1. New Dental Office
1. I am building a new office and I want to be sure it is ‘computer friendly’.   What should I do first?  

As with any important decision, we recommend that careful planning go into this decision, as it’s far easier to lay the infrastructure before the floor and walls are poured rather than after the fact. There are a number of decisions that need to be made. The most important is the layout of the operatory. The largest items that are place in the operatory are the computer and the monitor. For the computer, if the office will have a cabinet at the 12 o’clock position, you need to be sure that there is adequate space for the computers. Most of the major vendors, such as Dell, post the dimensions of their computer cases on their web site. The next decision is monitor placement. The office will need to decide whether they will have one monitor in the operatory or two, and where those monitors will be placed. Common locations are in the rear cabinet, the wall, ceiling, or a light pole. Once the computer and monitor placement is chosen, the final piece is to run the cables, including network, video and audio.

To be truly “computer friendly”, the office needs to lay the infrastructure for any and all future needs. It makes sense to have the installers run network cables (called a “drop”) to any location where you feel a computer may be needed. Also, and this is especially true for offices being built on a slab concrete floor, conduits should be placed to allow for all cables to be hidden as they run from the monitors to the computers.

2. What are the three most commonly overlooked items during the design phase of a new office?

3. Is there a rule of thumb for budgeting computer equipment in a new office?

There’s no rule of thumb as each office has different needs. If an office wants to go “paperless” or chartless from the start, this requires a significantly higher investment as they will require not only high-end software, but will need digital x-rays, intraoral cameras, digital cameras, scanners, etc. The initial cost will be determined by the number of operatories being outfitted and the digital systems that the practice is using. We’ve done some new offices for as little as $15,000 and others as high as $120,000 just for the technology systems, so there can be a wide range. The average new office we install is spending somewhere between $30,000 and $60,000.

One important factor to consider is that nothing lasts forever…and that includes computer equipment. With the advances in technology, we are telling clients to expect about a three year life expectancy for their computers. Sure, many will last longer but at three years, the higher requirements of software at that time will likely cause the computers to slow down. A new office needs to be aware of these recurring expenses and should budget accordingly. Many offices will institute a yearly replacement of a portion systems so that they can stagger the upgrades and not have to be faced with a major expense at one time.
 

4. What is the best use of technology that you have seen in a new office?

We’ve been very impressed with the offices that have truly started a chartless practice. I’m not a huge fan of the term “paperless”, as there will always be a need for paper, whether it’s walkout statements, reminders, insurance forms, etc. However, the technology now exists for any office to completely eliminate their paper records and move to a digital format. As I mentioned earlier, it does require a higher initial outlay. Any money you save by not using cabinets for your charts is easily surpassed by purchasing high-end software capable of recording clinical notes, and all the hardware necessary to have a digital office. I’m impressed with dentists who understand the value of this technology in the big scheme of things and are willing to take the plunge. However, I also realize that until the costs of the technology come down, this type of practice is not practical for the majority of new dental offices.

2. Existing Dental Office
1. What is the biggest challenge to networking an existing dental office?  How do you solve that problem?

Existing offices are always faced with more challenges as the technology has to adapt to the infrastructure, not the other way around. The biggest challenge is the running of the cables and cords. Many offices, for example, want to mount the monitor to a light pole, which is an excellent option. However, if the floor is concrete, there is no esthetic way to run the video and audio cables from the monitor to the computer, which is typically on another side of the room or a cabinet. The monitor also needs power and many existing practices do not have adequate power outlets at the ideal locations.

The way we’ve typically solved those problems is to figure out which is more important to the dentist, function or esthetics. Since there are so many options for monitor mounting, we find that the majority of offices are happy to find a compromise that gives them both an esthetic and a functional result.

2. Are Tablet PCs an option?  What problems do you see with a wireless network?

Tablet PCs are certainly an option, although not normally my first choice. There are a number of reason why Tablets are not ideal. First, the screen size and resolution are usually far below what you can find with desktop systems. Most Tablets still only have a 10.5” or 12” screen, and a few are now 14”, but when compared to modern 17” and 19” monitors, they are tiny. Digital x-rays require screens with a high contrast ratio, something that Tablets don’t provide. Tablet PC’s are not inexpensive; a top-end model will cost around $1000 more than a good PC and monitor. Finally, as you alluded to, they all use a wireless connection (wired is also an option, although it then defeats most of the advantages of the Tablet). While wireless is not a bad option, it has certain disadvantages. It requires additional hardware. Most wireless networks needs to be configured by a network expert as there are significant security concerns with wireless. Also, the speed of wireless, especially when working with images, can seem slow. While the top speed of a wired network can approach 1000 MB/s, wireless has a theoretical maximum of 54 MB/s, and it’s closer to 25 MB/s in practice. A new standard, 802.11n, will approach 100 MB/s in practical use, but that standard is probably 12-18 months away.

3. Internet
1. How do your clients use the internet in their practices?

Well, obviously, the main use is to be logging onto to DentalTown throughout the day J Seriously, we do find that exchange of information is a huge asset for any practice. Between DentalTown and Internet Dental Forum, dentists are able to communicate with their colleagues to get answers about new products, procedures, and practice management. There are a few services that allow for online collaboration. In other words, a general dentist can upload patient images to a specialist on a secure web site, and then the specialist can comment and make annotations before sending the information back. In this way, an ongoing online “conference” can exist between multiple providers without the delays of the mail system.

Many practices order all their supplies online and many communicate with their labs online. With online access, e-claims are quick and easy. There are many functions of software that require online access, such as sending patients reminder emails for upcoming appointments.

4. What is the future of office networking?  Smaller computers, wireless, …….???

5. Digital Radiography
1. Many offices are adding digital radiography to their existing systems.  Will this require server and memory upgrades?

Absolutely. Many offices fail to realize what a quantum jump occurs when they go from practice management data (primarily text data) to images. While an office can have decades of practice data fit onto a single CD, that same CD, in a busy office, may only hold 2-3 weeks of images. So, when an office makes the jump to digital radiography, it almost always requires either a major overhaul of their current server or a brand new server. The servers we currently recommend have a minimum of 250 GB of storage for the hard drives and at least 1 GB of memory (RAM).

2. How often do you run into conflicts between different technologies (ie: digital xrays not playing nice with practice management software, etc.)?  If the technologies are supposed to be compatible, is the problem with the network set up, the computer OS, or something else…?

Actually, many of the problems are created by the large practice management companies themselves. It’s important to understand the history of the imaging software to realize how the market has become very segmented. Initially, practice management software only handled management data. As imaging started to become a reality with the introduction of intra-oral cameras in the late 80’s and then digital radiography in the mid-90’s, there was a need to store and manipulate these images, so many companies produced image management software. The practice management companies, realizing that imaging was rapidly becoming an integral part of the modern practice, then chose to adapt existing image programs to become part of their software suite. Since many of these software companies are owned by dental supply companies, it makes sense for them to encourage their customers to purchase digital systems that they sell, rather than those of other companies.

So, at this time, you really have two different market segments. You have the practice management companies that have imaging components, and you have third-party image programs that bridge to the practice management software. To complicate matters, many of the digital systems are only available from a single vendor and only work with a single software program.

What we suggest is that offices should decide on their image software first. Once they decide on whether to use the imaging modules of their current software or another software program, then they can choose their digital systems based on which ones are compatible with their software. While many dentists choose their systems based on the hardware specifications, I feel this is a mistake. The software is the more important decision and will dictate which systems work together and which do not.