Management Office Design Paperless

Digital Workflow and Front Desklessness

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.

Hardware Paperless Security

The File Room of 2027

Today: The dentist has a room filled with charts, radiographs, correspondence, EOBs and all the other records along with endless little white boxes filled with plaster models. Finding the models and records for a case done six years ago requires an exploratory party and soon bears a striking resemblance to a wilderness expedition. But make no mistake about it the records are there and we will find them eventually.

Ten Years from Now: All the records including forms, histories, treatment notes, radiographs, tracings, photos and 3D images of bones and teeth are stored digitally. Thirty years of patient records don’t take up a room but are stored somewhere in the cloud actually taking up a physical space smaller than a deck of cards. The records can be called up immediately from anywhere in the known universe with a computer and an Internet connection.

Paperless Dental Records:


Electronic Dental Record guidance from the ADA

From ADA News:

The committee earlier this year published ADA Technical Report No. 1030, Dental Provider’s Guide to the Electronic Dental Record, which discusses key concepts of the Electronic Dental Record and provides guidance on implementing an Electronic Dental Record system into dental offices.

Source: Electronic Dental Record concepts, guidance for use laid out in report

The report may be downloaded at no cost to members available from the ADA catalog at

Management Paperless

Paperless Thoughts

officepaperwork600Dead tree (paper) data can only be in one place at a time. There is only one paper appointment book, only one paper chart, only one film radiograph. As a result if one of the pieces is missing, say the chart is in the back (or just lost in a stack on the doctor’s desk) or an x-ray is misplaced the functions of the front desk stop.

Once we transfer the data from paper to electronic we no longer need a single physical place, like the front desk, to gather the information. An administrator can gather the data where ever there is a computer. That could be at the front, in the back or even in a different building! The computer rather than the front desk becomes the Data Center of the practice

More Help:


Guide to “Going Paperless”


2016 is the year to “Go Paperless”

Stop putting it off, going paperless can save you tens of thousands of dollars. Make it your goal – paperless in 2016.

My comprehensive technology guide, “How to go paperless in the dental office” will answer the basic question…Why bother?  It then provides step by step help in setting up a paperless office, including the eight essentials that need to be in place before you get started, four ways to digitize stuff, and front deskless workflow. There is even a budget and financial analysis that shows how your current paper system is costing you over $40,000!

“How to go paperless in the dental office” will answer all your questions, provide a plan and show you how to save money… all delivered in a fun and easy to understand style.

Follow the link to order your copy today.



“Paperless” Mistake

One of the common mistakes dentists make with electronic charting is that they only go part way. For example: The office may 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.

The tendency is to concentrate on individual processes or technologies without integrating the process into the whole.

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.

I frequently find dental offices that have everything they need in place to “go paperless” but they keep plodding along with an inefficient hybrid system as described above. The secret to going paperless is to:

Stop Making Paper!

More help going paperless here:

Internet Paperless

Interactive “Smart” Forms

nopdfWhen we consider using online forms our first notion is to simply copy the paper forms we have always used in a digital format like a pdf. However once you start thinking digital and electronic the forms can become so much more. Forms can now be smart and interactive.

For example, Men do not become pregnant. So why ask them if they are? A smart system would eliminate that question if the patient checked the M box and include it if she checked the F box. An even smarter system might eliminate the question for children and older women.

A smart form would change based on responses. If the patient checked the Yes box next to “Are you pregnant?” the form would then ask “When are you due? or How many weeks?”. If the patient checked the No box then on to the next question.

Another example could be, “Are you diabetic?” It the Yes box is checked the follow up questions could be: When were you diagnosed? Is your blood sugar well controlled? Do you take oral medication or use injections? How often? And so on. If the patient checked the No box then on to the next question.

These “smart” forms would not be handed to a patient when he or she walked in for an appointment but would be online linked to the patient chart. Digital online forms are not just for new patients but can be accessed by every patient in order to update their health history or other changes like a new address or employer.


Your Practice and Patients Will Love Going Paperless

A Guest blog from Dayna Johnson. The opinions expressed are from Dayna not Dr. Larry Emmott. However I believe it is valuable for dentists to get various takes on technology issues in order to make good technology choices.


Exhausted dentistBy: Dayna Johnson

Reasons Why Your Practice and Patients Will Love Going Paperless

You’ve probably heard it: “It’s the 21st century—go digital.” It sounds like an easy feat until you start to apply it to your practice. With tried and true methods of filing and billing, switching over would be a lot of headache, right?

Wrong. For the business side of running your practice, dental practice management software is the solution for going paperless, which will save you and your patients money.

Today’s Patients Expect Digital

Many patients expect their information to be available to you and them in seconds. No one wants to be sitting in a chair while their dentist fumbles with papers or deciphers handwritten notes.

Your younger patients are certainly more likely to respect your practice if it is up-to-date with technology. Studies have shown that 91 percent of millennials find digital documents more current. But if catering to 20-30 year olds isn’t your goal, consider the fact that 64 percent of all American adults own a smartphone, and even users aged 50 and older are regularly texting and emailing.

Patients Will Love It

Being able to correspond via email or text message, including appointment reminders and statements, streamlines the process of communicating with patients. Not only can they access all the information from their handheld device, they also can do it at a time that is convenient for them, rather than during business hours.

Many people claim that a visit to the dentist is inconvenient to fit into their busy schedules. Save your new patients time by making forms available to fill out online beforehand will cut down on their time in your waiting room.

Without physical files to keep organized, your office staff can focus on building personal relationships with your patients. The better experience the patients have during their visit, the more likely they are to keep returning.

Gets Your Office on the Same “Page”

Being connected with interoffice chat systems, digital patient files and easily accessible information ensures that everyone in your practice will see each other’s notes and comments about a patient—from scheduling to billing to their favorite flavor of toothpaste.

Plus, any team memos or reminders can be sent out to the whole staff for easy communication between shifts and departments.

Enhanced Security Features

There is not much security surrounding a printed piece of paper, even with the likes of envelopes and shredders on hand. But going digital provides confidential, password-protected arenas for patients to look at their dental information and billing with confidence that HIPAA laws are being upheld, and that no prying eyes will see their charts.

Additionally, the paperless system comes equipped with automatic backups for patient charts, X-rays, insurance claims, billing statements and calendars, so you never have to worry about accidentally tossing an important document.

Need more reasons to switch to digital? Download this infographic to find out how your practice can become more efficient, consistent, and secure.

Need More Help Going Paperless? Look Here:

Management Paperless

Eliminating Dead Tree Charts

officepaperwork600It has become fashionable on the Internet to refer to traditional newspapers as “dead tree” media. This of course refers to the many thousands of trees that are cut down every day and used to make paper. If you are using traditional paper charts then you are using “dead tree” charts. There is a better way.

It is possible to turn dead tree (paper) information into electronic digital information. There are four ways to create digital information.

Enter it
Capture it
Scan it
Import it

Enter it: What this refers to is the process of directly typing or clicking in information.

Capture it: Digital capture refers to a process that creates or captures information (usually images) into an electronic format. In dentistry the best examples would be digital photographs and digital radiographs.

Scan it: A scanner is a hardware device that converts hard copy papers into soft copy digital information.

Import it:  Data import does not create new digital information. It is a function that allows users to add already existing digital information to a patient record. The difference between scanning and importing is that scanning starts with a piece of paper. Importing never goes through a paper phase.

Health Care Politics Paperless

Electronic Health Records Mandate

Krauthammer Follow Up:

Hospital physicians will tell you endless tales about the wastefulness of the data collection and how the lack of interoperability defeats the very purpose of data sharing.

via Electronic Health Records Mandate — Doctors Are Being Needlessly Demoralized | National Review Online.

This is a follow up article to this from last week. Krauthammer answers misguided critics and further explains. The bottom line conclusion remains the same:

The EHR as mandated by the federal government was designed by bureaucrats not practitioners. As a result it does not serve the best interest of the physician or the patient.

Medical professionals are becoming corporate drones or government employees. Neither option will attract the best and the brightest to choose medicine and dentistry as a future profession.

Paperless Security

NBC News Reports on Medical Records Hacks

This is what your patients will be seeing.

Future Tech Internet Management

Third Generation Online Referrals

First generation attempts to create digital referral slips simply recreate the paper form in an electronic format, usually pdf. The referring dentist needs to download and print the form then fill in the information (patient name, practice information, tooth #, diagnosis etc.) by hand. The patient takes the form to the specialist and the data is entered just as if the patient had come in and was handed a form to fill out.

Second generation online referrals can be filled in online, no paper. However the referring dentist or the patient still needs to fill in the information by hand using a keyboard and mouse. Once the information is filled in the specialist office could access it from the Internet and create a new patient record with no additional data entry.

Third generation digital referral slips will be smart and interactive. The system will upload data directly from the electronic record without the dentist or dental staff member re-typing or pasting the data. It will include the basics we have done in the past as well as a complete medical history, patient demographics and insurance information.

When the patient shows up at the specialists office there will be no clipboard and forms they will already have complete electronic record waiting for them ready to go.



Fuzzy no More

One of the best things about a digital x-rays is that they are…wait for it…they are…digital! That means we can use diagnostic software to examine and possibly enhance the image and improve our diagnostic efficiency. Most dentists believe that digital radiography is all about the sensor, but when it comes to diagnosis it is all about the software.

With digital radiography we tend to forget we can enhance the image; we are used to analyzing a similar non digital film image with our eyes so we don’t easily appreciate the software analysis. Most dentists in fact just analyze and diagnose from the raw digital radiograph with their eyes. Just as they did film in the past; it just seems like a different version of the same old diagnostic.

Here is an example of how software can enhance diagnostics. These images are from the XDR Radiography system.

Above is a raw image straight from the sensor. Can you detect interproximal decay? Most dentists can see the lesions but we feel the image is “fuzzy” not as clear as we are used to with film.

Now look at the same image after a “sharpening” tool has been applied.

The sharpened image is more like film and most dentists find it better diagnostically. Interestingly the sharpening tool extracts data to make grayscale changes more abrupt. Here is what Dr. Doug Yoon a dentist and the brains behind XDR Radiography says about sharpening.

“I think sharpening can serve as a visualization aid by making the fuzzy borders of lesions look more distinct (even though we all know lesions really do have fuzzy borders).”

The point to remember is that a primary advantage of a dgital image is that it can be enhanced with software. Don’t judge digital radiography by the image alone it is both a high quality image and good diagnostic software that makes digital better than film.

Internet Paperless Software

Paperless…Chartless? What’s the Difference?

nopdfMore good advice from Dayna the Dentrix Diva.

If your office sends the patient paper forms to fill out before their appointment, sends the patient a PDF attachment of your new patient forms, or if you send your patients to your website where they have to download a PDF form, your office is ”chartless” not “paperless.”

via  The Dentrix Office Manager: Thinking of implementing electronic forms? This is a must read.

Providing forms as a pdf on your web page is a lateral technology move that provides very little benefit to the practice or the patient. True digital forms never go through a paper phase. The patient fills them out online and the data is synched to the patient record. No dental team member needs to put hands to keyboard.

Dentrix users can do this with e-central and website manager.

Another option is DentForms. DentForms works with Eaglesoft, Softdent as well as Dentrix and others.

True online forms provide several benefits:

  • Number one of course is efficiency. Team members spend less time transcribing paper entries from forms (including printed pdf forms) to the computer record.
  • Digital forms are not just for new patients but should be used with every patient to quickly update their chart information. Online forms are the quickest way to transition from paper forms to electronic.
  • Sending every patient to your website to fill out forms will create web traffic. This in turn will enhance your Google presence.
  • Patients will notice. They will appreciate the efficiency and it will help your office stand out as high tech.
Paperless Software

MedicTalk DentForms Paperless Dental Software

eForms-v4With DentForms, patients’ can electronically complete their forms either online or on a computer in your office. All of these forms can then be electronically signed with a digital signature pad or touch screen monitor in your office.

via MedicTalk DentForms Paperless Dental Software | The Dental Record.

I have tried several electronic forms systems. My favorite is DentForms. Mostly because it works. Sadly many other systems look great but don’t actually work as advertised on a consistent basis.

You can set up the system to work online, with a tablet or on a desktop workstation. DentForms will integrate with Dentrix, Eaglesoft and many other Practice Management systems. The office can use the pre-made forms or completely customize them. Once the forms are filled out the patient can sign with an electronic signature pad.

Health Care Politics Paperless

2015 – High noon for federal health records program?

SFrom Politico:

2015 promises to be a critical year for determining whether electronic health records will enable physicians to communicate with each other efficiently to create better care. If they can’t get their systems to interact, the program may be seen as largely a waste.

via High noon for federal health records program? – Arthur Allen – POLITICO.

Many doctors hate the clunky, time-sucking software they got through the massive subsidy program…

I would change many to most.

I am a huge fan of electronic paperless records and am pained to see them so thoroughly botched up.

The failure of EHR can be traced to two major issues which happen to be two of my major pet peeves.

  1. Government mandates have resulted in clunky time consuming systems. Inevitably when the government decides what must be included the resulting system is not designed to provide service to the patient or improve efficiency for the doctor. The system is designed to provide what is important to the government.
  2. Proprietary systems limit data transfer. As long as the companies providing the technology can keep users hostage in a walled garden they can charge exorbitant fees to manage and transfer the data.

Risk Analysis Video

Following is one of a series of videos the Government has produced to help medical and dental professionals understand the basics of a HIPAA risk assessment.

The video is a good overview but does not have the detail you will need to actually do an analysis. For that you will most likely need the help of your office IT specialist. The primary thing to discover is where are you storing health information? Is it at risk of a breach, that is damage, loss or theft? What can you do to reduce that potential breach?

Future Tech Health Care Politics Internet Management

Google’s Brin & Page: on Mission Creep, Healthcare and the cost of Regulations


But why isn’t the company devoting more of its innovation firepower to the wildly inefficient U.S. health care industry, which hogs about 18% of GDP? Brin explained:

Generally, health is just so heavily regulated. It’s just a painful business to be in. It’s just not necessarily how I want to spend my time. Even though we do have some health projects, and we’ll be doing that to a certain extent. But I think the regulatory burden in the U.S. is so high that think it would dissuade a lot of entrepreneurs.

via Google’s Larry Page: “I Think the Government’s Likely to Collapse Under Its Own Weight.” – Hit & Run :

They go on to speculate that if researchers could data mine electronic medical records tens of thousands of lives could be saved. However privacy concerns and HIPAA specifically prevents that. This goes back to my big topic, “Who Owns the Data”?

Google is famous for gathering data about us and then using that data in marketing or other lifestyle applications. That is what has made it a 392 billion dollar company. It is also more than a little creepy when Google starts advertising items to you that you just searched for or knows where you work based in your driving habits.

It is that creepy factor that scares people about their personal medical data.

Another factor has to be hacks at big time marketers like Target and Adobe not to mention the NSA debacle. People do not believe (with some justification) that their data will remain secret.

Finally Page speculates that as regulations continue to grow that government will eventually collapse under its own weight.

Follow the link for a full transcript or video.

e-Services Software

At the ADA: LocalMed

localmedOne of the few things I saw at the ADA meeting in New Orleans that was truly new and unique was LocalMed an online service that allows patients to actually book an appointment in your office.

I believe we are ready to take that step. Of course you do not allow patients to take control of the appointment book but you can make limited appointment times available. For example you could allow new patients to schedule an exam or existing patients to schedule or change a routine prophy.

LocalMed is still quite new, it does not yet integrate with all the major practice management systems and is expanding both as a service to dentists and to patients seeking a dentist.

I really like the concept and properly set up and managed I believe it would be a great asset for any practice. I predict two things will hold it back in the beginning. Dental practice management systems that do not allow outside parties to work within the software and dental office administrators who see it as a threat.

Dentalcompare e-Services Management

Do Older Patients Need More Dental Work?

In case you missed it, from a Dentalcompare article published last January.

So, do older patients need more dental work? The answer will probably surprise you. (These numbers were generated by “Action Run” a unique e-service that finds and re-activates patients.)…if a patient slips out of re-care and fails to see the dentist for two years the money spent per dental appointment by sixty year olds is more than double that spent by twenty somethings. In fact the cost per visit starts increasing at about age forty.

via No More Management By Guesswork |

We gather immense amounts of data about our patients and the treatments we provide as a by-product of doing business and using a computer. Some people call it data exhaust. You can use this data to manage your practice and improve patient outcomes.