November 2001
"He is a techo-geek with a sense of humor."
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First Things First
A Step By Step Program to Develop the High Tech Dental Office
Where do you begin to develop the ideal high tech dental office? It seems obvious that you start with the first things first.
Starting with first things first is so important Stephen Covey identified it in his famous book as one of the "Seven Habits of Highly Effective People ". Covey also wrote that you should " begin with the end in mind". In other words know where you are going before you start.
Your ideal dream high tech office of the future starts not with technology but with a vision. Once you know where you are going there are five steps to help get you there.
- Establish a technology Infrastructure.
- Consider the "Big Two" digital images and digital radiography
- Add advanced dental applications.
- Remember there are many non dental programs which are very useful in dentistry
- Keep a future focus.
The Technology Infrastructure: The very first step must be to install and use a good, complete, integrated practice management software like Dentrix.
The second element of the infrastructure is to establish a network with treatment room based computers. In other words, computers in the operatory. The are many reasons for this, however the most compelling is that a computer in the treatment room is the most logical and the most effective way to use computers in dentistry. Dentrix is designed to be used with clinical computers and is far more effective when used in the operatories.
What makes treatment room computers so powerful is that they allow for the electronic transfer of information from the clinical area to the administrative area then on to anywhere it may be needed, including a third party. That simple process is the key element in the digital revolution and leads to all the other high tech marvels we can use in the dental office.
The Big Two: Once the infrastructure is in place the next step would be to consider what might be thought of as the Big Two, digital images and digital radiography. These technologies have been available for many years, they are fairly mature in their development and they are essential if the dentist wants to use a truly paperless, digital patient record.
It is possible to use these systems without the infrastructure in place. However it is hard to do well and most offices that try it do not get the full benefit of the technology. For example trying to use digital radiography on a cart system moved from room to room is possible but very awkward. Since it must be moved it tends not to get used. When it is used the cart must always follow the patient to any room where x-rays are to be viewed. If the radiography system isnt integrated with a digital chart it requires extra time every time it is used to set up proper patient files and such.
The actual computer functions involved in image management and radiography management are very similar and the most advanced software like Dentrix Image 3.0 packages these systems together.
Advanced Dental Applications: There are an amazing number of advanced applications for dentistry that can be added to the basic system once it is in place. These range from interactive digital patient education programs to computerized probes, to diagnostic software, to blood pressure monitors, to jaw tracking devices, to data bases such as a drug program to replace the old fashioned paper PDR.
Once again it is possible to use any of these systems without a proper infrastructure but it seems foolish. For example, do you really need a complete computer system just to record perio probings or to monitor blood pressure? Of course not, but if the infrastructure is in place these applications are relatively easy to add and cost effective.
Non Dental Applications: There are many programs developed for general business use that have great value in the dental office. The most obvious of these is word processing, every dental office should have word processing capability from the moment the office is computerized. As a rule these general business programs are very powerful and cost much less than specialized dental applications.
Other examples of non dental software would be check book accounting, time clock, spread sheets, slide show, remote access, virus protection and data back ups.
Future Focus: If there is one fundamental truth about technology it is that it is going to change. For this reason it is best to plan for flexibility. Dont get locked into one solution. Plan for change with modular systems and accessible wiring channels.
For example one change looming on the high tech horizon is the Internet. It is not essential that a dental office be using the Internet now but we will see the net being used in very creative ways to benefit dentistry in the next few years.
We have seen the future and the future is digital If you
want to control that future begin with the end in mind. Develop
a vision of your preferred future and what part technology will
play in it. Do first things first. Establish the technology infrastructure
before you try and add on advanced programs. And remember, The
Future is Coming and it Will be Amazing!
Saving Money on High Tech
By following the advice in this newsletter over the last five years dentists could have conservatively saved well over $120,000. This includes hardware buying, room layout efficiency, management systems and so many time saving tips they can't be counted.
Why Computers Crash
If you have ever used a windows computer (as all Dentrix users must) you have seen the infamous "Blue Screen of Death" This is a solid blue screen ( and it is a very pretty shade of blue) with white lettering that tells you your system has crashed. Alternatively sometimes the computer just stops responding to commands. The mouse curser doesn't move and the keyboard is nothing more than a useless piece of plastic.
By Definition: "A computer crash occurs when the machine stops working and no longer responds to user input. The cause of most crashes is usually a program trying to do something it shouldn't or the lack of available resources such as memory"
The Blue Screen of Death is really just a serious error message. If you recorded the message such as "Core Dump" which refers to RAM messages it is possible that you could pass this on to a windows expert who could prevent the problem from re-occurring. But lets get real no one ever does that. Most of just say a prayer of thanks to Microsoft, hit Control/Alt/Delete and re-boot, hoping we haven't lost too much critical data. By the way, the Microsoft Prayer is any phrase that uses both God and Microsoft in the same sentence.
An Infinite Loop is one of the many errors that can cause a crash. A loop is a series of instructions that gets repeated until a specific condition is met. When a condition can't be met the loop cycles endlessly, never quits, never moves to the next part of the program.
Another problem is Thrashing. All computers have a limited amount of resources, such as memory or processing capacity. When a user makes a request that can't be met the system borrows the resources from another process. But then the borrowed from process needs help and looks to borrow from yet another process. And so on and so on. Eventually the entire system is looking for help and the user is looking at a blue screen.
Deadlock is a crash condition which occurs when two or more programs are too polite. "Oh please, you first." says one. "No no, I insist, you first." says the other. "No, I couldn't possibly." Says the first, and so on and so on, nothing goes anywhere. Deadlock is a legacy problem from the days before multi tasking. Most newer programs and operating systems are designed to prevent deadlock but it still crops up now and then.
Finally there is the classic Fatal Error. When this happens you may be tempted to just shoot the computer. "Fatal error, ha, I'll sow you a fatal error! BLAM!" This response may be emotionally satisfying but does have limited effectiveness. There are certain commands that an ordinary user isn't allowed to issue. Typically these commands have to do with basic hardware operation, memory and processing.
Sometimes a program wanders into this forbidden zone and the machine shuts down to protect itself. That way when you re-boot everything works the way it was supposed to, in theory.
Some day soon we will look back on these dark early days of computing with a mixture of loathing and nostalgia. In the mean time don't take the blue screen of death personally and learn a good Microsoft Prayer.
Perioscopy
The DV2 Perioscopy System is both a high tech diagnostic and a therapeutic instrument. The system uses a miniature fiberoptic endoscope, which can be attached to a variety of periodontal instruments. The result is a system, which allows users to actually see well below the gingival crest into pockets and even furcations. It is possible to see and to access deep subgingival root deposits, root fractures and soft tissues. Users can actually see tissue inflammation adjacent to calculus deposits. The system can also be used to check deep crown margins for integrity and the presence of excess cementation materials.
The system comes complete with the fiberoptic endoscope, reusable instruments, a flat panel video monitor, a CCD video camera with light source, disposables and a cart. A composite video out source is included which will allow users to use an exiting monitor or TV to view the endoscopic images.
Early users have reported remarkable results. First the system allows you to find problem areas in a quick non invasive manner. For example root surfaces, which feel clinically perfect using traditional methods often, have large areas of flat smooth calculus. Once the problem areas have been identified the calculus can be removed once again while you watch with close to 50X magnification. As you would imagine the clinical results are extraordinary.
or more information contact Dental View Inc. (800) 370-4891 or www.dentalview.com
Technology Presentations
Dr. Emmott is scheduled to give technology presentations at the following meetings:
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Nov 7 |
Middlesex Dist. Dent. Soc. |
Boston, MA |
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Nov 8 |
Dentrix |
San Francisco |
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Nov 9 |
Blatchford Connections |
Las Vegas |
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Nov 16 |
LVI Masters |
Las Vegas |
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Feb 21-22 |
Chicago Mid Winter |
Chicago |
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Feb 28 |
AADPA |
Tucson, AZ |
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Mar 21-22 |
Hinman |
Atlanta |
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April 12 |
Sullivan Schein |
Los Angeles |
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April 21-22 |
Star of the North |
Minneapolis |
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May 3 |
Texas State Mtg |
San Antonio |
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May31-1 |
Las Vegas |
Dr. Emmott is also featured as the dental high tech columnist in
Dental Products Report
magazine.
ClearMatch
ClearMatch is a new product that takes the shade matching process from guesswork to a science. ClearMatch is a software-only digital shade matching solution which runs as either a stand-alone program or it can be bridged to Dentrix Image.
ClearMatch works with standard shade guides and a digital camera. It is not hardware dependent. In other words it doesn't matter which digital camera, computer, video card, or monitor you use. It also does not depend on which shade guide you use, or environmental factors such the mix of ambient vs. outside light.
To
use it you simply take a digital camera picture with the color guides
in place. The software thenproduces a detailed and mathematically
precise shade map of the desired teeth in about twenty seconds.
It also creates a color map of the exact shade percentages for any
specific area of the tooth. It prints the map for the lab, with
a legend indicating the order and prevalence of all occurring shades.
This map along with patient images can be emailed to the lab. When
the case is received back from the lab it can be analyzed and checked
for quality control.
With the ClearMatch system the quality of the final work is superior, and remakes due to shade mis-matches are virtually eliminated. It can be used for single tooth lab restorations, direct restorations, bridgework and bleaching control. The system has been tested successfully in dental practices, and selected AACD certified labs, with both simple and complex cases.
ClearMatch is priced at $1995. Similar technology ranges from $4,000 to $20,000. ClearMatch can be easily downloaded from the web. to test with real cases and includes a 30-day money back guarantee
For more information contact Alan Halbert at Smart Technology www.smart-technology.net
or (541) 386-9311.
Comet Curser
Beware of Spyware
Web Site Advantage
The following comes from Dr. Ronald W. Schalter.
One of the advantages we've found in having an office website
is web site information on what to do in a dental emergency. Since
we have included this information on our web site my after -hours
emergency phone calls have decreased by about 65%. We put our web
address on everything . We take it one step further by mentioning
on both our main phone voice mail and the emergency line voice mail
that information about what to do in a dental emergency can be found
on our website.
The Three Tiers Re-Re-Visited
Last month I wrote about Avrom King and his prediction that dentistry would segment into three tiers. Tier I would provide basic services in a clinic at low fees or on a capitation basis. Tier II would provide retail type dentistry, high volume and insurance driven. Tier III would provide extreme boutique type service at high fees and outside the influence of insurance.
King predicted 20% each in Tiers I and III with 60% in the middle. So far, in my opinion, there are no more than 10% in tiers I & III and 80% are in the middle. However 90% of dentists think they are either already in tier III or will be. The sad part is that although most dentists believe they are in the top tier they are doing next to nothing to place themselves there. I believe the use of high tech equipment will be one of the determining factors between Tier II and Tier III in the future. This includes treatment room based computers, advanced systems like imaging and digital radiography. The use of lasers, microscopes and other high tech treatment options. Computerized muscle and jaw tracking to determine occlusion and non metal, esthetic boned restorations.
In my opinion there are three things dentists need to do to place themselves in Tier III.
- Provide awesome dentistry. Constantly be learning, improving, stretching the limits and provide a level of service that is obviously better. Here's the tricky part, 90% of you think you already do this but only 10% of you do. That means that most dentists reading this article need to improve the dentistry they provide if they truly want to be in Tier III.
- Lead, don't manage. Practice management based on the traditional medical model of fix it when it breaks, or the high volume dental model of the eighties and nineties where more is better and time management is king won't put you in Tier III. Leadership will. Leadership means providing a clear vision and communicating it to your team and to your patients. A tier III vision must be one of health, enhancement and well being, not one of fix it when it rots or how to squeeze another unit of chair time into each day.
- Understand and use technology. This part will become increasingly obvious to patients. Tier III dentists will have computers in the treatment rooms. They will use digital image management and digital radiography. They will employ high tech diagnostics like the K6I from Myotronics to determine proper physiologic function. They will use high tech instruments like lasers and they will communicate freely using the Internet.
The danger in writing al this is that you set yourself up for criticism.
Any dentist who isn't doing tier III stuff will search for any number
of reasons to discredit these ideas. It is usually easier to slam
the message than to confront change. Never the less I freely admit
all of the above is my opinion only, I have no real data or crystal
ball to see into the future. It is presented as food for thought.....what
if?
"The Future is Coming and it Will be Amazing"