Clinical Dentistry and the Internet: A Marriage Made in Heaven?

There are few practices today that are running without the assistance of at least one computer system and dental practice management software. Most dentists have come to appreciate the convenience and additional efficiency of centralized patient data, insurance estimating, claims processing, treatment planning, financial tracking, and a host of other features that are provided with a computer and well-designed software. In a recent article in Dentistry Today (August 2002), I examined the benefits of extending the reach of computers from the front office into the treatment rooms in the back.


There are obvious benefits to having computers in the operatories. Most practice management consultants promote the advantages of treatment room computers, focusing on the obvious advantage of being able to schedule the patient while they are still in the chair. In many offices, instructions relayed to the assistant, and subsequently relayed to the patient, and then the receptionist can lead to miscommunication and scheduling problems. At each visit, the doctor will know exactly how much time is needed for the next visit, and this might be different than the “standard” time slots that the practice normally reserves for individual procedures. The best time to schedule, therefore, would be while the patient is still in the chair. Many offices have also trained their clinical staff to accept payments and process insurance claims from the chair, thus eliminating many of the bottlenecks that patients often experience at the front desk.

Other benefits to computers in the operatories that are frequently cited are the ability to incorporate digital images and overall decentralization into the practice. One area that receives little notice, however, is the advantage of having Internet access from the computers in the treatment room. While some dentists may consider this to be a very trivial gain reserved only for the extremely “hi-tech” practice, I believe that almost any office will benefit from Internet access in the treatment rooms. In this article, I will explore some of the reasons why dentists should consider adding Internet access to their operatory computers.

NUTS AND BOLTS
Contrary to popular belief, it is relatively easy to add Internet access to operatory computers, depending on the existing software and Internet access currently available. Many offices will have one computer, usually a front office computer, that has a modem installed and is hooked up to one of the phone lines. This is the computer that is usually used for sending electronic claims at the end of the day (so as not to tie up the phone line during business hours). If the office is using a dial-up line to connect, I do recommend that they consider adding a phone line to be used exclusively for data access. While some Internet service providers will disconnect a connection if it is idle for a period of time, it only takes a few seconds to reconnect, and there are many inexpensive programs out there that can “trick” the Internet provider into thinking that you are online and surfing the Web, even when you are not.


What many people don’t know, however, is that you can easily share this connection with other computers in the office, assuming some basic conditions. First and foremost, all computers that share the connection must be on a network. Most offices with multiple computers meet this criterion. Secondly, the computers should be running some version of Windows, although different computers can be running different versions. Finally, all computers should have a Web browser installed. Most computers come with either Internet Explorer or Netscape pre-installed.

The Internet connection can be shared through either a software or hardware solution. Software is the easiest solution. All versions of Windows, from Windows 98, Second Edition, and onward, contain a free program called Internet Connection Sharing (ICS). By running the program and the setup wizard, it is easy and cheap to configure all the computers on the network to have Internet access. The downside to this solution is that the computer with the modem must stay on and be connected to the Internet. It will also tend to result in a slow Internet connection because the connection is shared. To avoid these problems, a hardware solution is to use a device called a router. A decent router can be found for under $100. This device hooks into the network, and will allow each computer to get online. Unlike the previous scenario, you don’t need one computer to stay on; the router itself does the connection. Also, most routers today have built-in firewalls to protect the network from viruses and hacking. Most routers are designed to work with a broadband connection, such as DSL or cable, although a few are made specifically for dial-up lines. If you can afford it, I certainly recommend having broadband Internet access to the office.

DISCUSSION GROUPS
I find discussion groups to be one of the best aspects of the Internet. Few people realize that long before the World Wide Web broke onto the scene, discussion groups, or Usenet, were the main form of online communication. To see a list of groups in Internet Explorer, click on the Mail icon, then click on Read News. If you’ve never done this before, you’ll need to download the entire list from your Internet provider. Most providers have a list of over 35,000 groups! The best-known group for dentistry is sci.med.dentistry. You can post a question here and get replies from other users. However, many dentists do not frequent these groups. If you’re looking to see if anyone has asked a similar question before, go to a Usenet search engine. The best one is Google Groups at www.groups.google.com/. Enter the key words or terms, and it will search for any instance of these words that have been posted in the past 6 to 7 years. There are, however, better discussion groups out there. The message boards at Dental Town (www.dentaltown.com) are quite busy with over 11,000 registered members. I also find the message boards at Gener8tnext (www.gener8tnext.com) to be a great source of information and dialogue.

ONLINE ORDERING
There are many different sources for finding great deals on dental supplies. Some of my favorites are Net32 (www.net32.com), DentalXchange (www.dentalxchange.com), and Dentistry.com (www.dentistry.com). In most cases, they can offer better prices than traditional suppliers and can allow you to easily track current and previous orders to assist you in placing new orders. Of course, many dentists enjoy the service they receive from their current suppliers, and have no desire to change suppliers. These suppliers are starting to jump on the online bandwagon as well. Patterson (www.pattersondental.com) has an excellent site that will permit you to set up shopping lists, have barcode ordering, and allow you to schedule future orders as well. Henry Schein (http://www.henryschein.com/dental/) and Benco (www.benco.com) also have well-designed sites that make ordering easy. I do feel that ordering directly from the operatory makes a lot of sense. The assistant (or the doctor) often is most aware when a particular supply is running low, and rather than trying to keep a list, it is very easy to simply log on to the website and place your order. If you have the luxury of a persistent broadband Internet connection, you can keep an up-to-the-minute inventory log running and set up parameters where supplies are automatically ordered.

ONLINE COLLABORATION
While e-mail is the number one application on the Internet, it is not ideal for exchanging patient data. E-mail is not secure, and it is vulnerable to viruses and worms. Also, many Internet providers limit the size of e-mail attachments you can receive, and digital photos and images can be quite large. One of the most exciting uses of the Internet for dental applications is online collaboration. Here’s how it works. An account is set up with a website that specializes in storing digital images and notes. The two best sites for this are Transcend Online (www.transcendonline.com) and Digitalightbox (www.digitalightbox.com). Transcend’s service is called TransNet. It allows for a virtual consultation, where a dentist can send patient notes and any digital images (such as intraoral photos or x-rays) to any number of colleagues, such as specialists. These images and notes are saved on a secure server, accessible only to the dentists or labs that you designate. Once you send the info, the recipient is notified and can access the images and notes. What’s nice about this system is that the recipient can add his own notes and comments, and the original sender can view these comments at any time. This truly allows for rapid and easy communication between general dentists and specialists, and can be modified to work with dental labs as well.


The Digitalightbox system is also excellent. Users can send images to specialists, laboratories, colleagues, and even to patients if they wish. The recipient only needs a web browser and a digitalightbox.com mailbox number to view them online. Not only can images be exchanged, but the person viewing the images can modify them. You can easily zoom, pan, negate, flip/rotate, sharpen, and perform real-time two-dimensional contrast and brightness adjustments on images. While this is a free service, the sender must use the TigerView imaging software program to send the images.

APPLICATION SERVICE PROVIDERS 
A final advantage to having Internet access in the treatment room is the opportunity to use an application service provider, or ASP. ASPs are software programs that run on secure servers and require a minimal amount of information to be stored on your computer. The best use of this technology is to have an entire practice management software program reside on their servers, and not on your computers. As long as you have Internet access and a Web browser, you can access this data from any computer in the world. A well-designed ASP will have redundant servers so that there is constant and consistent backup of your important data. It handles all of the program updates on its end, eliminating the need for the dentist to try to upgrade their own software or to have to deal with some of the incompatibilities that often arise after an update. In most cases, there are little or no start-up costs, and the ASP will charge a low monthly fee to use the software. Also, because only an Internet connection is required, it allows the dentist to use less expensive computers in the treatment rooms. This type of system is also ideal for the practice that has multiple locations, because there is only one centralized database, which can simplify scheduling and billing from multiple sites. There are currently two major ASPs in use for dental practice management. An established system is Practice Connect, which is part of Dentalxchange.com (www.dentalxchange.com/practice/practice.jsp). Their service costs $249/month, which includes setup, all updates, and training. Another newer player in the field is Ciraden (www.ciraden.com).

 

CONCLUSION
There are many reasons why dental practices should consider adding computers to the treatment rooms. While many experts have commented on the value of these systems as they relate to scheduling and practice decentralization, there are also numerous other advantages to operatory computers. With Internet access, the dentist and his staff have an excellent and limitless resource for obtaining information, tracking inventory, online collaboration with other practitioners and patients, and the ability to run the entire practice from the Web. As the Web and Internet access become more secure, and as broadband becomes more prevalent, I see a time when Internet access in the operatory will become just as important as the front-office computer.


Dr. Lavine has practiced periodontics and implant dentistry since 1992. He is an A+ Certified Computer Repair Technician as well as Network+ Certified. He is the president of Dental Technology Consultants, which assists dentists in all phases of technology integration in the dental practice. He can be reached at (866) 204-3398 or This e-mail address is being protected from spambots. You need JavaScript enabled to view it , or visit his website at www.dtc4u.com.
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