The Computerized Point of No Return
by Barry Freydberg, D.D.S., F.A.G.D., F.I.C.D.
In audience interviews with thousands of dentists, I've learned one very important fact about practice automation: once a dentist opts to computerize his or her practice, there's no going back. In fact, I've never met a dentist who has chosen to re-institute a manual system after automating his or her practice.
When you consider that some dentists had very bad first experiences with computer systems (such as poor software or inadequate vendor support), it is truly remarkable, really, that none choose to go back to using a manual system. Instead, they make a new foray into the automation market to find a new and better vendor or a different software package that can do the job.
Why would they do that? They have just spent thousands of tens of thousands of dollars on a bad system, and thrown their offices into turmoil trying to train their staff to run it. Wouldn't the obvious response be to give up on automation in disgust? Why risk more expense and more training turmoil? What creates this against-the-odds commitment to technology that I observe so often?
This is an interesting question, and it's got me thinking. It seems to me that dentists reach a point of no return once they automate. Even if the first systems they buy are failures, they see some value in automation that rules out any chance of going back to where they were before. I think the point of no return for automation is defined by vision. Through their first interaction with automation, these dentists see that the old way, the manual way, is about the most inefficient way to manage a dental practice imaginable.
How Automation Helps
Let me give you an example based on the all-too-familiar task of sending out statements. In manual practices, this is a dreaded high-pressure work binge that creates havoc at the end of every month. Ledger cards are pulled, photocopied,n and checked for accuracy. Staff stay late stuffing envelopes, sorting them by postal code and running them to the post office. A few days later, the office is flooded with phone calls from patients asking about their accounts.
How does automation improve this irksome situation? Well, for starters, in a computerized office no one has to pull, check and photocopy charts. This saves a tremendous amount of staff time, all on it's own. Staff simply instruct the computer to generate statements overnight. When they arrive in the office the next morning, the statements are there fthneatly stacked at the printer all ready to be mailed out. Even better, there is no reason why a computerized office has to limit itself to producing statements once a month. Today most practice management systems are smart enough to allow statements to be mailed every week, every other day or even daily. The Computer automatically makes sure no patient receives two statements in one month.
Using this approach, the large, cubersome task of manual monthly billing is broken down into small, manageable chunks that can be done quickly and efficiently on a weekly or daily basis. With the work distributed throughout the month, there are no more late night marathons and last minute trips to the post office, and the cash flow of the practice improves.
New Ways of Thinking
When I asked about how automation makes it so much easier to send out statements, I also touched on how computer systems can create opportunities for new ways of doing things in a dental practice. Even in automated offices, where statements can now be prepared more or less any time, most dentists still only send them out once a month. Why? Because that's the way they've always done it. But is it the only way, or even the best way? Automation certainly allows us to be more efficient than we ever were before. What many dentists miss, however, is that automation also allows us to do new things as well. Schedulers are a good example. Some dentists look for electronic schedulers that work just like their schedulers that work just like their old paper books did, but there's no practical reason for using this format at all. Dentist who use more flexible software find that they can keep track of cancellations, no shows and short-notice possibilities, schedule their time to meet financial goals, and generally do more than they ever could with paper books.
Decentralizing the Dental Office
Once dentists start realizing that computer systems allow them to do much more than automate what they used to do manually, it isn't long before they start thinking about the possibilities of integrating automation into the overall management of their practice. And here's where automation can really pay off in decentralizing the dental office. The front desk in many dental offices is the highest stress area in the practice. Think about it. Front-desk staff are responsible for greeting and dismissing patients, scheduling and confirming appointments, recording charges, updating names and addresses, writing letters, and more usually all at once and with the telephone ringing. Most dentists respond to their front-end crises by hiring additional staff, but this comes at the expense of what happens in the operatories.
With a decentralized office, however, tasks can be redistributed so that for the same payroll you can afford more staff in the productive areas of the practice. Decentralization also reduces duplication, increases accuracy and productivity, and improves the atmosphere of the workplace by reducing unnecessary stress.
Let me expand on this a little. In a manual practice and even in many automated ones, the assistant writes up notes on charges or treatment plans. She then walks to the front desk with the patient, who stands there while the data are recorded. Since the assistant has already written everything down once, it makes little sense to have someone else copy it all over again while the patient waits. Now consider what could happen in a decentralized office with computer terminals in the operatory. The assistant can enter the information directly into the practice computer, eliminating the need for duplication and reducing or eliminating inconvenience to the patient.
The double entry of treatment plans, charges, recall status, scheduling, medical histories, names and addresses, personal messages, and a host of other items can all be eliminated by automation, resulting in greater efficiency and more accuracy. There's another advantage too. The people at the front desk now have the time to greet and dismiss patients with a smile, and to pay them the attention they need to feel good about your practice.
In-operatory terminals also help to assure cross-training. Computers become part of the office itself, to the point where all staff members know enough about it to keep things running smoothly when a co-worker goes on vacation or leaves the practice.
Let's summarize a few of the main points to remember about decentralization through the use of in-operatory terminals. First, decentralization means integrating automation into the management model of the practice. By redistributing tasks and eliminating dual record entry, i.e. in the operatory and later at the front desk, decentralization eliminates the bottleneck that traditionally occurs at the front desk.
Patient information is accessed and updated chairside, and it's ready and waiting at the front desk so that patients don't have to wait as long and staff members have the time to pay them some personalized attention.
There's No Going Back
I've found that dentists who opt to use in-operatory terminals to decentralize have the same attitude toward automation as dentists who change from manual to automated practices: they never go back to a front-desk office. The other advantage of practice automation, of course, is computerized claims processing, or Electronic Data Interchage (EDI). With the development and implementation of CDAnet, insurance claims can be adjudicated in minutes before the patient leaves the office.
Looking To the Future
I think the use of in-operatory terminals will increase dramatically in the future. This move will be driven in part by the increased use of electronic insurance claims. Charting, radiovisiography, and the combining of visual images with patients' text records will all become increasingly common. In addition, as clinical and management software begin to interact and share the same hardware, the link between the two will become more and more seamless. How should you prepare for the electronic future? Automate, and move the data-entry function from the front desk into the operatory. With good software, good training and good technical support, you'll never go back.