For the graduating senior dental student or recently graduated dentist, there are an unbelievable number of decisions that must be faced. Some of these include whether to buy, associate, or build a new practice, choosing which supplies to use, your lab, and a whole host of other details. In the modern world, however, the choice of technology systems is often the most crucial of these decisions. Most practices would have difficulty functioning without their practice management software. The choice of which software to use and, just as importantly, the hardware and computer network that is designed to run this software, will be a very important decision.

There are often many scenarios under which a new dentist would be making decisions about their technology systems. The purpose of this article is to examine these different scenarios and to assist the dentist in making the proper choices that work for each individual.

The Start Up

The start-up is a young dentist who, in most cases, is starting his or her practice from the ground up. They are either building an office or purchasing or leasing an existing office space. Often in these cases, the new dentist has considerable debt from dental school and is acquiring new debt to finance the purchase of the office space and equipment. In this scenario, the dentist will usually want to start off slowly with the technology systems, and to then expand and upgrade as time goes by. The most important choices at this point are the practice management software, the computer up front, and future planning for a computer network.

The practice management software is far and away the most important piece in this puzzle. The recent consolidations in the dental software industry have brought this point home to many dentists. Software that was purchased just a couple of years ago has become obsolete as companies were bought out and their products no longer supported. The practice management program will run the practice for many years and it is usually very difficult to change programs down the road. It takes many days of training to learn a new program and converting the data from one program to another can be very disappointing for many offices, as much of the data cannot be converted.

Currently, there are three main dental software companies that I am recommending: Dentrix, Eaglesoft, and PracticeWorks (which includes Softdent). Large dental companies own all three products, and it is safe to assume that these companies will continue to support their products for the foreseeable future. This is not to say that there are not excellent programs out there, produced by smaller companies. However, the dentist considering these products should be aware of the risks involved. When considering the purchase of a program, there are two ideal ways to evaluate the software. First, see the program demonstrated at either a dental show or in your office. Most software vendors would gladly do an in-office demo. The advantage of a dental show is that it does allow you to evaluate different products in a short time frame. The other important aspect is to ask the company for references of other users with an office similar to yours. A dentist with 10 operatories and 15 computer systems should speak with another user whose office is similar in size, rather than someone with just one computer in the office. These programs have different strengths and weaknesses when it comes to large networks or connecting multiple offices together.

Secondly, the start-up office needs to pick a computer for the front office. The choice of practice management software will often help in this process. The software normally will have an info sheet with recommended minimum hardware and configurations. The best advice I can give a dentist is to purchase the most computer that you can for the money. Personally, I find that the most “bang-for-the-buck” is found in purchasing a system with a processor that is one or two generations behind the top-of-the-line. For example, as of this writing, the Pentium 4 2.53 GHz processor is the fastest on the market. Purchasing a Pentium 4 2.3 or 2.2 GHz will lower the cost of the system by hundreds of dollars. One caution: the software companies will often try to sell you the hardware along with the program. It has been my experience, though, that these systems are rarely a good deal. Buy your systems through a major vendor such as Dell or HP, or work with a local integrator who is familiar with dental offices and have custom-built systems.

Finally, even though the start-up office is normally placing only one computer in the office, you should be thinking ahead for the future. Eventually, you will need more computers, both in the business office, and the treatment rooms. These computers will work best if they are networked together, allowing all computers equal access to data in the office. In the past, the only way to network computers was through network cables that needed to be run through the walls. This can be quite expensive and difficult, especially in older buildings. If you are building a new space, this is still the recommended method of connecting the computers. It is relatively easy and cheap to run the cables and position outlets before the walls are actually built. In those cases where running a cable is not practical, a newer option is wireless networks. These networks have a centralized access point, and receivers attached to each workstation. The first wireless standard, which is currently the most popular, runs at about 11 MB/s, which is adequate for most dental practices. A newer standard runs at 5 times the speed of the older standard, but the equipment is still quite expensive. Offices considering wireless networks should have a site survey performed by an integrator or networking expert, as line of sight issues must be considered during the planning phases.

The Upgrade

The upgrade scenario will normally apply to two different situations. In some cases, a graduating dental student will be purchasing an existing office from a retiring dentist. In these cases, there is often a computer already situated in the front office, although it may be outdated. There is also typically a practice management program that has been in place for many years. In the more common scenario, though, the dentist has followed the path of the previous example, the “start-up”. He or she has been in practice a few years and has properly integrated a front office computer and practice management software. Like many dentists, they are contemplating the addition of digital cameras, digital radiography, and cosmetic imaging to the practice. In this scenario, the focus is more on computers in the operatory and networking than it is on a true upgrade, as would be true in the example of the dentist taking over an existing practice.

In both cases, I recommend that the same philosophy hold true: add components slowly or one at a time, integrate them properly, and expand when you and your staff are comfortable with the current systems. Let’s look at a few examples to see how this might work.

In the case of the dentist who is taking over an existing office, the first decision when it comes to technology systems is to evaluate whether the systems are powerful enough to run the existing software. Most software companies upgrade their programs at least once or twice each year, adding new components, features, and functions. Often, this puts additional strain on the computer systems and a system that worked perfectly one or two years previously is suddenly underpowered. My basic rule-of-thumb is that if the system is more than three years old, it probably is time to replace it. Less than three year-old systems can still function, depending on individual circumstances. The other part of the equation is to evaluate the practice management software itself. I have consulted with numerous offices with programs that are 5-10 years old with no updates, and the software functions fine for that office. However, newer bells and whistles, such as digital imaging, electronic and voice-activated charting, and true integration with image management programs will require the latest practice management software. The dentist who upgrades an office should consider their short and long-term goals to adequately plan for the future.

Another component to this process is to consider your staff and their comfort level. In many situations, a dentist who is buying out another practitioner will keep the existing staff. If the office manager and front office staff is happy and comfortable with the existing software, you will often find resistance to change. In previous articles in New Dentist magazine, I have suggested methods of dealing with this resistance. Some of these ideas include involving the staff in the decision to change. Find out what they like and dislike about the software, service, support, and see if there are programs better suited for their needs. Get a software company to do an in-office demo so that the staff can see firsthand how a newer software program can make their jobs easier and more efficient. And, most importantly, once the new program is installed, get thorough training for the staff and the doctor before you see patients. You’ll often need to clear two or three days of your schedule for this, but it will be one of the smartest decisions you can make.

For the dentist who is building on a basic system, there are a few areas that should be considered. In many cases, the dentist is considering digital technologies, and this means computers in the treatment rooms. I do recommend that if there is trepidation, you can start by adding one system to one operatory. Most dentists will find that once they make this move, computers in every operatory will soon follow! One of the most difficult decisions is to deal with the placement of the actual hardware. You have a computer system, monitor, keyboard, and mouse, and all of them need to fit into the typical 10’ X
10’ room. Most dentists enjoy a clean look to the treatment room, so another factor will be how to best hide the cables and wires that are part of a computer system. Wireless keyboards and mice can eliminate two of these wires, but there will be a video cable that runs from the computer to the monitor, and power cables for both the monitor and the computer. The computer itself tends to take up a lot of space, and unless there is a cabinet in the operatory where a computer can be hidden, this may present a problem. I prefer to work with CPU holders, which are special C-shaped brackets that can be hooked to a cabinet or a wall, and the computer can then be laid flush against these surfaces, off of the floor and out of the way. Another solution is to use a low-profile computer system that can fit into a small space, under a drawer for example. These systems, though, often involve trade offs in that they are difficult if not impossible to upgrade and are often more expensive than other systems. Of course, even the best-placed systems will be ineffective if ergonomics have not been considered. Monitor placement is crucial for the assistant, dentist, and patient. The keyboard and mouse must be placed in a location that allows the dentist or assistant to enter data without putting undue stress and pressure on their back or arms.

The other factor that must be considered is the computer network. Unlike the start-up situation where there might only be one front-office computer, if you are putting a computer in a treatment room, it must be connected to the front office computer in some fashion. If they are two separate systems, there will be no way to share data between them. One of the best uses of computers in the treatment room, in my opinion, is to allow for scheduling directly from this room. This would not be an option if there is one schedule up front and another in the back.

As I previously discussed, there are numerous ways to connect computers together, both wired and wireless, or a combination of the two. I highly recommend that the dentist consult with a networking expert at this point. Not only are there issues of cable or wireless receiver placement, but the true challenge is in planning for the future. I’ve seen many offices that have grown from 2 or 3 computer systems to 15-20 systems in just a few short years. A network that is only designed to handle 4 or 5 computers will be brought to its knees if you are adding another 10 or 15 computers, so proper planning is mandatory.

The Major Overhaul

As a technology consultant and systems integrator, I find this final scenario to be the most challenging, yet the most rewarding as well. In these scenarios, I am often working with a dentist who has either bought an older practice, or a young dentist who has followed one of the first two scenarios that I discussed by buying one or two computers and software at the start. In both cases, the dentist has come to the realization that the current systems are woefully inadequate. The dentist often has decided that they want to add digital radiographs, digital imaging, cosmetic imaging, voice-activated charting, or other hi-tech upgrades. While they know that they can add components slowly, they want to jump in with both feet and make the right choices from the beginning. They want to present the office as a progressive, forward-thinking practice, often to differentiate themselves from other practices in the area.

In certain aspects, these situations can be easier than adding one component at a time. When you start slowly, you often don’t know if or when you will be adding other technologies down the road. It is then difficult to plan on the amount of computing power and networking that might be needed in 3-5 years. For the office that is adding everything at once, this is not a concern. By working with the different manufacturers and a networking specialist, we will have a very specific idea of how powerful the systems need to be, how much storage is needed for the software and digital images, and the speed of the network cables and switches needed to efficiently handle the load. This scenario will also allow us to set-up a more efficient client-server network, a scenario that will allow multiple computers to be added in the future without slowing down the entire office network.

Of course, there are also significant challenges to this approach. First and foremost is cost. If the typical dental student debt wasn’t enough, adding hi-tech systems can add a whole new meaning to the term “sticker shock”! It’s very easy to add computers, digital cameras, and digital radiography to a solo-practitioner office and to see the total bill exceed $50,000. As I often explain to my clients, this really should be viewed as an investment and not just an expenditure. Often overlooked or forgotten in figuring the costs is the need for service and support. There are normally three different areas of support that should be considered. The software companies offer different levels of support. I recommend a plan that allows you unlimited access to their support technicians and includes unlimited upgrades to the program throughout the life of the support contract. Secondly, the computers should be covered under a contract from the manufacturer or the integrator. One reason that I prefer to work with systems from companies like Dell is that they offer same-day service for computer malfunctions; few systems builders can do this. Finally, you should consider a contract with the system integrator. In the computer world, there is often finger pointing when something goes wrong. The software companies will say that it’s a hardware problem, while the hardware manufacturers have no problem blaming the situation on the software company. A good integrator with knowledge of software and hardware can be invaluable in diagnosing the problem and often finding an easy solution without the need to be at the dentist’s office. Most of my clients are set up with remote access programs, such as pcAnywhere or the Remote Desktop Sharing that is built into Windows XP. These programs allow anyone with Internet access, with your permission, to control your computer as if they were sitting right at the computer screen. Many computer manufacturers already use this system as their main method of offering support, since it is cheaper to do this than to send a technician to the office.

When the dentist is planning to add digital technologies, the practice management software company can be a good source of recommendations. Often, the software is optimized to work with certain products. Most software is heading towards true integration, although this goal is still out of reach. The basic premise is that the practice management program and the image management program appear to be one program. All patient data transfers into the image management section, and all images are easily retrieved from within the practice management program. Although the software companies will often recommend a specific brand of camera or digital radiography system, these recommendations should be taken with a grain of salt. Many of the digital radiography vendors, for example, have been purchased or are controlled by the parent companies of the PMS programs, so they will usually only recommend that product. The dentist should know that most of the digital radiography systems and digital cameras use industry-standard formats and protocols, so they will be work with almost any image management program.

Summary

Whether starting with one computer, slowly adding clinical workstations, or taking the plunge from the start, the new dentist is faced with many choices and decisions regarding their technology systems. By working with objective consultants or integrators and getting all the information that is needed upfront, costly mistakes can be avoided. Dentists planning to upgrade their technology systems should decide not only what is needed for the present, but should also think about where the practice might be a few years down the road. A healthy dose of foresight will go a long way!

Bio

Lorne Lavine, DMD has practiced periodontics and implant dentistry since 1992. He is an A+ Certified Computer Repair Technician as well as Network+ Certified. He is the president of Dental Technology Consultants, which assists dentists in all phases of technology integration in the dental practice He can be reached via his website at http://www.dtc4u.com, by email at dtc@dtc4u.com or toll-free at 866-204-3398. He currently resides in Woodland Hills, California.