As many dentists are well aware, numerous integrated technology systems are part of the modern dental practice. Few will argue that practice management software is the most important component, as it ties many of these different systems together. Practice management software systems continue to improve, but as most users know, those changes are often incremental and don't address the needs of every user. Fortunately, a number of third-party programs and services can fill in the blanks where practice management software may fall short. These programs include charting, online confirmations and scheduling, progress notes, digital signature pads and paperless systems, patient education, appointment reminders, in-office communication, and fee analysis.
The goal of this article is to review the major systems available and discuss why dentists are using these products and services to improve their practices.
Illustration by Nathan Zak
Most of the practice management programs on the market have a module for charting restorations and periodontal conditions. However, one common complaint we hear from offices is that the charting does not accurately allow the dentist to record restorations as they appear in the mouth, nor does it allow the ability to chart the spatial relationship of teeth to each other, such as you would see when there is crowding or diastemas. One of the programs that appears to address these concerns is The Complete Exam (http://www. thecompleteexam.com/frame.html). This program has been around for many years, and while it offers a full-featured suite of software, the program can be purchased just for charting. This was one of the first software programs to develop a 3-dimensional chart that shows teeth and restorations exactly as they appear clinically. Some newer programs, such as the upcoming version of Dentrix, G2, (http://g2.dentrix.com/beta/screenshots.aspx) will be adopting this 3-dimensional chart model for the software as well.
ONLINE CONFIRMATIONS AND SCHEDULING
While we discussed this concept briefly in the March 2006 issue of Dentistry Today, it would be prudent to review the major systems available. These services have become very popular with busy offices, as they find the amount of time and manpower necessary to confirm appointments can be overwhelming. While some dental consultants recommend that offices do not confirm patients, many offices are not comfortable with this. When it comes to confirming patients, various companies have taken different approaches. Elexity (http://www.elexity.com/), a relative newcomer, uses a system of voice calls in the office managerís voice that are tracked through a computerized management program, allowing offices to know if patients were reached and how long they stayed on the phone, and giving patients the opportunity to confirm. Smile Reminder (http://smilereminder.com/ home.do) works on the premise that most of our patients have cell phones and all cell phones since 1998 can accept text messages, so the software will send out text reminders to the patient. Uappoint (http://uappoint.com/) and Demandforce (http:// demandforce.com/) focus on sending automatically generated e-mails and allowing the patients to click on links in the e-mail to confirm the appointment. Demandforce also permits the practice to send e-mail surveys to the patients to gauge their satisfaction with the practice.
Many of these products are now exploring ways to develop some type of online scheduling system. They may face some resistance from staff members who are reluctant to give up control of the appointment book, but a hybrid system that would allow patients to request appointments based on certain criteria should prove to be an added bonus.
For offices that wish to be paperless or chartless, there's no doubt that there has to be an effective and easy method to enter progress notes into the clinical record. While many practice management programs have similar systems in place, they are often clunky and difficult to use. For example, any system that uses exploding codes and requires the user to go back and edit the teeth, surfaces, anesthetic, etc will be time-consuming. There is an excellent alternative in EasyNotesPro (http://easynotespro.com/). Developed by a dentist, it integrates with almost every practice management software on the market. Rather than use macros that need to be edited, this software reduces the entire clinical note to a series of mouse clicks, where the practice can customize the options so that the choices are specific to that practice. Most offices will be able to enter an entire procedureís notes in under one minute with a program like this.
PAPERLESS SYSTEMS...THE MISSING LINK?
I am not a huge fan of the term paperless, as many systems still use paper, such as insurance forms, walkout statements, and printed im-ages. However, more and more practices are doing away with the physical paper chart that needs to be carried from room to room. The problem for many of these offices is that they had no way to deal with the numerous forms that required patient signatures, such as HIPAA forms, Informed Consent, and Medical History. Enter Dent-Forms (http://www.medictalk. com/). DentForms allows the practice to create digital reproductions of all their paper forms. Patients can then sign either a digital signature pad or a Tablet PC in order to enter their signature into the record. Not only does this system work with most of the practice management software companies, but it also has an online component so that patients can fill out their medical and dental history forms before they arrive at the office. The online forms are then downloaded into the practiceís server, bringing all the necessary information to the practice automatically.
Very few practice management programs have a patient education module. There are really two schools of thought when it comes to patient education. The first is to use short video clips with sound. The patient can watch these videos, with or without a team member present, to learn about procedures that the office is recommending. This is the type of system that is used by Caesy (http://www.caesy.com/). The other school of thought, used by many other vendors, is to remove the sound from the video clips and instead use highly detailed animations to demonstrate procedures. The thinking behind this is that patients are at the office to gain confidence in the dentist, not just to learn about the procedure, so the goal would be to use the software as a tool for dentists or assistants, but they would need to be chairside with the patient. Some of the products that follow this philosophy include Orasphere (https://www.orasphere.com/) and Consult-Pro (http://www.consult-pro.com/home/index.php).
While many offices still use the older, hard-wired light systems to communicate between the back office and the front, these systems have certain limitations. Besides costing thousands of dollars, they have limited customization and interactivity. Assuming that the office has computers in the operatories and other strategic locations, it would make sense to consider a software-based messaging system instead. One of my favorites is BlueNote Com-municator (http://bluenotecom-municator.com/). One nice feature of this system is that besides a pop-up window that alerts you to a page, how do you deal with the fact that the front office may not know where a staff member is located? So, BlueNote uses a series of tones that are customized for each member of the office. That way, as long as you can hear the tone from any other computer, you can respond to the page. Another newer system that was recently released is PatientTracker (http://www.patient-tracker.com/home.aspx).
One of the most misunderstood systems is the one that dentists use for setting their fees. Some will compare the fees of competitors, some raise their fees an arbitrary percentage each year, and some just pull the fee out of thin air. Obviously, this is not a very effective system, and dentists are not collecting the fees they should because they donít use a scientific system for establishing their fees. This is where a system like the Fee Schedule Optimizer (http://sikkasoft.com/fso.html) can help, by using established business models to help the practice become more profitable.
While practice management programs continue to evolve, there is no one system that ìdoes it all.î Fortunately, many innovative companies have developed, and are continuing to develop, programs and services that add to the functionality of the software and can be very beneficial to practices that wish to be-come more efficient and profitable.