Practice Management Systems: Foundation for Dental EHRs

Dental electronic health records (EHRs) software has evolved over many years yet still lack standardization of most of its processes. From small, private practices that have not yet implemented electronic records to major dental organizations that have well-established EHRs, integration is in its infancy and may be a while before it is fully realized.

However, most dental practices regardless of size use some form of practice management (PM) system and have for many years. These system capabilities range from the very basic administrative applications to software that practically mimics a fully functional electronic health records package. But the issue of integration still looms and this is because of the lack of standardization practices.

“The American Dental Association (ADA) developed guidelines for clinical systems that include the acquisition, storage, retrieval, presentation, and communication of computerized patient information. ANSI/ADA Specification No. 1000…provides a blueprint for the logical architecture of health information systems at the data level. This is a voluntary standard and as such does not truly mirror what is available in the actual market” (2011).

The standards are not enforced and as a result, EHR and practice management systems vary to such a high degree that it makes interoperability and integration more difficult to accomplish.  To be successful with current technologies, dental practices are utilizing a combination of office-based and web-based EHR and PM systems.

As a result of all the variability, there are a number of dental EHR and PM options available to tailor a dental practice. The question is to determine which one or more to choose that best meets the needs of the office or organization. Options include, but are not limited to:

  • In-office client/server hardware: This is basically a one-stop-shop for all your EHR and PM needs especially for new systems as it includes everything: software, hardware, support, maintenance.
  • In-office client/server hardware with clinical applications bridge: This option may be more viable and compatible with previously established systems without having to change or replace existing hardware and/or software.
  • Web-based PM: Subscription based software that is not as robust, but may be more cost-efficient especially for smaller practices.
  • Value-added software applications: These third-party software vendors utilize the current system and tailors to the dental practices needs.
  • Independent task-specific software: As the name implies, these do very special jobs such as treatment planning and image management. Any size practice can utilize these as the practice needs dictate.

“The ultimate goal should be a complete digital patient record that can seamlessly integrate all the clinical and administrative functions with a fully relational database that can be queried for data analysis” (2011).

Even though it may be a while before the fully functional, integrated dental EHR is realized, an increased focus on standardization could propel more change as it is needed to improve patient care and safety. But that may be difficult since most of the existing PM software applications are “similar to yet different from this standard, and to migrate fully to the standard would be a major undertaking” (2011). As more dental practices and organizations implement EHRs and PMs, the need to become more integrated and interoperable will encourage vendors to work more cooperatively.

Lessons learned:

  • Dental practices need to consider the EHR and PM software applications to best meet their current and future needs.
  • Vendor products may or may not be compatible with the established software.
  • EHR and PM categories are administrative, clinical, and Internet with applications falling under one them.
  • Make sure current EHR/PM software packages can integrate to the needs of the practice.
  • Dental practices with new EHR/PM system should hire, if only temporary, training and support staff.

Levato DDS, C.M. (2011, Nov./Dec.). Management systems: the glue that holds a practice together. Compendium, 32 (4); 96-98.