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Profile in Oral Health By Trisha E. O’Hehir, RDH, BS, Editorial Director, Hygienetown Magazine

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Official Townie “Jamaicanmenuts” from Philadelphia, Pennsylvania, raised some provocative questions in a message board titled, “Going paperless, be honest.” Her basic question was, “Is it possible to be paperless?” She understands how easy it would be to start a new dental practice with computers, digital radiography and the works. However, she is in a 20-year-old practice that has been in transition for three years, still using both paper and computer charts due to 20 years worth of charts full of notes and comments. Doing double duty is time consuming and takes away from actual patient care. In the end, the bottom line suffers.

 
Other Townies have raised the issues of going paperless; going digital; using various software programs, intraoral cameras, TVs and computers in the operatories; and all the infection control surrounding new procedures. This is the computer age, and just as Avram King preached several decades ago, offices are doing away with paper charts, radiographs and photographs. From all the discussion on Hygienetown.com, it’s clear that this is not a quick transition. The learning curve is steep, and knowing that from the outset makes the conversion much easier.

Converting an existing paper-driven office is a process and not an overnight transformation. Despite the rapid changes in technology, not all dental teams are moving in the digital direction. Some have tried but decided against it. If the team isn’t on board and the dentist/team leader isn’t leaning in this direction, the changes needed are impossible.

There are various stages of “going paperless.” Replacing one paper aspect of the office is a move in that direction. Replacing film radiographs with digital images is where many offices start. Some refer to this move as “going digital.” Replacing paper charts with digital charts is another step often called “working chartless.” Using intraoral cameras to document rather than photographic prints or slides is another step. Even using a multimedia system to educate the patients, rather than handing out pamphlets, is a step in the process of “going paperless.” Most dental offices have completed one or more steps in the process of going paperless, but only a few hundred are truly “paperless.”

To learn more about this process I spoke with consultant Laci Phillips who worked for several years with Paperless Technologies, a company that provides the ultimate step in going paperless – the software to take information from digital forms and seamlessly integrate that information into whatever dental software program is being used in the office.

Technology consultant Laci L. Phillips

Laci Phillips is a practice management consultant and speaker for Banta Consulting, Inc., of Grain Valley, Missouri. She attended New Mexico State University, majoring in Communications and has a diverse background in public speaking. Her dental career has spanned 15 years, including chairside dental assisting, practice administration, technology transition coaching and speaking. Her consulting emphasis is helping dental teams integrate technology in their practices. She has worked with dentists around the country. Laci lives in Phoenix, Arizona, with her husband and two young children.

Trisha O’Hehir: I hear clinicians talking about going digital, being chartless, and more often I’m hearing about paperless offices. Do all these terms mean the same thing?

Laci Phillips: Surprisingly, the terms do have different meanings, but they’re used interchangeably, which is confusing. Going digital usually means transitioning from film radiographs to digital images. Chartless means digital charts, but chartless offices still use some paper forms to communicate and gather information from patients, like health history, insurance information, informed consent, and reminder postcards. A truly “paperless” office means just that – no paper at all.

Tell me more about a paperless office. How do they get the patient information?

Phillips: Patients no longer fill out paper forms. They use a digital tablet to complete the forms and sign them, just as you do when making a credit card purchase. They can also complete the forms on the dental practice Web site, or by accessing a link sent to them in an e-mail. The information captured in the tablet computer or online is then uploaded to the office computer and integrated into all of the dental software used in the office. It’s all done electronically – no paper involved.

What are the advantages of a paperless practice?

Phillips: Going truly “paperless” saves thousands of dollars each year in paper expenditures alone. Just think of all the forms, charts, photocopies and mailings done in one year in a dental office.

There is also a significant savings in staff time to enter or even scan the data from paper forms into the computer. Paper forms also need to be filed or shredded afterwards, which are more time consuming steps. To see how “paperless” an office is currently, follow the paper trail. Where is paper still used in your office? Patient forms? Health history forms? Signature forms? Informed consent forms? Periodontal charting forms? Patient reminder postcards?

How do you suggest an office start the process?

Phillips: I suggest beginning with new patients first. Have these patients complete the new patient forms either online or with a tablet computer when they arrive at the office. After a month or two, convert a few established patients each day to paperless entry and electronic charts. Over a period of six months, nearly all the patients will be entered into the system. This is much easier than attempting to change the practice overnight.

The dentist generally makes the software choices for the practice. Do some seek the input of their staff members?

Phillips: Hygienists and other team members often have valuable input from their experiences with various practice management technologies in other offices. Most dentists only have the experience of using the practice management programs that are in their own practices, but team members have the advantage of working in several different offices with a variety of systems and technologies.

Are there any software programs designed specifically for hygienists?

Phillips: A new software program called Strawberry was designed by Victoria DaCosta, one of your own Townies. This wellness oral health program is designed specifically for the hygienist focused on the mouth-body connection.

For hygienists, the periodontal charting system is critical. What’s available in this area?

Phillips: There are several products outside practice management software that are specific for paperless periodontal charting. The Florida Probe and the STM Probe from Pro-Dentec offer complete probing systems. Two products in this category were designed by dental hygienists: PerioPal Software and the Dental R.A.T. foot control. The PerioPal system designed by Townie Kimberly Goodson uses voice command with a 200-word dictionary compared to the voice dictation found in many practice management software programs which use several thousand word dictionaries. Limiting the number of words to scan for recognition increases accuracy. It will soon have a module to assist with dental hygiene treatment planning. The Dental R.A.T. 2.0 wireless (or USB), designed by Townie Becky Logue, is a wireless foot control allowing the clinician to simply tap the probing depths into the computer.
 

“Once a patient is able to see his or her own mouth, teeth, and gums on a large screen, treatment acceptance becomes a ‘no brainer.’”


It seems that many offices begin the paperless transition with digital radiographs. Is that true?

Phillips: Trisha, you’re right about offices starting with digital X-rays. Picking the right sensor is the key for hygienists. There are wired and wireless versions and some are thicker and more difficult to place than others. The wired sensors are connected directly to the computer, and images appear immediately. That’s the good part – instant feedback. The sensors are a bit bulky and learning to place them correctly does take time and practice.

A step away from direct digital radiographs uses photostimuable phosphor (PSP) sensors that most resemble traditional film and add an additional processing step. The PSP sensors are exposed to X-rays just like traditional film. They are then removed from the barrier material and cardboard protector and inserted into the processor that rapidly focuses a laser light across the plate to capture the digital image. These sensors are less expensive and easier to place, but do require a processor and this additional step.

Traditional radiographs are included in the paperless chart by scanning them into a digital image.

Intraoral cameras have certainly changed over the past decade.

Phillips: Intraoral cameras have changed as much over the past 10 years as computers have. They have such a huge impact in the dentist’s chair, and we are finding more and more that they are are being used by the hygienist the most. Cameras today can be portable so they can be used in each treatment room, and they are smaller and more compact, as to be used with one hand. The cameras are accepted by the clinical staff, typically with no problems, but the real fun is with the patients. Once a patient is able to see his or her own mouth, teeth, and gums on a large screen, treatment acceptance becomes a “no brainer.”

Patient education has traditionally involved flip charts, posters, brochures and books. How is this going paperless?

Phillips: The CAESY Educational Systems for patient education is the first digital program to focus on education. Dentrix, Easy Image, MedVisor Dental and other companies now offer digital educational programs with both still and animated imaging.

What other products are included in the paperless category?

Phillips: Smile Reminder is an example of a program that sends out e-mails and text messages to remind patients about their appointments.

Thank you Laci. Dental hygiene is definitely going paperless and as with any change, learning is involved to achieve the outcomes that will save time and provide better patient care.
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