Going Digital - My Journey to a Paperless Practice

When I was a junior dental student at Ohio State University in 1984, I approached an instructor and asked for some advice on getting started in private practice. He gave me a tip on a practice broker in the Columbus area. I consulted the broker, listened to advice given in the college about success in rural settings, and decided on a practice in Newcomerstown, Ohio, about 50 miles from my hometown of Canton.

Dr. Scott Lawrence from Ohio

The practice had been started by an Ohio State graduate in 1959. By the time he was 55, he decided he was burned out from overwork (which I have come years later to completely understand), and decided to sell me the practice. I bought his practice, and along with it inherited the dip tanks, belt-driven, low-speed handpieces, one “pump,” and two chairs. The office had a pegboard accounting system and 5 x 8-inch charts into which every little paper had to be folded (with something like 10,000 patient records). And certainly there was no panoramic X-ray.

I took over this operation in August 1985, and within a year or so purchased three rooms of newer reconditioned equipment. In 1987, I purchased an automatic processor and panoramic by Midwest. The practice was thriving and all was well. We were working at overflow capacity, so I thought we had made progress. Why rock the boat? All the while, the staff was manually filling out insurance forms and placing them in envelopes. We had to store panoramic films in a separate location because they would not fit in the small charts. I had been telling the staff - which then consisted of one front-desk person, one assistant, and later a part-time hygienist (who wasn’t there when I first started) - for years that if I retired, they would first need to adopt full-sized charts and then store panoramic film in a separate location.

Allow me to digress to reflect briefly on my now-deceased father, who practiced dentistry in the Canton area for 47 years. During his career, he reared three children and supported his family in a fine fashion, in a dental office with 500 square feet and two small operatories. My father had one assistant who took care of front-desk duties and assisting. He never had a hygienist. He never had an automatic processor and used the little (what seemed to me) 3 x 5-inch cards for files that were stored in cardboard boxes. When I think about this, it’s apparent we have come a long way.

I purchased a second practice on July 4, 1988, from a general practitioner in Gnadenhutten, Ohio, a small town about 11 miles east of my original office. He wanted to sell his practice, which he started in 1952, and his condo dental building, which he shared with a practicing physician. The agreement was signed, and I became the owner of a second dental operation. The former dentist became my associate for the next six years. This also was a thriving practice and equipped similarly to the one in Newcomerstown. Both were brick, modern, free-standing buildings in excellent repair.

Using CAESY patient education software, Dr. Lawrence demonstrates root canal treatment of a molar to a patient, showing a picture of an infected tooth.

Time transpired, children were born, a new home was built, and finally a decision was made in the winter of 2004-2005 to go to full-sized charts. After only months of what I thought would be a revelation in organization, I quickly realized that this was no panacea. All this time, I had been reading in the dental journals and hearing at meetings about digital X-rays. Even my personal dentist had purchased a digital system. I had been reading about sending insurance forms via the Internet and going paperless, so I called Patterson Dental, who had been supplying my sundries, and asked them to come in and give me a demonstration of these services. I selected Patterson because of the positive things I had been reading about Schick and EagleSoft.

After listening to the Patterson presentation, I decided to remodel the Newcomerstown office and its three operatories. In that office, we purchased three operatories’ worth of new equipment and X-rays, including the Schick digital intraoral system, intraoral video, and panoramic. We purchased Patterson EagleSoft to integrate all the paperless functions and connect the operatories with the front desk. We are connected to the Internet and use Patterson software to submit insurance forms and all pretreatment estimates, as well as digital X-rays when needed. We also purchased CAESY Patient Education software and have set up a wall-mounted, 32-inch, plasma television monitor in the reception room to provide a continuous loop of interesting dental educational materials. With all of this, we discarded the old processor, X-ray equipment, papers, envelopes, X-ray film, and solutions. Today, the daily chart is on all computer screens, and I no longer have to wait for someone to physically tell me when the next case is here.

This last decision was really the most difficult of the entire process. We had been going along quite smoothly for many years, but I knew that after seeing what the future had to offer, I didn’t want to finish my career in what I call “ball and stick” management. Some years before, having put all of my problems and victories into the hands of our loving God, I figured now was the right time, so I plunged forward. Today we employ numerous digital technologies throughout the practices:

• We are completely computer-integrated with Patterson EagleSoft, CAESY Patient Education, and Schick, with a Schick digital panoramic room in each office.
• We have six computers in Newcomerstown and eight in Gnadenhutten.
• The processors are history, and there is no longer any film in the offices.
• We are now scanning the old records with a professional-grade scanner. As of Nov. 30, 2006, we had entered 2,721 charts!
• We are entirely digital for all intraoral and panoramic X-rays. We got rid of the automatic processor (which was two years old) and no longer have the stinky, caustic developer and fixer solutions.
• I use a Canon 100 mm lens to take intraoral photographs with mirrors and enter them into patient records.

We began to fully use the clinical and practice-management system in Newcomerstown after three days of training provided by Patterson Dental. The first day of hands-on use was Dec. 17, 2005. This was a profound period of trial because we went from doing things totally manually to completely paperless with computers, so you have to understand this was a total commitment.

I admit this was stressful at first with a large learning curve. But I have found that if we are committed, it can be done with God’s help. I read the Patterson EagleSoft book repeatedly to learn how the software works. I am awed by the whole thing. Shortly after completely revamping the Newcomerstown office, I began a much larger project in the Gnadenhutten office. I purchased the physician’s part of the office and remodeled the practice to include five operatories, two of these becoming hygiene treatment rooms. We added a second hygienist to the practice in June 2006, and the office has grown from 900 to 2,100 square feet. Here are some of its features:

All new A-dec equipment

• Planmeca intraoral X-ray
• Schick panoramic and sensors
• Patterson EagleSoft practice management and clinical software
• CAESY Patient Education in all treatment rooms and reception area

We installed all new waterless vacuums and air as well as all new heating and cooling, plumbing, and roofing. Today we have a new building, and the reception by our patients has been nothing short of incredible. For the most part, they are ecstatic to be a part of this magnificent operation! I always had a shortage of waiting space in the reception room, and today have expanded it to accommodate about 20 chairs. Happily, we have become so efficient that we no longer have the long waits that were common for many years. What a joy!

To make a long story short, one year later almost to the day, things are running as smoothly as can be expected. I am close to having the right personnel in the right places, which is no easy task. (Sometimes there are good employees who are not computer literate, but who can still perform very meaningful tasks.)

We are totally paperless, and our year-by-year collection is up more than 20 percent in one year - and we were doing very well before! The computer generates lab slips and prescriptions, and I do not even carry a pen in my pocket. I don’t even wear a wristwatch.

Today, I have two full-time hygienists, four assistants, and two front-office personnel for the operation of the two offices. I share time with the practices weekly, - a total of 35 production hours. I am looking for more doctors to help. I consider the digital and computerization aspects to equate to at least one staff person - if not two or three - when I consider the management of a large volume of insurance forms, filing and pulling charts for the next day, and refiling charts. I think of the time my hygienist and I used to spend processing X-rays, not to mention the increase in quality and large size of the immediately processed film, as well as the patient’s reaction to this instant film and its considerable reduction in radiation.

X-rays that are instantly processed and viewable on-screen, including panoramic, intraoral, and instant film storage, are further technological advantages. I remember the days when we had films hanging in the office drying out from dip tanks. Often I will have a new patient who brings in old bitewings from a previous dentist in a film card, just like the old days. I get a chuckle out of looking at the film in the light. (I have since thrown my old view boxes away!) We now use an electric keypad like the ones in retail stores to sign documents, HIPAA and medical history forms, etc. Soon we will be using Patterson EagleSoft software to confirm patient appointments - no more telephone calls - and electronically process our credit card transactions.

When I come to the office each morning, I can scan the day’s entire schedule on all six computers in Newcomerstown and eight in Gnadenhutten. The color-coding on the schedule tells me what procedure is scheduled, and the colored ball next to the name tells me if the patient is in the reception room, in the chair, late, or dismissed. There is no longer a central sheet to consult to see where we are in the schedule. As soon as a patient arrives, it is noted on the screen. When the schedule changes during the day, we see those changes instantly. As a patient is treated, we make notes (many times using preconstructed auto-notes) at chairside in minutes, enter treatment codes, chart new treatment, make treatment plans, and estimate pretreatment (which used to seem to take hours to prepare). The next appointment can be set up at chairside and sent directly to the front desk without verbal communication. This sends an accurate report to the scheduler with no chance for error. I can pull the calendar, look at the schedule, and set up the next appointment very easily, even printing an appointment card for the next visit.

I owe my practice’s success to my patients, family, and staff. I thank all of my patients for the joy they have brought me and the trust they have placed in me. Without them, none of this would have been possible. I am grateful to my wife and family for their support. Additional thanks goes to my extremely dedicated team members who have been instrumental in my journey, many of whom have been with me for more than 13 years. This work would have been impossible without their efforts to embrace digital technology.

The journey to a paperless practice has been wonderful; I would do it all again. My advice: Take the advice of experts. Buy the best equipment available for the best practice imaginable