Sending images to other doctors

Many dentists have embraced the digital dental practice. Paper-based systems have been replaced by practice-management software, intraoral cameras, and digital radiography systems.

Many dentists have embraced the digital dental practice. Paper-based systems have been replaced by practice-management software, intraoral cameras, and digital radiography systems. One of the biggest benefits of these systems is the ability to share data with our patients and our colleagues. Unfortunately, many doctors fail to realize how easily this system can break down.

I was recently speaking with Dr. Mike Sagman, a dentist in Newport News, Va. Mike was lamenting the fact that a patient had recently shown up at his office with a digital X-ray printout from another practice. The printout was at less-than-the-best resolution on regular copy paper, making the images nondiagnostic. Retaking X-rays can be time-consuming and affects our relationships with our patients. So, it’s important to review the various methods we can use to send our images to other dentists and patients.

The “killer application” that has driven the Internet in the first 10 years has been e-mail. E-mail is fast, easy, and practically everyone has an e-mail address. Many image-management programs have the ability to send e-mails directly from the program. Even if they don’t have this feature, it’s relatively easy to cut and paste images into most e-mail programs. While this system is quite easy, there are a few caveats. First, image files can be quite large. While many people have access to high-speed Internet connections, there are still a lot of dentists who use dial-up connections. Before sending files to colleagues, make sure they can easily download these images.

You also can compress images or use a format to export images, such as JPEG, although this typically results in a loss of image quality. A few image programs save their images in a nonstandardized format. In these cases, you can’t send the images in their native format unless the recipient is using the same image program. For this reason, it’s better to convert the images to a standardized format before sending them.

Some Internet providers and most online accounts, such as AOL and Hotmail, will limit the size of the files they will accept. Also, keep in mind that e-mail is inherently insecure. There is no native encryption in files which are sent through popular programs such as Outlook and Outlook Express. The HIPAA standard that recently went into effect addressed the need for data security. The part most relevant to e-mail is the rule requiring “securing patient records containing individually identifiable health information so that they are not readily available to those who do not need them.” The rules do not specify which technologies should be used to preserve the confidentiality of patient records. The regulations under HIPAA do not state that e-mail encryption is mandatory, but do specify that encryption is an “addressable specification” for controlling access to patient records. How this plays out is anyone’s guess, but dentists should realize that standard e-mail may not meet these requirements.

Another option is to use a secure online site to store and access images. Sites which are popular for dental applications include Transcend Online ( and Digitalightbox ( Other options include nondental sites such as X-drive ( for storage and sharing of images. These sites require you to designate users who can view your images. Some also allow for an online exchange of comments between multiple individuals.

Images can be burned to media such as CD-ROMs or DVDs. Most modern computers come with a CD burner, and many are equipped with a DVD burner as well. While this is a relatively inexpensive and easy way to share images, it still requires use of the mail system or the patient to deliver the images. Delivery won’t be any faster than with the older paper records.

Speaking of paper, the final way to share images is by printing them. The office should be sure to use a good quality inkjet printer, although color laser printers have dropped recently in price and might be a good option. Most importantly, use a high quality photo paper to print these images for patients and for referring offices.

The digital era has ushered in a new way for dentists to share information. However, a lack of standardization in this relatively new field still requires dentists to take the time to properly plan how they will share this digital information with their patients and other practitioners.

Lorne Lavine, DMD, practiced periodontics and implant dentistry for more than 10 years. He is an A+ certified computer repair technician, as well as Network+ certified. He is the president of Dental Technology Consultants, a company that assists dentists in all phases of technology integration in the dental practice. He can be contacted by e-mail at or by phone at (866) 204-3398. Visit his Web site at

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