Computers have profoundly changed the ways an efficient dental practice operates. This article discusses 5 new habits your staff should acquire to make their jobs easier and make your practice more profitable. You do not need to change your PMS (practice management software) program for staff to learn these new, more productive habits. These new habits can be applied to any modern PMS program (Figure 1). When you rent a car at the airport, you may have to take a minute to figure out the windshield-wiper control, but you do not have to learn to drive all over again. You already have good driving habits and can apply these in any make of car you rent. Similarly, your staff may need a few minutes, or a little extra training, to learn how to operate the windshield wipers of your particular software, but it is not necessary to buy any new software to do these things!
Figure 1. Kick back and let your computers do the work! Some new habits, such as accurate, correctly spelled, extremely rapid, and very easy charting with only a few taps with a stylus, saves an incredible amount of time over the course of a day. And it makes the whole office much more efficient!
Figure 2. You don’t need computers in each operatory to enter treatment plans and post from the back. One wireless, mobile Tablet PC can replace 2 or 3 “fixed” operatory computers at one-third the cost.
Figure 3. We need to put our old paper-based habits in the Dumpster where they belong! Our new computer-based habits make everyone’s life easier and significantly boost practice profitability.
1. TOSS OUT THE ALPHABET!
With paper-based office systems we had to use the alphabet. We could only file things by one attribute, and using the patient’s last name was the easiest. When someone needed to “work the accounts,” they started at the front of the ledger tray in the A section and worked through toward the Z section. These “paper habits” still persist in dental offices today. But by using the power of the computer to file data using many different attributes, we can quickly compile a list of accounts by the oldest balance first or by the largest balance first. Because generating these reports requires no work on the part of staff, they can be run more often than the traditional, once-a-month routine. When either of the authors consults with other dental offices, we encourage our clients both to run these A/R reports at least once each week and never to run an A/R report sorted by alphabet. (For the other weekly reports we recommend, visit PaperlessDentistry.com.) Unpaid insurance claims are better sorted by oldest or largest claims, or by the name of the insurance carrier. Using the alphabet to sort a list of unscheduled treatment plans is terribly inefficient. Treatment plans should be sorted by date, provider, value, or procedures such as “pontics.” Recare lists should be sorted by date or reason for the recare appointment, never alphabetically by the patient’s last name. When we want to locate a particular patient, it is often easier to find him or her in the appointment book because we know the patient was in last Tuesday, or to find the patient by first name rather than last name. These new search-and-sort computer habits save work and time as well as increase profitability.
2. ENTER TREATMENT PLANS AT THE TIME OF DIAGNOSIS
When we start training a new office, we often find they don’t enter treatment in the computer until it is completed. We try to immediately establish the new habit of entering all treatment at the time of diagnosis. This requires the same amount of work by the staff—entering the procedures—but derives many more benefits. For example, if the patient does not immediately schedule his or her next visit, the treatment is not “lost on the shelf.” When a treatment plan is entered into the computer at the time of diagnosis, either at an initial exam or a recare visit, it is automatically added to a computerized “unscheduled treatment” list. This list later can easily be searched by date, provider, dollar amount of treatment plan, or by procedure such as “pontic.” This also provides an automatic “quick call list” for cancellations. Case acceptance is enhanced because the PMS progam can print a clear, professional, color tooth chart and descriptive treatment plan for the patient to take home.
Once the treatment plan is in the computer, printed financial arrangements with accurate insurance estimations are easy. “Pre-estimating” insurance, which reduces dental office production by 40%, is rarely necessary. Front office staff can enter the treatment plan, but it is usually more efficient to have the chairside assistant or hygienist enter the information, as this is closer to “the horse’s mouth” (the dentist) and therefore less prone to error. This does not, however, require computers in every operatory, although we find most offices are moving to this option. One wirelessly connected mobile computer such as a Tablet PC or Notebook can simply move to where it is needed in the office to enter treatment plans (Figure 2). Or, alternatively, back office staff can continue to write the treatment in the paper chart, and then move to a computer to enter it. Regardless of how your office does it, entering treatment at the time of diagnosis allows great benefits to flow from only a small change in office habits. No extra work, but lots of extra rewards.
3. GOOD COMPUTERIZED SCHEDULING HABITS
The majority of dental offices now use a computerized scheduler, but we find that many of them are missing some of the key benefits. For example, if the treatment plan has been entered at the time of diagnosis, it is easy to “pull” treatment into the appointment when it is scheduled. It involves no extra work, but allows anyone to see what the doctor plans to do. Anyone can answer the patient’s questions or see how to set up the operatory without searching for and through a paper chart. And because the treatment is “booked” for that day, the computer keeps a running total of the day’s “booked production,” so staff is constantly updated on meeting goals and making bonuses. Having this information visible makes the numbers improve.
We are applying the Hawthorne Effect from industrial psychology to dentistry. (The Hawthorne Effect demonstrates that simply measuring and recording a variable, such as office collections, tend to make that variable improve.) Should an appointment need to be rescheduled, all the treatment tied to that appointment moves with it, with no extra work or typing. Posting completed treatment from the appointment book screen requires one or 2 mouse-clicks. Again, no extra work and no extra typing. The computer interaction between the appointment book and treatment plan automatically maintains the status of treatment plans, either scheduled or unscheduled. Accurate, legible, printed appointment cards for the patient are created with the click of a mouse. These cards never confuse a Tuesday with a Thursday or inadvertently write down the wrong date. An e-mail confirmation service can confirm appointments automatically, eliminating wasted staff time with telephone confirmations. “Broken appointment” lists and “ASAP” lists require no staff work, but they provide a quick, easy way to fill cancellations. We find that good computerized appointment habits increase office production by 25% to 35%.
4. POST FROM THE BACK
The late Larry Faber said 20 years ago that there was a 10% loss in production by having the front office rather than the back office do the posting. We didn’t believe him at the time, but after working with several hundred different offices over the last 20 years, we now not only agree, but we think his estimate was too conservative. When a dentist hears this, the typical response is, “No, I always check my own daysheets.” Nevertheless, with a close examination we find that offices lose more than 10% when posting is done from the front office, regardless of the protests and good intentions of everyone involved. Get out of denial and accept this fact; then turn the posting over to the chairside assistant who was there when the treatment was done! Post the treatment while the patient and the doctor are still in the operatory so questions can be answered and everyone agrees on what was completed. Was an extra surface added or an extra tooth restored? Did the filling change to a crown or an endo? Exactly how many pontics are in that bridge? Was something done to the patient at no charge? That “something” still needs to be charted!
Treatment can be posted with only a few mouse-clicks by the chairside assistant while the doctor is finishing treatment, placing retraction cord, polishing a restoration, cleaning cement, or holding an impression. In our office, the assistant uses this “dead time” to post all treatment, do the clinical charting as the doctor dictates it, prepare and submit any insurance forms with appropriate x-rays and documentation, and schedule the next appointment. This is obviously more involved than simply posting the completed treatment, but posting from the back is the first and most productive part of this new habit. Ideally, posting should be done from a computer in each operatory, but initially this is not mandatory. As with treatment plan entry, it can be done with a Tablet PC or Notebook or from another computer already in the office. Move the posting as close to the action as possible and reap that additional 10% you are losing when posting from the front desk.
5. PAPERLESS PROGRESS NOTES
Putting progress notes into a computer system is a big psychological hurdle for dentists, yet one of the easiest and most profitable things you can do for your practice (Figure 3).
No, no one needs to type those notes—that’s way too hard and inefficient! Some PMS programs have a built-in feature that prompts you to enter the specifics of your treatment, such as the amount and type of anesthetic, the type of liner, etc. Although this is better than programs that only allow you to enter precanned notes that are tied to a procedure, we find both of these methods slow and cumbersome. Most dental offices already have Microsoft Word, and our method works with all Word versions and with all modern PMS programs. It uses a Word feature called auto-correct located in the Tools drop-down menu. Autocorrect allows you to customize a few short keystrokes to “explode” into a complete sentence, paragraph, or even several pages. For example, when we type pfmr, our mnemonic for a porcelain-to-metal crown, we get, “Pre-op Blu-Mousse double-bite; caries removal and preparation; plain cord retraction; Blu-Mousse and silicone wash in a double-bite tray; Luxatemp temp cemented with Temp-Bond; shade: see lab slip.” This is our usual charting for this procedure, although we can amend it if necessary.
We have similar mnemonics for all of our common procedures and for the types and amounts of local anesthetic we use. We can quickly combine several mnemonics to generate fast, customized, accurate charting with only a few keystrokes. We then “cut and paste” these notes from MS Word into our PMS program. (More detailed instructions and a copy of all of our mnemonics are available at www.PaperlessDentistry.com, then “Free Lunch Counter.”)
If you don’t already have a copy of MS Word on your computer, then you have a couple of options. The first option, in keeping with the title of this article, is free. It involves downloading a copy of OpenOffice at www.openoffice.org/, an open source program similar to MS Office. The specific feature in Open-Office is called autotext instead of autocorrect. Your second option is to purchase (money well spent!) a copy of Easy Notes Pro (www.easy-notespro.com). This nifty program works with all Windows-based PMS programs and allows you to do your customized charting without using a keyboard at all…you simply click with a mouse, or (better) you use a stylus to tap on the screen of your Tablet PC.
Any one of these 3 methods will greatly reduce your charting time while boosting your entire office efficiency, providing fast, complete, legible, accurate, customized progress notes. The dentists, hygienists, and staff with whom we work are unanimously enthusiastic about computerized chart notes once a system is in place. It makes the whole office run more smoothly!
The 5 free new habits we are suggesting—tossing out the alphabet, entering treatment plans at the time of diagnosis, effectively using the appointment scheduler, posting from the back, and paperless progress notes—are all easy but make a powerful change in office profitability. These 5 habits are easier to add to your office culture by doing them one at a time and in the order presented here. Each new habit builds on the previous habits. For example, it is simple to post from the back if the treatment is in the computer and tied to the appointment. To get more benefits from dental computing, you don’t need to buy a new car… or new dental software. Your staff simply needs to find the windshield-wiper controls in your particular software and then apply these new, free driving habits to make their jobs easier and your office more profitable. These good habits make the computers, not the people, work harder!
Dr. Stephenson practices in a paperless and wireless restorative dental practice in San Leandro, Calif. He has been lecturing, writing, and consulting on dental computing since 1985. You can obtain a free copy of his dental computing newsletter at PaperlessDentistry.com, a free Internet resource to help dentists safely and inexpensively derive many more benefits from their office computer systems. For more information about his computer consulting services and seminars, call (510) 483-2164.
Disclosure: The authors have no financial interest in any dental or computing products.