Common misperceptions about going paperless

July 16, 2012

It is 1962 and Dr. Jones has an air compressor installed with air lines to all the treatment rooms running to units with highspeed air turbine handpieces, yet he continues to use the old belt driven dental drill because he just doesn’t trust the new system. That seems silly today, but it is the same situation many dentists find themselves in 50 years later with regards to paperless dental records.

It is 1962 and Dr. Jones has an air compressor installed with air lines to all the treatment rooms running to units with highspeed air turbine handpieces, yet he continues to use the old belt driven dental drill because he just doesn’t trust the new system. That seems silly today, but it is the same situation many dentists find themselves in 50 years later with regards to paperless dental records.

Time and again offices have everything in place to go paperless, but they still make paper because that’s the way they’ve always done it. They just don’t trust the new system. Sometimes it is the old, “can’t see the forest for the trees” issue. In this case, the trees are the individual processes that can be used to create digital information. The forest is the paperless record. The tendency is to concentrate on individual processes or technologies without integrating the process into the whole. As a result, one of the common mistakes dentists make with electronic charting is they only go part of the way.

For example: The office may use a paper chart in the treatment room during diagnosis to mark future treatment. Then they take the paper chart to the computer and enter everything again. They will use the computer to create an estimate, insurance forms and schedule. Then they will go back to the paper chart to enter procedure notes, back to the computer to take a payment, back to paper for a prescription, back to the computer for the next appointment, then back to paper to check the x-rays.

The office ends up with a mess. Everything is done at least twice, the paper chart is still needed, and no one is ever sure if something is on paper or in the computer. As a result, the computer chart doesn’t save time and money. It makes things worse.

Many dentists believe that to go paperless they must convert all their old records by scanning everything into a digital format. This is a huge, time consuming and expensive task with a very limited benefit. Do not try and scan in all the old records. Going paperless is a process not an event. You do not one day shred all the old records and declare the office paperless. At first you will need the paper charts on all your patients as you will be referring to the previous paper entries. As time goes on you will need to refer less and less to the old paper records. After a year all the current x-rays will be digital and all the patients recent entries and treatment plans should be digital. It is now possible to stop pulling charts. However, at first you will need to refer to the old charts fairly often for entries or x-rays more than a year old. Eventually you will rarely ever need to pull a chart.  You still don’t shred those old records-the paper charts are the archive.

Let’s be clear. Maintaining and referring to old paper records does not mean you continue to make paper entries. Once the system is in place, you simply stop making paper. Everything new is electronic; everything from the past is paper.

Dentists often see paper records as inexpensive and digital systems as costly. However, the costs to create and maintain paper charts can be significant but we often don’t see it because it is hidden in the process of doing business.

Paper charts don’t just appear in the office for free. The paper folder and all the other papers cost about $2.50 each. Other chart contents, like x-rays and photographs, can be even more costly. A set of bitewings with film, processing and mounts can be a dollar or two. It is reasonable to add at least another $3 to the cost of each chart for a total of $5.50 each. If you have 2,500 charts they cost you at least $13,750 to create and every time a new patient walks in it’s another $5.50-cha-ching!

Storing the records isn’t free either. A typical office with 2,500 charts will need three or four full size lateral files to hold them all and a file room to keep them in-let’s say $11,500 (for the files and the build out). Not to mention all the “inactive” charts stashed away somewhere else.