Practice Management Software Update—
The Chartless Office is Closer Than You Think
Martin Jablow, DMD
More than 90% of the offices in the United States have practice management software.1 However, most offices use the software primarily for billing and fail to maximize the use of this important resource.1 This asset is probably fully paid for and underused. The intent of this article is to demonstrate how to maximize the use of this software and to show different aspects of the three most popular practice management software packages: Dentrix (Dentrix Dental Systems, American Fork, UT), EagleSoft (Patterson EagleSoft, St. Paul, MN) and Practiceworks (Practiceworks, Atlanta, GA).
By 2015, all dental offices will be required to have electronic health records (EHRs).2 EHRs are intended to make patient records consistent among dentists, physicians, and hospitals. The goal is that each will have a patient’s complete medical history. EHRs will include health information entered for a specific patient at a specific point of service and follow the patient.3 They will contain a patient’s entire health history for medicine, dentistry, pharmacy, vision, laboratory tests, and all other health needs.3 Dentists and physicians (with patient authorization) will have access to complete patient information at the point of service, and will update the patient record with any new information. This will lead to improved clinical decisions, increased quality of care, patient safety, and prevention of redundant or unnecessary procedures, greatly reducing costs.3 Patients and doctors will be reminded about appointment scheduling, when and how to take prescribed medications, and potential drug interactions, leading to increased patient compliance and safety. The data will increase research opportunities and more rapid development of “best practices” based on sound evidence.3 EHRs can be easily accessible when disaster strikes, allowing for rapid response.3 More information on the American Dental Association’s approach to this government mandate is available at www.ada.org/goto/ehr.
Why are EHRs important now? Digital records will soon be mandatory3 and the sooner the infrastructure they require is established, the easier it will be to integrate EHRs along with reducing costs and improving office efficiency now.
What is needed to get started with EHRs? Start with computers in the operatories and a local area network in the office, then add in digital radiography—either sensors or phosphor plates. Now let us theoretically walk a patient through the initial encounter, treatment, and compilation of the digital record.
A new patient initiates a call or e-mail to the office and requests an appointment. A time is coordinated and new demographic, health, and dental history is needed. In the past, the patient would come into the office and proceed to fill out the forms. Sometimes this can take longer than anticipated and cause the office to fall behind schedule. Would it not be easier to e-mail or have the patient download the forms in portable document format (PDF) and fill them out before coming to the office? All practice management software systems have the ability to store documents in the patient’s digital chart. The forms (or any correspondence) are then scanned into the software and the originals are shredded. (Check with your legal advisor as to your state’s regulations before shredding original documents.) This method is good, but with Dentrix you can subscribe to their eCentral service, which allows the patient to enter this data on a secure Web site and has the records automatically entered into the office’s software. EagleSoft has a kiosk mode where the patient can be handed a tablet computer or sit down at a work station and fill out the information on a computer. This eliminates data entry by the front desk person and hopefully eliminates transcription mistakes. Practiceworks does not have either a Web or kiosk input method at this time, but these features will be implemented in a future release.
Once the patient has filled out all of the forms, he or she should be examined and appropriate photographs and radiographs should be taken. All three practice management software packages have imaging software available that stores and organizes the images (photographs and radiographs). Dentrix offers Dexis Integrator, Eaglesoft offers Imaging, and Practiceworks offers Kodak Dental Imaging as part of their platform. These images are placed into the practice management software’s imaging soft-ware or third-party imaging software that is bridged to the practice management software. This makes managing images extremely simple. With a simple mouse click every photograph or radiograph for a particular tooth, teeth, or arch can be viewed (Figure 1). This is so much easier and more efficient then rummaging through a paper chart looking for the radiographs.
Once the treatment plan is entered, the patient screen is updated and color coded, just like using the red and blue pencil in dental school to chart a patient. The treatment plan (Figure 2) can be finalized and the patient can view the appropriate patient education modules so that they can have a complete understanding of their treatment. This is good for the practice and the patient along with covering the medical/legal informed consent. Some patient education programs have very tight integration with their practice management systems but all can be used in a stand-alone format as well. CAESY (Patterson EagleSoft) can then place a line in the patient record indicating that the module has been reviewed (Figure 3). In Guru (Henry Schein Practice Solutions), the patient can sign an image of the module to indicate that they have reviewed the information (Figure 4). Documents can be signed with an electronic signature pad similar to the ones used for credit card purchases. Now, informed consent to treat the patient is stored electronically in the patient’s chart.
Next, the patient needs to schedule an appointment for treatment. All of the information is available to the treatment coordinator, making the job to print and discuss the financial arrangements and scheduling simple. The appointment is entered and the patient can be reminded of the appointments via e-mail or text message. Dentrix and EagleSoft (Figure 5 and Figure 6) both have this integrated into the software (additional fees apply) but there are many third-party reminder programs that can interface with Practiceworks or the other practice management software systems.
Now the patient presents for their appointment and is sitting in the chair. Any health concerns can be flagged to automatically pop up as a reminder before viewing the patient’s chart. The treatment plan can be opened and the corresponding images displayed, all with one or two clicks of a mouse. The complete patient record is available at a glance.
After the treatment is rendered, the practice management software can have pre-defined chart entries. With a minimum of mouse clicks, a full, easy-to-read chart entry can be established. This is important because in a recent survey, 30% of respondents attribute poor handwriting as a leading cause of miscommunication between medical personnel.4 If you need to make alterations to the chart entry it is very simple to do. Just like working in a word processor, you can edit, cut, paste, and type. You then sign your entry with the mouse or signature pad.
Laboratory prescriptions can be automated as well along with the ability to submit supporting documentation to the laboratory securely via the Web or e-mail. An easy-to-read laboratory slip with photographs can be generated. The software also keeps track of the laboratory cases. This information is then available to everyone in the office with a computer without going to look for the laboratory case management calendar or book. The cases can be tracked by name, date needed, status, etc. The appointments can be flagged to see if the case has arrived or not. There is no longer any need to wonder if the case has been delivered to the office or not while having the patient seated.
Insurance claim submissions can be done via the practice management software and then handled by the software company or a third party. The software will scan the claim for errors before submission, resulting in fewer rejected claims. Processing is faster when the claims are submitted electronically, and also gets the practice its money sooner. Many insurance companies require less supporting documentation when submitting electronic claims. Billing can also be outsourced. The practice reviews the bills generated by the practice management software and the appropriate bills are tagged for being sent to the patient. The bills are then uploaded to the service where they are printed, collated, and mailed. The practice maintains control of the billing process but eliminates the time-consuming tasks of printing, stuffing envelopes, and mailing.
Automating the dental practice using practice management software is easier then ever before. The systems are in place to make the transition from paper to digital easier. Do not forget that along with the systems, training is very important. Each practice management software system has training available to make the transition easier. Take advantage of what you have already purchased and watch how your staff responds to no more filing, less confirmation calls, and reduction in busy work. Let the staff do more profitable endeavors for your office and watch your stress level go down.
1. Computers in the dental practice. ADA Survey. 1994.
2. 2015 EHR deadline “just around the corner.” American Dental Association News. July/August 18, 2008. Available at: www.ada.org/prof/resources/pubs/adanews/adanewsarticle.asp?articleid=3069. Accessed April 7, 2009.
3. Update: dentistry and the electronic health record. American Dental Association News. July 2007. Available at: www.ada.org/goto/ehr . Accessed April 7, 2009.
4. Docs bad handwriting no longer a bad joke. Wall Street Journal. Dec 26, 2007. http://blogs.wsj.com/health/2007/12/26/docs-bad-handwriting-no-longer-a-bad-joke. Accessed April 7, 2009.
About the Author
Martin Jablow, DMD
Woodbridge, New Jersey