Corona Pandemic Management Telemedicine

Planning a Return to the Office

Do you have a plan for office work of the future?

Policies about the mix of remote and in-office work have ramifications beyond short term cost and efficiency. Because of what we’ve gone through over the past year, we are about to enter a new era in the evolution of organizations. Decisions that CEOs make over the next few months will set the tone for how work will be done in the future, impacting the relationships employees have formed and their emotional connection with the company. They should be made carefully.

Source: A CEO’s Guide to Planning a Return to the Office

The pandemic has shown us that a great many of the tasks we used to do in the office can be done as well or better remotely. That is either as work from home or outsourced to an online e-service.

Don’t be in a big hurry to get things back to the way they were in February of 2020. Now is a perfect opportunity to redesign the workflow of the office to outsource some work, transfer some tasks to your web page and reassign some tasks to remote work from home options.

For example:

Online bill pay instead of a person answering the phone to take a credit card number or opening an envelope and depositing a check.

Month end billing, reports, and accounting can be done by an administrator working from home.

No paper charts to pull and refile at the end of the day if you use fully digital charts.

Billing, and insurance claims can be done from home or outsourced to an e-service.

No paper re-call cards with postage but use text or e-mail to send reminders electronically. This can be set up and monitored remotely as work from home.

There is more, be creative.


Pediatric dentists using teledentistry the most

From Becker’s:

The percentage of respondents by dental specialty who said they were using any kind of virtual service, ordered from greatest to least:

  • Pediatric dentist: 75.2 percent
  • Orthodontist: 62 percent
  • Prosthodontist: 42.3 percent
  • Dental surgical specialist: 38.5 percent
  • General practice: 33.1 percent
  • Periodontist: 32.3 percent

Source: Pediatric dentists using teledentistry the most: 7 stats per ADA

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Telehealth used in 30.1% of visits during COVID-19 pandemic

Telehealth visits accounted for approximately 30% of total outpatient visits early in the COVID-19 pandemic, with uptake varying among specialties and by patient characteristics…

…Among specialties, telehealth was used at least once by 67.7% of endocrinologists, 57% of gastroenterologists and 56.3% of neurologists. However, the use of telehealth was considerably lower among some specialties, with just 3.3% of optometrists, 6.6% of physical therapists, 9.3% of ophthalmologists and 20.7% of orthopedic surgeons using teleh

Source: Telehealth used in 30.1% of visits during COVID-19 pandemic

From the ADA via Becker’s

The percentage of respondents by dental specialty who said they were using any kind of virtual service:

  • Pediatric dentist: 75.2 percent
  • Orthodontist: 62 percent
  • Prosthodontist: 42.3 percent
  • Dental surgical specialist: 38.5 percent
  • General practice: 33.1 percent
  • Periodontist: 32.3 percent
Corona Pandemic Health Care Politics Telemedicine

Congress Gets Another Shot at Easing Telehealth Licensure Restrictions

From mHealth Intelligence:

The TREAT Act, which has the support of dozens of health systems and connected health organizations, would allow providers to bypass licensing rules and use telehealth to treat patients in any state during the coronavirus pandemic.

Source: Congress Gets Another Shot at Easing Telehealth Licensure Restrictions

I have often made the point that the primary barrier to increased acceptance of telemedicine is not the technology but the politics. This act is a good step but it is very limited. Hopefully it will lead to more permanent rules.

I am usually a big fan of local control in politics however the Internet has expanded the meaning of local. I cannot determine how it is in the best interests of our patients to not allow them to seek the best most timely care online simply because it is offered by a dentist in a different state. Or why insurance companies will not pay for a telemedicine appointment if the outcomes are good and the cost is lower.

Future Tech Hardware Mobile Telemedicine

CES sees rise in telehealth tech in response to pandemic

From Las Vegas Review-Journal:

“This year, with all of the digital health products, we’ve seen rapid acceleration of these technologies given the global pandemic,” said Lesley Rohrbaugh, director of market research for the Consumer Technology Association, which owns and presents CES. “It’s definitely a category that has been rising over the past few years. It’s been a big category during CES. It will be again for CES 2021.”

Source: CES sees rise in telehealth tech in response to pandemic | Las Vegas Review-Journal

Follow the link for a rundown of some of the amazing devices now available for at home telemedicine, including:

— Toothpic, a teledentistry program that partnered with Philips. For $10, users can get help with a specific dental issue within six hours just by taking a photo of the problem area. An in-depth oral health report using six photos is available in less than 24 hours for $35.

Corona Pandemic Health Care Politics Telemedicine

U.S. lawmakers reintroduce House bill safeguarding access to telehealth

I am a huge fan of the concept of telemedicine and teledentistry. I believe it has the potential to reduce costs and improve care to a remarkable degree. This is critical to solving the “Healthcare Crisis”.

From  Healthcare IT News:


The bill, which was first introduced in July 2020, would help safeguard access to virtual care after COVID-19 via four main provisions. According to a press statement from Thompson’s office, it would:

  • Eliminate most geographic and originating site restrictions on the use of telehealth in Medicare and establishing the patient’s home as an eligible distant site.
  • Authorize the Centers for Medicare and Medicaid Service to continue reimbursement for telehealth for 90 days beyond the end of the public health emergency.
  • Make permanent the disaster waiver authority, enabling Health and Human Service to expand telehealth in Medicare during all future emergencies and disasters.
  • Require a study on the use of telehealth during COVID, including its costs, uptake rates, measurable health outcomes, and racial and geographic disparities.

The bill avoids some of the thornier issues around telehealth, such as coverage parity or interstate licensing issues, while making permanent broadly popular policies such as eliminating geographic and originating site restrictions.

Source: U.S. lawmakers reintroduce House bill safeguarding access to telehealth | Healthcare IT News

The primary barriers to the acceptance of telemedicine are not technological but political. Government, especially regulatory agencies, professional associations (including the ADA) hospitals, insurance companies and others all have a vested interest in the status quo and an incentive to block the acceptance of robust telemedicine.

One of the few good things to come from the Covid 19 pandemic is the use and acceptance of telemedicine.

This is why IMHO telehealth has such tremendous potential.

Corona Pandemic Management Telemedicine

Why the five-day workweek is outdated for working from home

From Fast Company:

It’s time to get realistic about how people work in the 21st century. To the degree that we can acknowledge what is actually happening—and what is actually effective—we can begin to experiment with work hours in ways that simultaneously increase productivity and well-being.

Source: Why the five-day workweek is outdated for working from home

Technology allows us asynchronous work from home options. Doctor do you care if your office manager submits the days insurance claims, sends out statements and records payments from the computer on the right side or the left side of the office? Of course not. Then why can’t she/he do it from a computer in a different building? Why not from home?

The 9-5, five day a week office work week was needed when everyone needed to be in the same place and have access to the supplies and data to do their job. Now all they need is a computer with an Internet connection and they can do the work from anywhere. Not just anywhere but any time.


Four Types of Teledentistry

From Teledent:

Four Types of Teledentistry

Live Video (Synchronous)
Best described as a two-way interaction between patient and dentist, using audiovisual technology.

Store and Forward (Asynchronous)
Recorded health information, such as radiographs, photos, video, digital impressions or
photomicrographs that is transmitted through a secure electronic communications system. The
practitioner then uses the information to evaluate the patient’s condition or render a service
outside of a real-time or live interaction.

Remote Patient Monitoring
Personal health and medical information is collected from an individual in one location then
transmitted electronically to a provider in a different location for use in care. This could be
used in a nursing home setting or in an educational program.

Mobile Health
Health care and public health practice and education supported by mobile communication devices,
such as cell phones, tablet computers or personal digital assistants. Patients can access
teledentistry by a smartphone app, and could include apps that monitor patient brushing or other
home care.

Health Care Politics Telemedicine


It should have been titled the ANTI Dental Telehealth Bill.

From NY State Dental Association:

The amendment protects dental patients by requiring that dental telehealth providers identify themselves to patients and provide their New York State license number. It also stipulates that patients undergo proper examinations, necessary X-rays, and reviews of medical and health history before treatments can begin by a licensed dental practitioner.



Teledentistry in action

So, Ruiz did what many people do when they have a question—she turned to the internet. That’s where she found a teledentistry app called Toothpic.

Toothpic allows people like Ruiz who need a check-up or have a specific dental concern to snap a few photos of their teeth and submit them along with a short write-up of their issue. A licensed dentist then reviews the submission and sends back a personalized report with recommended treatment options and estimated costs, in as little as six hours.

Source: A reason to smile | Coverage

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The shift to virtual and home care: An interview with Annie Lamont

Interesting, from McKinsey:

“There is no doubt that the patient–provider experience during the past several months has accelerated virtual models of care by five to ten years.

…Hospital systems have been the drivers of our healthcare system. Our nurses and doctors in those hospitals have been heroes throughout the COVID-19 outbreak. But the reality is that if we want to lower costs, if we want to provide the best care, the future of healthcare has to be driven from outside of the four walls of a hospital system.

Source: The shift to virtual and home care: An interview with Annie Lamont | McKinsey

The “Health Care Crisis” is not a crisis of care it is a crisis of affordability. New techniques and new uses if digital technology will lower costs and improve quality. The linked article focuses on medicine but applies equally to dentistry. In dentistry we will eventually have to actually touch the patient but there are many diagnostic tasks and business tasks that can be done virtually.

Health Care Politics Telemedicine

ADA updates teledentistry policy

This is very disappointing.

Dentists who deliver, direct or supervise teledentistry services should be licensed in the state where the patient receives services unless otherwise authorized by a state’s dental board, according to the policy. Patients have the right to know the identity and qualifications of oral health practitioners involved in the teledental encounter, costs they are responsible for in advance of the delivery of services, and be actively involved in treatment decisions, according to the policy.

Source: ADA updates teledentistry policy

I am happy that the ADA is addressing the issue however it is upsetting that they have fallen back on old ways of thinking that limit the application of new technology. I am afraid there is more politics here than patient care.

Does the ADA really believe that my friend Dale Miles, one of the best dental pathology and radiology specialists in the country cannot diagnose a CBCT that was sent to him via the Internet from a dentist in a state that Dale is not licensed in?


Teledentistry App – Grin

Dvora Brandstatter used to drive her son Elchanan half an hour to the orthodontist and back every month to make sure his braces were working properly. Now, from the comfort of her home in Bergenfield, New Jersey, she attaches a special scope to her smartphone camera, opens an app and inserts the contraption into the 11 year-old’s mouth. A video of the boy’s choppers is sent to his dentist who checks progress, diagnoses any issues…

…The app and the scope were created last year by New Jersey-based startup Grin. After the pandemic hit, Chief Executive Officer and dentist Adam Schulhof said the company sped up development of the technology and partnered with manufacturer 3M Co. to quickly distribute it to as many orthodontists as possible. About 5,000 units have shipped out and roughly 1,000 patients have used the system so far, according to Grin.

Source: Dentist visits go remote during the covid-19 pandemic

Another promising teledentistry app. The next step will be to incorporate AI into the app to assist in diagnosis.

Future Tech Telemedicine

Boston Dynamics Is Putting Legged Robots in Hospitals

From  IEEE Spectrum:

For the past eight months, Boston Dynamics has been trying to find ways in which their friendly yellow quadruped, Spot, can provide some kind of useful response to COVID-19. The company has been working with researchers from MIT and Brigham and Women’s Hospital in Massachusetts to use Spot as a telepresence-based extension for healthcare workers in suitable contexts, with the goal of minimizing exposure and preserving supplies of PPE.

Source: Why Boston Dynamics Is Putting Legged Robots in Hospitals – IEEE Spectrum

I love the concept…but…It is more than a little creepy. Follow the link for a video.

Corona Pandemic Management Telemedicine

Making healthcare more affordable through scalable automation

From McKinsey:

As more healthcare companies start to implement automation technologies, the ability to coordinate across the organization in achieving scale will be a major determinant of success.

Source: Making healthcare more affordable through scalable automation | McKinsey

Another thoughtful analysis from McKinsey. The linked article looks at many business sectors, not just medicine/dentistry and analyses how much of each business is liable to become automated. Healthcare is not high on the list, nevertheless there are a great many tasks we do in the dental office which can be automated and or done from home via telecommuting.

As I have said many times the health care crisis is not really a crisis in care it is a crisis in affordability. Anything which reducers costs while maintaining or even improving the quality of care will help relieve the crisis.

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Could your Fitbit or Apple Watch detect early COVID-19 symptoms?

From  Reuters:

Fitbit and other wearable devices typically linked to exercise are being studied as ways to identify people who are potentially infected with COVID-19 before symptoms appear, when they can unknowingly spread the disease.

Source: Could your Fitbit or Apple Watch detect early COVID-19 symptoms? – Reuters

The linked article hits many of my hot buttons regarding future tech in medicine and dentistry. It is also up to the second relevant as it provides a potential break through in Covid 19 diagnosis.

it seems that researches could identify people who had contracted Covid 19 based on changes in heart rate before any of the overt symptoms were apparent. Click the link for the details.

Reportedly researches could detect 80% of users who had Covid 19 based on wearable data. What the article does not state is how many false positives were detected. In other words did Fitbit data suggest a person had Covid who in fact did not? In many ways a large percentage of false positives is a bigger problem than the 20% who had it who did not receive the early warning diagnosis from their wearable.

The potential to improve the human condition with this type of technology is awesome. Would it not be fantastic if our health could be constantly monitored by that big data AI in the cloud and potential diseases detected and treated early? Wouldn’t it be wonderful if we knew we had early asymptomatic Covid and we could avoid infecting the rest of the family? Would it not be great if the doctor in sky knew everything about us and could remind (not nag…remind) us to get more sleep, loose a few pounds and skip that extra six pack of Bud?

Okay you see the problem. Who has access to all that extremely personal health information? Is it safe?

RELATED: Garmin a major supplier of GPS and other wearable devices has suffered a MAJOR cyber attack.


Management Telemedicine

How business leaders (and dentists) can plan for the next normal

From McKinsey:

The figures for telemedicine and virtual health are just as striking. Teladoc Health, the largest US stand-alone telemedicine service, reported a 50 percent increase in service in the week ending March 20, and is adding thousands of doctors to its network. The Federal Communications Commission is spending $200 million to improve connectivity between patients and virtual-healthcare providers, and the US Department of Health and Human Services has increased reimbursements for telemedicine and enabled cross-state provision of virtual care.

Source: How business leaders can plan for the next normal | McKinsey

More evidence that telemedicine (and teledentistry) will be a huge part of the future of health care. There are many reasons for this and the Covic pandemic has accelerated the change and eliminated many of the barriers to change.

Dentistry will continue to be a hands on profession however there are many tasks we could perform remotely. Following is an article I wrote a couple of years ago written as “News of the Future” that presents how we could be using teledentistry a few years from now. All the technology presented in the article is already available.

May 21, 2022: Arnold Zimmer , a San Jose dentist, prepped a tooth on a patient in Fargo North Dakota. By means of tele-dentistry techniques Dr. Zimmer used 3D images of the patient, including bones, teeth and soft tissue integrated into a virtual patient simulation transmitted to his office in California over the Internet. He transmitted his telepresence image back to the clinic in Fargo to talk with the patient and inevitably to ask him to open his mouth.

With Augmented Reality Glasses to guide him Dr. Zimmer slipped his hands into a pair of cyber gloves in San Jose to guide the digital laser handpiece connected to a surgical robot at the other end in Fargo. He used real time 3D images of the tooth prep including patient vitals off to the side and a shadow image of the pulp below the surface to help guide the prep.

The image of the prepped tooth was than transmitted to an artificial intelligence driven online system to design the restoration. The design process took 12 minutes. A master technician in Bern Switzerland then reviewed the design and checked it off in one minute. The design was whisked back to a 3D printer in Fargo to create the restoration.

Dentists and lab techs in Fargo could not be reached for comment.

3D images, virtual patient integration, telepresence robots, 3D goggles, surgical robots, augmented reality, digital impressions and 3D printers all exist right now. 

Management Telemedicine

Telehealth: A post-COVID-19 reality?

From McKinsey:

COVID-19 has caused a massive acceleration in the use of telehealth. Consumer adoption has skyrocketed, from 11 percent of US consumers using telehealth in 2019 to 46 percent of consumers now using telehealth to replace cancelled healthcare visits.1 Providers have rapidly scaled offerings and are seeing 50 to 175 times2 3 4 the number of patients via telehealth than they did before.

Source: Telehealth: A post-COVID-19 reality? | McKinsey

Right now most telemedicine is little more than Facetime or Skype. However as DIY digital diagnostics become more accepted future telemedicine will become even more significant. The two biggest factors holding back telemedicine are payers and regulators. For example Medicare refused to pay for telemedicine until the Covid crisis forced them to.

Be creative, how can dentistry use telemedicine?

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Virtual health: The next frontier of care delivery

From  McKinsey:

For the past 10 to 15 years, virtual health has been heralded as the next disrupter in the delivery of care, but there has been minimal uptick in adoption. The COVID-19 pandemic is pushing against structural barriers that had previously slowed health system investment in integrated virtual health applications.

Source: Virtual health: The next frontier of care delivery | McKinsey

A nice overview on the current state and expected development of telemedicine. The article is focused on medicine but never the less as many good insights dentists should be aware of. As the article states the Covid pandemic has made people in general much more open to telemedicine. It has also reduced some of the structural barriers such as government regulations and insurance limitations.

Corona Pandemic Telemedicine

OralEye teledentistry Network 

Provide Virtual Checkups For Patients Using Your Computer

Source: OralEye Network | Join Today and start using teledentistry

Another teledentistry resource.