Digital workflow

by Dr. Larry Emmott

For more on this topic, go to www.dentaleconomics.com and search using the following key words: paperless office, front desklessness, digital workflow, Dr. Larry Emmott.

Many years ago in the BC era (Before Computers), when office data was on paper or film or even a plaster model, it (the data) could only be in one place at a time. Moving it from place to place was time-consuming and expensive. Thus we assigned work to a specific place (such as the front desk) and a specific person (the front desk person) to that place.

The result was the back office/front office divide. Workflow meant: where does the chart go and who does what task?

Once a dental office develops a paperless (digital) system of records, charting and scheduling the workflow changes significantly. In many ways, workflow is data flow. Digital data can be accessed anywhere there is a computer - in the back, at the front, or somewhere in the cloud.

Workflow can now be described in terms of tasks, not places. The most basic tasks are either clinical or administrative. Secondary tasks are communication and documentation. People are freed from the drudgery of filing, typing, looking for lost records, and doing all the rest of the busy work needed to keep a dead-tree system working. This new pattern of doing things has been called front desklessness.

Does this mean there is no actual desk? No, front desklessness is not about discarding a piece of furniture or eliminating a staff person. It is about workflow ... doing the nonclinical business functions in a different way because technology allows the handling of data in a more efficient manner.

When all the practice information or data - including patient records - is on paper, we need some place to pull the information together to make use of it. Additionally dead-tree data can only be in one place at a time. There is only one paper appointment book, only one paper chart, only one film radiograph. As a result, if one of the pieces goes missing - say, the chart is in the back (or just lost in a stack on the doctor's desk), or an X-ray is misplaced - the functions of the front desk stop.

Once we transfer the data from paper to digital, we no longer need a single physical place, such as the front desk, to gather the information. An administrator can gather the data wherever there is a computer. That could be at the front, in the back, or even in a different building! The computer becomes the "data center" of the practice.

Why answer the phones at the front desk? Answering the phone is the task. The front desk is the place. Do you answer the phone? Of course. Do you have to answer at the front desk? No.

What about making an appointment? If you use an electronic schedule with treatment room-based computers, why not schedule from the treatment room? Who better to make the appointment than the chairside assistant? She has just heard the dentist and patient discussing treatment. She knows exactly what needs to be done next, if the patient is a gagger who needs extra time, if there is lab work involved, or any of the other clinical considerations that would affect the appointment time. Just make the appointment.

These tasks are distinct yet flow together. For example, the dentist may diagnose tooth decay and then document that with a chart entry and a treatment plan. This is communicated to the patient, financial arrangements are documented, and a payment taken. All four types of tasks (clinical, administrative, documentation, and communication) are involved, but the person and the place are irrelevant to the task.

Workflow tasks with digital data often do not need a person of any kind. For example, making reminder calls, sending bills, or submitting insurance claims are done in the cloud (online) with e-services - no human involved.

The front desk workflow system of the BC era developed because it was the best we could do with dead-tree data. Digital data changes everything. The future is coming and it will be amazing!

What is the front desk?

• Is it a person? "The front desk will make your appointment."
• Is it a place? "Stop at the front desk and ask."
• Is it a thing (a system)? "The front desk handles all that."

It is all of those. The term front desk, as used in the dental office, does not refer to a piece of furniture. Front desk refers to the business system of gathering information (or data) at a single location and administering the nonclinical business functions. Nonclinical functions include scheduling, billing, insurance processing ... in fact, everything except the diagnosis and treatment of dental disease.

The front desk is the "data center" of the office.

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