A Must-Read Guide for Dentists Considering Electronic Records

If you are new to dental electronic records and looking for one brief authoritative guide to get you started and give you the big picture, Schleyer & Thyvalikakath have an article for you (2011). Written by dental informatics specialists at the University of Pittsburgh, this guide will introduce you to selection, implementation, and maintenance, and give you the confidence to move forward. This article summarizes the guide.

A large component of electronic record implementation involves change management.

“Electronic Dental Record (EDR) technology has been and is developing rapidly. You should therefore consider your EDR implementation not as an endpoint, but rather as the first step in the continuous evolution of your office information technology (IT) infrastructure.”

While most dental practices now have computerized billing, this guide is designed for those ready to move beyond that to paperless clinical records. The transition involves many of the basic elements of project management. Pre-implementation includes establishing a vision, setting milestones, and budgeting, in addition to deciding on infrastructure and selecting software.

The article includes a table of average component costs, including maintenance and upgrade fees. The authors reiterate that application service provider (ASP), or cloud-based, systems such as Curve Dental and Dental Symphony, advertise as being cheaper than standalone counterparts, but may end up not being so when all costs and benefits are weighed. Also mentioned are the hidden costs of training, initial production loss, and malfunctions.

Vendors do not tend to provide specifications on your computing infrastructure, such as processor speed, memory and networking speed. Most dentists install a computer at each operatory workstation. A wired network is more expensive, but provides faster speeds and improved security. Decisions are often based on the number of images that will be generated. Be aware that disc space can always be added.

When selecting software, many dentists choose among the top four vendors, Dentrix, Eagesoft, Practice Works, and SoftDent, because they consider smaller startups riskier. Yet smaller startups tend to be more innovative in offering features such as text communication with patients.

The authors prefer the “big bang” approach to implementation, where training occurs right before a “go-live” event, and the practice transitions completely to the computerized records at once, rather than a slower “phased” approach. While EDR systems are notoriously not intuitive, slower implementations that maintain paper and computer records afford greater risk for inconsistency and malpractice. Practices generally enter demographic and financial information on all clients, while digitizing clinical information and marking paper charts “read only” as needed.

The implementation phase also includes establishing disaster recovery plans and backup protocols that include a Redundant Array of Inexpensive Disks (RAID) to prevent service interruption. Administrators should prepare for a loss of productivity initially as users often spend time trying to determine if malfunctions are due to system or user error.

As a practice transitions into a maintenance phase, regular upgrades, retraining, and evaluating unintended adverse consequences is needed.

Lessons Learned:

  • Electronic records are constantly evolving. Look at them as an ongoing process.
  • Be sure to consider hidden costs such as training, production loss, and malfunctions when planning for electronic record implementation.
  • Software vendors don’t always specify the processor speed, memory, and network speed that you need. A wired network will allow for greater speed and security, and the more images you generate, the more speed you will require.
  • A phased implementation that maintains paper and computer records presents greater legal risk. The authors prefer a “big bang” approach.
  • Practices should prepare for an initial loss in productivity when implementing electronic records.

Schleyer, Titus; Thyvalikakath, Thankam P. (2011, May). Transitioning from paper to electronic records: A process guide.  Metlife.