Table of Contents

Cover Story
Practice Building
View Point
Continuing Education
Implants
Restorative

Inside Dentistry

September 2014, Volume 10, Issue 9
Published by AEGIS Communications

Making Practice Management Software More Ideal

Cloud computing is taking dentistry in the right direction

Claudio M. Levato, DDS

Computers have been used in dentistry for almost half a century,1 starting as billing systems and evolving into indispensible multi-tasking solution systems for administrative, clinical, and communicative applications. For those of us who have lived with all the iterations of these applications, it has been a long, hard struggle, involving significant investments of time, energy, and money.2-10 Be that as it may, none of the dentists I have ever spoken to would revert back to paper, regardless of their frustrations.

The very few who have not engaged in some sort of digital patient record already will be precluded from rendering care for compensation from any federal health program. A key provision of the American Recovery and Reinvestment Act of 2009 requires that as of January 1, 2014, all public and private healthcare providers and other eligible professionals must have adopted and demonstrated “meaningful use” of electronic medical records to maintain their existing Medicaid and Medicare reimbursement levels.

Practice management software companies are continually investing in upgrading their products to provide better solutions for their users, and with the ever-changing technology applications in both hardware and software, the solutions become more complex and require ongoing investments of time, energy, and money. The question that frequently comes up is, “Why can’t this be simplified and cost effective?”

The Cloud

Cloud-based systems have been described as the ideal solution for dentistry; however, this technology is the new frontier and has a relatively small share of dental market. There have been growing numbers of dental software programs using web applications to solve many relevant dental management issues. The question for many remains, “Is it time to move our practice management to the Web?”11,12 The answer for many is yes.

There are small companies like Planet DDS (www.planetdds.com), CurveDental (www.curvedental.com), and Dentisoft Technologies (www.dentisoft.com) that have a decade or so of experience with satisfied customers and now are being joined by larger long-term dental software companies like Dentrix Ascend (www.dentrix.com) and MOGO Cloud (www.mogo.com), both of which have had client/server solutions since the early 1980s.

Cloud computing requires sufficient bandwidth to use the Internet along with any hardware that has Internet access, such as a computer, browser, tablet or smart phone. In cloud computing, the company using the physical infrastructure does not actually own the infrastructure. Instead, companies follow a pay-as-you-go plan for accessing resources and applications from a service provider. There are also services, such as those designed for the dental industry, that regularly enable subscribers to run highly sophisticated programs on their own equipment for a fee based on usage. These services offer the ability to employ a number of computers, hardware, software, and servers to meet computing and storage needs remotely without actually owning or running the software and hardware.

Benefits of Cloud Computing

Convenience

One has unlimited access anytime, anywhere, from any computer with sufficient bandwidth without concerns about software compatibility, processing speed, or data storage capacity.

Reduced hardware costs

There is no need to constantly upgrade equipment for speed and memory. All that is needed is sufficient processing power to run the cloud computing application necessary to connect to the cloud system, and there is no need for a large hard drive because information is stored on a remote server by the cloud provider.

Instantly scalable

More computer stations hooked into the business network can be added to or removed from the cloud at any time without impacting operation. There are virtually unlimited processing and storage capabilities for the use of cloud computing.

Constant backup

A great advantage of cloud computing is that it is clustered—meaning data are stored on a redundant server cluster with multiple backups and failover systems—so you do not have to worry about backing it up. You have real-time synchronization of data online with the cloud, so your data is always safe. Even if you lose connectivity, you will lose only what you have entered at the time the power goes down.

Risks of Cloud Computing

Dependence on available broadband connection

Effective cloud computing depends upon a broadband connection, which is not available worldwide. Uploading large data files, like three-dimensional visualization of DICOM and STL files, as well as PowerPoint and Keynote files, takes time.

Secondary connectivity

In terms of safety and convenience, the benefits of cloud computing all hinge on connectivity; therefore, a second Internet provider such as your cell phone wireless service becomes critical.

Future Advances and Applications

Historically, software updates have been a result of programmer’s attempts to incorporate end user requests into the software program. Unfortunately, dentists and staff have very limited knowledge about strengths and limitations of computer hardware and software, and software engineers have equally limited knowledge of dental procedures and protocols. To help address this problem, the University of Pittsburgh, under the leadership of Titus Schleyer, DDS, PhD, has developed a Biomedical and Dental Informatics Program that offers advanced degrees in the new arena of healthcare computer science.

More insight into the future of practice management software development comes from a PhD dissertation by Thankam Paul Thyvalikakath, DMD, MS, PhD, titled, “Designing Clinical Data Presentation Using Cognitive Task Analysis Methods”.13 Dr. Thyvalikakath evaluated the existing status of our EHRs (electronic health records) and argues that using cognitive task analysis methods in the software design phase, rather than just in the testing phase, will bring practice management software to the next level of usability.

One current problem with EHRs is that they are not user friendly, making it difficult for clinicians to navigate through the system and obtain an integrated view of patient data during administration of care. If cognitive task analysis principles were used to help design dental practice management systems, it would mean observing the cognitive processes and information management strategies used by dentists during a typical patient exam and using the results to inform the design of a dental EHR interface. Dr. Thyvalikakath found that taking this approach yielded “systems that provide clinicians with better cognitive support during patient care [and] will contribute to enhancing the quality and safety of patient care, and potentially to reducing healthcare costs.”

He also calls for further research on the impact of the information presentation and visualization in current systems on clinical decision making activities of clinicians to determine how it affects their practice and the delivery of optimal patient care.

Conclusion

Dental practice management systems have been and will always be a work in progress. Looking back to the early days, what is available today is so much better and relatively inexpensive due to phenomenal advances in computer technology. In 1987, the clinical workstations I placed in my operatories to accommodate digital radiology, voice-activated charting, and intraoral cameras required proprietary cards for each application that cost additional thousands of dollars for each station, not including the proprietary software and devises.

Today most applications are plug and play with greater speed, reliability, and compatibility. Taking this to the Cloud is another step in simplification and greater flexibility with significant hardware savings. I have no doubt that sooner rather than later, every practice management software company will have Cloud options for their users. My recommendations for dentists looking to invest in their digital patient record is to first work with your current source to see if their latest version meets all your needs. In most cases, upgrading hardware, software, and training will be more cost effective than a completely new system and the costs of retraining outside your staff’s comfort zone. This leads me to a critically important parting thought about dental practice management software—involve your staff in the entire process of investigating and determining the best solutions for your particular environment; this will maximize success and minimize intentional and/or unintentional sabotage.

References

1. Delrose DC, Steinberg RW. The clinical significance of the digital patient record. J Am Dent Assoc. 2000;131(suppl):S57-S60.

2. Levato CM. Integrating computers in dentistry: a front line perspective. Dent Today. 1997;16(4):124-127.

3. Golub WS, Levato CM. An educated vision about software. Dent Econ. 1997;87(8):30-32, 34-36, 38 passim.

4. Levato CM. How to profit from computers. Intangible benefits of climbing new peaks. Dent Econ.1998;88(8):90-92, 94.

5. Levato CM. Technology integration: a journey, not a destination. Compend Cont Educ Dent. 2002;23(10 suppl 2):4-10; quiz 19.

6. Levato CM. Putting technology in place successfully. J Am Dent Assoc. 2004;135 suppl:S30-S37.

7. Levato CM. Dental practice management software. Contemporary Esthetics and Restorative Practice. 2005;9(2):42-44.

8. Farman AG, Levato CM, Gane D, Scarfe WC. In practice: how going digital will affect the dental office. J Am Dent Assoc. 2008;139 suppl:S14-S19.

9. Levato CM. Management systems: the glue that holds a practice together. Compend Contin Educ Dent. 2011;32 Spec No 4:10-2.

10. Levato CM. Dental practice management software: choosing the right solution. Compend Contin Educ Dent. 2013;34(10):732, 734.

11. Meyer E. Cloud computing: is it time to get on board? Inside Dental Technology. 2012;3(2). www.dentalaegis.com/idt/2012/02/cloud-computing-is-it-time-to-get-onboard. Accessed July 23, 2014.

12. Jablow M. Is it time for the cloud to come to your practice? Dent Econ. 2011;101(8). www.dentaleconomics.com/articles/print/volume-101/issue-8/features/is-it-time-for-the-cloud-to-come-to-your-practice.html. Accessed July 23, 2014.

13. Thyvalikakath TP. Designing clinical data presentation using cognitive task analysis methods [dissertation]. Pittsburgh, PA: University of Pittsburgh; 2012. http://d-scholarship.pitt.edu/13518. Accessed July 23, 2014.

About the Author

Claudio M. Levato, DDS
Private Practice
Bloomingdale, Illinois