Nothing But Net
by Barry Freydberg, D.D.S., F.A.G.D., F.I.C.D.
An old story:
A woman was preparing to cook a roast. Before placing the roast in her pan, she cut the end off and placed it next to the roast. Her husband asked, "When you make a roast, why do you cut the end off and place it next to the rest of the roast before placing it in the oven?" She responded, "I'm not certain, but that's how mother taught me to do it. When mother comes over for dinner tonight, we'll ask her." When mother arrived, the daughter asked her, "When you taught me to make a roast, why did you teach me to cut the end off and place it next to the rest of the roast before placing it in the oven?" Mother answered, "I'm not certain, but that's how your grandma taught me to do it. When she comes over for dinner tonight, we'll ask her." When grandma arrived, they asked her, "When you taught us to make a roast, why did you teach us to cut the end off and place it next to the rest of the roast before placing it in the oven?" Grandma answered, "Because my pan was too short to hold the roast!"
I've begun many lectures and articles with that story. In order to maximize present and future technology, we need to forget our old paradigms, and let the technology flow into our lives. If we resist, then the inevitable social-technological changes will pass us up, and our ability to participate, compete, and thrive will be thwarted.
What are theses future technology driven changes we might expect to change our day-to-day professional lives? Most of these are already here, but not yet adopted by most of us.
The original computer technology in dental practice, now accepted by over 70% of dental practices, was used to send statements and manage patient accounts. Soon afterward, they were used to prepare, print, and track insurance forms. Later, the systems generated "recall" or "continuing care" notices for patients and tracked overdue patient visits.
The next step in computer use was to monitor treatment plans. This meant tracking incomplete dentistry (our true practice inventory) and providing patient handouts describing the services they require. Additionally, taking all the information within the system and using it to benefit the practice resulted in increased new patient referrals, treatment plan acceptance, productivity, recall effectiveness, growth, and profitability. And, if a practice participated in managed care, the system monitored the profitability of the program.
Later, scheduling electronically became the norm, when good electronic schedulers, properly integrated with the rest of the practice data, were developed. This led to the next step of practice decentralization; the placement of computer terminals wherever transactions are made. This has been the most significant boon to dental practice management we have seen in our profession. The "reduced paper" practice has now become a reality. A reduced paper practice equates to: electronic scheduling, electronic progress notes, electronic claims, telemarketing, telemanagement, electronic tooth charts, electronic periodontal charts, electronic radiographs, electronic patients images, video conferencing, electronic journals, Internet access, extensive use of e-mail, and image transmission.
But now, another new pan is being incorporated into our professional and personal lives with blinding speed! Just as cost reductions have allowed us to participate in other new technologies, the Internet will allow us to reach capabilities not yet even imagined. The Internet, and it's technology, driven by outside influences such as the government, universities, our children, insurance companies, available up to date information, and ease of use, will be a key player in reshaping our personal and professional lives.
What kind of changes might the Internet soon cause in our profession?
Patient Records on the Internet (and/or Intranet). It is likely that your practice will have secure patient records on the practice Intranet. These records, along with personal practice information, will be on your internal Web Site. Patient records, x-rays, progress notes, retirement plans, office manuals, and employee records will be secure and kept in the Internet paradigm. A "fire wall" of security will protect them from "outside".
How certain is this prediction? Very! Already, some insurance companies are experimenting with medical records on the Internet, each patient with their own "home page", accessible from the doctors home, office or hospital. Our government wants "outcome analysis", in order to determine what modes of treatment are the best and most reasonable for a particular ailment, and most dental problems are ailments. Only with electronic records can this analysis be achieved.
Even some medical malpractice companies are beginning to offer malpractice premium reductions to doctors using electronic records, since they are usually more complete, secure, legible, accessible, unable to be changed, and can be duplicated if lost or destroyed. Some medical schools are beginning to use hand-held computers for record keeping, requiring their students to be computer literate. The direction is clear, we will have electronic records.
Expect your patient records to have hypertext links related to information in the record. Expect a patient's drug regimen to link to the PDR or its equivalent. Expect their medical history to link to references about their medical problems.
Electronic claims will grow, but use the Internet. It is likely that our office computers will access the websites of insurance companies or clearinghouses, instead of the way we send electronic claims today. Transferring x-rays and images will be no different than the way we send files and images over the Internet today. And clicking on the patient's insurance record can give us their benefits and eligibility instantly.
- Continuing Education credits earned on the Internet. This exists today and will grow. Learning with text and subsequent tests on the Internet is growing in popularity. Soon the education will be in full multimedia video and audio, but for now it's already adequate.
- Comparative supply ordering is on its way. You can already order supplies through the Internet, but expect this capability to also grow, along with inventory control, MSDS sheets and product instructions, all already on the Internet. In multi-practice purchase contracts, the Internet is the ideal way to get supplies to you at low cost.
- Roving specialists. One of the changes in the dental profession delivery model is the "roving specialist". They go from office to office, or work within multi-location practices. How should they be scheduled, do their billing and record keeping, record x-ray and image reviews? Obviously, through their Internet connection.
- Confirmations, billing, reactivation, recall and other patient communication will be done with E-mail over the Internet. Our leading dental computer management vendors are aware of the fact that in addition to "printing labels" or "printing envelopes", they need to "print to E-mail", sending E-mail instead of paper notices. E-mail is less expensive, quicker, and most likely to be read and responded to fast!
- Teledentistry consultations will become popular. Consultations with leading authorities in dentistry will be possible on the Internet. Whether clinical or management, the availability of experts will increase the level of dental practice everywhere. Remember, we have a new pan, we are not talking about the USA and Canada, but the world!
- FTP, File Transfer Protocol will be used frequently. Obtaining software and retrieving files through the Internet will become more commonplace. Whether sending x-rays or graphic treatment plans to patients, colleagues or specialists, or receiving software or text, we will no longer use yesterday's traditional mail or trips to the store.
- Chat rooms, newsgroups and mailing lists based upon our own interests, will enable us to practice better dentistry. And, it will also help the rural third world country dentist obtain the education necessary to change the world's level of dental health care. Assume that since most of the Internet uses the English language, in a few generations, educated people throughout the world will communicate in English.
- The World Wide Web and your Home Page. Interactive marketing and distribution of information to present and potential patients is already underway. Go look at the dental practice Internet Sites. Staff introductions, services offered, before and after cases, hours, testimonials, maps, newsletters, links to other sites and Internet hookups in your reception area for business people and patients have already become a reality in some practices.
Is it fair to call these "predictions"? Not really. They are already here. None of them will go away, and frankly I think they'll be great. The Internet will become an interactive television/audio medium, while television as we know it will disappear. They will become indistinguishable.
You probably already have a new pan in your office or at home. If not, check your children's room, It's probably there. But, you may not be using it, or may be only using it for fun, not realizing its present and future potential.
Yes, sometimes I monitor flights on the Internet, watching their progress. And I do read the sensors placed every 1/3rd mile on Chicago's expressways before I venture out. And I do have the Internet draw a map of an unfamiliar address I am going to. I have also been known to even pop bubblewrap. I monitor my frequent travel awards on one site, check wholesale car prices on another. I read book reviews from experts and readers before buying, do research on any subject, send flowers, check speedtraps, find long-lost relatives (and was recently found) and friends, check weather, travel information, wine, movie times and reviews, restaurants, bike trips, cruises, politics, subway and airport maps, order theater tickets, and if I continue, this article will never end.
So, take out your new pan. It's so much fun. Like anything else good, it can get out of control and become addicting. Learn how to use it now, and then you'll be ready to take advantage of it as the technology matures and becomes secure.