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Like Eating an Elephant, Computerizing Your Practice Should Be Done "One Bite at a Time"

Computerizing the dental office offers many potential benefits. It can help you run your practice more efficiently, it can help you attract patients, and it can help you improve case acceptance. But computerizing a dental practice is also like eating an elephant. You have to do it one bite at a time.
When you walk into my practice today, you see state-of-the-art digital equipment. My front- and back-office procedures—accounts payable, accounts receivable, and scheduling—are fully computerized, as are my operatories. I capture x-rays digitally using a Schick digital radiography system, and when I photograph patients, I use a Kodak DX4900 dental digital camera kit.
But I didn’t get here all at once. I first became interested in computers in the late 1980s, when I attended a seminar on computerizing dental office bookkeeping. Shortly afterward, I bought my first system: a DOS-based PC. From there, I grew with the industry. I acquired a Windows-based PC when the operating system was launched. When local area networks for small businesses became affordable, I installed one. When EagleSoft (Patterson Dental Supply), the practice management software I still use today, added a clinical module in the 1990s, I computerized the clinical side of my practice.
It took years for me to get where I am today. But computerizing a “bite” at a time ensured that I would understand each piece as I implemented it. I avoided overwhelming my staff. I avoided making radical changes too quickly to my office’s procedures.
It’s an approach I recommend for any dentist interested in digital technology.

The First Bite
Today, the majority of dental offices have at least one computer. But if your office doesn’t, then a good first step toward computerization is to purchase a PC and a computerized scheduling program. Computerized scheduling is a well-established application with well-established benefits. (You don’t hear anyone saying they regret throwing away their old scheduling book.)

Figures 1 and 2. As dental offices computerize their operatories, new opportunities arise for incorporating digital imaging into clinical routines. However, the placement of monitors and other computer equipment is often less than ideal. Wall-mounted monitors can be difficult for patients to view during treatment. Bulky computer equipment can also be difficult to fit on older cabinetry.

The next logical step is to computerize your accounting. At this point, you can still work with simple, stand-alone computers. But as you ready yourself to continue computerizing, you will need to graduate to a network. With a network, multiple computers are linked so they can share information and software programs. Small networks that are suitable for dental offices typically follow a hub-and-spoke design. The hub is a server—a large, powerful computer that acts as a central repository for both data and software applications. The spokes are the other computers in the office. With this type of network, you and your staff can run any of your software programs from any of your office computers.
Once you’re networked, you’re ready to take the next step in computerizing your office: installing practice management software. Practice management software lets you integrate all areas of your practice—front office, back office, and clinical—into one overarching software system. You can now (1) replace your hard-copy patient files with electronic records, (2) link billing data to patient records, and (3) start to incorporate clinical diagnostic information such as digital x-rays into your patient records.
The changes to a dental office made possible by practice management software are enormous. For this reason, before you purchase this type of software, it’s important to involve your staff. For many practices, the front-office staff experiences the least turnover, so have these individuals—along with anyone else who has made a long-term commitment to your practice—view demos of the software. Will it be easy enough to use? Can staffers easily envision how to migrate existing processes into the software? Will using it add cumbersome steps to their jobs or make things easier?
In addition, talk to other dentists who have used the software. How stable is it? Software that crashes too often is more than disruptive–it can also cause you to lose data. Ask questions about the software manufacturer as well. How responsive has the company been to requests or problems? Are its reps on staff or hired on contract? At one time, a company selling dental software in my area was using a local rep on a contract basis. At the end of the year, the contract wasn’t renewed, so anyone who had purchased from that company lost their rep.
Is the company itself stable? How long has it been
in business? What is its installed user base—that is, how many other dentists are using the software? If the user-base number is low, proceed with caution. You don’t want to invest in practice management software only to have the manufacturer go out of business in a few months.
It’s also useful to think about what other equipment you may want to add to your office in the future. Perhaps you’re considering a digital radiography system. Do you have a particular brand of system in mind? If so, check to see whether it works well with your choice of practice management software. Talk to other dentists who have used the 2 together. Do the 2 systems “talk” to one another fluently, or do they experience glitches?
Finally, once you’ve chosen and installed your practice management software, take the time to become comfortable with it before you add any other digital components to your office setup.

The Digital Operatory
While many dentists today have digitized their front and back offices, the computerized operatory is still relatively new. But with a network and practice management software in place, it becomes fairly straightforward to add components such as digital hardware for clinical use.
One option that is fairly easy to adopt is digital photography. Today’s digital cameras are affordable and offer very respectable image quality. It is helpful to select one that is “dentalized.” With my Kodak DX4900 camera, I’ve actually taken new staff members who know nothing about dentistry and taught them in just a few minutes how to capture standard dental views. In addition, the DX4900’s operation is simple enough that anyone on my staff can take the clinical pictures I need. This lets me delegate photography tasks, providing me with some important benefits. First, it means that I don’t have to stop what I’m doing, take my gloves off, and pick up the camera every time I decide I’d like another image. Delegating photography tasks also helps my staff manage patients efficiently. For example, if a patient mentions an interest in whitening during a hygiene appointment, my hygienist offers to get the patient started right then. If the patient agrees, the dental assistant photographs the patient and takes the impressions immediately. My time, on the other hand, is usually much tighter. If the patient needs an unscheduled filling, for example, it typically has to wait until another appointment. So, by delegating photography tasks to my staff, I ensure that my staff can contribute fully to the productivity of the practice.
Once digital images are captured, they need to be imported into practice management software and associated with a patient record. There are various ways to do this, depending on the camera’s make and model. Some cameras need to be hooked to a computer with a USB or serial cable. Once attached, you can read the images stored on the computer just as you might read data from any other computer device.
In our office, I use 2 different methods, depending on where I am when I’m ready to transfer the images. My operatory computers are equipped with camera card readers, so I can simply remove the memory card from my camera, insert it into the computer card reader, and transfer the images. I also have a Kodak EasyShare Camera Dock that can be used to transfer pictures to our network.
Another piece of digital hardware that many dentists are considering is a digital radiography system. To pick this type of equipment, it’s again important to involve your staff. Many dentists rarely, if ever, take x-rays. So have your hygienist or assistant evaluate the digital radiography system you’re considering to make sure it is easy to use. In addition, verify that it will integrate well with your practice management software.
Once you’re capturing either digital photographs or digital radiographs, you will need a printer for generating hard-copy prints of your images. There are a number of quality inkjet printers on the market today that you can use for this purpose, but make sure to use high-quality paper. My family was in the printing business; I learned a long time ago that if you aren’t going to print on good paper, you may as well not print at all. For my office printing, I use Kodak Dental and Medical Imaging (DMI) Inkjet Paper, and it really makes a difference in my printed image quality.
Last but not least, you need to provide for data backup (creating copies of your computer records). In my opinion, the more careful you are about backing up your data, the better. Disaster can strike when you least expect it. I once had a tech support person who was troubleshooting my office software instruct me to perform a procedure that, as it turned out, erased my entire 4.5-gigabyte database of photos and x-rays. Fortunately, I had a backup copy of the images, so I was able to restore them.
Every night, I back up my text records and my image records to multiple computers located in my office. As a result, should one hard drive fail, I always have at least 2 other copies of my data. In addition, I put yet another copy of the text onto a Zip disk (Iomega) and a copy of my images on my laptop’s hard drive. I then take both the disk and the laptop home with me. This way, even if the unthinkable happens and all my office equipment is lost, I would still have a copy of my patient and office records.
When you install your backup system, test it; perform an actual backup, then try restoring the data. I’ve known dentists who have inadvertently backed up their data onto corrupted disks. Don’t assume that just because you’ve copied your data, the copy is usable. I know another dentist who recently upgraded his office network. The vendor who did the upgrade discovered that the old office backup software hadn’t been properly installed. For 3 years, the dentist had “backed up” his data every night, and for 3 years, no copy of his data had been made. Fortunately, he didn’t discover this the hard way.
Some vendors are now offering another backup option: you can contract with them to store your data off-site. With this type of setup, your network server automatically uploads a copy of your data to an off-site data center every night.

Figure 3. To integrate computers more seamlessly into operatories, dentists today are opting for specialized cabinetry and innovative ways to mount computer screens. Using track-style hardware, for example, it’s possible to mount a flat computer monitor so that it is moveable. This monitor can be viewed by patients whether they are sitting upright or—by moving the screen up onto the ceiling—reclined.


Figure 4. Customized cabinetry in the operatory enables dentists to hide cabling and unobtrusively place the computer console. Flat-screen monitors also help by taking up less space. With this type of setup, computers can be used for viewing images and other data, without competing with other clinical equipment.

Fully Wired
As you progress toward a fully computerized office, a final step to consider is specialized cabinetry and other touches like flat-screen monitors in your operatories. For my practice, I hired a systems integrator, Computer Resource Technologies, to completely redo my operatories. My computers are now housed in cabinets that let me hide the wiring and towers. My flat-screen monitors are mounted on a track similar to that used for track lighting so they can be positioned on the ceiling above my chairs, making it easy for my patients to view DVD movies or television during procedures (Figures 1 through 4).

Over the years, I’ve found that investments such as those discussed in this article more than pay for themselves. When patients walk into my office, they see that I invest in state-of-the-art equipment—equipment that improves patient care. As a result, they often become excited about my practice. They tell their family and friends. I’ve also found that I tend to attract patients who are comfortable with technology. These patients are usually well-educated, with the resources to pay for dental procedures. So, as my experience shows, computerizing is useful for more than increased efficiency. It can also help you grow a successful practice.

Dr. Flucke is technology editor for Dental Practice Report magazine and for Focus MDA, the Missouri Dental Association's publication. He lectures internationally on technology and dentistry and maintains a private practice in Lees Summit, Mont. He can be reached at This email address is being protected from spambots. You need JavaScript enabled to view it..



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