When Data and Images do not Compute
by Barry Freydberg, D.D.S., F.A.G.D., F.I.C.D.
Seamless integration is a loosely used term these days. Don’t assume it applies to all intraoral camera, digital radiography, or practice management software programs.
For all the benefits that intraoral video cameras, digital cameras, and digital radiography offer, they also present us with a considerable challenge. If we want to work efficiently with these technologies, they must work well together with our practice management software.
Getting these systems to work harmoniously has been no easy task in our group practice. In fact, our main goal this summer was to get all of our diagnostic and intraoral camera images to integrate seamlessly with our practice management software in all of our operatories. As of this writing, we’re working with an independent technical consultant on sorting out our hardware and software needs. It appears we’ll be able to keep some of our intraoral video cameras, but we’ll have to replace others. We also need to replace our current digital radiography system.
Some of the difficulties we’ve encountered are due to the fact that each of our components (intraoral video cameras, digital radiography, and practice management software) was purchased from different vendors at different times. Compounding the complexity of our situation is that we have a large, busy practice. In addition, some vendors from whom we bought equipment are no longer in business or have been acquired by other companies. In the case of our digital radiography system, we haven’t received the level of technical support we expect from the manufacturer.
This hasn’t soured me on these technologies. I know they work well as stand-alone systems. The challenge has been in getting them to work together.
The American Dental Association’s dental informatics committee has been working with technology vendors on creating standards to help address this issue. (For more on this, see related story below.) But even with the progress that has been made, it’s clear that the "seamless integration" so many vendors tout with their systems is a work in progress.
With this in mind, the onus remains on us to make sure the systems we buy live up to vendors’ promises. This means we’ll have to adhere to a standard I’ve echoed many times. When evaluating whether a given system will meet your expectations, live by this rule: Don’t purchase the system unless you’ve seen it functioning well in another doctor’s office who has a similar configuration to the one you’re planning.
I can’t overemphasize the importance of this point with regard to managing images and how they pass through practice management software programs. The software bridge that the vendor of your image-capture components (digital radiography, intraoral camera, etc.) creates must interface effectively with your practice management program.
If it doesn’t, here are just a few of the problems or frustrations you may experience (all of which happened in our practice):
- Difficulty in transferring images and/or data into the patient’s electronic chart
- Repetitive entering of the same patient data into two different databases
- Frequent loss of connection to the computer network when performing certain tasks, such as adding a new periodontal chart to the system
- System crashes, i.e., terminals freezing
It can be difficult to determine the exact cause of problems like these. Your individual system vendors may attribute problems you experience to one another’s software.
The result in these situations is that you may become frustrated and not use the systems as often as you would like. Also, we have to realize that, particularly in the case of digital radiography, components from different manufacturers aren’t always compatible. Before you add hardware, it’s a good idea to have each vendor approve the equipment you plan to buy.
Until there is a universal compliance with standards that have been and are continuing to be implemented, we have to be educated shoppers. We should visit the offices of colleagues who have successfully linked the specific systems we’re considering buying. We need to interview these sources before purchasing to develop a complete picture of a system’s strengths and limitations.
If you’re considering buying a digital radiography system, for instance, ask the vendor for a list of customers who use your particular brand of practice management software. Select candidates from this list to interview.
Ask them questions such as the following:
- Can you access all images and practice management data from any location in the practice, not just the room in which the images were captured?
- Has your system crashed or frozen? How frequently?
- Are all of your X-ray and intraoral camera images backed up at once or does each have to be backed up separately?
- Are you satisfied with the technical support you’ve received?
- How many different software programs did your staff need to learn?
The bottom line is that the quality of your vendor is more important than any specific features a system offers. Place greater emphasis on quality of software support than system price or nuances between systems.
It’s true that today’s software programs are superior to those that came before them. In fact, many of our team members who are not overly experienced with our computers don’t even complain to me about the fact that they have to exit our digital radiography software program to enter our practice management system. They will appreciate the difference, though, when we achieve true seamless integration.
New integration standards emerge
Ideally, digital radiography systems would communicate flawlessly with each other and universally transfer images among different systems. Users would be able to choose image-capture components from different digital radiography vendors with the assurance that all would function smoothly together.
Wake up and smell the mocha latte, you say? It’s going to take a while for this level of compatibility to be achieved, but progress is being made.
The American Dental Association’s dental informatics standards committee has supported the Digital Imaging and Communications in Medicine (DICOM) standard. Dr. S. Brent Dove, who chaired one of the committee’s working groups for seven years, reports that DICOM and subsequent standards being proposed and acted on will benefit dental technology users.
DICOM compliance provides the mechanism by which digital X-ray images can be sent from one database to another. Images would retain their original features, including the patient’s name, tooth number and date, even if they were transferred to another system.
"DICOM is designed to benefit both vendors and doctors," Dove notes. "It puts in place standards that should help facilitate development of plug-and-play systems so we can do our jobs efficiently and cost-effectively in the digital world."
The Digital X-ray supplement to the DICOM standard was approved in August of 1998, Dove notes, and supports virtually every type of dental radiographic image (e.g., intraoral X-ray, cephalometric, panoramic, tomographic.) It applies to diagnostic image-generating systems, not to images used for documentation purposes (e.g., intraoral video camera images).
Vendors who claim their systems are DICOM-compliant must be able to produce a DICOM conformance statement.
"I don’t know of any manufacturer that meets the DICOM standard today, but I know it’s very high on manufacturer’s priority list to meet the standard," Dove says.
Until manufacturers meet the new standard, Dove suggests doctors who are considering buying digital radiography systems discuss with vendors how to obtain DICOM-compliant software upgrades when they become available. Vendors may charge for these upgrades, he says, but that is to be expected given what manufacturers will have to invest in system development to meet the standard.