is not paperless.
“What we found surprised us a little,” Karen Dunn Lopez, the director of the Center for Nursing Classification and Clinical Effectiveness at the University of Iowa, said in a statement. “After two and a half years of continuous use, clinicians’ cognitive workload remained very high, and they still found the new EHR system more difficult to use than the prior paper- and computer-based hybrid system.”
This is sad.
I have had some limited experience using medical EHR software when I did some sleep dentistry and I found it very challenging. Much harder to use than dental software. It did not have to be this way.
Medical EHR systems were not designed by physicians. They were not designed with patient care in mind. They were not designed to facilitate workflow. They were designed to satisfy a “meaningful use” check list that politicians and bureaucrats thought was important.
From a Sesame Communications promotion:
• Online Appointment Booking: New and existing patients can quickly book appointments on your website that sync with your Dentrix PMS
• Virtual Waiting Room + Tap-to-Text: Deliver a safe and effective virtual waiting room experience for patients and staff
• Custom Design, Branding & Copywriting: Help your practice’s website stand out from competitors
• Virtual Consultation: Provide a basic, free consultation, before the first in-person visit with a prospective patient occurs
• SSL Certificate: Secure communication between your practice’s website and your patient’s internet browser
• Responsive Design: Your website will provide a great user experience across all device types including desktop, mobile, and tablet
• Live Backgrounds: Immediately capture the attention of visitors to your site with a beautiful, moving, site background
Your practice web site should not be a once in a lifetime experience just for new patients. A good dental website includes support for existing patients. In addition to the appointment booking and tap to text features shown above your website should also allow patients to fill out interactive forms (not just a pdf) check the time of future appointments and pay their bill.
From AZDA Inscriptions:
e-Prescribing can reduce errors. Pharmacists are no longer deciphering handwriting. Phone calls, missed calls and voicemails no longer add steps to the process and the potential for your patient’s prescription getting lost or delayed during the game of “Telephone”
Mandates are in place or on the way to requite eRx for all controlled substances. However the linked article makes a great case that all Rxs should be electronic. I agree.
SO MANY ROBOTS work at Changi General Hospital in Singapore that until recently it wasn’t uncommon to find two delivery bots sitting in a hallway or outside an elevator in a standoff.
I concede it will be necessary for robots to interact with each other.
MORE IMPORTANTLY I would like our applications to interact with each other. This is called interoperability. It is almost nonexistent in dentistry. It is outrageous that we can still not transfer an electronic dental record from one office to another.
When a new patient walks into Dr. Retro’s office, the first thing that happens is Judy, the receptionist, hands the patient a stack of forms, a scuffed-up clipboard, and a pen tied onto the clip with dental floss.
“Fill these out,” she says to the patient, “and be sure and sign every page.”
Eventually, Judy collects the forms and while the patient waits she starts typing the patient’s name and other data into the computer. Then, the forms go into a chart. They are the first entry in what will soon become a mass of paper.
There is a better way.
It is possible to gather all the data online away from the office in such a manner that the patient does not need to be in the waiting room, does not need to touch anything and the team member does not need to touch a clipboard or even touch the keyboard. In fact the team member does not need to be in the office, he/she could be working from home.
A web based system puts the same paper forms as you would use on the clipboard onto a web site as digital forms. The patient fills out the forms from home or office. Once the forms are filled in the data then transfers to the dental office and eventually to the patient’s electronic record. In order to do this the office needs to have complete paperless records, practice management software that can accept web based information and a well designed practice web page.
Online forms in pdf format do not count. The patient needs to download the form, print it, fill it by hand, remember to bring it to the office, and a team member needs to enter the data. It is essentially the same as the old clipboard.
The new Imaging Case and Collaboration (ICC) app from Carestream Dental is the easy-to-use platform that makes sharing cases more secure and straightforward. From the GP to the specialist to the lab—even practices within the same network, such as a DSO setting—ICC makes it easier to connect oral health care providers for closer collaboration, getting patients the answers and care they need sooner.
Dentistry has needed an app like this for years. There have been many attempts but so far none has caught on.
This is from Carestream, follow the link for the full press release.
From Marcus Buckingham:
If you overwhelm your people with tons of goals, or many sub-goals, you run the risk of them trying to do everything in a superficial or inadequate way. Instead, try to create total clarity around a few — probably 4-6 a quarter is about right.
What is true about goals in general is also true about implementing technology in particular. If you try and do everything all at once you are likely to be frustrated and discouraged.
Let’s say you want to add a digital pan, launch a practice web page, convert to paperless charts, add photos to every patient exam and install CAD CAM. All of those things will benefit your practice but you are doomed if you try and do them all at once.
People can only cope with so much change at one time. If suddenly everything is different then people simply slow down and quit. People, that is both the team and the dentist, will be frustrated and burn out preferring to slip back to the old way of doing things and your new technology never gets implemented properly.
For example; switching to paperless records is not an event – you don’t do it in a weekend – it is a process that will take from three to twelve months. First you create a system to digitize everything in the paper chart, and then you stop making paper. However you will still refer to the old paper records as needed to review last year’s x-rays or see when some treatment was done. By the way we refer back to these old records far less often then we imagine.
NOTE: Do not try and scan all your old records in order to go paperless it is a big waste of time and money,
Many years ago in the BC era (Before Computers) when office data was on paper, work flow meant; where does the chart go and who does what task.
Once a dental office develops a paperless system digital data can be accessed anywhere there is a computer, in the back, at the front or somewhere in the cloud.
This new pattern of doing things has been called Front Desklessness.
Does that mean there is no actual desk? No, Front Desklessness is not about tossing out a piece of furniture or eliminating a staff person. It is all about workflow, doing the non clinical business functions in a different way because technology allows us to handle data in a much more efficient manner.
For example, why make all the appointments at the front desk? If you use an electronic schedule with treatment room based computers why not schedule from the treatment room? Who better to make the appointment than the chairside assistant? She has just heard the dentist and the patient discussing the treatment. She knows exactly what needs to be done next. She knows if the patient is a gagger who needs extra time. She knows if there is lab work involved or any of the other clinical considerations, which would affect the appointment time. Just make the appointment.
Often work flow tasks with digital data do not need a person of any kind. For example making reminder calls, reactivating non compliant patients, sending bills or insurance claims are done in the cloud (online) with e-services, no human involved.
From ScienceDirect: Following is the summary of this scientific article by E. Dianne Rekow, King’s College, London.
Digital innovations have unquestionably disrupted dentistry. With these innovations, patient experience has improved. More restoration options are available delivering longer lifetimes, and better esthetics. Fresh approaches are bringing greater efficiency and accuracy, capitalizing on the interest, capabilities, and skills of those involved. New ways for effective and efficient interprofessional and clinician-patient interactions have evolved. Data can be more efficiently mined for forensic and epidemiological uses. Students have fresh ways of learning. New, often unexpected, partnerships have formed bringing further disruption — and novel advantages.
Is digital dentistry disruptive? Absolutely. Is it destructive? Absolutely not!
I have been saying the same thing for many years. It is nice to see some research backing me up.
Imagine a world in which—if you owned a Volkswagen—you could only fill up at a Volkswagen gas station using Volkswagen gas. Ford gas won’t work. You can only drive in the Volkswagen lane and take the Volkswagen off ramp. If the Volkswagen off ramp is closed for repairs, you can’t take the Ford or Toyota off ramp. That whole scenario is ridiculous but it is basically what happens when we use closed proprietary dental systems.
Interoperability is the ability of different systems from different vendors to work together. The opposite is proprietary, where users are restricted to one vendor’s products.
Dental management systems with electronic records, digital radiographs and digital impression systems are all highly proprietary. That is the user can not transfer a patient record from one office another electronically. Radiographic sensors are limited to specific software and some vendors even restrict which transfer system a user can use to send and impression over the Internet.
When shopping for a digital product, tell the vendors that an open system is an important buying factor. Ask the sales person if you can transfer the digital impression to any lab of your choice or if you can load the impression into design software of your choice. In most cases, the answer will be no. Let the sales person—or, better yet, the sales managers and product managers—know that you won’t buy a closed system.
Vendors love closed systems that keep dentists captive. They will not change until the dentists buying the systems demand a change.
It is amazing how many dentists will spend enormous amounts of time every day writing, editing and reviewing poorly scribbled, hard to read handwritten notes but will not do a little planning and take a few hours to create digital notes so they never have to write in a chart again.
Digital progress notes are:
Now is the time NO EXCUSES the dentist and the team members have time on their hands during the pandemic shutdown use it to complete all your note templates and set up the software to automatically enter the notes for each procedure. Follow the link below for a how to from Dentrix.
NOTE: be sure to set up codes and notes for procedures not covered with a standard ADA Code such as crown delivery, suture removal and the many steps involved in a denture fabrication. You need notes based on appointments not just procedures.
From Dentrix Tip Tuesdays:
Clinical note templates can save you a lot of time and can help you keep more accurate and detailed notes. Set up clinical note templates to help you document the procedures you complete regularly in your practice, like prophies, periodic exams, fillings, root canals, and crowns.Clinical note templates can include both the standard phrases you use to document these procedures as well as specific information like tooth number, surface, or treatment plan.
In many ways work flow is data flow. In the past when the data was on paper or film or even a plaster model, it (the data) could only be in one place at a time and moving it from place to place was time consuming and relatively expensive. Thus we assigned work to a specific place (like a front desk) and a specific person (the front desk person) to that place.
The result was the back office – front office divide. Work flow meant; where does the chart go and who does what task. Once a dental office develops a paperless (digital) system of records, charting, scheduling even impressions the work flow changes significantly. Digital data can be accessed anywhere there is a computer, in the back, at the front or in a different building. Workflow can now be described in terms of tasks not places. Tasks can be assigned to a person or to an e-service. People are freed from the drudgery of filing, typing, looking for lost records, calling patients and doing all the rest of the busy work needed to keep a dead tree system working.
A great example of the evolution of workflow is the process of reminding or confirming patients:
Paper data and paper workflow: A team member collects all the charts for the next days appointments, looks up each phone number then calls repeatedly to confirm (remind) the patient.
Digital data with same old workflow: A team member clicks on each appointment in the electronic schedule, a number appears, the team member then calls repeatedly to confirm (remind) the patient.
Digital data digital workflow: An e-service calls or texts every patient on the digital appointment book every day with no human intervention needed.
E-services can be used to take payments, bill insurance, link up forms and data, re-activate patients and much more.
This new pattern of doing things has been called Front Desklessness.
Front Desklessness is not about tossing out a piece of furniture or eliminating a staff person. It is all about doing the business of dentistry in a different way because technology allows us to handle data in a much more efficient manner.
Source: Home – Carestream Dental
I will be presenting sessions on Google Juice, Digital Workflow and Data Security.
The Thomas P. Hinman Dental Meeting is an annual tradition, providing dentists, dental hygienists, dental assistants, laboratory technicians and dental office staff with the latest and most comprehensive continuing education in dentistry today. Our meeting is known for its Southern Hospitality, extraordinary educational programs, impressive roster of speakers, unsurpassed social events and all-inclusive technical exhibition.
Source: The Hinman Dental Society
The biggest mistake dentists make with digital charting is they only go part way. For example: They use a paper chart in the treatment room during diagnosis to mark future treatment. Then they take the paper chart to the computer and enter everything again. They will use the computer to create an estimate, insurance forms and schedule. Then they will go back to the paper chart to enter procedure notes, back to the computer to take a payment, back to paper for a prescription, back to the computer for the next appointment then back to paper to check the x-rays.
What the office ends up with is a mess. Everything is done at least twice, the paper chart is still needed no one is ever sure if something is on paper or in the computer. As a result the computer chart doesn’t save time and money it makes things worse.
Once you have the process in place:
From The Dentrix Office Manager Blog:
Using Electronic Prescriptions: In Florida, and as of January 1, 2020, a new law became effective that requires prescribing doctors to send all prescriptions electronically. Arizona, Iowa, Massachusetts, North Carolina, Oklahoma, and Rhode Island also have mandates that took effect January 1, 2020; and in September 2018, California passed a law that requires electronic prescribing for all medications.
Check the laws for your state. Is your practice required by law to send prescriptions electronically? It may be time to think about how your practice is going to implement this requirement into your daily workflow. You will need to use a service to electronically submit prescriptions to pharmacies. I recommend using Henry Schein One ePrescribe, which allows you to send electronic prescriptions directly through Dentrix.
A new system to create complete chart notes. Click for a free trial.
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Source: Ez Dental Charts