Dentistry Uncensored with Howard Farran
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192 6 Steps To Going Paperless with Lorne Lavine : Dentistry Uncensored with Howard Farran

192 6 Steps To Going Paperless with Lorne Lavine : Dentistry Uncensored with Howard Farran

10/15/2015 2:00:00 AM   |   Comments: 0   |   Views: 805





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AUDIO - HSP #192 - Lorne Lavine



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VIDEO - HSP #192 - Lorne Lavine



Lorne Lavine, DMD has a background that makes him the perfect person to help you go paperless.

 

 

Dr. Lorne Lavine, founder and president of The Digital Dentist, has over 30 years invested in the dental and dental technology fields. A graduate of USC, he earned his D.M.D. from Boston University and completed his residency at the Eastman Dental Center in Rochester, NY. He received his specialty training at the University of Washington and went into private practice in Vermont until moving to California in 2002 to establish DTC, a company which focuses on the specialized technological needs of the dental community.

 

Dr. Lavine has vast experience with dental technology systems. He is a CompTia Certified A+ Computer Repair Technician, CompTia Network+ certified and will soon be a Microsoft Certified Systems Administrator. As a consultant and integrator, he has extensive hands-on experience with most practice management software, image management software, digital cameras, intraoral cameras, computers, networks, and digital radiography systems.

 

Dr. Lavine writes for many well-known industry publications and lectures across the country. He was the regular Technology columnist for Dental Economics Magazine. His articles have appeared in Dentistry Today, Dental Economics, Dental Equipment and Materials, Dental Practice Report, New Dentist, Dental Angle Online, and DentalTown magazine, where is a moderator of ten of their Computer and Software Forums. He has lectured to the Yankee Dental Congress, American Academy of Periodontology, American Academy of Endodontics, the DentalTown Extravaganza, and numerous State Dental Society and Study Club lectures. In addition, he is a member of the Speaking and Consulting Network. He is also the former technology consultant for the Indian Health Service.

 

 

thedigitaldentist.com

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Howard: It is a huge, huge, huge honor today to be interviewing my buddy, Lorne Lavine. Lorne, you were one of the first 100 people to ever get on Dentaltown. Gosh darn, you posted almost 16,000 times. Dude, I owe you my first born son. In fact, I'll give you all 4 of them because now, they're at the age where they cost money. Man, thank you so much.

Did we actually meet for the first time on a mountain?

Lorne: That was one of the first times. I actually came out to Phoenix to meet with you years ago. Then, we did the Climb for a Cause on Mt. Charleston with your 4 boys. I remember that trip very well.

Howard: No, no. I thought we met first on Mt. Adams.

Lorne: Oh, that's right, when you brought the poncho as your gear.

Howard: Climb for a Cause.

Lorne: I remember that.

Howard: Was that the first time we met?

Lorne: That may have been one of the first times we met, absolutely.

Howard: Yeah. I left Phoenix, Arizona where is was 117. I was going up there. I thought, "Oh, it's going to be nice and cool, maybe 80 degrees," so I packed sweats and a …

Lorne: Yeah. You had a solstice poncho. I remember, that was your snow gear.

Howard: Oh, my god! It was a glacier of ice, I like to add. If the one guy didn't give up and then give me all of his warm clothes, I couldn't even have gone on. The only reason I made it to the top was someone threw in the towel and gave me all of his warm stuff.

Hey! I can still remember one of your first emails clear back in 2001 or 2002. You said you wanted to be a volunteer moderator for all things digital. Tell the story because most of us are wondering, how did you go from being a dentist to a periodontist to all things digital?

Lorne: My family owns an electronics business in Canada. I grew up with technology. It was always something that interested me.

Howard: So, you're Canadian?

Lorne: I'm Canadian, yeah.

Howard: Born and raised?

Lorne: I'm a US citizen as well. I have dual citizenship.

Howard: You were born in Canada?

Lorne: Born and raised in Toronto, yeah.

Howard: That's why you're so proper.

Lorne: That's right. Let me just turn up the speaker here a little bit.

It was always of interest to me but this was back in the early 90s. This is long before the Scheins and [Pattersons and kirasheens 00:02:21] were involved in dentistry. It was all small companies. It fascinated me. I did my own office. I got interested in it.

The way that it basically mushroomed is that I shared an office with the orthodontist one day a week. He came to me. This was in the mid 90s and said, "You know, Lorne, I know you're into this technology stuff. I just got a quote to computerize my office." This guy had literally 2 chairs to himself and one front computer. They gave him a quote for $50,000 for basically 3 computers and some software. I just thought, "You know, it's really too bad that dentists don't have someone that they can turn to who not only understands technology but understands things from a demist standpoint."

All of a sudden this light bulb went off and I said, "Well, I can do that." I started offering it to my referring offices. I was periodontist at the time. I just said, "Hey, if you guys need some help, I'm happy to come in and do it." I was doing it for free but then, I started getting calls from non-referring offices. I was getting busier and busier. I was doing it weekends and evening. I thought, "You know, I should be charging for this time." It became a side business.

Then, what happened was that California announced they were going to pass licensure by credential. I've gone to college in California. I was practicing in Vermont at the time where there was 300 dentists in the entire state. I knew I wanted to do some consulting and do some IT work for dental offices. I thought, "Well, this is perfect because I can move back to LA. I'll practice 3 or 4 days a week. I'll do my consulting a day or 2 a week and maybe in 5 years, 10 years, I can kind of shift that ratio or whatever and phase out of dentistry, move to LA."

Send in my application. They said, "Hey, by the way, thank you for your application. You're number 15,000 something on the waiting list and we should get to you in about a year." I'm thinking, "Oh, crap! This is not good." I'm living in the heart of LA with literally no income.

Then, I lucked out because I had sent an email to Howard Farran. I said, "Hey, I'm just starting to get into Dentaltown. Would you be interested in having me helping moderate the forums?" All of a sudden, my name was getting out there to tens and thousands of dentists across the country. To this day, 85% of the offices that I work with are out of state and there are people through Dentaltown, through the magazine, through when I was moderating the forums that I've been able to establish myself as someone who knows a little bit about technology.

That's what we do. I work with offices all over North America to help them with their technology decisions, going chartless or paperless. Of course, with HIPAA, that's a big deal now. All of that ties into what we do.

It's been a convoluted story. By the time I was able to get my license, at that point, I'd already had a couple of employees. I was loving what I do. I still do. I just never had a desire to go back and do perio. Perio's tough, as you know. The patients aren't the most compliant in the world. I just got frustrated with it. With technology, the most part, if I do it the same way every time, it works out the same way every time. That's not the case, obviously with perio patients.

Howard: When I look at the 9 specialties recognized by the ADA, the periodontal specialty has changed the most. It's almost unrecognizable. I see now the members are all voting on changing the name from the American Academy of Periodontology to the American Academy of Implantology and Periodontology. That might have been a good move that you moved because that's just … For you to go from periodontal surgery to IT is not very different than all your peers who … I remember back in '87, you'd send patients to a periodontist. They do these heroic surgeries on these maxillary molars with trifurcations and trying to section teeth and all this. Now, they just, "Hell with it." Pull it and do an implant.

Lorne: When I started my practice in '92 in Vermont, I was the only periodontist in the entire state who was placing implants which I thought would be great because I love doing implants. Of course, the general dentists are used to referring to the oral surgeons. I had to explain to them, yes, as a periodontist, I think I can handle soft tissue and bone to the point now, I work with a lot of perio practices and 70, 75% of their practice on average are implants. It's definitely changed quite a bit from what I was doing.

Howard: Lorne, I'm going to be truthful about HIPAA to you. I'm going to tell you what guys tell me all the time. When you're out there at a bar watching a football game with 5 minutes, drinking some beers and you mention OSHA or HIPAA, they just roll their eyes. Dude, dentists need to take HIPAA seriously. Why is this a real issue? Is it a phantom ghost monster that lives under your bed that's going to come out and bite one dentist every year out of 150,000 or is it a real issue?

Lorne: It's a real issue. I actually just did a webinar a couple nights ago with another company. We thought we went through 10 case studies of all of them were $100,000 plus fines. HIPAA is not like OSHA. HIPAA's gone through a bunch of variations. It's actually been around since '96. A lot of people don't know that. They knew more about it when the high tech rules came out in 2009. Then, in 2013, they had the "final rule," was called the Omnibus Rule. They really identified what the fines and penalties are going to be.

The problem is, for a long time, there really was no people out there that were doing anything about it as far as enforcement of it. What's happened over the last couple of years. I've just got something in the mail yesterday is that Health and Human Services have been tasked to increase the amount of audits that they do. Last year, I think they did something like 1,200 random audits.

Howard: Okay. I got to stop you right there because these are watched in 206 countries on every episode. I'm afraid there's people in Africa, Asia and Latin America that doesn't even know what HIPAA is. Will you just explain what HIPAA is and what you're talking about? What is HIPAA?

Lorne: HIPAA came about from the standpoint that most practices, whether you're in Canada, US or around the world but a lot of practices, in order to be efficient are moving towards a chartless or paperless environment. Records are becoming more digitized, whether it's x-rays, intraoral camera images, patient information, it's all now being saved on computers.

HIPAA came about because the government said, "You know, if we're going to have this information available now on these electronic records, it's going to be much more prone to some type of hacking or accessibility issues." It's not like a paper chart where someone has to physically break into the office to get it. There's other ways to get to electronic records.

HIPAA came about because the government said, "You know, patients have a right to expect that as health care providers, we're going to take reasonable precautions to keep that information private and secure." The problem is, of course, is that basically having the dental profession, the medical profession self-regulate was never going to happen. People just, they don't know about it. They don't know what they need to do. We all have different definitions. HIPAA came about because there was a desire to say, "We need to have a set of rules and basically a set of standards that can determine what we really should be doing to keep that information protected."

It's different. In Canada, they have PIPEDA. It's HIPAA in the US but the concepts are basically the same. What are we doing to make sure that we keep private information private? What are we doing to keep that secure information secure?

The problem with HIPAA is a lot of offices have come to find out, especially ones that we've worked with and gone through audits is more than 50% of HIPAA rules and regulations are administrative. That's the bugaboo in all of this because a lot of the stuff the offices need to do, encrypt the data and have a good backup and things that we can talk about, these are all standard things that all offices should probably be doing even without HIPAA but where it really bogs down is, "Well, what are you doing to document it? What types of policies and procedures do you have in place? Do you have this all written out? Do you have an incident report? If there's been a breach, what do you have to do?" That is really tough for a lot of offices. Most offices don't have the manuals in place. They haven't done what they need to do. You're right. A lot of dentists roll their eyes and say, "Oh, I don't want to deal with this."

The problem with HIPAA, unlike OSHA, is that it's not a slap on the wrist like OSHA for the most part is. HIPAA indented 4 different levels of fines and penalties. What they define as the lowest level is not only were you not aware of the fact that there was a breach of your data but realistically, you probably shouldn't have known that there was a breach. Even that lowest level is up to a $50,000 fine for each type of incident. They had to go all the way up to what they call willful neglect which basically means you knew about this. We know you knew about it. You didn't do anything to rectify it. We're going to make sure you never forget us. Those fines go up to 1,500,000 for every type of incident as well. It's devastating.

Howard: Have you seen real fines for real dentists in the United States?

Lorne: Yes. There's been a number of practices that we've worked with that have been fined or certainly in the news. You just Google it. Dental HIPAA fine. You can see a lot out there. HIPAA also, the Health and Human Services has what's called the Wall of Shame which, if you Googled in HIPAA Wall of Shame, you'll see there's about 13, 1,400 medical and dental practices that have all had declared  breaches but we're seeing for the average dental office with the fines somewhere between 200 to 500,000 seems to be fairly typical for the fines.

The real issue for a lot of practices is that if you have had a breach of your data, by the law, you have to notify every single patient in writing. We have found that, again with the offices that we've worked with or gone through it, somewhere around a 25 to 30% loss of patients overnight once that letter's gone out which is going to dwarf any fines that HIPAA going to give you.

Howard: I hear it's worth if you shoot a lion.

Lorne: Yeah!

Howard: Lorne, right now, there's about 7,000 dentists. Almost all of them are commuting to work. How does these individual dentists know if they're HIPAA compliant?

Lorne: When we work with an office and we provide all kinds of services and consulting for offices, the very first thing that I'll say to an office is, "Listen, we are going to get you a lot closer to compliance than you are right now." Nobody can get you 100% compliance. There are 700 plus pages of HIPAA rules and regulations. A lot of the HIPAA rules, unfortunately, are what's called addressable rules.

There's 2 types of rules. There's basically required and addressable. Required means you got to do it no matter what. Addressable which, it gets really confusing for dental offices and all health care providers, says, "Well, if it's reasonable and appropriate and you got to do it, if it's not, come up with some alternative. If there is no alternative, then just document that there is no alternative." The challenge is that who decides if something is reasonable and appropriate. It's up to you as a dentist to make that decision but if HIPAA police ever show up, you ever get audited, they then get to make that decision. Hundreds and hundreds of those rules are addressable. HIPAA did not give any specifics.

For example, there was, when Microsoft ended support for Windows XP last year, there's nothing in the HIPAA rules and regulations that says, "You can't use XP. You've got to go to Windows 7 or 8 or 10," or whatever the case is. What HIPAA did say is that you got to do a risk assessment on an annual basis and if you discover vulnerabilities, you got to do something about that. Most people in the HIPAA world would say, "Hey, an operating system that's no longer being supported by Microsoft is really not secure. By definition, Windows XP is not really a HIPAA complaint operating system, but again, they don't specify that. HIPAA doesn't say you have to encrypt your data. They don't even use that word.

Howard: Let me play devil's advocate. Most dentists just assume, everybody I know is using Dentrix, Eaglesoft, SoftDent, Open Dental, that if you're using one of them, it's all HIPAA compliant.

Lorne: It's not.

Howard: First of all, is that the 4 main softwares you see dentists using because there's a lot of young dentists that are always asking, they're buying their first system. They just got out of school. It seems like almost everybody has Dentrix by Henry Schein, Eaglesoft by Patterson, SoftDent by Carestream who also owns PracticeWorks and Open Dental. Are those 5 pretty much the main ones?

Lorne: Those are the main ones. What we're also seeing …

Howard: Are there any other main ones?

Lorne: Yeah. It depends on your definition of main. What we are seeing is a lot of dental practices are looking seriously at web-based options, partly because of the HIPAA rules and regulations. The web-based software programs, none of the data's in your office. It's on your servers. The things you normally had to worry about with HIPAA, things like backing up the data and encrypting the data, all of that is now removed from your responsibility because …

Howard: Who are these web-based dental practice management systems?

Lorne: The biggest one out there is curve. Curve Dental's been around …

Howard: Are they out of Utah?

Lorne: They're in Utah. They started off in Canada actually. That's how I knew about them. That was back in 2004, 2005.

Howard: Oh, you Canadians all stick together. You just all plot against Americans, right?

Lorne: Yeah. They've done really well for themselves.

Howard: Is Curve out of Provo?

Lorne: Curve, I believe, is out of Provo or Salt … I know they're near American Fork near where Dentrix is actually located.

Howard: Yeah, because that's what I'm thinking. That's where Dentrix was started.

Lorne: They're close to that.

Howard: Are there American Fork?

Lorne: I believe so. They're near there. I know that Denticon.com from Planet DDS has been around a long time. There's a new one called Umbie, u-m-b-i-e, that's out there. We're seeing more and more of these …

Howard: Okay but this dentist. She's 27 years old and she's all alone. If you had to pick one of those web based, what would you tell her to buy?

Lorne: Curve. Curve's been around the longest.

Howard: Okay. How long is something like Curve?

Lorne: It works on a subscription model. That's one of the beauties of the systems. If you get the basic program, it's around $300 a month but a lot of people want some bells and whistles. They want image management and module, maybe they want to do recall of the patients, things like that. It's not uncommon for us to see a Curve client paying between 4 and $500 a month.

Howard: That solves a lot of the HIPAA stuff because over the web, they're going to do your data encryption, data storage and that takes a lot of the HIPAA burden off of you?

Lorne: The back up and all that stuff is now on someone else's service. I could tell you that the absolutely most HIPAA-compliant dentists out there in the entire country would still be less compliant than a web-based practice management software system would be. They have data centers, they have security. They have multiple levels of redundancy and encryption.

Howard: I would say on Dentaltown, I've been on that thing 4, 5, 6 hours a day since 1998. It seems like when people talk about Dentrix by Schein, Eaglesoft by Patterson, SoftDent by Carestream, PracticeWorks, it seems like its mostly moaning, bitching and complaining but when the raving fans are all Open Dental. With Open Dental, it seems like they have everybody who has of known says they love it, they love it, they love it. Do they do a web-based system?

Lorne: Not that I know if. Almost all of them in my discussions with them are working on it. They see the writing on the wall. I think, as a society, with the prevalence of Facebook and Amazon. Everyone is online for basically everything, banking, insurance. All that stuff is now online. I envision a day, whether it's in 5 years or 50 years, who knows where all software, not just dental practice management software's going to be web based. We're heading in that direction.

Howard: The dentists say on Dentaltown, they say, "Yeah, but if my internet goes down, my dental office goes down." What would you say to that?

Lorne: They have a valid point. What we typically recommend for an office that's going to go with web based is to have a backup. Most people are going to have some type of broadband, a cable, DSL, whatever. You can, in theory, get a second line. Let's say you're on cable. You get a DSL line. It's going to cost you 30, $40 a month. Most people have smart phones that have some type of tethering function that normally when an internet goes down, it's not down for days.

Howard: I know. I know. I can't even remember the last time the internet went down.

Lorne: Here in Burbank, we're down maybe 5 minutes a month. It's not a big deal but you have a backup. You have some type of thing that you can use but to answer your previous question, I think many of the current systems, Dentrix, for example, does have a web-based program now called Dentrix Ascend. Open Dental, I'm sure is probably have given it a lot of thought. I know Eaglesoft is looking into it as well. Yeah, we're heading in that direction.

Yeah, if someone came to me as a new dentists and said, "Hey, what do you recommend?" Typically, my first recommendation would be Open Dental. I think it's fantastic program. It was developed by a dentist. They understand it. I would say, "You know, I wouldn't rule out [crosstalk 00:20:07]"

Howard: That's out of Oregon. That's out of Portland, Oregon?

Lorne: Yeah. It's Jordan Sparks.

Howard: Jordan Sparks.

Lorne: [Crosstalk 00:20:13] and he's been doing it for quite some time. I think around …

Howard: Where in Oregon is he?

Lorne: That's a good question. I can't remember exactly where they are.

Howard: He's really huge now into cryogenics where you deep freeze the brain, when you die they deep freeze it so 1,000 years from now, they can thaw you out and fire you back up.

Lorne: Personally, when I'm gone, I'm gone. They can put me in a microwave.

Howard: I want to ask you. You said something about when you do a web based, that they're encrypting the data to do a backup. Lorne, I can point to 20 threads on Dentaltown that the computer crashed and when they went to restore the backup, they found up they were backing up to the C drive and it should have been the D but some technical deal.

Long story short, I can point to 20 threads where the backup couldn't be restored. How often do you see that? How many dentists listening to you right now think, "I got everything backed up." If their computer crashed, their backup isn't done right. What percent would you guess?

Lorne: I would guess probably about 20 to 30%. That's been my experience. I consult with offices all over North America. I can go into the practice, we evaluate things. Now, for our clients, we've never had a practice that we have set up the backup that we haven't been able to restore. A backup is not a cut and dried process like dentistry. It's not. We tell our clients, "Listen, we expect to get you up in 20 to 40 minutes on average," and that is the average, "But things happen." There are technical difficulties. Sometimes we've have a backup that takes a few hours, much longer than we typically would expect it to do. To my knowledge, we haven't had anyone ever lose our data.

A lot of people are not backing up their data properly, they're backing up the wrong files. Really, you should be testing that backup. Yes, part of HIPAA by the way. HIPAA says is it must test and verify that backup on a regular basis. We don't think it has to be more than 2 to 3 times a year. There's a lot of ways you can verify it. To me, the absolute easiest way to do it is take your practice management software, install it on a laptop, a home computer, whatever the case may be and take that day's backup. Put it in, copy it over to that other computer and fire up the program. Does this look like my schedule from today? Do these look like our transactions from today. That's the only way to know for sure, to give yourself that piece …

Howard: What percent dentists are technically smart enough to do what you just said?

Lorne: On Dentaltown, there's a fair amount that I would say are up there. It'd say probably 30 to 40% of the dentists on Dentaltown probably can do it. Part of the reason that we have developed that service for our clients. We've been doing that close to 15 years now is that the majority don't. If they do know how to do it, that doesn't mean they have the time to do it, doesn't mean they have the desire to do it. People get busy. It's just reality. The modern dental practice with HIPAA and OSHA and marketing and all the social media, all the things you need to do to run a practice, who really has the time or the desire to sit there for an hour or 2 and test their backup and make sure it's working. That's why we do it for our clients. We said, "Listen. We'll verify it for you. We'll test it for you a couple times a year."

Howard: Explain that. You keep saying your clients. What is that? A monthly subscription plan? Is that a fee for service menu à la carte? What do you mean when you refer to your client?

Lorne: We do everything. We started off over the years just offering different services. For example, when I first started out, of course and everything that we started doing, we still do. My focus for a long time was hardware, software, networking, setting up backup systems. What's happened in the IT industry is that we've moved towards a model called managed services. What that means is in the past, people would call you up when there's a problem and we would fix it.

Think about dentistry. There's a reason you put people on a 3 to 4 month, at least when I was doing perio, we put them on a 3 to 4 month recall. It's because we catch things at an earlier stage, we can be more proactive, more conservative in how we took care of the problem. Same thing in IT. If we don't know about the problem until there is a problem, often times it's too later or it's so advanced that we're talking about re-installing windows or having to completely … It's a major 3, 4, 5 hour undertaking.

What managed services is to say, "Let's monitor this in real time." If we're going to have an antivirus software on there, let's know that there was a virus. Let's have that software report back to me, the IT provider, immediately. If someone's logged in with an incorrect password or user name, if there's a corruption in a hard drive, if the computer's running too fast or the CPU is at 95% of it's usage, I want to know these things so that we can be very proactive in it. Those are more of a subscription based model.

We have clients who just use us for support, to buy a block of support time that we'll log back in and fix any problems that come up. We have people that get individual services from us, backup, disaster recovery, network monitoring and anti-virus software. The support, things like that, HIPAA compliance.

After a while, this is what we really focus on the last couple of years is that a number of our clients came to us and said, "Listen. We have 4, 5, 6 services with you guys. Is there anything we can do since we're good clients of yours to bring the costs down because it starts to add up obviously as you get all these different services." Then, we decide to put it all together as a bundle, what we call our Practice Byte Guard Suite, where people can get all of the services that we offer plus unlimited support for one monthly payment. They know every month what it's going to be. The meter is never ticking so they never have to worry. We have some offices that call us twice a year. We have other ones that call us twice a day.

Howard: Lorne, what percent of these offices do you physically have to send a human being to their office and what percent of this do you do over the internet?

Lorne: It's changed a lot over the last few years. I would have said up till about 2, 3 years ago, 90% plus were practices that I had to go out to. I really only do that nowadays for people that want a true HIPAA evaluation because there's a lot … With HIPAA, there's 2 basic types of rules. There is the security rule which is all the IT stuff, the encryption and firewalls and all that type of stuff, the backup which are all things that can be handled remotely but the other part of HIPAA which is really the initial HIPAA stuff which is privacy. What are you doing to keep that information? How is your practice set up? Do you have sign-in sheets? Where are patient information discussed? Things like that. That's a little more challenging to be able to evaluate over the phone.

Someone wants a more comprehensive HIPAA privacy and security evaluation, I'll fly out but if someone comes to me and says, "Hey, Lorne, I want to get as HIPAA compliant as I can. From the security end of things, I want you to evaluate my network, our hardware, our software, our security." We do that remotely but that's actually something we do for free. We've been doing that for years.

Howard: Okay. Would you say, of the major software, Dentrix, Eaglesoft. SoftDent, PracticeWorks, Open Dental, that Dentrix is the biggest, the 400 pound gorilla?

Lorne: Keep in mind that when these companies discuss their user numbers, they consider anyone that was basically ever on their system as a user. If someone's using Dentrix and decides to stop going on support, Dentrix doesn’t necessarily count them as somebody that left the company. You have to take the numbers with a grain of salt. These are all self-reported. There are no standardization or government that would be able to monitor. That being the case, just from my own experience, I've worked with over 2,500 practices. I'd say somewhere around 25 to 30% of all software users are Dentrix users.

Howard: They could upgrade from Dentrix to Dentrix Ascend and move all this to the cloud and then forget about backups, encryption, data recovery, disaster, all that stuff?

Lorne: To a certain degree. There's 2 parts …

Howard: But would you recommend that if somebody's listening to you right now and they say, "Well, I'm on Dentrix and I don’t know how to test my backup and I don't know if it's encrypted and he didn't mention that Ascend thing." Are you recommending upgrading to Ascend?

Lorne: Not yet and for a couple reasons. Number one, it's a relatively new program. It's not Dentrix in the cloud. It's an actual, completely different program. It's called Dentrix Ascend. There certainly are some crossover but it is a completely different program. It's a new program. We would never recommend to our clients or people that I'm talking to that they be the first on the block. Dentix itself has been out for a couple years. It's getting there but it's still new enough I wouldn't say go out and do that immediately. The other challenge is …

Howard: Microsoft never releases anything until every bug is worked out.

Lorne: Not exactly.

Howard: That is a huge joke. Those guys do find out where there bugs are by selling you the software. That's what Microsoft does.

Lorne: But you know what? Even with dental practice management software programs, we typically see at least 3 to 6 patches for each version of the software that comes up. They can't catch every bug.

The other thing that people have to worry and this is where a lot of practices got into trouble is that they assumed incorrectly that their practice management software is encrypted. For the most part, it's not. Dentrix, for example, for a long time, they were saying they're encrypted. They're not. They were using data masking. They have to change that. It's closer to encryption than some of the other ones out there but the other thing is that HIPAA refers to electronic, protected health information. The information that's in the practice management software is just one piece of the puzzle. There are images, x-ray images. There's QuickBooks data. There's Word files, Excel spreadsheets and [Vizzle. 00:30:14] All that stuff. If that stuff is sitting on your server, then you still need to do all the other things that we've talked about. You're not out of the words by just going to a web-based practice management software. People have to be aware that yes, it's going to help them out a lot, I think, from the backup and security. When it comes to that information, they still need to be aware if there's other locations in the practice that has his protected health information, that has to be protected in compliance with HIPAA rules and regulations.

Howard: Man! There's just so much things to think about. Crazy!

Lorne: Yeah. That's why we decided to do it for our clients. A lot of IT companies don't really focus on that. We realized years ago, this is going to be a big deal. It is a big deal that we've seen huge fines. I hate to use fear tactics when talking to our clients but people need to be aware that, listen, this is the risk.

It's like car insurance. You're probably never going to need it. The one time that you do, you're going to be really glad that you got it in place. That's going to be  the same thing with this. You're going to be really happy that the day that HIPAA auditor shows up, you've got your manuals and policies and procedures in place. You've got all your documentation. You're encrypted everything. You've got all the things. As I said, the services we provide our clients are the main things. We know having talked to offices that have been audited that there are certain things they're looking for.

If an auditor comes in and they say, "You know what? I am going to nail this practice. I don't like this dentists so I'm going to nail him," you're going to get nailed. There's no way around it but take the precautions. What they're looking for is what's called VDE. Visibly demonstrable evidence. If you have made a good faith effort to be compliant, they're going to look at that very fair, [variably 00:32:04] first as a practice. They'd say, "Oh, what do you mean, 'I need to be doing this?' I never heard of HIPAA," or, "We just …"

Howard: VDE? VDE?

Lorne: Yeah. Visibly demonstrable evidence that you can show …

Howard: Now, we've gone from VD to VDE. It's getting worse.

My job is to estimate what these dentists are thinking in their car. One of these dentists say, "Well, Lorne, am I not a candidate for a web-based software like Curve because I bought myself a CBCT and I heard those files are just too big to store over the cloud." Is that true or false.

Lorne: No. you can store whatever you want over the cloud. We have clients that we support right now that have 500, 600, 700 gigabytes of data. That's a lot of data.

Howard: How long would it take to upload a CBCT? That's a much bigger file than a [panno 00:33:00] or a PA.

Lorne: Correct. The way that a lot of the web-based programs works, especially when it's[inaudible 00:33:05] Curve for example when it comes to sensors and phosphor-plate systems or digital pens, it's a real time imaging module. It's automatically saved up there. For those larger files, that's almost always done at nighttime. Of course, it's going to depend on the size of the files, it's going to depend on your internet connection. It can be difficult. There's no doubt about it. We have offices that, if they run their backup every single night, they can't get through all that data in one night. It's hard way to describe it but we basically say, "Okay, we're going to run the backup at night on the weekdays, then once Friday evening comes, then we're going to do it full bore. We're not going to throttle it as we do during the day but we'll let it go full bore on the weekend to the point that we can get it all out there."

Howard, most offices don't put their CBCT images up in the cloud. They'll put it on an external hard drive, encrypt it, get it out of the office on a regular basis because most data centers including the one we work with charge based on the amount of data you have up there. It can get very expensive. A lot of offices realize, "You know what? It's just not worth it. I'd rather get my practice management data up there, my sensor images, my intraoral camera images, I'll do all that but the CBCT images are so large and so costly that I'm going to store it locally on an encrypted drive. I'll get it out of the office on a regular basis." A lot of offices …

Howard: You say get it out of the office in case the office burns down?

Lorne: Yeah. One of the things that HIPAA says is that all your data has to be "retrievable." By definition, that means off site.

Howard: A lot of dentists just use a firebox. You go to Home Depot and they say, "This box will survive a fire," but that's not good enough?

Lorne: Yeah. Here's the takeaway from this presentation today. Fireproof does not mean melt proof. It won't protect it at all. We have offices, unfortunately, that that's exactly what they did. They put it in a fireproof safe and it melted. It's got plastic components for the most part, these external hard drives have. They couldn't retrieve the data.

Howard: There's a dentists on Dentaltown, just I mean, just 6 months ago and he was driving home from a restaurant and he's, "Ah! I wonder what's burning over there. I wonder what that fire is? It's kind of near my office." Drove by there. It's his office.

Lorne: Yeah. It would be devastating. There's other things that can happen. Theft, flood. There's a lot of ways you can suffer a disaster, having that data offsite now.

Howard: Do you recommend the dentists takes it home?

Lorne: For something like CBCT. For most backup systems, we don't recommend that from the simple standpoint that you want to try to eliminate the human component as much as possible. If you have a staff member that's responsible for sitting there every night and doing the backup at the end of the day and then taking it home with them, you know it's not done every single day. It's going to be forgotten. People get busy. People might leave it in their car. People may not be encrypting it the way they're supposed to. It gets stolen. Now, you've suffered the most common breach that exists out there. Why not consider a system where the human element is completely eliminated, where it's automated. You can get an email every morning that tells you that the backup was successful. It's going to a secure HIPAA-compliant data center. Again, this is what we do for our clients. They can do it themselves if they want.

Howard: You talk about your management system but you haven't mentioned price. How much are these bundled things? The dentists listening, I know they're wondering. How much money are you talking?

Lorne: We have clients, it would start as cheap as $35 a month for someone that just wants encrypted email, for example. If someone wants our entire package which is disaster recovery, data backup, real time monitoring the network, encrypting the email, policies and procedure manual, breach insurance, encryption, antivirus software, there's a whole new class of viruses out there called ransomware where they lock your files and require ransom. There's protection …

Howard: That happened to my son. We decided to just …

Lorne: It's happened to about a dozen of our clients as well. You include unlimited technical support which we provide. The worst case scenario is someone paying 799 a month. That's our highest package. We have a lot of practices that do that. We have other practices that pick and chose. They say, "You know what? We don't want the unlimited support or maybe we just want 2 or 3 of these things." We'll bundle it any way you want.

Our typical client is somewhere between 200 to 400 a month, going on just a number of the service but for the people that  want and we've got close to 100 probably that are on the full suite of packages, the 799 seems to be a decent price. We work with IT companies all the time that work in other fields, in medical fields, in law, whatever. The typical managed services contract that they set up with their clients is 2,500 a month. They require a 3 year contract so we feel, "Hey, 799 a month. We only require a one year," that seems to be much more cost effective than what's standard for the industry here. Most of our clients agree.

Howard: Just to pin you down on an exact number, what percent of dentists do you think are reasonably HIPAA compliant so they would pass a visibly demonstrable evidence of VDE HIPAA audit? What percent listening to you right now, do you think?

Lorne: One.

Howard: One?

Lorne: One person.

Howard: It's you?

Lorne: One percent? Well, I shouldn’t say that. As I said, the clients that we have who are on our suite of services would be for the most part find again. If someone comes in and the want …

Howard: You know, Lorne? I don’t think dentists are going to get serious until they think it's going to hurt their pocketbook. That's human nature. You ought to find some dental office on that Wall of Shame that got fined.

Lorne: You know what? There was one in Northern California in December, 2013. It was on the CDA California Dental Association website where he was a Dentrix user. He thought it was encrypted. In a sense, it was not. His server was stolen. I believe the fines were between 2 and 300,000. It's hard to get exact …

Howard: Why don't you get him to write an article for Dentaltown magazine or give me his name and email and I'll see if he can do a podcast on it.

Lorne: That's a great idea.

Howard: Or you guys could do an online CE course on it.

Lorne: Yeah. Wayne …

Howard: You can have him talking about … Because Socrates said, what, 2,500 years ago that humans only work on greed or fear. He said fear was much bigger because you see a bunch of zebras and they want to cross a creek but there's 3 crocodiles sitting down there. They rather just wait it out. That's why the biggest drops on Wall Street are much bigger than the biggest one day against. Maybe we started out with here's a good dude. He thought he was doing good and here was his fine and then talk about it.

Lorne: That's a great idea because there are plenty of practices out there. I did a webinar with an office manager from an office in Massachusetts about 6 months ago that her office had gotten nailed as well, due to a theft as well. Yeah. There's plenty of real life examples.

Howard: That is the biggest issue?

Lorne: Oh, yeah.

Howard: Can I tell you my theft issue in my dental office? Oh, god. I opened in '87. I think it was about 1994. I had an alarm system and it went to my home. I was home. I went off in my home. At 1:00, my alarm is going off, so I run out, jumped in my car, drove in my office. When I got there, the police were they. He was a patient of mine. His name was Star. Officer Star said, "What the hell are you doing?" I said, "My alarm went off." "You idiot!" He goes, "If someone was in here stealing your stuff and here you show up, you're going to get shot because you're afraid they're stealing your computers." He goes, "If you're going to do that, take the damn alarm out of here. Let him steal your damn computers. You don't need to be shot over a bunch of computers. Don't ever do that again. I know you. You got 4 kids. You don't need to be shot trying to get a bad guy," but you're right, these dental offices are broken into because they think they got Vicodin and computers.

By the way, that's why you never, ever, ever, under any circumstance ever dispense a narcotic in your office because when people lose their heroin supply or whatever and they're in withdrawal, they'll do crazy shit. If they remember you gave them 2 Vicodin or something after, that's just crazy. Don't ever, ever hand out a narcotic. Would you agree with that, Lorne?

Lorne: I 100% agree. When it comes to theft or loss of data, far and away, the number 1 by multiple times as far as reason that people suffer breaches is loss of a mobile device. By mobile device, I mean external hard drive or thumb drive that people back up to and take it home with them or leave it in their car or a phone or a laptop. That is easily the number one reason for breach and going on that wall of shame, more than half, I believe are …

Howard: Explain that. The dentist has data on their laptop or their tablet or their iPhone?

Lorne: Yeah. That's crazy.

Howard: Then, that gets stolen. Is the person stealing it trying to get that data or is it just stolen?

Lorne: It was just stolen. I saw some statistic one day that in US airports, it's something like 12,000 laptops a year are stolen. It may not be a year. It may have been a week. It's a common thing. People want laptops. External hard drives. You leave it in your car. You forget about it. Your car gets broken into. You lose it. People put them on these little thumb drives as a backup and they lose it. If it's not encrypted at that point, you've suffered a breach and you have to report it. So easily preventable, you encrypt that data, you are exempt from the breach notification.

Howard: That's a matter of installing some type of software on your laptop so that … What percentage of the dentists like … I don't have my SoftDent on my laptop at work but you're saying other dentists do?

Lorne: Yeah, but it's not just their SoftDent data. A lot of people have their email on there. Another referring office sends you an unencrypted email with information on it. It's got the patients photos. It's got their digital x-ray, the patient name, date of birth maybe or social … People shouldn't be sending social but they do but anything that's considered. HIPAA has identified 18 identifiers, everything from a face, a name, a chart ID, initials, all that stuff. If any of that stuff is on the laptop in that email and someone gets that laptop and they have access to it, you've suffered a breach.

Howard: Lorne, dentists are posting CBCTs on Facebook every day and if you enlarge the picture, you can read the patients name on the bottom corner of the x-ray. Have you seen that?

Lorne: I have seen that. Hopefully, they have had the patients sign a waiver that they have agreed to allow their information to be posted online because if not …

Howard: You know they haven't. You know they haven't.

Lorne: I know they have and you know they have. A little bit facetious so yeah.

Howard: They're in trouble for that. They could be in trouble for that.

Lorne: Big trouble. A lot of offices will post patients information on Facebook. They'll take pictures of patients and put them on Facebook without the patient's permission. That's not allowed. You absolutely should have a social media policy in your practice that you have the patient sign if you want to be able to do it. A lot of offices say it's not worth the trouble or the hassle. Yeah. You can't take someone's private information, their photos [inaudible 00:44:48] and put it online.

Howard: I know they're putting CBCTs and you can read right on the deal "Charlene Wilson." I've seen name and birth date on CBCTs on Facebook.

Lorne: Unless the patients wrote, asked them …

Howard: You and I know Charlene Wilson would not and she sure as hell wouldn't give away her birthday. You know any women who give away their birth date?

Lorne: None that I know that give away their birth date or their weight.

Howard: Or their dental x-rays.

Lorne: Yeah. Anything. As a patient, I wouldn't want myself up there unless I give permission. Honestly, there wouldn't be a whole lot of reason I would give permission.

Howard: Almost every woman in my practice of 28 years that wears a full denture has told me her husband's never seen her without her teeth in, ever. She sure as hell wouldn't want her CBCT up there showing 6 upper maxillary implants and 4 on the floor. It's crazy.

We're 3 quarters done. I got you for 15 minutes. I want you to talk to the young kids. These podcasts are just devoured by 30 and under. They're just podcast addicts. Every time someone sends me an email or whatever, I always reply back and say, "What's your age? What year did you graduate?" They're kids.

This person is brand new and they're starting up and office. They want to go paperless. You started before there was paperless. This is funny. I went paperless for the year 2000. You young kids don't realize this but 15 years ago, we all thought the Y2K, that was … Instead of having 4 digits of space wasted for the year 1999, they were just going 99. When the computer went to the year 2000, it would be 00 and your computer would have thought it was 1900. Everybody was trying to upgrade their software. That was when our office decided, "Hell. Let's kill 2 birds with one stone. We'll just go completely paperless."

What should these young kids be thinking about when they set up a paperless practice? What is the big picture from Lorne Lavine's 30,000 foot looking down. What should maybe be thinking about if they want to go paperless?

Lorne: This is probably one of the most common lectures that I give around the country, it's 6 steps to a paperless practice.

Howard: You should put that on Dentaltown.

Lorne: I'm happy to put it on Dentaltown.

Howard: We put up 350 courses. They just passed 550,000 views.

Lorne: Wow!

Howard: Every course has been viewed by every single country. All 206 countries watch every single course.

Lorne: Wow! [crosstalk 00:47:30]

Howard: I would love it, Lorne. I'm a huge fan of yours.

What are the 6 things? You got 13 minutes to tell me the 6 things that every practice should be thinking about?

Lorne: You can do it in about 2 minutes. It's all stuff we can talk about as well. Number one in my mind the most important decision is to practice management software, certainly for a young office, I would be looking at something like Open Dental. Not only is it a fantastic program, very cost effective. You pay a monthly fee of $160 a month for the first year, then it drops down to $99 a month. That's it unless you're converting data from other program. You have no other upfront cost. It's a great program. All the decisions you make are going to be affected by that practice management software. That's number one.

Secondarily, what are you going to do for image management? Open Dental, programs like that have their own image module. We don't typically recommend that most of the, especially the younger dentists.

Howard: When you say, "Image," that's an intraoral camera image or a digital …

Lorne: Digital x-rays, digital camera, panno, just being able to store all images with exception of CBCT.

Howard: But it includes intraoral camera photo?

Lorne: Intraoral camera, yeah. All the other stuff.

Certainly you can get like Dentrix tends to work with Dexis and Eaglesoft works with Schick and SoftDent PracticeWorks work with Kodak but a lot of our clients tend to look at more open ended programs, programs like XDR and Apteryx that will work with multiple sensors and multiple cameras and multiple digital pads and have them all mixed up together, working together on the same program. People want to have that flexibility versus saying, "Hey, I need to be locked into the Patterson or the Carestream or Schein." There's nothing wrong with that. It's just a lot of people want to have that flexibility.

The third component would be, how are you going to design your treatment wings now? Are you going to do a single monitor, dual monitor? You going to have 3 or 4? Scott Leune with his Breakaway seminars, he recommends multiple monitors. There's a lot of ways to skin that cat so people have to think how they're going to design the whole system.

Now that you've got the software and the design in place, you need the infrastructure. That's point number 4. That's going to be the computers, the server, the laptops, the backup devices, the network, all that hardware that's needed to go into place. You don't need to go crazy with this. Yes, you can get a HIPAA-complaint server that has self-encrypting hard drives and same day support. Most of our clients go that route for a startup practice. Maybe they're going to look at beefing up a workstation. Put a couple hard drives in it that you can mirror. Maybe you don’t have an operating system that's designed for servers. There's ways to get the cost down.

The fifth step would be all the digital stuff. Sensors, cameras, digital pans. We don't obviously normally for a startup practices recommend CAD-CAM and cone beam. I think those are fantastic technologies. Most offices, they have enough things to worry about. They should be focusing on the basics, on marketing the practices versus going really high end with the equipment.

Then, the final part is all the services. Getting HIPAA-compliant backup, disaster recovery, network monitoring, all the things you need to do to be compliant and secure. Get all those things in place. You don't need to go crazy. Our typical practice that is going, like a scratch practices is getting and they want to go digital with their x-rays. It's not unusual for them to spend 40,000, 50,000. That's a lot but compared to the fit up of an office, it's not a huge expense. You can go crazy. You can spend over 100,000. We've had offices that have done it for 20,000. It just really depends on your budget and what you want to do.

If you follow those 6 steps in order because for example, a lot of times, we work with younger dentists, they're really excited about getting digital x-rays. They'll go to a trade show. They'll look at the sensors and say, "Yeah, this is the one I want. Looks great." Then, they don’t realize that, "Oh, by the way, does it really integrate with that practice management software you currently have in the practice," or you don't really have the computer infrastructure in place to run that. Your computers are too old.

You have to walk through that step by step and have basically a treatment plan of how you're going to do it. Again, this is something that I do for practices all over North America. We'll work with you individually and say, "Hey, let's figure out what you want to do, what your budget is and find a solution that's going to work for your practice."

Howard: These guys, listen to this. Some day, can you log on Dentaltown and see these 6 steps in order?

Lorne: I'll get it on there. I have it on my website at the digitaldentist.com. I certainly am more than happy to put them on Dentaltown. I think I had an article on it in Dentaltown magazine years ago. I'm happy to get it up there again. Absolutely.

Howard: Not to be rude or anything but just succinctly, you said the 6 things you'd be in order so succinctly say the 6 steps in order again.

Lorne: Number one, practice management software. Number 2, image management software. Number 3, operatory design. Number 4, computer and hardware infrastructure. Number 5, digital technologies and number 6, services.

Howard: I just want to say to you young kids out there. You're walking out with $250,000 student loans. I know you think that's a lot of money. Lorne, how many offices could you give these guys a name to that do $1,000,000 a year and take home 3 or $400,000 a year that do not own a CAD-CAM, a laser or a CBCT?

Lorne: I would say … Again, I've worked with 2,500 practices. Ninety-five percent plus and these are established. I mean, most of the time, I'm working, when I go out to an office, I'm working with an established practice. I would say only 5% of them have those technologies in them.

Howard: Yeah. You kids don't need to buy all that stuff. Then, I also tell them, Lorne, that they think $250,000 is a lot of money but it won't be a tenth of what their first divorce costs. I try to put it in perspective.

I want to say another thing to the young kids that are always telling me, they're always saying, "Howard, all you old dentists out there, you're all Microsoft fans and everything and they're all Apple fans. They have Mac and iPhones." Are any of these software that you're talking about, are any of them Mac friendly?

Lorne: There are a number and increasingly larger number of Mac-specific programs that are coming out. Where we're finding the limitations is the image management. Most of the digital pans out there, for example, use a standard interface called Twain. It's the same thing that scanners use. Twain does not work with Apple operating system so you're limited there, there are very few sensors that will work with Mac-specific programs. There are very few intraoral cameras that work natively.

Now, you can certainly work around that. You can get boot camp or VMware or parallels, some of that run PC applications on a Mac but in my mind, you've defeated the purpose of the Apple which is to run its software. There's no doubt you can do an Apple-only solution. There's a dentists here in Encino that has done that. It certainly can be done. I would caution new dentists. "Hey, it's a great operating system but for a dental office, you're probably going to find that your options are much more limited in what you can bring into the practice and it's usually going to be a higher cost premium as well."

Howard: Lorne, there's 150,000 dentists in America. There's 2,000,000,000 around the world but just for the American, US market of 150,000 dentist, what percent would you say are paperless today in 2015?

Lorne: Between 5 and 10%.

Howard: Really?

Lorne: Yeah.  [Inaudible 00:55:16]

Howard: What percent do you think have gotten rid of film x-ray and gone to digital x-ray?

Lorne: That's a good question. I've seen all of the surveys at Dentaltown does. It's about 50%.

Howard: Half of them got rid of film. By the way, I had a patient swallow a film and I hope nothing develops. That's a pun. That's a pun.

Lorne: I got it.

Howard: You think 50% have gotten rid of the old Kodak and Fugi film and gone digital x-rays but only 5 to 10% are paperless. Lorne, I have to throw that definition under a bus because on my [obs, 00:55:52] you have said to me, "Howard, are you paperless?" "Absolutely." God, we still use a lot of paper. What is your definition of paperless? Getting rid of the chart?

Lorne: Yes. No, no. No paper. The only practices that we work with that are truly paperless are new builds. They can go paperless from the get go. Existing practices, we don’t even use that term because none of them are. We use the term chartless.  Let me rephrase it. I would say 5 to 10% of the practices that we work with are chartless, that no longer use a physical chart but I would put the ones that are, of all the practices that we work with that are truly paperless, some are between 1 and 2%.

Howard: What is the difference between a paperless practice and a chartless practice?

Lorne: Chartless practice would not be using the physical chart but like most practices they still have paper. They have EOBs that come in, that they scan. To me, taking paper and scanning it which is what a lot of practices do is not paperless. You've got paper in there. They've got no physical chart but they have walk out statements that are paper. They have EOBs that come in that are paper, they do prescriptions that are paper meaning there's still a lot of paper in the practice. If you're scanning documents in, you're not really paperless but by all definitions. It's impossible for an existing practice.

Howard: Lorne, you use the word. I don't know if it's a typo. Is there a word antimalware?

Lorne: Anti-malware.

Howard: Anti-malware?

Lorne: Malware is a virus.

Howard: I thought maybe that was animal wear and you misspell and it was a typo.

Lorne: Yeah. Mal is …

Howard: Anti-malware?

Lorne: Yeah. Mal is a Latin for bad so viruses, spyware, ransomware that we talked about. There's cryptoviruses. All of that is considered malware, things that can do bad things for your computers. You've got to protect yourself against some of that. Any practices to know the need to run antivirus software. It makes perfect sense but as I said, the problem is is that most of the antivirus programs out there don’t protect against these ransomwares.

Honestly, one of the best things that offices can do to protect themselves besides getting … There's a program called CrytoPrevent which will actually prevent most of it but it's already something I've talked about. If you have an encrypted backup, I'm not aware of any virus that can attack an encrypted backup. The dozen or so practices that we've worked with that got hit with these ransomware, all we had to do was restore their backup.

Howard: What anti-malware do you recommend? Is there any name brands that you like?

Lorne: Sure. I come from a different perspective from that I'm an IT provider. We use a product from a company called Eset, e-s-e-t. They've got a program called Nod32. We like it because we have literally thousands of computers that we monitor and manage at any given moment. We can monitor all of them. Rather than the updates going back to the company, it actually goes through our server so we monitor that.

Any decent program out there. Trendmicro, Kaspersky is good one. The ones that I would recommend staying away from are the free ones. People love free programs and makes great sense. The problem is number one, with one exception which is Microsoft Security Essentials, most of the free ones, you're not allowed to install them in a commercial environment like a dental office but secondarily, they're just not all that good.

Howard: Lorne, if someone's listening to you and has a question that I wasn't smart enough to ask, how can they get a hold of you?

Lorne: Lots of ways. They can go to my website, the digitialdentist.com and fill out the contact us form. They can find me on Facebook under thedigitaldentist, twitter thedigitaldentist. They can certainly email me drlavine, d-r-l-a-v-i-n-e @thedigitaldentist.com. We have a toll-free number, 866-204-3398. I never charge for phone consultations. If someone wants to pick my brain or see if there's a way we can help them with whatever they wanted to do, I'm more than happy to speak to anyone so …

Howard: You're company's called The Digital Dentist but I always think of you at DTC.

Lorne: Dental; Technology consultants was and still is the name of our company. For so many years, people knew me as The Digital Dentist. I was writing articles online under The Digital Dentist moniker but about 2, 3 years ago, I actually did a DBA, doing business as The Digital Dentist so it's both names right now.

Howard: DTC stands for …

Lorne: Dental Technology Consultants,

Howard: Dental Technology Consultants.

Lorne: … but I'm also known as The Digital Dentist. That's actually my company name now as well.

Howard: I'm serious. I'm serious. If you're out there listening, I've known this guy for 15 years. I climb mountains. I don't know anybody that knows all this shit in dentistry. You've posted 16,000 times. You're even a programmer. You got all these certifications. You're a freak. I want to tell you that seriously, dude, seriously. From the bottom of my heart, thank you for all you done for dentistry, all that you've done for Dentaltown. This is a huge part of dentistry. We went to school 8 years, learned how to do a root canal. Now we have to install anti-malware software. This is not what we went to school for. You've answered so many damn questions to us dentists who don't know any of this stuff.

Lorne, thank you so much. I hope you put those courses up on Dentaltown because what we see, Lorne and the reason why is, I look at the data, who's taken the online CE and who's doing the podcast and they're different behaviors. You always know that some dentists. I always like to get the textbook. When Miche come out with a textbook, I wanted to read the textbook. Other people wanted to go to the course. Some people do online CE at the desk and they want AGD credit. Other people do the podcast thing is purely a multitasking behavior. Everybody listening to a podcast is doing something else. They're mostly driving to work or they're on a treadmill or something like that and that's why we always send these things off to get a transcript so they don't just stop. I spoil my homies so they don't have to stop and take notes. It'll all be put up on a transcript.

Lorne, thank you so much for all you've done for dentistry and Dentaltown.

Lorne: Thank you, Howard and right back at you. Fifteen years ago, when I signed up for Dentaltown and there weren’t many people on there. I had no idea what it was going to turn into. I would say, somewhere around two-thirds of all the practices I work with are townies.

Howard: Those are the best two-thirds.

Lorne: They are the best two-thirds but Dentaltown is an amazing resource and what you've done with it is fantastic. It's been great for my career. I am more than happy to give back whatever I can because I'm a townie and will be for life and thank you for all that you do for dentistry.

Howard: I hope that next time I see you, we're on a mountain.

Lorne: It'll be nice.

Howard: Okay. Talk to you later, buddy.

Lorne: Okay, Howard. Take care.

Howard: Bye-bye.

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