Going Chartless

[BFD676]

We have been evolving toward a "paperless" practice in increments. Currently we are compiling AutoNotes, Default Notes, and Quick Notes in preparation for our "chartless" goal. Our in-office beta-tester who is the most-adaptable dentist has made the transition and will enter all case notes in the computer at the end of each patient visit. (Yay!) The doctor has been using the workstation in the operatory to do this...at the exact time and place that I would be cleaning up and setting up for the next patient. Are there any suggestions from truly paperless offices on the best ways to enter treatment but not slow-down the operatory flow?

[teethdood]

Learn to group teeth together. For example: During ExistingCharting, say "Crowns on #5,12,19,31" "MO amalgams on #3,14, 18" etc. You get the idea.

Some DAs are not technically savvy and therefore quite slooooow. If so, create a sheet of paper with a few columns as follows:

Teeth # Existing Needed
1
2
3
4
etc

Then afterwards they can go back and input it into the computer. Not completely paperless but close enough.

[jordansparks]

The way I always did it was that the assistant entered the notes throughout the appointment. This can frequently be done while the doctor is out of the room, while waiting for anesthetic to take effect, etc. By the end of the appointment, there is nothing left to do but verify and make any slight changes. If the doctor needs to dictate something which is typically related to diagnosis, then that goes in at that point rather than at the end of the appointment. Most importantly, do NOT let the patient up out of the chair until the chart notes are 100% done, or it messes up the front desk billing. If the patient needs to get out of the chair to use the bathroom, then you have to warn the front desk to wait for the signal from the assistant that the chart notes are done.

[Hersheydmd]

The way I always did it was that the assistant entered the notes throughout the appointment. This can frequently be done while the doctor is out of the room, while waiting for anesthetic to take effect, etc. By the end of the appointment, there is nothing left to do but verify and make any slight changes. If the doctor needs to dictate something which is typically related to diagnosis, then that goes in at that point rather than at the end of the appointment. Most importantly, do NOT let the patient up out of the chair until the chart notes are 100% done, or it messes up the front desk billing. If the patient needs to get out of the chair to use the bathroom, then you have to warn the front desk to wait for the signal from the assistant that the chart notes are done.

Jordan, no question that your way is the ideal, but it's only feasible if you work 4-handed with an assistant in the operatory most of the time, and your operatory computer is accessible to the assistant while you are treating the patient. I would need to totally revamp my office to get there. Meanwhile I have to type up my notes during a break or at the end of the day. I am sure there are many other old-timers like me in the same boat.

[Tom Zaccaria]

Move over and I'll help you row!!!

I recently tried to get rid of written hard and soft tissue exam paper sheet.
Bought a new Dell 13" Netbook had everything in place to do hard and soft tissue exams in OD.
Tested it on two new patients. Everything working as it should.
After one day were back to our paper sheet.
Reason 'we have too much to do other than assist'.
Usually they never complain and are on board with anything new I incorporate but not this time.
Will revisit it in the future but as of now it is not for us.

drtmz

[jordansparks]

I guess the fact that I had three chairside assistants assigned to me at all times affects my opinion on this. The three of them also shared sterilization duties. But isn't it more efficient to pay them their hourly rate than for the doctor to do the chart entries themself? I mean, assuming you have the space for all those people. There are also procedures that actually require 6 hands, not just 4. I don't know how you could perform the procedures without all 6 hands.

[teethdood]

I don't think he is doing the chart entries himself. Even with multiple assistants, you are still slowed by the speed at which the assistants move the mouse and click the right buttons.

As an example, patient has crown #2, MOD amalgam #3, crown on #12, DO amalgam #13, MOD amalgam #14, crown #15.
I would say:
"Crowns on #2, 12, 15"
"MOD amalgam #3, 14"
"DO amalgam #13"
That way, the assistant can click on the teeth numbers all at once, then click the proc code. Faster that way instead of yelling out tooth by tooth and waiting for them to move.
That's for hard tissue.
Soft tissues should be part of your Autonotes. Make everything WNL, unless changed by you later.

[jordansparks]

If I was going to group them, I would say it differently. I would say
"2, 12, and 15, crowns"
"3 and 14, MOD amalgams"
"13, DO amalgam"
because that's the order they need to click.
Soft tissue is usually part of the default note. It can also be an autonote or Exam Sheet.

[Hersheydmd]

I guess the fact that I had three chairside assistants assigned to me at all times affects my opinion on this. The three of them also shared sterilization duties. But isn't it more efficient to pay them their hourly rate than for the doctor to do the chart entries themself? I mean, assuming you have the space for all those people. There are also procedures that actually require 6 hands, not just 4. I don't know how you could perform the procedures without all 6 hands.

With the Isolite system, 2 hands is more than enough most of the time, depending on what procedures are being done.