New Horizons: Filling in the Blanks

There is little doubt that the dental practice of the past, a paper-based system, is quickly being replaced by a digital one. Paper charts, insurance forms, photos, x-rays…all of these different systems now have digital options. When trying to design a chartless or paperless practice, as many new practitioners attempt to do, the glue that holds everything together and that acts as the core of the office is the practice management software. Almost all digital decisions that are made in the office are built around the choice of which software will be used in the office. One of the goals of this article is to review the steps of choosing a practice management system. However, one area that many dentists find challenging is to find a practice management program that “does it all”. The fact is, while these programs are large and feature-rich, most of them are lacking many of the functions that dentists are now requesting. Fortunately, there are many smaller companies with excellent products and services that have stepped in to add increased functionality to the practice management software, and we will explore some of these products throughout the article.  

While the hardware infrastructure is certainly important and most be chosen as the first step in a technology system upgrade, there is little doubt that the practice management software is the one component that ties everything together. Every program has strengths and weaknesses. Dentists should try to choose a system based on two over-riding principles: features, and service and support.

The choices that face the dentist are almost overwhelming. While recent consolidations have reduced the “major players” in this area, there are still dozens and dozens of programs from smaller companies that are, in many cases. As different systems are compared, one will see how certain features are handled better on one program than another, while another feature is better on a different program. In other words, there is no one perfect program that is best for each individual dentist. I recommend you review independent studies and comparisons and ask colleagues for their opinions. When comparing products, there are a few things that I recommend that you keep in mind:

1. Every program has dozens of bells and whistles, but most dentists end up using only a very small portion of these “features”. There are certain areas of practice management programs that almost all offices use. These include but are not limited to patient registration, scheduling, treatment planning, insurance estimation and processing, recall patient management, and reports of practice parameters, such as production, collections, etc. Every dentist and every practice is unique and each dentist should decide what is important to him or her before you start to research different programs. Make a list of what’s important to you and compare every program you evaluate using your list.

2. While it is prudent to focus on the main features of the software, the ability of the software to add new innovations over time should not be discounted. It has been my experience that the average practice uses about 10% of the features of their software. With proper training, most offices can learn the untapped and underutilized features of their software that will improve the practice’s profitability and efficiency. As just one example, DENTRIX has a direct link to patient financing built into their software. Rather than spend a considerable amount of time having the patient fill out forms and calling in the information, the office now has quick and immediate access to information that will allow the office to determine if the patient is eligible for financing.

3. You must involve your staff in this decision. With the exception of the reports, it is your staff that will be handling all of the administrative functions that the software handles. If they find the program difficult to use, it will be disastrous to your practice. Many new dentists are fortunate enough to hire an office manager who has experience with dental software; someone like this can be an invaluable resource for determining the advantages of a particular program.

4. Although most dental software today involves both administrative and clinical features, it is the administrative component that will, in most cases, be the most important part. This does not mean, though, that the clinical functions are not important. The topic of integration of clinical data with practice management systems is outside the scope of this article, but it is important that the software you purchase today is capable of working with the software and hardware of hi-tech products.  

5. One method that I have found effective is to take either an existing patient or create an imaginary patient and see how the software tracks this patient. In other words, create the patient record, schedule them, create a treatment plan, post treatment to their account, create an insurance form re-schedule the patient, etc. In this case, you can compare “apples-to-apples” when evaluating how software handles this. Keep in mind that you should see how well the software could adapt to how you prefer to see and treat patients. Poorly designed software will force you to change how you practice and process patients and you should avoid this at all costs.

Training, Service and Support

It is very unfortunate that the factors that are probably most important when choosing a software package are usually given the least amount of consideration. Most dentists will spend hours evaluating software, choosing features, looking at the price of the program, but will barely even think about the need for training and ongoing support.

Let’s start with training. There is no better way to ensure that your staff never adapts to a software program than to bypass proper training. Unfortunately, many dentists will try to save money by justifying their decision to not spend money for onsite or classroom-based training. Don’t make this mistake. Training is one of the best investments you can make. Dental management software programs are complex; don’t let anyone tell you otherwise. Having everyone in the office (and, yes, that includes the doctor) up to speed on the software is crucial to ensure that it is rapidly integrated into your practice.

Service and support is the other part of this equation. Many dentists make the mistake of looking at the price of the software and do not factor in the costs of ongoing support. I have seen support packages that are as low as a couple of hundred dollars per year to packages that are over $5000/year. When choosing a support package, you need to ask a number of questions:

1. Is unlimited telephone support offered as a part of the package or is it on a per-minute basis?
4. What other means of support i.e. email, web based, fax, etc are offered?
5. What are the hours for customer service and support?
6. Is on-site support offered?
8. Are different levels of support plans offered?
9. How often is the program updated?
10. What are the qualifications of the support staff?

One important question to ask is how soon your call will be answered. Time is money and the sooner your software vendor can get you off the phone with your problem solved the better. Ask to see performance statistics, such as the average on-hold time and average length of call. This information will provide you with an insight into what’s in store for you. Independent surveys are also available, like the ones I mentioned earlier, that rate customer support for many different systems. Also ask your colleagues for their experience.
 

The Supporting Cast

As I mentioned earlier, while many of the practice management programs are quite robust, none have all the features that many dentists are requesting for modern practices. It’s important, then, to review some of the other companies that have brought excellent products and services to the market.
 

Patient Confirmations  

Almost every survey I’ve seen, both in the medical and dental fields, show that the vast majority of patients prefer to be contacted about their appointments by email. There are a number of systems that dentists have used in the past. The old standby, postcards, still work, but there are many disadvantages. They require a considerable amount of staff time to fill out, are expensive to send with the ever-increasing cost of postage, and often never make it to their intended recipients. Offices that use postcards do not claim to see any significant decrease in no-shows if they use postcards alone. Because of that, the phone has been the second frontier for patient confirmations. Most offices will assign a staff member to make reminder calls. Of course, this is also not always the best solution, since most patients are not home during the day, and it requires a significant amount of that staff member’s time. Enter online confirmations. The two major players in this category are DemandForce and Uappoint. Both, while having different features, work in the same manner. Patients are entered into the scheduler in the practice management software. Within a few minutes, an email is automatically sent to the patient, so that it will be in their Inbox by the time they sit down at their computer. In that email will be a link that the patient clicks on. Clicking that link will then send a confirmation to the confirmation software that the patient has confirmed. Additional confirmation emails can be sent at customizable intervals, such as two weeks before and four days before. Once the patients are confirmed, the office staff have an easy-to-use “dashboard” where they can quickly see which patients have confirmed. Another system that is similar in scope but a bit different is Smile Reminder. This system works on the premise that all cell phones have text-messaging capabilities, and almost all patients have cell phones. So, the software will integrate with the practice management software to send patients any reminders you deem important to their cell phones as text messages, such as appointment reminders, reminders to take premedication, birthday greetings, etc. All three of the services I just mentioned are working towards some form of online scheduling as well, where patients will be able to either request or actually book time slots for their appointments.

The trick with all of these systems is that you need to train your staff to collect the email addresses and cell phone numbers. Almost every PMS program can store this data, but many offices still do not collect it routinely.
 

Patient Education  

I have always been a big fan of patient education programs. Most dentists are not the best artists in the world and while we can all agree that educating patients is an important part of increasing patient case acceptance, we lack some of the tools to accomplish this. The system that has been around the longest and has the best name recognition is Caesy. While Caesy is a good system, there are some drawbacks, especially for the new dentist. First and foremost is cost. While they still sell a DVD version, most offices need the network server, and this will run around $8,000. The other concern that I have is that many young dentists will use the system improperly. Caesy is basically a series of small “movies” that can be played to explain treatment to a patient. Some dentists make the mistake, though, of leaving the room and asking the patient to watch the movie, and they will then return afterwards to discuss it. Why is this a mistake? Because, in my opinion, the patients are not there to buy the procedure, they are there to buy you. In other words, they want the confidence that the dentists and staff can provide the level of care they desire, and this is not something that you can usually achieve if you leave the patient alone. Instead, I highly recommend using patient education chairside with at least one person there, either the dentist, assistant, or hygienist. The patient education should ideally be played without audio, with someone walking the patient through the procedure and answering any questions as they arise.  

There are a number of excellent patient education modules on the market, and most are priced more competitively in the $2000-$2500 range. Some of the better ones include Orasphere, Consult-Pro, and Case+.
 

Paperless Software

Many of the practice management programs are capable of eliminating most of the components of the paper chart, such as the treatment plan, scheduling, and progress notes. Where most fall short is handling the forms that need signatures, such as informed consent, medical history, HIPAA forms, and similar. For an office to become truly chartless, they will need to find a way to create digital forms, since these forms are all part of the patient record. The best known product that meets these needs is DentForms. This program will integrate with the practice management software by pulling the patient information into their software. You will then have a list of forms that the patient hasn’t filled out and one that have been. Using either a signature pad or a Tablet PC, patients can fill out the forms and sign the documents, which then become part of the patient record. The other really nice feature is that the software links to an online web site, where patients can fill out their practice questionnaires online and have that information sync with the office’s server twice daily. That way, by the time the patient arrives for their first appointment, all forms are filled out and all the patient needs to do is sign the signature pad. Another new product that was just released is Paperless Technologies. It’s similar but has different functionality. For example, it allows the patient to fill out their information on the Tablet PC and have that data converted into text that goes into the practice management software.
 

Office Communication  

For new practitioners, one of the largest expenses is the light systems used to communicate among the dentist and staff. Since we recommend having computers in every operatory, it makes sense to look at software alternative that are a fraction of the cost. My favorites right now include BlueNote Communicator and Patient Tracker. These systems work by not only bringing up a visual page on the screen, but also a tone will sound to alert each staff member that they are needed. You can customize each of these so that you can reply with one keystroke if you prefer.
 

For the new dentist, it’s important to understand the importance of practice management software and its role in the modern dental practice. Equally important, though, is to understand that there are many factors that make up these modern practices and in many cases, the practice management software is missing some functionality. Most of the companies mentioned will gladly send free samples of their products or offer online demonstrations.