The
Road to Paperless Nirvana
I
would suspect any orthodontist who has a few years with his or her computer
system hears the call of the “Paperless Nirvana”.
Most of the big players in orthodontic management software all tout
this goal as the ultimate one in office technology.
However, every time each one of us thinks about becoming paperless,
we also come up with the “but, what if?” and the “how could it do this?” scenarios
that brings us back to our paper and film based realities.
My
vision for “paperless” has its foundation based on twenty-one years of dreams.
In 1982, I entered a practice as an associate working in an office
with a ‘state-of-the-art’ system that was the size of a small refrigerator,
had 10 mega-bytes of memory and handled all patient accounts. Just their accounts mind you, no scheduling,
letter writing, etc. just accounts. Progressing
through the years, I am now on my 5th system, one that is truly
capable of providing all that is needed for a paperless operation.
My
goal is to describe my thoughts and the decisions that led me to where I am
today. I will also offer my observations on my current
software, its company and where I see it heading in the future.
Working
with orthodontic software companies is like dating.
After the initial passion and lust for the ‘best’ system, you find
a company that suits your personality, has answered all the questions right
and or has the best price for the product and support.
Now, reality sets in. That initial
passion is tempered with the understanding that as your relationship develops,
you both have responsibilities. You
pay for product, support and service that they are contractually bound to
supply. They try to provide training, even though we
might not have blocked off the entire day for training. They try to make software that is user friendly
and yet very user definable. They rely
on us to enter data accurately and use the software as designed.
We as ‘users’ rely on regular upgrades, prompt support and a reliable,
non-crashing system. It is a relationship much deeper than most
imagine or acknowledge. Both parties
have the ability to make the other look good or bad. The question is how do you choose?
I
chose Advanced Orthodontic Systems,
LLC (AOS) led by Charles Lewis based on my relationship with him since 1993.
At that time, he was with Integrated Management Systems (IMS).
This company’s software offered many innovative ideas running on reliable,
economical hardware that prompted my conversion from my 2nd system
and first comprehensive software, Analog Digital Services (ADS).
Around 1999, Charles Lewis decided he had a different vision for orthodontic software development and he sold out his majority in IMS to start a new orthodontic software company, CPI Technologies Corporation (CPI stands for ‘computerized patient information’). At this time he shared his business prospectus with me and I was impressed. Not only had he analyzed the orthodontic software market and vendors, he had also described a direction for development that was impressive and innovative. I was faced with the dilemma of having to upgrade my software due to new program changes when all software went from DOS to Windows. I had to choose either a new IMS version or be a ‘beta’ development site for CPI. I chose CPI based on his vision and a feeling that he would provide what he had described in his prospectus.
As with any conversion, not everything goes exactly as planned. Little surprises are found that require unplanned fixing, etc. After minor glitches, the new hardware and software was in and running smoothly. Data conversion (provided by CPI) transferred all critical information. Patient conversion and staff training were unremarkable. Around 2001, CPI developed a relationship with American Orthodontics that offered CPI the opportunity to focus additional efforts on the orthodontic software market. A new sub-company of CPI was formed, AOS, to focus exclusively on orthodontic software. Around this time, wireless Internet access became a reliable networking option. Finally, I was ready to make my biggest step towards going paperless.
As of July 2003, I took the plunge with a new upgrade from AOS to its IPD (Internet Program Delivery) version. At this time I also added wireless workstations to all chairs. This software was significantly different from the CPI and AOS original versions. Most unique was the fact that the server for the network was based in their office: connection to the network was done via the Internet.
Why would I do that, you ask? The advantages - they have the software all the time to tweak, revise, correct, and improve. This means not waiting months and months for the next upgrade. They are responsible to back it up daily, on redundant servers in various locations to insure security and access. This is better than my best efforts in-house. This set-up allows for inexpensive, reliable ‘thin-client’ hardware that is tailored for limited scope applications like in orthodontic offices. It requires no big in-house server or hard-wired network. No on-call network service person was needed to set it up. My old hardwired network and workstations integrated seamlessly. The new ‘thin client’ laptops at the treatment chairs were a snap to set-up. From the hardware side, the conversion went easier than I had expected.
On the disadvantage
side there were few. There is always some expense with new hardware
upgrades, but ‘thin-client’ units seem to run about
60% of the cost of a conventional workstation. We have had some minor irritations with Internet
connectivity affecting the speed of transmission or occasionally breaking
the connection. This however does not
cause loss of data or corruption; you just log back on and proceed.
All in all, the downside list is short and technological improvements
related to Internet connectivity will only make it shrink even more.
Another reason I jumped, is that it was new. I’ll admit it. New technology and applications excite me. It seems many orthodontists are techies, gadgeteers at heart, always wanting the newest, fastest, and latest model of whatever. I could also see future applications and expansions into increased patient Internet applications for the office. And as you might guess, I am one of those orthodontist-gadgeteers who like to stay close to the leading edge.
Now, four months later, where am I? How is my orthodontic software relationship going? Great!! I still firmly believe that the company, AOS, is innovative, it gives us excellent support and training. More importantly, they give us what they have promised. They do what they say they will and pretty darn close to the timeframe that was promised as well. The software is stable (both original CPI version and the AOS IPD version) and has had no crashes. I am still learning the nuances of the new IPD software; but each day my staff and I know we are one day closer to that paperless nirvana. Now it is not I who is pushing for this change, but often them. They, too, can see the vision.
I routinely email the AOS support team with questions or suggestions. They regularly answer. Sometimes it is with a program modification. Sometimes it is with additional training or an explanation on how to use the software. And yes, sometimes it is with “we will consider that for future upgrades.” My track record with those responses is that they really do consider them. Often I find these suggestions in later program modifications.
I look forward
to expanding my use of this very sophisticated and comprehensive software.
It will lead me to being paperless. Currently, all my patient data, scheduling,
accounting/insurance, treatment, diagnostic, letter writing is done via the
software. My goal is to stop pulling
those old paper charts as of January 1, 2004.
I had gone digital on radiography as of 2002 and I had been a Dolphin
Images user since 1996. These areas
are integrating nicely. I still need
to work out my scanning arrangements for input of incoming paper forms and
correspondence. I look forward to adding
a tablet PC for patient use so that they can complete their “paper” forms
directly into the system (for items such as personal information, health history,
insurance, informed consent, HIPPA, etc.). The software and technology are already there,
but my staff and I can only accommodate so many changes at once.
In a few years, I envision the keyboard will be replaced by voice recognition. E-mail will likely replace most phone use and I foresee consults or treatment discussions being done routinely via the Internet. Patients will expect and demand such service as routine, not extraordinary. Keeping up with this pace of change will be a challenge.
Thanks
for reading through this missive. The
publisher requested that I provide this story as an example of a positive
experience with a software company. I
have worked hard to find good companies and have been rewarded over
the years with many good systems. I
have learned a few things from the various ‘bumps in the road’ as you might
expect and I will share those as well. What
have I learned and what would I do differently with all these experiences? Three things.