots of excuses as to why they can`t do it - they`d be in the way, I`d never use them, I don`t have enough room, my staff won`t like it, it is too expensive.
However, once the computers enter the treatment rooms, everything else changes. It opens the way for adding on all the wonderful high-tech systems and making them work profitably in the office. Conversely, trying to use image management and cosmetic imaging without chairside computers is expensive and difficult. Good examples of Windows®-based, complete practice- management software are Dentrix and Practice Works.
Intraoral cameras
The single, best technology investment a dentist can make is an intraoral camera. You can buy and use a camera without treatment-room computers. However, we rapidly are moving from an analog video world to a digital world. That means that it no longer is necessary to use a video printer to freeze display and record intraoral images. It no longer is necessary to have big TV monitors in every room with a hard-wired network. Using the computer to capture, store, retrieve, and manipulate images is much more flexible than old printer-based systems.
Once there is a computer network with computers in every room, the computer network becomes the video network. The computer becomes the printer (that is, it freezes images) and the computer monitor takes the place of the TV. Putting a computer in every room just to capture an intraoral image doesn`t make much sense. However, adding image-capture to an existing system is easy and cost-effective.
Logical steps to technology
The next logical step is to add image management. That calls for software which captures, stores, and retrieves images. These can be captured camera images, images from a digital camera, or scanned and digitized images. Image-management systems create a kind of photo album of images, which are linked to an electronic patient chart. Advanced systems also will allow you to display various images for before-and-after comparisons. They also make it easy to arrange and print images. The newest systems provide for easy transmission of images via e-mail and the Internet. Tigerview is a good example of an image-management system.
The next high-tech tool to consider is a digital camera. Digital cameras range in price from under a hundred dollars to several thousand. To be useful in the dental office, the camera must take a close-up of the mouth only and a three-quarter to full-face shot without distortion or wash-out from the flash. You also need a fast method to transfer images from the camera to the computer. The best way is with a flash memory card or a floppy disk. Good models to use are the Olympus 620, the Sony Mavica 91 or the Richo RDC-2.
You now are ready to add cosmetic-imaging. This is software that allows you to manipulate the picture of a smile to simulate the results of cosmetic treatment. Cosmetic-imaging hit dentistry a few years ago and, after a brief period of interest, seemed to die out. It declined because it was hard to do, took a lot of time, and was expensive to buy and set up. Cosmetic-imaging now is making a big comeback.
It is coming back because new software systems have tools that make cosmetic manipulation fast and easy. It now is much more cost-effective to add imaging to an existing computer network. It should not be a stand-alone system, but part of your overall technology system. The two leading image-management and cosmetic-imaging software systems are Image FX and Vipersoft. If you use one of these imaging programs, you will not need separate image-management software.
The final piece of the puzzle is digital radiography. It could be added before the camera and imaging is put in place. It is remarkable technology that promises to completely change how we take and analyze radiographs. Again, first things first. It is possible to use digital radiology with a cart system rolled from treatment room to treatment room or, worse, to use a laptop. The end result is a system about as useful as a cart with a rear-mounted horse.
After all, where do you most need a radiograph? It is in the treatment room. If you don`t have networked computers in all the rooms, it is awkward or impossible to bring the X-ray image into the room. Also, if the images are not linked to an electronic chart in a management system, it is awkward and time-consuming to find and retrieve images. As a rule of thumb, if you don`t have electronic, paperless charts, you aren`t yet ready for electronic, paperless-digital radiographs. On the other hand, adding digital radiography to an existing treatment-room-based computer network is easy and less expensive than trying to set up a stand-alone system. The new leader in this field is Trex Trophy.
Learn to use systems
It is amazing how many dentists spend tens of thousands of dollars on technology and never spend a penny on learning to use it properly. Training is not an option. For example, you could buy the world`s best chair, unit, and handpiece, but it wouldn`t make you a great dentist. You would be a great dentist only after you had studied, practiced, and mastered the skills of fine dentistry. The dental handpiece has value only in the hands of a master. Technology is the same way.
To profit from technology, the dentist and staff need to use what he/she buys. Technology tends not to be used if it is too hard to use, takes too much time, etc. The dentist must make a commitment to use any new technology. He/she needs to encourage the team to become involved and set goals for using the new "techno-whatever." The dental team must be flexible with where it is positioned and be willing to make changes. Be careful not to fall into old ruts and just "get by" doing what you`ve always done, and let the techno goodie sit on the shelf.
Be prepared for it to "take too much time" and be awkward the first (and probably the second and third) time you use it, but don`t give up, just get better. Establish protocols and time schedules for the use of technology. For example, you may wish to set a protocol that all new patients will have a digital picture taken and a cosmetic-smile design presented at the consultation appointment. Or, you may set a protocol that all patients who have whitening or anterior bonding will have a before-and-after image in their digital chart.
Another way to use these tools is to prepare customized case presentations. These can be word-processing documents, which include copies of the patient`s own photos and X-rays, as well as enhanced cosmetic images. These are combined with text specific to that patient describing the need for and benefits of treatment. For major cases involving elective treatment, these will help the patients understand and accept proper care. In other words, the high-tech tools will increase case acceptance and ultimately profit to the office.
Specialists can do the same thing - creating beautiful case reports with photos and X-rays, which look like magazine ads, for referring doctors. Once the protocols and templates are established, the dentist and staff can prepare these incredible documents in less time than we used to spend writing up a treatment plan or case report by hand.
Budget for technology
The final step to profiting from high-tech tools is to establish a technology budget. Be prepared to spend money every year on improving your technology infrastructure and on the training and development of the staff.
A recent Wall Street Journal article indicated that the average health-care company (including hospitals) spent 2 percent of gross annually on technology. By comparison, the average business overall spent 10 percent on technology. Look at your situation and establish a budget of at least 2 percent. If you want to aggressively build a high-tech office you may want to budget 5 percent or more.
Planning with a budget is important for several reasons. The most significant reason is psychological. That is, you already have planned to spend the money and are less likely to put off important items, such as training, because of cost. The second thing a budget does is help you focus on what to buy. You will be less likely to purchase toys and more likely to purchase tools to stay within your budget.
Developing a high-tech practice and profiting from high-tech tools is an ongoing process. Be careful to avoid toys and concentrate on tools. Establish an infrastructure which will support advancements in technology. Add on new technologies in a logical sequence. Get training and provide ongoing, advanced training for yourself and your dental team. Establish goals and use new technologies on a daily basis. Finally, set up and follow a budget.
The future is coming ... and it will be amazing!
