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Robert Elsenpeter is a freelance writer and frequent contributor to Dental Products Report and Digital Esthetics. He is also the author of 18 technology books, including the award-winning Green IT: Reduce Your Information System's Environmental Impact While Adding to the Bottom Line. As such, he’s particularly interested in the technological side of dentistry.
EHRs might seem scary, but if used well they can streamline your practice and make it more profitable.
As tools, materials and techniques continue to evolve, the things that were once considered high-tech become archaic. Amalgam fillings and film-based X-rays, for example, are no longer the cutting-edge technologies they once were. So too is the status of one of the world’s most ancient technologies - paper.
Electronic health records (EHRs) make it possible to rid the practice of file folders, cabinets and rooms full of paper. But beyond simply removing the clutter, EHRs make it possible for practices to do more with patient information, ultimately saving both time and money.
Practices embracing EHRs typically see an upswing in their overall productivity.
“When all the data is at your fingertips, you’re not wasting time pulling charts,” says Dr. Lorne Lavine, founder and president of Dental Technology Consultants. “At least, when I was in practice, I would oftentimes leave charts lying on my desk or wherever, so you have all that information available to you. Your staff is not spending time running around trying to find data, giving them more time to do things like marketing and just being more productive in their day-to-day work.”
In many cases, practices using EHRs are probably still not getting the most out of them. Lavine observes that there is an abundance of capabilities that most practices don’t even tap.
“Keep in mind that, in dentistry, we don’t have true EHRs,” Dr. Lavine says. “We have practice management software systems that have been cobbled together to get them more like in an EHR system, like they have in medicine. Almost every major dental practice management system existed before HIPAA, before EHRs were a ‘thing.’ Those systems, as a rule, most people are completely underutilizing what the software can do. They are using maybe five to 10 percent of the software’s capabilities. They are using it for scheduling, for treatment planning, for billing, for insurance. They run some reports on a monthly basis. They’re using it, in a lot of ways, like a glorified QuickBooks. Where I think a lot of practices can really improve is utilizing that information where it relates to how they schedule their days, how they market their practice. There’s a lot of data they have that they’re just not using.”
That underutilized data can be used for such capabilities as marketing and effective scheduling.
“A lot of it is understanding the patient demographics,” Dr. Lavine says. “For example, you can run reports that let you know if there are certain times of the day that are more productive than others. Are there certain demographics, whether it’s age group or socioeconomic standing, male or female? There is a lot there that will allow you to schedule more productively, that will allow you to tailor your marketing for certain groups, and it’s all there, but people just don’t run those reports. They don’t know that they have access to that data or that they can utilize that data to change the way that they run their practice.”
Time savings is, of course, an important factor, and just being able to spend a few minutes here and there over the course of the day adds up. For instance, Dr. John Flucke, DDS, Technology Editor for Dental Products Report, went paperless in the late ’90s, and he immediately saw the time savings affording him a better work/life balance.
“I’ve always had my assistants and my hygienists write up their patients, and then I would always review it and make any additions,” Dr. Flucke says. “I did that to save time, so that at the end of the day, I wasn’t writing everything and trying to keep up during the day. So what would happen is, this big stack of charts would hit my desk at 5:15 p.m. When we went digital, just having the digital chart notes, and people writing in them during the day, and then I would add to them when I had time over the course of the day. Then, at the end of the day, rather than getting this big stack of charts sitting on my desk, I would just pack up and go home. I was getting home from the office about an hour earlier. That was huge. Having an hour more with my family was well worth the trouble of converting.”
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Being paper free can certainly be liberating for a single practice. However, those capabilities are almost critical when practices expand into multi-location organizations. If a group practice does not have a standardized, electronic system, it is just asking for trouble.
“How do you manage consistency and standardize how you treat patients?” Mike Uretz asks. Uretz is a dental software and EHR expert and the founder of DentalSoftwareCompare.com, which compares dental EHRs for groups and practices. “As an efficient group, you don’t want to necessarily have, for example, 20 locations in your organization and 10 of them are doing the procedure a certain way and the other 10 doing it a different way, with no quality control over how you do your clinical processes. With electronic health records, the group itself can standardize how they do their examinations, their procedures and overall clinical workflow.”
For those who may worry that standardization means that a computer is telling the doctor what to do and how to do it, that is not the case. Clinical standardization is not dictated by EHR, per se. EHRs are a tool that a clinical committee would use to help implement their agreed-to clinical best practices. This would include evidence-based dentistry as determined by the individual group.
“Once these best practices are finalized, they are rolled out to all the locations and all the clinicians,” Uretz continues. “Electronic health records let you develop that consistency, so it gives you the tools so that you can decide how you, as a group, do things. Because if you’re doing things all over the place, you don’t have any control or know what’s going on. This standardization and clinical consistency helps the group from both a liability and patient care standpoint. From a marketing standpoint, we all know that groups and DSOs have sometimes been viewed negatively as being too large to have good quality of care. But EHRs can actually help improve quality of patient care throughout a large organization.”
When software first came along, it streamlined all sorts of daily functions - but some inefficiency still existed. Initially, different applications did not work with each other. Modern software streamlines those inefficiencies.
“When digital dentistry first came along, you had digital X-rays, and it didn’t interface with your software,” Dr. Flucke says. “What you would have to do is open a patient in Dentrix, for instance, and then when you wanted to look at their X-rays, then you had to open a separate X-ray program, and then you had to enter that patient into that. So basically you had two or three programs open all the time, and you had to switch between all of them, which could be a little bit of a pain and a little clumsy. Over the years we’ve gotten to this system where everything is so tightly integrated that most of the stuff now that I use, I just use right out of my dental software. I don’t have to have other programs open and have data entry for the practice management software and then have to put that data into the X-ray software and then have to put that into the intraoral photo storage software, and all that kind of thing. So there are a lot fewer steps. Being able to click in just one program makes a difference as well because you’re not jumping between programs.”
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Getting rid of paper files means getting rid of the storage space. That also means that one is free to do something more productive with that dead space.
“A lot of offices have space that is taken up with charts, and if you can find a way to get rid of those you’ve just created space,” Dr. Lavine says. “Whether it’s for another operatory, whether it’s more space for staff - if you want to bring in somebody else who can do marketing or serve other functions. On the flipside, if you have a truly efficient system, you can minimize the need for staff. You may not need as many people, so you can do some cutbacks as necessary. If you’ve got data already entered, you don’t need as many people handling those responsibilities.”
While having a standardized system is vital within an organization, Uretz points out that EHRs also facilitate the ability to work with outside providers like specialists, even if they have different software systems. Being able to transmit a complete, comprehensive patient clinical file between members of the patient’s care team makes the work more efficient and timely. No more faxes, returning phone calls and other hassles.
“EHR technology exists where, for example, the oral surgeon can get the clinical information for a specific patient electronically from the referring dentist, including medication, allergies, past procedures, recommendations and so forth,” Uretz says. “The information for the oral surgeon is invaluable because they want to know what you did and, in return, once the oral surgeon completes his or her work and you have to treat the patient, on the flip side, as a referring dentist now you have a record of what the oral surgeon did with your patient - and it’s all electronic and at your fingertips.”
Patient information can be shared between dental and medical providers via EHRs, allowing all providers on a patient’s care team to give care with the best, most complete information.
“It is truly an ‘organic patient health record,’” Uretz says. “Wherever that patient goes, whatever specialists they see - including hospitals - all pertinent clinical information is available at the touch of a button. So different specialists, different hospitals can see and can add to that record. What we’re developing with the electronic health records is an organic growth of that patient’s health records, no matter what happens to them - whether it’s medical or dental.”
Another issue with EHRs comes down to a matter of doing business. There may come a time when EHRs are the standard way to conduct interoffice communication. From a business standpoint, Uretz observes that having an interoperable EHR can lead to more efficient business relationships.
“Over the years, as I’ve helped medical and dental clients of mine select and purchase EHRs, they point out that they would prefer to do business electronically, if they have a choice,” Uretz says. “If they have a choice of having to fax somebody or make phone calls, or they can just push a button and get that information on their computer, what the patient did with another group, obviously, they’d rather do business with them. I believe that more people want to do business with each other that way.”
Another timesaver, Dr. Flucke notes, is simply the ability to have convenient access to patient data.
“You don’t have to be with the patient to look at something about the patient,” he says. “I can be at my desk and review X-rays or I can be at my desk and I can look at intraoral photos or I can check a new patient’s health history, or anything like that. The data goes anywhere you want it to, so it’s not like I have to go to a certain spot in the office and do everything. I can be sitting at my desk and when a new patient comes in, the minute their data is available for viewing, I can do that right then. There’s no having to find the health history or having to go down to the hygiene operatory to access it. And that just streamlines everything. You don’t always have to go up and do things when the data is mobile.”
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It’s not only staff directly benefitting from EHRs. Patients are becoming more and more reliant on the ability to access their own patient data online. Being able to provide that data to your patients is a marketing benefit.
“Patients are requiring more and more information about themselves, about their health,” Uretz says. “EHRs help you with the clinical aspects of patients. In the past, we just had our dental software support practice management functions. Now with EHRs, they are about the clinical information and health of patients. Medical groups have long seen the benefit of this, and I think this will start happening in the dental world as we get more competitive with each other and looking for that edge. The ability to give patients better care through the use of EHRs is going to be a differentiator when patients compare their options.”
EHRs are not widely available currently, but Uretz expects the technology to be more prevalent as demand develops.
“It’s expensive to develop and implement in their software and vendors have to have a reason to do it,” Uretz says. “Unless more and more dental groups ask for it and see the benefits of it, they’re not going to want to spend money or time doing it. They’re just going to want to keep going along how they are with their standard software. However, I have seen more and more innovative vendors entering the EHR market, just as we saw in medicine over the last few years - the industry started asking for it, so then the vendors started doing it.”
And that capability, Uretz says, may attract patients.
“With the way consumers are interested in their own health, they would be more interested in a group that has that ability,” he adds. “I think it will be a differentiator between groups having it or not having it.”
There is a lot of data made possible by EHRs. The ability to analyze the data can be used by the practice or group for a variety of purposes - both directly for patient care as well as for business functions.
“We can see the outcomes, we can see how we’re doing,” Uretz says. “We can see if certain clinical techniques and procedures work better than others. We have all that data, but you can only capture that with the electronic health records. So now we can do analytics, which leads to better dentistry, better outcomes. Analytics, along with electronic health records, let you analyze on a higher level how your practice is doing from a clinical standpoint.
Those analytics can also be helpful, especially as insurance companies start requiring more and more comprehensive clinical information surrounding submitted claims.”
Uretz has seen those insurance requirements become standard in the medical world, and he expects to see the same happen in dentistry.
“Accountable care has come to the forefront and EHRs are critical in satisfying where insurance is going,” he says. “You’re starting to hear more and more insurance companies talking about changing their reimbursement models, where now you have to actually show what you did and how you did it. You have to justify the procedure you did. Once insurance in dentistry changes that way, then you’re definitely going to see a need for EHRs and associated clinical analytics.”
Practices may be resistant to making the switch to EHRs because it can be seen as a headache and an unnecessary expense.
“We see an increase in productivity and efficiency, that’s in my mind, for a lot of practices, difficult to quantify,” Dr. Lavine says. “What you see is, ‘Gee, I have to buy more software and now I’m paying for more tech-support time,’ and ‘We have more issues,’ and ‘We’re down more often,’ ‘We need new computers,’ ‘We need a bigger server,’ and ‘We have to do all this stuff for HIPAA compliance and it’s really hard to see that they are saving money.’ In the short run, you don’t see that, because you’re just writing all these checks.”
While EHRs can be a great way to save money and time, they may be critical to practices’ growth and overall health.
“Groups that do not incorporate electronic records as part of their software will really have issues with how they grow and their success,” Uretz says.