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Dental Computing, Some Small Steps: Working Smarter is Easier and Saves money

The sagging economy and gloomy stock market make this a great time to invest in your practice! The old adage, Invest in what you know, has never been truer. Sometimes it's difficult to see because we are right in the middle of it, but this is truly the golden age of dentistry. We have avoided the managed care nightmares our medical colleagues have brought upon themselves, and the demographics are perfect for us. The baby boomers with their accumulated discretionary income are awakening to the things modern dentistry has to offer. Even the government is trying to help with the Job Creation and Worker Assistance Act of 2002.1

In my 25-year-old restorative practice, my staff and I are in the process of "reinventing" everything: operatory design, computer systems, management systems, directions in which we would like to grow, and directions we would like to avoid.

It is really a fun process! Take a few minutes to think about a new operatory. What would you add that you do not have now? What would you leave out? Dentistry Today is a great source of fascinating ideas, but I have to decide what will really work profitably "in my hands." We are currently building one "Treatment Room of the Future," where we can prototype and test things before we commit our other five treatment rooms. One thing we are leaving out is computer cabling. Wireless networking has eliminated our need for it! We are also choosing new management and imaging software. Which ones will best suit the anticipated needs of our practice 5 years from now?

Some of the key products we will need for our re-invented practice cost an awful lot of money. But a successful dental practice is not based on one or two good ideas. It is based on a synergy of hundreds of good ideas that, combined with hard work and diligence, create a solid, stable, gainful enterprise. And it behooves all of us to keep a sharp eye out for more of these good ideas and apply them to our unique situations.

Okay, end of sermon! But with these thoughts in mind, let's look at some small ideas the frugal dentist can use to add value to his or her practice right now, without spending very much money and without re-inventing the whole practice. Some of these things are free and none cost more than a few hundred dollars. All of them will quickly pay for themselves and help move a practice along the road of Paperless Dentistry. All are tested, proven ideas that will help any practice for many, many years.



In this case, free means you do not have to spend any money but you do have to spend some time and effort (sorry, no free lunches here). Your current computer management software should allow you to do both of the things I discuss.

First, stop making your staff work so hard at managing your accounts receivable. As I mentioned in a previous article,2 you must insist they run aging reports sorted with the largest or oldest balance first, not alphabetically. The accounts that need the most attention are at the top of the list, not buried in all the clutter. Staff should run these aging reports weekly, not monthly, and you should spend 5 minutes a week quickly reviewing with them the top 10 accounts on the list. This is an extremely productive use of your time, and can be used to dispense praise as problems disappear off the top of the list. This is a very easy, "One Minute Manager"3 technique, even if it really takes 5 minutes to do!

The next technique is only slightly harder: you need to insist that your staff enter treatment plans into the computer at the time they are diagnosed. This means that immediately, while the patient is still in the chair, a chairside assistant or hygienist enters the treatment plan into the computer for all recare, emergency, or new patient exams. This requires some changes in the way your office operates, but it pays very big dividends. First, it unloads the front desk and moves the task toward the place where it really belongs, in the back office. It allows you to quickly double check the treatment plan to make sure it is correct. It allows you to give the patient a clear, professionally appearing printout of the proposed treatment. It allows the computer to assist in determining the estimated insurance payment for the treatment. It allows you to track a proposed treatment plan that was never scheduled. It allows your staff to pull treatment into an appointment when it is scheduled and have the computer instantly calculate that appointment's contribution to your daily production goals. Lastly, when you complete the treatment, you simply change its status from pending to completed, you do not have to re-enter it in order to post it. If your computer software allows it, you can generate a list of pending treatment plans, sorted by the largest treatment plans at the top, and include a review of this list at your weekly 5-minute meeting. Whew! All those advantages and you don't have to spend a dime!


A small label printer is a great labor saver for the staff and makes a nice thank-you present for your 5-minute meeting. Sieko and CoStar both make very nice printers for less than $200. My personal favorite is the CoStar model 330 (Figure 1). If your management software supports any label printer, it is probably this one. This means you print your labels with a mouse click, no typing! If your dental software does not support a label printer, you can still use this one because the included software is extremely easy to use and will save the common labels you make all the time. You can use it to print chart labels and x-ray labels if you are not yet paperless, but you will continue to find it very useful in the future for making mailing address labels and return address labels. Because the included software is fairly well behaved and does not often interfere with software already installed on a computer, you can probably install this yourself even if you have a computer allergy. I often see labels as the last function in a dental office still done with a typewriter. A label printer is about one third the size of a typewriter, so you can improve your office efficiency and reclaim some desktop real estate in one fell swoop.


As I mentioned in a previous article,2 about half the practices I see do not have usable data backups. They have a daily backup ritual, but they do not have a tested backup procedure. When their computer system fails, they will not be able to restore their accounts receivable or any other data stored in their computers. Many dentists do not have business insurance to cover this type of loss. The solution to prevent this type of catastrophe only costs about $200 and allows you to test your backup as frequently as you wish. You simply have someone install a CD-R or CD-RW in your computer and set up the included software so you can easily "burn" a CD disk each night before you go home. I suggest you spend 30 cents each day on a new, one-use CD-R disk. Each night after you burn your data onto the CD-R, you write the date on the disk with a felt-tip pen, then take it home, and add it to the collection in your garage (Figure 2). Now comes the most important part: at least once a quarter, you "restore" a CD onto your home computer, then run an A/R report and check it against the report for the same date run on your office computer. They must match exactly. The advantage of this type of backup is that you can restore it on any computer built in the last 2 years without having to buy an extra tape drive or any other backup device. It is easy, simple, and cheap for all your data except your image data. Image data requires a different strategy and is covered in depth on our website (www.PainlessCom.com). But it is essential that you test these backups by periodically restoring them on your home computer and doing the A/R test. (If your home computer is ever exposed to the Internet, be sure to erase all the patient data as soon as you complete the test.)


Figure 1. Some front desk tools that make the office more efficient: The label printer on the counter prints appointment cards without typing! The flat panel monitor rotated vertically takes up less desk space and displays the entire day's appointments on one screen. The spindle just to the right of the monitor contains new one-write CD-R disks for the daily off-site backup. The laser printer has four paper trays so no paper swapping is necessary. Notice the lack of paper clutter. That's what Paperless Dentistry is all about!
Figure 2. At the end of each day, the backup data is burned onto a CD-R that is marked with the date and taken off site. This costs about thirty cents and takes about 2 minutes. Notice the CD-RW drive is in a wirelessly connected notebook computer that can be moved wherever it is needed in the office.


A very nice digital camera costs about $300 to $400. HP, Kodak, Cannon, and several other manufacturers sell excellent photo quality printers starting at about $100. My current favorite is the HP Photosmart 7550 for $399. The digital cameras and photo printers usually come with all the software you need to get started. You can immediately start taking "mug shots" of all your patients so you and your staff can better remember them. These can be saved in your computer and/or printed. We often take pictures of children we treat toward the end of their appointment. Sometimes I become the "patient" and the rug rat gets to be the "doctor." These take about 5 minutes to do, including the color print. Kids and parents love these pictures, and they get shown to lots of their friends. As you know, a happy appointment for mother's little angel is a great practice builder! Digital photography also works great at the other end of the age spectrum. I was showing an elderly patient how to place topical fluoride in an over-denture when it occurred to me that a picture really would be worth a thousand words. We took a quick picture of the procedure, then printed it out with some written instructions. Not only did it help that patient understand, but I also made an instant handout for all my other over-denture patients. New uses for digital photography pop up all the time in my practice.

I now routinely use the macro function on the camera to take pictures of soft tissue lesions I want to follow. A good, clear digital photo provides me with a much better memory of the lesion than even the best narrative charting I can do. If the lesion requires a referral, I can quickly print the photos and forward them to the doctor who will be seeing the patient. If you do a lot of clinical photography, you may wish to invest in a clinical digital camera. Kodak, Dicom, PhotoMed, and Lester Dine all have such units that combine an off-the-shelf digital camera with some special lens, flashes, and positioning devices to make them easier to use.

I started doing computer cosmetic dentistry using just a simple digital camera and the software included with it. It takes a little time to learn using the free software but you can do computer bleaching without spending money for anything other than the digital camera and color photo printer. However, when I saw how enthusiastic patients were and what a powerful patient education tool this was, I was more willing to invest in one of the commercial dental cosmetic imaging packages. I paid for it with one case acceptance. Computer cosmetics, with a glossy before and after color print to take home, has become part of my new patient exam. This one change has produced a dramatic increase in the number of cosmetic procedures I perform.


I find that few dental practices send very many letters to patients. The staff finds it too much work to jockey paper and envelopes and contend with paper jams. Yet a nicely printed, friendly letter is often a great way to make your practice more memorable and recommendable to a patient. What if you could send welcome letters, thank-you-for-referring letters, overdue recare letters, treatment necessary letters, and where-the-heck's-my-money letters all with just a mouse click? What if the letters automatically printed on letterhead, the addresses automatically printed on envelopes, and the walkout statements automatically printed on statement paper all without changing paper in the printer! Would your staff send these letters more often if you made it easier for them? Yes! And both your practice and your image would benefit. You don't need three printers; you need one printer with three paper trays. The only one I know that works is the HP 4100T (or 4100TN for a network). This takes a little doing to set up and configure, and you may wish to have someone do this for you. But if you believe as I do that nice patient correspondence adds great value to a practice, this printer is a must-have item.


Flat panel LCDs are very popular because they allow you to regain some desk space. You can add some additional functionality if you buy one that rotates into portrait mode and allows staff to see the full appointment day on the screen with larger fonts and without continually paging up or paging down. A 15" LCD such as the CTX PV520 is only 8" deep but has a viewing area almost as large as a 17" CRT monitor that is 17" deep. The cost of LCDs has dropped substantially, and the only advantage I now see for CRTs is their ability to display digital x-rays with more contrast. This may change as digital output video cards come into wider use.


In a previous article,2 I discussed the threats I see for a dental computer system connected to the Internet. I very strongly recommend, at least for the present, that you be extremely cautious about connecting your dental computers to the Internet. But this does not mean you cannot use the Internet in your office. You simply access it from a computer that does not contain any patient information or any other data you would care about if it was destroyed. And you make sure this Internet computer is not connected to your dental computer network. I recommend you buy the cheapest throw-away computer you can find, install it yourself, and put it in the staff lounge. Staff can surf on their breaks, but also can run in there when they want to check on a patient's insurance benefits. The last I heard, there was no OSHA or HIPAA regulation prohibiting a staff person from actually working while in the staff lounge! If you are nice, they may even let you in there so you can have some fun on the Internet yourself. But not too often! Remember, the Internet can become as big a time waster as television. That's why you put your Internet computer in the staff lounge and not at the front desk!


Computer technology changes quickly. Strategies that would not work at all a few years ago now are the preferred way of doing things. Wirelessly networked notebook computers in treatment rooms are an example. Many dentists are still recovering from the sticker shock of the $5,000 desktop computer and monitor they bought for an operatory 3 years ago. Now, for one-third the money you get a computer that is 10 times faster and has about 10 times the storage capacity! With Windows XP, it is also about 10 times more reliable! Bargains abound at Toshiba, IBM, Dell, Gateway, and several other highly rated computer manufacturers. But it may be fairly difficult for you to properly install this new computer yourself, and you need to be careful whom you choose to do it for you. This is a business computer, not a home computer. Pay it some respect! A misstep can bring your practice to a screeching halt when the wrong person messes with it. A "therapeutic misadventure" can shut down all your computers and destroy all your data! Be sure you follow the three backup rules discussed earlier in this article.


Successful dentists plan ahead. Where will dentistry, and specifically your practice, be in 5 years? In 10 years? Sagging economy aside, which are the major, proven, profitable techniques and technologies you see today but which you have not yet fully incorporated into your practice? Notebook and tablet computers, printers, wireless networks, good management software, good imaging software, and all the other, smaller, good ideas discussed in this article must all be combined to operate a Paperless Dentistry practice. But you don't need to buy them all at once or from a single vendor. Paperless Dentistry, like a successful dental practice, is a journey, not a destination. It is a road you follow and it is paved with good ideas. You cannot buy it; you have to do it! You need to spend some time thinking, carefully spend some money, and then work diligently in a clearly defined direction to earn the rewards it offers. I hope some of these suggestions help you on your journey. See you on down the road!

Note: Some of the products discussed in this article, especially notebook and tablet computers, digital cameras and color printers, change very rapidly. The author's current specific recommendations for these and a variety of other dental technology products are discussed in his seminars and on his websites, www.PainlessCom.com and www.paperlessdentistry.com.

1. Job Creation and Worker Assistance Act of 2002. www.henryschein.com/dental/equipment/sidekick1002_article2.asp. Accessed 11/11/02.
2. Stephenson BA. Dental computing. Dent Today. 2002;21:50-55.
3. Johnson S, Blanchard K. The One Minute Manager. Berkley Pub Group. New York, NY.

Dr. Stephenson practices in a paperless and wireless restorative dental practice in San Leandro, Calif. He is also the president of Painless Computing, Inc, a nationwide consulting, design, training, and in vivo testing laboratory exclusively for dental computing. Information about his lectures and hands-on seminars is available at www.PainlessCom.com. He can be reached through Painless Computing, Inc at (510) 483-2788 or This email address is being protected from spambots. You need JavaScript enabled to view it..


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