software -- Purchasing is only the first step!

Aug. 1, 2003
The dental profession has experienced an explosion in technology over the past few years. Adhesive dentistry, air abrasion, lasers, and other clinical technological advancements have increased our skills

Pat Little, DDS, FAGD

The dental profession has experienced an explosion in technology over the past few years. Adhesive dentistry, air abrasion, lasers, and other clinical technological advancements have increased our skills and our ability to provide optimal care for our patients. Likewise, computer technology is allowing us to practice more effectively and efficiently in the area of practice management. Dentists who utilize technology both clinically and on the management side will excel in today's technology environment. That is not to say that dentists who don't utilize technology can't have successful practices; but, it will become more difficult as more of our patients begin to appreciate how well they can be served through the various types of technologies available today.

Since my expertise lies with computers and the Internet, I would like to discuss how various software programs can be utilized in the dental office. First, let me say that while I am a big proponent of computer technology, I am the first to admit that technology can be a very expensive mistake if it is purchased and utilized incorrectly. It is of paramount importance to choose technology wisely and use it appropriately. Technology can truly pay for itself many times over when we utilize it to increase our efficiency and effectiveness.

Dentists are notorious for purchasing "cool stuff" at dental meetings ... and then not using it once they get back to their offices. Don't make this mistake with expensive technology. Plan how you are going to use the technology before you purchase it and make sure you understand exactly how it can benefit you and your patients. Having said that, I would like to describe some software that I feel is necessary for those of you who utilize computers in your office.

Practice-management software

Practice management software should be the nerve center of the computerized office. Through your practice-management software, you will be able to bridge or integrate with other programs, such as digital radiography, cosmetic-imaging, and digital-imaging. As a matter of fact, I believe that dental offices should be "networked" so that each treatment room has a computer. Now that HIPAA is in force, we need to de-emphasize some of the activity that normally occurs at the "front desk" and transfer this activity to the treatment rooms or consultation area. This concept is often referred to as front-desklessness.

Front-desklessness doesn't mean you eliminate the front desk, but rather change its role. The front desk now can become a reception area where patients are welcomed, as opposed to a business center. Many traditional front-desk activities can now be accomplished in the treatment room, utilizing the practice management software and your networked office. A number of doctors who practice this concept no longer separate "front office" and clinical staff. Rather, all staff members are cross-trained so that the chairside assistant also schedules appointments and files insurance, but does it in the treatment room. While one staff member is assisting the doctor, another can be finishing up with the previous patient in a treatment room, while a third staff member is greeting the next patient at the front desk. Thus, a patient receives continuity of care, instead of being "passed off" from one staff member to the next.

While this concept allows many activities to occur in the treatment room, many doctors who practice "front-desklessness" do not accept payment in the treatment room, but utilize another room for collections. The patient can then be dismissed without having to stop at the front desk and potentially have to wait in line and overhear protected health information being discussed with other patients.

Even if you don't utilize the front-desklessness concept, practice-management software and associated programs still are valuable technologies. However, it is critical to choose wisely. While there are still a number of choices, we are witnessing a consolidation in the practice-management software industry. The major reasons for this consolidation are the costs to develop the software, the cost to provide customer support, and the cost required to keep the programs updated. Because these costs are substantial, many smaller vendors either went out of business or they sold their programs to larger companies. As a result, we now have basically three large vendors: Dentrix (Henry Schein), PracticeWorks (which now includes SoftDent®), and EagleSoft (Patterson Dental). By having a large user base, these vendors hope to maintain good service and support. This doesn't mean some of the smaller vendors cannot accomplish the same goals. Indeed, a number of smaller vendors offer fine programs. However, if you choose a smaller vendor, be sure to ask how many users they currently support and try to determine their ability to provide timely updates and future technical support.

Since purchasing management software is expensive and not easily reversible, don't make a quick decision. This is one area that you really want to study and research. Involve the entire staff in this process, since everyone should utilize the software. You should also spend time talking with colleagues who have similar practices to your own. Ask them what they like about their software, but also ask them what they don't like and would like to change. Be sure and ask about the quality and cost of the training and technical support.

The Internet also can be a great tool, since it allows you to participate in discussion groups. Through these discussion groups, you can "pick the brains" of dentists all over the world. The Inter-

net Dental Forum (www.internet is one such site that even has specific discussion groups for the major practice-management software vendors. Additionally, the American Dental Association ( and the Academy of General Dentistry ( have discussion forums for their members. Weigh all advice carefully, since some participants may have hidden agendas and motives.

After some initial research, ask some vendors to spend time with you and your staff demonstrating how their software functions. Once you narrow your choices, ask for demo disks and actually simulate how you would use the program in your office. Again, be sure both doctor(s) and staff are included in this process.

Using software efficiently

Once you make a decision, utilize the software in a way that will ensure efficiency and effectiveness. One of the best ways to get the most out of your purchase is to obtain initial training, followed by periodic refresher courses or training in new features. The lack of training is a major cause of frustration and problems between doctors and vendors. Many doctors feel they can't afford the cost of training because the software is so expensive. In reality, you can't afford not to train. Through training, you will realize the many ways the software can benefit you and your patients.

For example, when I purchased my first practice-management software in the early 1990s, I used it to file electronic claims and to print statements. These two activities more than paid for the cost of the program. However, that was only the "tip of the iceberg." As I learned about other features of the program, the benefits increased. While it is unlikely that you will utilize everything a program has to offer, you can learn to use more of its features through continued training. Some vendors now offer user-group sessions during many of the major dental meetings. Be sure to take advantage of these opportunities.

I also recommend providing new staff members with formal training. If you do the training yourself, you may teach your staff the bad habits you have formed over time. Also, newly-trained staff members can bring back fresh ideas and techniques. I can't emphasize enough the importance of training. Practice-management software can be expensive, but it will provide enormous benefits when used properly. Don't become comfortable using only the "tip of the iceberg."

I mentioned earlier that I feel it is beneficial to network computers so that you can have work stations located throughout your office. Utilizing practice-management software and associated programs through a computer network can add efficiency to your office. However, the downside is that it can present security and privacy concerns.

The Internet and security

I also recommend that you have at least one computer in your office connected to the Internet. Space concerns in this article prohibits me from going into all of the advantages of having an Internet connection in this article, but to put it succinctly, you will find an Internet connection to be very useful. As a matter of fact, I feel the day is coming when we will no longer utilize practice-management software as we know it today. Rather, we will utilize Web-based services where all of our data will be stored on secure Web servers. This concept is known as "Application Solution Providers." There are advantages and disadvantages to this concept, but these Internet-based systems seem to be the direction in which we are headed. In any case, to utilize computer and Internet technologies in our offices, we need to be familiar with some additional security software. While these programs may not increase your productivity or profitability, they can protect you from losing production and efficiency.

Antivirus software: Unfor-tunately, there are people who love to create havoc with computer systems. They design small programs called viruses and worms and try to install these programs on your computer. Once installed and opened, they can perform their "dirty deeds." Some viruses are harmless jokes, but others can bring down entire networks. What you don't want to do is to make the mistake of thinking that if you don't have an Internet connection, you can't get a virus. If you open a floppy disk, CD/ROM, DVD, or any other type of medium, you can install a virus on your system. For this reason, you must protect your computer(s) from these viruses and worms through anti-virus software. Norton's Antivirus ( com/nav/ nav_9xnt) and McAfee (http://www.mcafee. com) are two major antivirus programs. Once installed, these programs work in the background, constantly scanning your files. While you can turn this background screening option off, I don't recommend doing so. Let this background scanning be your security net.

I also recommend scanning each individual file that you download from the Internet. As an additional layer of safety, I also scan all disks before opening them. I even scan CD/ROMs and DVDs that I purchase before I install them. Normally, however, CDs and DVDs automatically open or auto-run when you insert them into the drive. You can temporarily disable auto-run by holding down the "shift" key when you insert the disk. Keep holding the shift key until the CD or DVD stops spinning. Then you can scan this disk with your antivirus program.

You must constantly update your antivirus program. This is best accomplished through the Internet. You can even schedule these updates through the options menu of your program. I recommend scheduling an update at least weekly. However, many computer security experts recommend daily scheduling. While updates may not be available every day, checking daily ensures that your software is current and providing your computer system with the most up-to-date protection. You can even set an option for the software program to notify you when updates are available.

This is convenient, but it also gives your antivirus program permission to scan your virus definitions and then report back to the company's server when you connect to the Internet. I personally don't like giving software permission to automatically communicate with the vendor's servers.

Firewall protection: If you connect to the Internet and/or have a computer network, each computer in your network has a specific address called an I.P. address. This concept is similar to your telephone number. If I know your telephone number, I can contact you. Likewise, if I know your computer's I.P. address, I have the potential of contacting your computer and gaining access to your files. There are many "hackers" out there trying to do just that! It doesn't even take an expert to be a hacker!

Install firewall software to prevent unauthorized individuals from accessing your computer systems. Firewall software can prevent incoming and outgoing activity. It is especially necessary if you have high-speed Internet access such as cable or DSL. These high-speed connections are always open; thus, you increase your exposure to intrusions. Firewalls consist of free, simple programs, such as ZoneAlarm ( and Black Ice Defender ( While not free, Norton Internet Security provides virus and firewall protection, along with other protective features. For greater security, firewalls can consist of a combination of hardware (such as a router) and software. If your office is networked, consult with your network technician to determine the best type of firewall protection.

Even if you don't have a network in your office, but only have a computer connected to the Internet, you still need firewall protection. In this case, one of the free programs will work just fine. Some firewalls even allow you to restrict access to certain Web sites. Thus, if you feel you have a problem with staff members inappropriately accessing certain sites, you can prevent this activity.

Cookie-cutter software: Cookies are another privacy threat if you have Internet access. Cookies are text files that are placed on your hard drive when you visit various Web sites. These cookies can report our surfing activities back to the server that placed them there, thus causing privacy concerns. However, cookies provide useful functions such as user name and password management, shopping carts, and Web site customization. Thus, it would be beneficial to accept cookies from sites you trust, but reject cookies from sites you don't.

While your browser allows you to set general options for cookies, it doesn't provide the versatility I desire. For this versatility, I turn to "cookie-cutter" software. This software allows me to reject all cookies except for the sites I trust. I can change my settings anytime. Most of these programs offer a 30-day free trial. After 30 days, you must purchase the program if you still wish to use it. Most of these programs cost between $15 and $30, so they are very cheap privacy insurance. For more information on cookies and for a listing of some good "cookie-cutter" programs, refer to www.cookiecentral .com. This site also provides good information on other aspects of computer security.

There are other types of software that I utilize, but I would need much more space to explain them. However, I do recommend practice-management software and virus protection at a minimum. I also recommend an Internet connection, since the Internet is such a valuable resource. If you utilize the Internet and/or allow remote access to your network, firewall protection also becomes vital. Be sure to thoroughly learn the features of your software to maximize its usefulness, and continue to boost your knowledge level through periodic training. By doing this, you will become more effective and efficient, helping you to provide a higher level of service to your patients in a more secure environment. I wish you well as you journey through cyber- space!

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