Has anybody gone totally paperless?

[shvercer]

We are in the process of switching from physical charts and x-rays to paperless and digital. Can anyone share their experience in how to prioritize the changeover? Can we be truly paperless by having PDF forms on a kiosk and signature pads instead of having to scan paper forms? I would think that going totally paperless would reduce the amount of errors as well. What is your plan b in case of a major system failure with no computer access? How do you continue working?

[Pruce Dental]

yeah..i am totally paperless...

I have all my medical histories, registration forms etc captured on a med history sheet at a kiosk...all my radiographs are digital..

you might get more answers and better help if you tell us how far along you are going paperless..ie do you do ANY charting in OD yet?...do you have digital sensors, phosphorus plates or a digital pan?..do you have computers in the operatories yet?...do you have any sheets built for referral slips, lab slips etc.?

[shvercer]

This may sound like a joke, but we haven't done anything to get to paperless yet.
Our plan is to get the Airtechniques ScanX for radio-graphs and we plan to switch from Dentrix to Open Dental. We are using Dentrix to print out some insurance claims and keep the bare minimum of patient data in there. When we switched to Dentrix years ago the plan was to go paperless, but after several months everybody kind of gave up on the idea, because it seemed to difficult. It would have stayed that way if it wasn't for the state-mandated changes that are being introduced. We still have physical charts; forms and everything is still "old school".
We assume the "going paperless" switch is going to be painful with a steep learning curve, so we just want to do as much as possible to avoid a "hybrid" situation which could require double work of maintaining paper charts and digital charts and radio-graphs. It seems that for the Imaging portion Apteryx is the most flexible and secure solution and most likely we will go with that. No computers in the operatories yet. No sheets built either. What is the best way to approach all of it?

[murmsk]

we are pretty much paperless. I say pretty much because we have them fill out medical histories and the like on laminated forms with an erasable pen then scan them in it is fast,easy, and inexpensive. I looked into the kiosk , idea seemed to be more work than it was worth ... for my practice anyway. We have a tablet for pts to read/sign informed consent. We had no problem switching over

steve

[Pruce Dental]

far from a joke..there are plenty of offices that are not taking full advantage of PMS software...I couldn't be paperless with my old software too..

I would learn first how to build sheets..not sure if the trial lets you export sheets or if that is in a later version...if not in the trial ask if you can start paying for support once you get your trial conversion so you can use your trial conversion database (assuming you got something to convert) and build your sheets and export them into your real conversion database later...

play with the trial conversion for a few weeks and make sure you know OD inside and out before your conversion day...

not sure what your timetable is but I would just plan on doing your conversion maybe on a Friday so you can work over the weekend organizing stuff...in your situation it wouldn't hurt to block out an extra day too...

build your sheets for stuff like prescriptions, referrals, lab cases, consent forms, patient handouts, etc..and then just scan in your medical history and registration sheets until you get more advanced and start using a kiosk...

learn autonotes before your conversion...you can't set them up before your conversion but at least know what you want and write them all down...autonotes are your friend!

start charting immediately after your conversion...starting writing your clinical notes immediately but do not chart all existing restorations or try to rewrite all treatment plans until you do your next recall exam and after 6 months almost everybody will have full charting done...eventually when your more advanced you can scan in the old paper charts...

get a current copy of Mosby's drug reference and bite the bullet and enter each drug name..Mosby's is easy because it gives the generic and brand names...some will say this is crazy but once you got them all entered life is great...( do this after your conversion because it would really suck if you did it before...)

[shvercer]

I appreciate your thorough response and it seems that "doing it like the Swedes" won't be an option. In other words, just setting everything up and then switching over-night to "pure" paperless doesn't seem quite feasible anymore. One of the things that the office manager wants though is to start with a fresh database and just refer to the old Dentrix database occasionally when needed. We are a pediatric practice and as such we see a patient for about 5-8 years before they move on. Unfortunately our current database has been converted already once in 2000 from the EZ Dental that we started using in 1995, so more than 50 % of records in there are inactive. There is obviously lots of garbage from the conversions as well.
We definitely need to start somewhere and since the digital x-rays are the most pressing issue, it seems most prudent to start with that part and build up from there. I'm curious to hear what kind of imaging solution you are using? Just want to hear some more pros and cons...

[Pruce Dental]

I am using Apteryx with the Optime phosphorus plate system and got a OP-30 panorex...originally I was using the Kodak Imaging software...hated it..couldn't send my propriety images to any specialist without receiving a phone call from them saying they could not view my images then having to return the call to remind them that them had to use the special viewer program I previously sent them. The other offices couldn't save my images in their imaging software so I switched to apteryx and my problems went away...I have one local endo group practice that uses Kodak sensors and software...I hate receiving a copy of the radiograph only on photopaper .even when I was using my Kodak sensors with KDI software it was always a long winded phone call to get them to properly send me the images and some of the times the post-op image had only the apex on the film and no clinical crown cause the sensors were too hard to position ( and that was without the rubber dam)..and since I switched to apteryx the propriety Kodak images can not be saved in Apteryx so I solved the problem by using another endo group.lol...so use something like apteryx that you can send and receive images in Jpeg format easily...ohh originally I was looking at the scan-x unit too..I never even heard of the Optime unit before calling Schein...they kinda steered me to it...I demo'ed both units and felt the Optime was better...No buyers remorse from me...

[BFD676]

When my boss asked me to join his practice he wanted to "be paperless" in January 2011. This was on December 21st! It is now the following March and we are close but still not there. Although the transition has been a process it is mostly painless. Our mantra around here is, How would you do it in Open Dental? OD can do almost everything you can think of. When I started in December of 2010, the existing staff was using the entire system as a time clock. Yup. That's why they turned the computer on in the morning so they could get paid.

The next use was to replace the paper appointment book. We started with the prescheduled recalls from six months out and put them into the computer. And worked backwards from there with a "drop dead" date chosen when we would no longer have an appt book for anything. We beat our drop dead date by ten days. And this was by a woman who never used a mouse before! So now we have a new database of names and phone numbers for the active patients.

Then we combined them into family accounts.
Then we updated their account info when they showed up for the appt by paper form and added up to date info to the acct info.
New patients still fill out paper forms for us and we scan them into IMAGES and shred them. (Working on KIOSK is on our list. Just not our particular priority.)
As we were doing that the administrative staff was working on getting insurance fee schedules set up, NEA-Fast Attach, and E-claims.
The next step was digital Xrays for clinical staff.
And then we started to attach treatment to the appointments and mark them complete so we could send the insurance out the next day and do daily reports.
Then came billing. Treatment plans.
The hygienists started w charting in the the Chart Module.
Then we moved to recalls, tracking outstanding claims, and now birthday cards!

Many of the mini-goals we set were based on figuring out HOW WILL WE BE DOING THIS WHEN WE ARE PAPERLESS? AND THEN LEARNING WHAT YOU NEED TO KNOW TO ANSWER JUST THAT QUESTION. Whether it was lab slips, referrals to specialists, or the next thing. You do it the old way until you set your next goal. Little steps. Sometimes it was a leap of faith and some times you are dragging some staff over the edge. But we are now to the point that one of our three doctors is truly chartless and she is an inspiration to us all!

My advice:
Do not transfer all of your records to digital. You will get there in seven years anyway. Pick a date and anything before THE DATE you will know to check the paper chart.
One person should be in charge of the "process". The one who learns how to do it. Sets it up. Test-drives it and then teaches everyone else.
Take baby steps and set specific goals.
Call OD as often as you need to. They don't care if you just called an hour ago. They don't think you're an idiot. Just get your answer as quickly as possible so you can get back to work.
Appreciate that someone else has already discovered and worked out your particular problem. There are so few things to re-invent in OD. It is truly an amazing management package.

We are almost there--chartless--and it has taken me sixteen months to get here. You can't give up because it's hard or long or frustrating. We all have to evolve. Our patients depend on it.