E-Services: The Business Case for Implementation in Today's Dental Practice

Dentists practicing today are living in a historic time for our profession: we are experiencing the transition from noncomputerized to fully digitized dentistry. By the time many of us retire, dentistry will be changed forever, and we will have been the witnesses. We will have experienced, firsthand, how this new technology has helped reshape our profession.
My story begins in a way that is probably familiar to many other dentists. When I purchased my practice in 1991, it was completely computerless. We used a pegboard system for accounting and billing, and a scheduling book for appointments. Two years later, we installed our first computers, and we haven’t looked back since. In fact, we’ve now even moved beyond the computerized operatory, which many dentists consider to be the peak of modern dentistry, to take advantage of the next generation of computer-enabled technology: electronic services.
Electronic services—or “e-services” as they are often called—offer compelling benefits to dental practices. They can help the practice run more efficiently, cut down on errors, and focus more effectively on patient care. How do they do this? The key is outsourcing certain time-consuming functions—letting the practice delegate specific administrative tasks to a third party instead of doing them in-house.
This type of outsourcing isn’t new, of course. Large corporations have been outsourcing for years, beginning in the late 1980s. Their experience has proven that hiring a third party to handle their information technology (such as financial recordkeeping or network management) lets them cut their overhead costs and focus on their “core businesses.” If we translate this to the practice of dentistry, focusing on the “core business” means taking care of patients instead of paperwork.
The results can be dramatic. In my case, my practice has about tripled in size in the past decade. I’ve moved from the facility where the practice was originally housed, which had only enough room for 2 operatories and a hygiene room, to a larger one; today I have 7 treatment rooms altogether. At the same time, I’ve also been able to reduce the number of hours I practice. My office is now open just 4 days a week, and I no longer have to see patients on Saturdays to remain profitable.
Some of these productivity gains can be attributed to more familiar digital technology, including integrated practice management software and digital imaging solutions. But I’ve also gained significant efficiencies through implementing integrated e-services. Furthermore, e-services have helped me re-focus my staff on tasks that are more fundamental to my practice than stuffing envelopes. As we’ll see, this has also contributed to my practice’s financial success.

EVOLUTION OF TECHNOLOGY

Like many practices, I began my journey to computerization modestly, first computerizing our bookkeeping, then scheduling. The next step was putting computers in my operatories and switching to digital radiography. Today, my office is equipped with Kodak SoftDent practice management software, a Kodak RVG 6000 digital radiography system for intraoral radiography, and a Kodak 8000 digital panoramic system for extraoral radiography.
The benefits of computerized integrated practice management and digital radiography—including increased productivity and reduced cost of film consumables—are well documented. But for me, there was a logical next step. My practice management software was now tracking all of my patient information digitally. Why not leverage that capability to add even more efficiencies to my practice? So I began looking at e-services.
I started out with an electronic claim processing service. Like the other e-services I use, the functionality is integrated into my practice management software; it’s not an extra software application for my staff to manage, but is integrated with my SoftDent software. Its operation is simple to use: when we finish processing a patient’s appointment, the patient’s insurance claim is filed electronically instead of manually. All the “paperwork” is electronic; data from the patient record populates the claim automatically. The software also tracks claims, confirms they are successfully transmitted, and updates the patient record with claim information.
The benefits of using electronic claims were immediately obvious. My staff was no longer filling out insurance claims, printing them, putting them into envelopes, mailing them, and then notating patient files that the claims were filed.
The next e-service I added was electronic statement delivery service. With this service, all of my billing statements are generated electronically and transmitted to a clearinghouse. The clearinghouse produces high-quality, professionally printed statements and mails them to my patients. For my practice, electronic statements were a huge time-saver. We used to generate 200 to 250 paper statements every month. My wife, who is my office manager, would review them and decide which statements needed to be mailed. Those that needed to be sent would then go to my staff for mailing. This used to take 3 to 4 hours of my team’s time every month. Now, with an electronic statement-processing service, getting the job done takes only minutes. And my staff members still maintain full control of the statement process—they can even add personalized messages to our statements.
I also subscribe to an electronic insurance eligibility service. With this feature, my staff members can get insurance benefits and eligibility information over the Internet. All they do is push a button, and the software does all the rest. As a result, they no longer spend time on the phone with insurance companies to figure out whether a patient is covered, and in some circumstances, whether procedures are covered. Once they obtain this information, it is then stored within the patient record.
Another advantage of managing insurance eligibility electronically is that time zone differences don’t matter. If the insurance company is on the West Coast, and I have a patient come in for a 9 AM EST appointment, my staff can get eligibility information when the patient checks in, instead of having to wait 2 hours for the insurer’s work day to begin. While not all insurance companies currently participate in the service, many do, and it definitely adds efficiency to my practice.
The most recent e-service I’ve added to my practice is secure e-mail service. I often e-mail patient records, including pan-oramic radiographs, to oral and maxillofacial surgeons, so meet-ing HIPAA standards for pa-tient privacy is a concern. By using Kodak’s secure e-mail service, the burden of ensuring patient privacy is off of my shoulders; I’ve turned it over to a company that has far more resources than I do to both understand the regulations and figure out how to comply with them.

FOCUSING ON VALUE

With the exception of the secure e-mail service, which I implemented to ensure patient privacy, the one common thread to all the electronic services I use in my practice is that they have let us automate tasks my staff used to do manually. This is important for 2 related reasons. First, because the old way of performing all of these functions was very labor-intensive, it was also very time-consuming. And secondly, the tasks themselves weren’t part of my practice’s “core business.” They didn’t improve my patients’ experience or level of care. So not only were they taking up my staff’s time, but they also were diverting resources that I knew could be better utilized.
The implications are significant. Fully implementing my suite of e-services has freed about 4 hours of staff time per week. That’s 4 hours a week we’ve been able to put to very good use. For one thing, we now have the capacity to make “filling the book” a top priority. We call all of our patients to remind them about appointments; if we get a cancellation, we are able to move quickly to fill it. These are activities that contribute directly to the financial success of my practice, and I didn’t need to add staff to make sure they’d get done.
Using e-services has also changed my staff’s focus in more subtle ways. Their jobs are less about paperwork and more about our patients. Needless to say, my staff members love this. They would much rather help me care for our patients than sit on hold with an insurance company.

CONCLUSION
Technology isn’t free. But when we choose it wisely, technology can help practice staff work smarter instead of harder. It can also offer payoffs that might not be obvious at first. E-services are a great example: once we invested in a well-designed practice management system, e-services helped us leverage that investment, gaining efficiencies far beyond those offered by practice management software alone. No wonder it sometimes feels like we’re seeing dental history being made.


Dr. Cavola holds a degree in biochemistry from UCLA and received his dental degree from Emory University School of Dentistry in Georgia. He worked in a large group practice, Dentfirst, from 1987 until 2000. Currently, he manages his own solo practice. He is a member of the ADA, GDA, the Northern District Dental Society, and the I-20 East Study Club. He can be reached at This e-mail address is being protected from spambots. You need JavaScript enabled to view it .
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