Transition of dental practice from 19th to 21st century?

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eng2doc
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Joined: Wed May 19, 2010 8:40 am

Transition of dental practice from 19th to 21st century?

Post by eng2doc » Wed May 19, 2010 8:58 am

Hi all,
This is my first post and I need some help. I apologize for a long post.
I am planning to buy a practice, which is completely computerless. Scheduling, record keeping, insurance etc. are all done on paper. Also office has analog radiograph. I completely understand that I can't make the changes the first day I join and there has to be transition. I need to not only pickup my speed and make money but also try to slowly optimize some of these existing operations. I have strong computer background (computer software programmer and architect for about 15 yrs) and I changed to dentistry recently(new graduate). I am evaluting several practice management software for the future and seems like Opendental stands out extremely well (especially, when some of the competion is using c-tree database etc.). I have downloaded the trial version of opendental and playing with it.
As I mentioned, I am not planning to make drastic changes on day one, but I would like to gradually move the office to start using the computer. I completely understand that staff has to buy into this philosophy and train prior to making any changes. Could you please suggest something about the following questions:
1. Sequence of transition (should scheduling be the first or backend system (insurance etc.) or can things be done simultaneously.
2. How to migrate paper records or is it worth to scan all the existing paper records into opendental? Also, is it worth scanning existing radiographs into the system.
Any feedback will be highly appreciated. Again, keep up the good work with the software.
Thanks in advance.

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drtech
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Location: Springfield, MO
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Re: Transition of dental practice from 19th to 21st century?

Post by drtech » Wed May 19, 2010 9:14 am

1) I would do the it all at once...when you use the schedule, it is really easy to use the chart, billing, etc. They all work together.

2) I wouldn't worry about scanning in all the old stuff. Waste of time IMO. What I would do is continue pulling the paper charts for any records you need and start all new record keeping in the computer. This take very little prep time and you can start using OD right away without spending hours scanning in charts or old radiographs. Now for every patient that comes in, for x-rays take a digital photo of their standard x-rays on a light box after you have them mounted. (macro mode in Black and White on almost any $199 cannon camera) Place this image in your OD Images folder and now you have your "digital image." If you scan in all your new patient forms, etc, and have quality pictures you are getting from the x-ray photos, you don't even have to make new paper charts and just throw away the paper and film after digitizing. (The images will be very good if you take good contrast on the photos, very poor if you have sloppy staff or ones who can't run a digital camera.

3) It takes a little investment, but I would by XDR digital x-rays right away and just skip the processor, taking pictures of them, etc. (best value and great quality on the image...software at first seems childish, but is really easy to use and works great in a clinical setting) Get 1 size 1 and 1 size 2 sensor (or maybe 2) depending on how many patients you plan on seeing. We have 1 size 1 and 2 size 2 with 2 doctors and one hygienist. Sensors about about $5000-$6000 each. If you want a digital pan, Owandy I-Max Touch is great.
David Fuchs
Dentist - Springfield, MO
Smile Dental http://www.887-smile.com

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jordansparks
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Re: Transition of dental practice from 19th to 21st century?

Post by jordansparks » Wed May 19, 2010 9:15 am

1. I think you'll need to use electronic scheduling and billing from day one. The paper charts can continue for a while.
2. No, you wouldn't scan existing records immediately. And I wouldn't even bother scanning radiographs. Once you get computers in the ops and start doing all your procedure notes in the system, then you can start thinking about making the charts smaller. Start with the paper, but still don't scan radiographs. Only scan for patients that actually come in. Patients that don't come in will still have thick charts. But since the recently used charts will keep getting thinner and thinner, you won't require more space on the wall for charts. Once you move to digital radiography, you can think about ditching the charts altogether. Again, you would do this one chart at a time as they come in for appointments.
Jordan Sparks, DMD
http://www.opendental.com

apollonia
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Joined: Sat Nov 08, 2008 7:17 pm
Location: Bakersfield, CA

Re: Transition of dental practice from 19th to 21st century?

Post by apollonia » Wed May 19, 2010 9:43 am

dittos.

we scan charts as they come in (actually a couple of days before if we can)

we then put the (scanned) records in a box, labelled by date.

if somebody ever needs or wants original paper records, we know when they were scanned (datestamp on the images) and can look in the box.

not too difficult.

btw: when i've bought practices, i've found the existing records to be fairly useless. you might be OK to just not bother scanning.

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savvy
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Re: Transition of dental practice from 19th to 21st century?

Post by savvy » Mon May 31, 2010 8:49 pm

Here is a slightly different perspective"
The practice is 59 years old.
I have had the practice for 17 years.
6 years before that, computers were introduced.......accounting and recall only (Dentalis....MS Dos).
In 2000, Intellident (FABULOUS!!) Dental Software was implemented, though charts were still in use.
In 2004, Open Dental was implemented and at the same time (or there abouts), computers were added to each op, sterile, xray, FD and Dr office ( Lot of 10 Dell Optiplex GX270, ebay $600).
X-rays (pans and singles) were traditional film.
I purchased an Epson 1680 Pro Scanner w/ Transparency Adapter ($450) and an HP Scanner with Auto feed (<$150) both from ebay as well.
Each day, each patient on the schedule had their entire chart(including scribble notes and x-rays) scanned......in some cases it took forever because they had been patients for 50 years. However, now, we no longer use files. Everything is digital.
When you begin to enter patients, one only needs to enter the current balance as "Balance Forward".
One will probably have a need to double entry (computer and pegboard) for a while until past insurance claims are settled.
In 2007, the Instrumentarium OP100 panoramic was upgraded to the OP100D(digital) and Sordex Optime (phosphor plates) was added.
The xray images are managed in CliniView (Apteryx) which has a GREAT bridge to OD.
Now, all paper communication and forms are scanned into the chart and the paper is shredded.
I use Nuance PaperPort 10. All my paper documents that I want to save (other than patient specific) get scanned and managed here.
All EOBs are scanned to the patient A_Z file unless it is a batch EOB (ie: Delta Dental). Those EOBs get scanned into a master file called Batch Insurance and then into subfiles (Delta Dental, MetLife, Aetna, etc) and further subfiles (ie:2009, 2010) (ie: Batch Insurance EOBs/Delta Dental/2010).
The digital Data files are on one 500 GB hard drive.
I have upgraded my Server/Workstation a few times. I remove the data harddrive from computer A and install as a slave to computer B, install necessary program files and ...voila...up and running again.

On can start using this method immediately.
However, if one will also incorporate a third party accounting program like Intuit Quickbooks, it is best to start at the beginning of a new year for that.


For Back Up, I do the same at home.....all office data is copied and reinstalled on (currently 150gb) external HD.
Each program is opened and last data is verified.

Good Luck!!!!!
Cheers!
Candy is dandy, but sex won't rot your teeth.

Cheers!!!
Go Bears!!!!!
Savvy

atd
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Location: Minneapolis, MN

Re: Transition of dental practice from 19th to 21st century?

Post by atd » Mon Jul 19, 2010 8:52 am

We thought it would be a good idea to get the office staff trained and profficient before having the clinical staff use the system. Mainly because we thought it would be too hard to support (and train) that many new users and our office staff we're already used to using a computer system. However, after a month of that the front desk was begging us to train the dentists so they didn't have to do the data entry any longer (it took a lot longer than it did in the old system). Things run much smoother when you use Open Dental fully, as it was intended. Just using pieces of the program isn't the best idea.

We did a data conversion, so we have a lot of info from our old system available in Open Dental, but not a complete electronic record. Since we have digital xrays we're trying to get rid of our paper charts completely. Initially we were pulling paper charts every day for dentists to look back at, but they were looking at them less and less so now we only pull a chart at their request.
As for our scanning process, initially we were scanning each chart as each patient was seen for their next appointment. We didn't scan everything, just notes back to the last recall and intake forms. Then we put "CHART SCANNED" in the address/phone note so we didn't look for it again and filed it in a box in storage. For new patients we'd put "NO PAPER CHART" in the address/phone note for the same reason - nothing worse than looking for a chart that doesn't exist! But our staff was having a really hard time keeping up with the scanning on a daily basis. So now we have 3 summer student helpers that are getting everything scanned so we can get rid of these filing cabinets. I wrote a query and prioritized the scanning as follows:
1) Patients with a future appointment scheduled.
2) Patients that had an appointment after the data conversion.
3) Patients seen within the last 2 years but not since the data conversion.
4) Patients that haven't been seen in over 2 years. We're not scanning these, just boxing them up. If they come in again we'll have them fill out new paperwork anyway.
My query excluded anyone from the list that had "CHART SCANNED" or "NO PAPER CHART" in the addr/phone note already. I color coded an excel spreadsheet based on the priorities above and printed it out for them to work off of. That way they can just start at the beginning of the alphabet and work their way to the end, without wasting time searching for charts.

Hope that helps.

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