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Mike Uretz is a nationally-recognized Dental software and Electronic Health Records (EHR) expert. Mike has helped hundreds of individual practices and multi-clinic groups properly evaluate and select software vendors and solutions, structure and negotiate pricing and contracts, provide implementation oversight and vendor management. Mike was a member of the Certification Commission for Health Information Technology EHR vendor certification workgroup, and has been a member of various federal and state working committees for EHR business practices and policy. Having been involved with the EHR Incentive program from day one, Mike has helped a number of states, to evaluate and select EHR vendors, structure contracts and agreements, and manage vendor issues. As co-chairman of the Best practices advisory committee for EHR Contracts, Mike has been instrumental in developing standards for structuring vendor contracts and pricing for use by state programs nationwide He is the founder and editorial director of DentalSoftwareAdvisor.com, a trusted and objective online resource on all matters related to dental software. He is also the point person for Advanstar’s coverage of dental EHRs and their evolving role in the dental industry and can be reached by e-mail at firstname.lastname@example.org.
If you have been following my software related articles and podcasts the past few years, you are aware I have been a proponent of the growth of Dental EHRs and improved clinical software. And, as a matter of history, having been through the Medical Software revolution, I saw certain software concepts introduced that, looking back, were industry game-changers.
One such concept was the introduction of rules-based clinical documentation and templates. This concept led to Medical EHRs and clinical software becoming more “intelligent.” Basically, this is the incorporation of logic and associated rules to make clinical documentation much more powerful, customizable and easier to navigate, as well as providing decision support for maximizing appropriate coding at the point of care.
When helping my clients evaluate and select new software, I’m always looking for new and innovative features that can help a group or practice be more successful. Coming from a software and IT background, I very much appreciate what CareStack has accomplished bringing rules-based clinical documentation and templates, a standard in medical software for the past few years, to the dental software industry.
With this “next generation” concept, CareStack is bringing more intelligence to dental software. CareStack has, thus far, incorporated logic and customized rules in two major areas: Care Audit Rules and CareNotes rules-based documentation.
Care Audit Rules
Have you ever been concerned about the distinct possibility that an incorrect procedure code was entered without consideration of a more appropriate alternate code? Or are you paid less than what you could have received if you had entered the appropriate procedure specific code during the visit? Or have you ever been audited where the auditors found that a number of procedure codes entered into the software were incorrect.
Let the software automatically “watch your back” by giving you alternate codes to consider. For example you enter a D1120 Prophylaxis child and an alert pops up reminding you that if the patient is 14 years old or older you need to change the code to a D1110 Prophylaxis adult and allows you to change it with a simple click of a mouse (Fig. 1). Or, if you mistakenly enter a D3320 Endodontic therapy Bicuspid when it is actually a retreatment which calls for a more appropriate D3348 Retreatment code-changing it to the correct code is still just a mouse click away.
A library of alternate codes is included in the underlying database. Customization allows you to easily add your own rules-based alternative codes.
I find one of the biggest worries with providers is input screens and clinical templates can be too busy and confusing. This could possibly slow them down and cause extra work. There is concern with some software that there are many fields presented which are unnecessary in certain cases and can make the documentation experience cumbersome.
At this point, it is important to discuss what I mean by clinical templates. Many software systems claim to have Dental EHR functionality, but in reality you are just capturing the note as a blob of text, kind of like a Word document. You can’t really do anything with the data in the note because the fields aren’t captured separately. A true Dental EHR provides you with “clinical templates” for exams and procedures that capture all the information as separate pieces of data in a database. CareStack is one of the few true Dental EHRs I have found.
CareStack has answered the call. It is unique in its ability to add conditional rules logic to the navigation of templates, which you can customize to your own needs. These are referred to as “field” and “form” rules.
For example, a customized field rule would be “if yes was chosen for nitrous administered, then present additional options for percentage, minutes, etc.” However, if the answer was no, then the additional options for nitrous administered would not be presented (Fig. 2). The navigation through the note is quicker and unnecessary fields are not presented.
An example of a customized form rule would be adding a check box to the clinical template if a consent form was needed. The rule would be “if consent form was needed and was not previously filled out, then display on alert.” This makes sure all conditions are met before completing documentation (Fig. 3).
Where are we going?
The dental software industry is experiencing a revolution and evolution in features and functionality similar to what the medical software industry went through. Innovation is sorely needed in our dental software industry to address the rapidly changing needs of practices and groups.
Some vendors are innovating and some vendors are just resting on their laurels, hoping their customers won’t notice. With the incorporation of “next generation” functionality such as rules based EHR and customizable clinical documentation, CareStack is showing its commitment to being one of the leaders in software innovation.