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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.
How TeleDent™ from MouthWatch is improving clinical efficiency and the standard of patient care.
Like many types of technology innovations, teledentistry had its beginnings in the military. In fact, in the mid-90s, the United States Department of Defense introduced the Total Dental Access Program (TDA) to improve the access to care for soldiers in remote locations. In those days, providers and soldiers were connected via telephone consultations. By the end of the ’90s, this rudimentary phone connectivity was augmented by videoconferencing, email and fax.
Fast forward to 2017 when MouthWatch introduced TeleDent™, a complete turnkey platform that integrates digital imaging with secure cloud-based software to provide a flexible and fully functional clinical communication and collaboration system.
Currently, TeleDent enables members of the dental team to collaborate on patient care - even when they’re working in different locations. This is made possible by using an intraoral camera connected to a computer, which is in turn securely connected via the internet to HIPAA-compliant cloud-based software. With this platform of integrated technology, any member of the care team can share photos, X-rays, digital files, case notes and even videos.
What’s more, this information can be shared in real-time (synchronous) or stored for later viewing (asynchronous).
Perfected in public health
TeleDent was initially deployed in a variety of public health settings. Brant Herman, CEO of MouthWatch, and his management team quickly learned that public health programs were driving teledentistry innovation and adoption.
“The public health sector said, ‘We’ve got care delivery goals. We must reach a large number of patients more efficiently because connecting dentists with patients is the most expensive part of improving access to care,’” Herman says.
In addition, Herman soon discovered that progressive state practice acts are typically more favorable in public health settings.
“However, in pursuing innovative models such as teledentistry, the state entities still wanted to allocate their funding wisely,” Herman explains. “They were very receptive to our value proposition that they could send a hygienist who could do much of the screening, cleaning, fluoride and varnish application, etc. at a hospital, in a school, in a rural area or in an FQHC without a dentist present but also be able to quickly consult with a dentist if the situation required it.”
Using TeleDent enables off-site hygienists to collaborate with the dentist, have treatment plans created and approved, and also conduct a live video conference with the dentist in order to tap into that clinical expertise. Teledentistry-enabled visual communication helps reassure the patient, builds trust and fosters a relationship with care providers. But this efficient remote collaboration capability isn’t just suited for public health dentistry. In fact, Herman sees private practices as the next frontier of teledentistry.
Up next: Private practice opportunities...
A wealth of private practice opportunities
Teledentistry is an excellent solution for providing access to care in underserved areas, but Herman believes adoption rates will grow exponentially by providing more opportunities and revenue streams for private practices. The latest version of TeleDent was specifically designed for supporting this business model.
Herman and his team soon discovered that one key need for teledentistry solutions was in connecting providers to other providers. TeleDent connects hygienists to dentists to create solutions that not only solve access to care issues but also create new revenue opportunities for private practices.
In addition, teledentistry allows the practice to remain open and serve patients, even when the dentist isn’t present - assuming state law allows it. “We saw all of those opportunities when hygienists used teledentistry to connect to dentists and open innovative practice models,” Herman says.
For example, in Minnesota, Wisconsin, California and New York dental practices can have hygienists work in the office without the dentist being on site. This enables hygiene-focused practices to provide all the established and regulatory approved procedures that hygienists perform in terms of generating revenue, identifying restorative needs and building patient relationships - but without the high cost of an always-present dentist.
“Now, you can have a practice open from 8 a.m. to 9 p.m. with the dentist only on-site from 8 a.m. until 5 p.m.,” Herman says. “The expanded, hygiene-only hours are perfect for parents and working patients who can now conveniently schedule their hygiene appointments in the evenings or on the weekends.”
Moreover, teledentistry can enable the group practice owners to manage and supervise associate dentists in different locations or consult with specialists who rotate among different practice locations. This flexibility and convenience would also benefit a wide spectrum of prospective patients, such as a senior in a nursing home or a millennial who works at a company that offers dental services but doesn’t have a dedicated dentist. Having hygienists come to a nursing home or corporate office gets the patient into a dental home and provides him or her with dental care.
Teledentistry can also increase the rate of treatment acceptance. The dentist now can create treatment plans, even if that dentist is sitting at home on his or her smartphone. Plus, the dentist can do a quick patient consult to discuss the suggested treatment for something requiring clinical attention. “Teledentistry has created the virtual case acceptance tag team that is extremely effective,” Herman says.
But what happens if a dentist isn’t immediately available? TeleDent allows collaboration to occur both synchronously (real-time) or asynchronously (stored for later viewing).
“If one of the care team members is not available, the team member in the operatory can simply use the intraoral camera to record a video,” Herman explains. “For example, ‘Hello, Dr. Jones, this is Jill. We’ve uploaded all of Mary Smith’s records. She wants to schedule an appointment. Let’s video chat on TeleDent and we can go through the clinical data together.’”
Up next: Connecting the care team...
Connecting the care team
The tipping point for teledentistry may be its ability to enable closer collaboration between general practice dentists and specialists. According to Herman, the dental referral process is broken.
“You have a patient who comes in to see their regular dentist and the dentist identifies a problem out of their area of expertise, such as placing implants, oral surgery or a root canal. What happens most of the time is that the dentist gives the patient a business card and says, ‘You should call this doctor.’”
The problem with this, Herman says, is that it then becomes the patient’s responsibility to follow-up and set up an appointment for something that’s very expensive, possibly painful and may have a long recovery time. Herman says this puts the onus on the patient without any process for the practice to follow-up.
"We want teledentistry to help create a care team,” Herman says. “For example, when the dentist sees a need for implants, they can start a teleconference with the specialist and the patient.”
During this three-way TeleDent consultation, a webcam turns on, the intraoral camera comes on and the specialist is on the computer screen. They can discuss the recommended treatment plan, which helps to manage patient anxiety and build trust. There’s also case planning and care coordination happening between the specialist and the dentist. The care team can use TeleDent to share all of the relevant patient data - imaging, cone beam, CAD/CAM, health history, medical information, etc. - immediately.
Another important problem that TeleDent solves is security and compliance. That is, the platform is HIPAA compliant, ensuring patient data safety and keeping the practice out of compliance hot water.
“We’ve spoken to so many dentists at dental meetings who say, ‘I just take a picture on my smartphone and I email it.’” Herman says. “Well, okay, I’m not going to lecture you about HIPAA compliance, but that’s not absolutely non-compliant. Eventually, this is going to become an issue and bring with it steep fines. Many practices are realizing that they need a HIPAA-compliant teledentistry solution that’s also easy to integrate into our practice, and that’s TeleDent.”
Bridging the gap
The opportunities with teledentistry are just starting. In the future, Herman expects TeleDent will be a catalyst for improved integration of the dental and medical disciplines.
“I see a huge opportunity in medical/dental integration,” Herman says. “This is an area where there has been a lot of conversation about the possibilities, but TeleDent is making it a reality. We already have TeleDent-enabled hygienists working in a pediatrician’s office and in a hospital setting.”
The long-term goal of Herman and the MouthWatch management team is to facilitate a variety of medical practitioners to be able to use the TeleDent platform to perform visual screenings and assign them to dentists.
“There’s no reason why we can’t provide every medical specialty with the ability to collaborate with a dentist for co-managed patient care for optimal health,” he says.