The Orthodontic CYBERjournal: Starting a New Paperless Orthodontic Practice, Dr. Jesse Dana

Starting a New Paperless Orthodontic Practice:
Tips for the New Graduate and Existing Practices

When starting an orthodontic practice, many factors go into achieving a quick, successful start. First and foremost is to compile a proper business plan that includes research on population, demographics, office equipment and supplies. A good business plan makes it much easier to secure a loan and may, in fact, make you a very desirable candidate for a loan with competitive rates and terms.

I will now give you a photo tour of my recently established practice which got off to a fast start. As we begin, I want you to know that having unique aspects to our office that positively impress patients has been invaluable to our early success.

Above you will find an Internet terminal that allows patients and/or parents to surf the web or check E-mails. One concern with this however, is patients accessing inappropriate web sites. To prevent this, the computer has a program (in our case, NetNanny 5.0) blocking such sites.

On another wall, a PlayStation 2 is available for the enjoyment of patients and parents. We have many games and find the PlayStation 2 in big demand.

To the right of the PlayStation 2, there is a TV/VCR combination where waiting children can select movies to watch. This is great for younger children and keeps them occupied while their siblings are being treated. We also have a plastic Lego table that can be easily and regularly cleaned.

Another big hit is our cappuccino machine. We offer parents a choice of cappuccino, coffee or hot chocolate. The kids are also given a hot chocolate after their appointment is completed .All these extras make patients feel comfortable and welcome when they arrive at our office. (Care must be taken to follow the disinfection and maintainence of dispensing machines.)

One characteristic that can help separate your office from others is to use the latest technologies. In order to do this, it is imperative to choose software that will allow the options you want for your office. There are many software companies and choosing the right one for you is critical in ensuring that your office can operate the way you want. (Our office chose Advanced Ortho Systems). Most of our workstations are thin clients with flat screen LCD monitors. Thin clients are dummy terminals without hard drives that connect to and display anything on your server. It is beneficial to buy thin clients with Windows XP Embedded; a limited version of the Windows XP system. Thin clients do not have hard drives and therefore cannot be damaged by viruses. They also cost much less than a typical PC (as low as $500-$600 per terminal), last much longer, and don't have to be updated every 2-4 years. It is important to make sure that your software is compatible with the use of thin clients. This can dramatically reduce the computer/hardware cost in starting an orthodontic practice, or becoming computerized in an existing practice.

Another choice is whether to purchase a server which can cost thousands of dollars, or to have your software company host the server through Application Service Provider ('ASP') or Internet Program Delivery ('IPD') services. ASP/IPD utilizes the Internet to communicate with an offsite server containing the software and your patient data. Costs can be as low as $150-$200 per month; however, this is dependent upon which software company you use, as most do not support ASP/IPD. With Advanced Ortho Systems ('AOS') we are able to use IPD. AOS does daily backups of our data on multiple servers; they also prepare two monthly DVD backups, archiving one and sending one to our office. This eliminates backup failures and also reduces office/staff time. Another benefit of ASP/IPD is that it allows the software company to work on your system without requiring the staff to spend excessive time on the telephone. In some situations, the staff must call in and have the software company technical support staff walk them through the procedure to correct the problem. The technical support staff may need to log on to the office computer for long periods of time to resolve an issue. With ASP/IPD, if there are any adjustments that need to be made, the server is at their location and they can fix the problem without requiring your staff to be on the telephone or tying up one of your office workstations. Program updates can also be done when your office is closed. Updates are done immediately as the software company updates their server; you do not wait for disks to be sent in the mail. Another great advantage is that you can log on to your secure server (as long as you have the address and your password) from anywhere that has an Internet connection. This works great for satellite offices and allows you to work from home, while on trips, or at meetings.

Upon entering our reception area you will find a touch screen check-in monitor that displays patients' names, photo and appointment times.

The patient touches his or her name or photo on the screen and the photo enlarges with a personalized message (How was your soccer game? etc).

A non-touch screen LCD monitor can be used; however, our patients enjoy the interactive monitor. This check-in communicates to other workstations throughout the office that the patient has arrived and helps us stay on schedule.

In the treatment room, each treatment chair is equipped with a thin client and touch screen monitor. Contaminated touch screen monitors can be cleaned with disinfectant, which can be convenient when viewing images. However, touch screens are much more expensive ($800-$1,000 each) than LCD monitors and are not essential. For convenience, a non touch faucet may be installed on the sinks. Placing your knee against the door of the cabinet starts the faucet and decreases contamination.

As you enter the consultation room, you see a consultation table with a Notebook PC, a treatment chair and a 42" plasma television. The plasma TV has great benefits as the patient is able to see his or her photos enlarged, which makes explaining and understanding treatment much easier. This may increase the patient's acceptance of treatment as understanding is enhanced. A Notebook PC is used rather than a thin client because we use OrthoMation and it is not currently supported as a web based service.

In the back of our business office, we have our imaging station which includes a desktop PC. This is needed to load digital images to a hard drive so the images can be uploaded to AOS. We also have a professional scanner (we use Epson Expression 1680) which allows us to scan any x-rays, transfer records, or forms (with signatures) into the computer. This allows us to operate paperless and be able to view forms in AOS that require signatures such as informed consent, medical history, and financial agreements.

Our bathroom was decorated to provide a comfortable setting and we installed an automatic sink and automatic flushing toilet. This was done for patient comfort and enhanced sanitation; it is also consistent with the high technology used throughout the office. The extra attention to detail in designing the restroom helps assure patients that the Doctor and staff demand the best for their patients.

Our lab has a thin client which allows us to view panoramic x-rays for indirect bonding procedures. The schedule and patient charts may also be accessed. We placed telephones in all our rooms. This allows for fewer staff members if you are opening a new practice or in an existing practice. Having workstations and telephones in all rooms (including the lab) allows appointments to be scheduled from anywhere in the office. Operating expenses can be decreased since one full time cross-trained employee can access everything needed, wherever they are in the office. In existing practices, this allows communication through the telephone as well as the computer system.

Another important selection is the printers to be used. We use a color laser printer to print all materials including school absence slips, receipts, patient pictures, etc. Our choice was the Minolta Magicolor 2350EN which prints photo-like pictures on plain paper. The Magicolor color laser is relatively inexpensive with exceptional quality on plain paper. This helps reduce the costs incurred in using expensive photo paper without compromising quality. An alternative printer, also with excellent photo quality on plain paper, is the Minolta Magicolor 2300. It is good to have an inexpensive inkjet printer as a backup. We have an HP OfficeJet 6110 all-in-one unit that gives us a backup inkjet printer, if needed. It is also used to make copies and serves as our fax machine. This is an affordable way to have all of these options. We take digital pictures at the patient's initial appointment, load them into our imaging software (we use VistaDent) and print them to send home with the patient at the conclusion of the appointment.

Our AOS software allows us to customize the treatment chart to our needs. We have patient codes that we can fully configure for our initial exams and display on the plasma TV in front of the treatment chair as the exam is conducted. A treatment coordinator enters the patient codes on the Notebook PC while the doctor completes the initial exam. The customized patient codes are then merged to all of our letters. We then print an initial exam letter containing our findings to send home with the prospective patient. As a result, he or she leaves with a letter explaining the malocclusion and treatment benefits, a photo composite and fee information. This gives the prospective patient two positive items to take home to show family members along with the fees, thereby adding value to the proposed treatment. You may also enter a treatment plan later into the patient codes and it allows customized letters to be merged. For example, referral doctor letters (including photos, malocclusion and treatment plan) and insurance letters can be merged which saves office time. Any type of letter can be customized and merged with these patient codes and their pictures.

Providing a high technology office can decrease staff time, increase efficiency, improve patient acceptance and starts, and place your office in a one-of-a-kind memorable category. However, most important of all is to treat the patient as if he or she is the most important person in your office; like a part of your family! Our goal for each patient is for him or her to leave our office excited and amazed (Raving Fans¹ ) because we have greatly exceeded their expectations!

1. Blanchard K, Bowles S. Raving Fans. William Morrow and Company, Inc. New York. 1993.

About the Author: Dr. Jesse M. Dana received his dental degree (D.D.S.) at the University of Nebraska Medical Center in Lincoln, Nebraska. He completed his orthodontic residency at Nova Southeastern University in Davie, Florida. Dr. Dana lectures at the Nova Southeastern University Orthodontic Department and is co-author of 'Comparative Study of Lateral Cephalometric Analyses: Manual, Dolphin 8.0, VistaDent 9.0,' an upcoming article in the Journal of Clinical Orthodontics. Dr. Dana is in the private practice of orthodontics in Spearfish, South Dakota and his high-tech, state of the art practice has been featured, complete with color photo spreads, in two newspapers.