Paul Feuerstein, DMD
Today, it is rare to find a practice operating with a manual accounting system. Over the years, dental software has matured from a billing system to a complete practice-management product. The initial thrust was, of course, to automate billing, insurance forms, and recall notices. Today, patients will not accept photocopies of handwritten ledger cards; they look unprofessional and inaccurate in a world where even the local pet store sends out printed statements.
I recently had a chance to observe an office that does not send statements, does not accept insurance assignment, and actually collects more than 100 percent (allowing for some patients who prepaid for services). One of the reasons this dentist wanted a computer system in his office was that some of his patients were questioning why he didn't have one. Patients believe computers are a part of today's business place, and he did not want to look low-tech to his patients while offering modern services. Of course, instead of a computer system, he could have gotten cardboard computers - such as those shown in retail store displays - but he went forward with the actual system.
A more common scenario is an office that has made an initial commitment to computerization and is looking at new systems and upgrades. A few years ago, this article would have focused on why you should have a computer in your practice. Although the initial investment was steep, there were numerous advantages to leave the old pegboard/ledger card systems behind. Today, almost 90 percent of practices have a computer in place in some capacity. Some offices purchased practice-management systems in the early 1980s and still use them. Many of the original PC-based systems are running programs in MS-DOS and, in one case (Alpha Healthcare), there are computers in service that are pre-PC.
Recently, many of the smaller companies have disappeared because it wasn't feasible to keep any reasonable support if there were a limited number of users paying a few hundred dollars a year. In addition, several mergers and acquisitions have taken place. A fear exists that InfoCure's purchase of more than 15 practice-management products would abandon those products' users. Not so, says Al Fiore of PracticeWorks.
"All of the existing products that were assumed by InfoCure still are being supported," Fiore said. "Some still will receive minor enhancements. They will be under the PracticeWorks umbrella. If many practices leave a particular program and it becomes unfeasible for PracticeWorks to support it, the company will announce a 'sunset date' for that product's support. This will be done by attrition and evolution and ample notice will be given. The users then will be encouraged to go to a Windows-based product."
Fiore also states that most of the company's future development will concentrate on the PracticeWorks and Softdent products. As an aside, he notes that the company is actually still supporting the old Alpha hardware, although it cannot continue much longer (and it is advisable to move on).
So where does this leave the practitioner? Should he or she scrap the old system and get some shiny new computers and new software? Why make an investment if the current system still works? Better yet, why upgrade to a newer version of existing software when the company is still in existence and things seem to be running fine?
The "computerization" of a practice has changed dramatically. It is no longer enough to have a "data-processing system" which prints bills, insurance forms, and recall notices. Microsoft, despite emotional negatives, is constantly striving to make computer operations better, faster, and more efficient. The same holds true for the Apple/Macintosh clan. However, in making these improvements, there are hardware requirements that must be met to enable that software to operate properly. In simple terms, you can't just upgrade to the latest Microsoft or Mac version without making improvements to your computers. Unfortunately, it is not as simple as adding more memory or replacing a CPU chip. As we explore the pluses and minuses of upgrading, we have to be cognizant of costs. There are different needs for different functions, and all of the computers in the office network do not have to be the latest, top of the line, gizmo-filled units.
Software
DOS software will run at lightning speeds on the newer computers. If you have an existing management system, this is a reasonable upgrade. It will appear as if you have a reborn system. However, this is similar to putting a Corvette engine in a VW bug. You still are limited in the functionality of the practice-management (PM) system. The newer versions that were written to take advantage of Windows are capable of tasks that were previously impossible in DOS. Besides, no new adjunct software is available for these systems. Word processors, financial management (Quicken et al), and some of the new hardware, modems, and monitors require Windows.
I put this question to many of the PM companies. According to Dentrix, "most DOS programs basically are accounting systems. Most software companies now have moved from an accounting software concept to management of the office. This includes using graphical charting as a place to begin the billing process, with as few keystrokes as possible. A doctor that is using a DOS system is inputting the same procedure three to six times. With new software, the doctor puts it in once and then accesses it throughout the system. In addition, DOS support will be gone in the near future."
Jeff Campbell of Genesis Software states that "it is much easier to make the switch while your old DOS-based system is working properly, rather than having your office computer down and changing under duress." He adds that you may have to make an instant - and perhaps irrational - decision if the DOS software or hardware suddenly fails and you need an immediate replacement. In the current marketplace, you will be hard-pressed to find any repair technicians who are well-versed in the old software, and you can be sure there will be no replacement parts available for the antiquated (by computer standards) hardware. With a Windows-based system, a replacement/loaner can be in operation in very little time.
Hardware
Luckily, the costs of hardware, although more sophisticated, have dropped dramatically. Storage space is one of the most notable areas. Some newer functions, such as digital images and digital radiographs, take up a lot of disk space. The newer hard drives available - with more than 50 MB of space available at a reasonable price - allow a virtually unlimited amount of storage. If your computers are on a network, Quantum's SnapServer is a simple device containing additional hard drives that plug directly into your hub. I can say from experience that this is a true plug and play device. There also have been major advances in video and graphics capabilities. The newer dental software takes advantage of these products for better graphical charting, image management, and other areas that require a lot of colorful on-screen images. As Intel and AMD jockey for "the fastest," we also benefit as yesterday's speed demons (which were the top) drop in price. A dental practice surely can "limp" along on a 600MHz processor!
Although purchasing a few new computers for the office at today's sub-$1,500 prices seems simple, connecting and organizing must be addressed. Connecting a few network wires to a hub may seem easy, but there are many cases where more complex integration has to be addressed. WindowsNT and Windows 2000 installation is not just a simple "insert CD and hit enter." Also, networking printers, Internet services, or image storage may be a more complex process. An investment may be necessary to hire a network installer or a high-tech coordinator, which could save hours of headaches later on.
Integration of new technology
As part of the thinking process of an upgrade, computers will start appearing in the treatment rooms. The people at Eaglesoft point out that the original systems were front-desk only. Utilizing clinical software in the treatment rooms obviously requires additional hardware and a more sophisticated network to get the information to the front desk. In addition, many new dental-equipment products have software components requiring the addition of better, faster computers and software, including the amazing, now Windows-based, CEREC3.
With the sophistication of the new software, there is a seamless use of products such as digital cameras, intraoral cameras, digital radiography, etc. You can easily explain patients' cases by showing pictures of them, photos of similar patients, and dynamic descriptions of the actual upcoming treatment, all with the push of a button. Patients are more apt to accept treatment plans if they can see them more clearly. With some PM systems, plans can be presented immediately (Mark Dilatush of Softdent points out that his company's PowerCase module does just this). We all know that once the patient leaves the office, at least 80 percent of what was discussed is forgotten and very few will follow up without constant reminders. "Let me think about it," are the dreaded words following any presentation.
Other factors that should encourage an upgrade are improving efficiency and taking some of the pressure off of the "front desk." In most new systems, the patient's next appointment can be made in the treatment room. If the staff is trained well enough, the treatments can be entered at chairside and the patient's billing information is at the front desk before he or she gets out of the chair. Depending on the office's third-party policy, the patient can be given an exact copayment figure, handed an insurance form (if the office does not accept assignment), and leave with a professionally printed receipt in a rapid sequence, all without tying up the front-desk staff. The patient's next appointment is already made, so there is more time for other tasks, including increasing counter cash receipts. In some cases - such as Robert Davis, who has a wonderful high-tech office and training center in Watsonville, Calif. - there is no front desk at all!
Another point made by Jeff Campbell is aimed at a practitioner with retirement in sight. Having an updated system will not only enhance the value of the practice, but will allow a better analysis for the parties putting the purchase together. There are many other technical reasons for an upgrade, including one that Ken Miracle of Dental.com points out: The newest systems now will allow the dentist to take a version of the patient data home using a handheld device. In Dental.com's system, this is done using a Windows-based Pocket PC. Other companies have come up with similar designs using the Palm operating system. For many offices, this is an invaluable tool if there is an after-hours page.
Return on investment
Although an office may become complacent with a system that is "doing the job," there is a distinct advantage to upgrading or even changing to different software. Of course, there is another fear of having to teach and learn a new system, but if the staff goes in with an awareness of new efficiency, productivity, and even changes in job responsibilities, it can be an exciting and perhaps invigorating time for a practice. This brings up an important point: A resistant employee could destroy the whole tempo of such an important change. A staff member who feels that it will be too much extra work to do his or her own appointment scheduling "in addition to everything else" could hurt the process. Everyone has to be involved - it is not a "front desk" or a "back there" issue; it has to be understood that the entire practice stands to gain efficiency and production from this. The PM companies should be able to refer you to other offices to talk to or, better yet, visit to see how the changes were helpful.
Once a decision has been reached, the actual change requires careful analysis. There will be confusing documents outlining hardware and software installation. There will be charges in the proposals that appear to be written in a foreign language. It is not uncommon for these plans to be rewritten a couple of times to get the desired result, and it is advisable to ask your colleagues what errors or regrets were made in similar conversions. There is always the "If I had to do it again ellipse" statement, where a practitioner says he would have either left something out or added another component in at the time of purchase. These statements are intentionally vague here to encourage you to go out to dental meetings, speak to several manufacturers, or get information from your colleagues in local evening study groups or online in forums such as the Internet Dental Forum and genR8TNext. Of course, continue to study resources such as this magazine and others in the marketplace, which constantly publish articles on the specifics.
This is a big investment and the entire substructure of the practice will depend on a good decision. Most of the PM products available today can accomplish all of the tasks discussed here - it is more of a question of comfort with the individual company and how it fits in with your own style of practice. Don't agonize over this change. As Nike says, "Just do it!"
