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Electronic Orthodontic Charting

Author: Charles A. Lewis

During the past 2-3 years, our company has noticed an appreciably increased interest in using electronic orthodontic charting. Although our software has always offered digital charting, many orthodontists have indicated that treatment charting would be the ‘final step’ in their staged conversion to being paperless. This ‘dragging of feet’ was evidenced by the 2005 JCO Orthodontic Practice Study ¹ wherein only about one-third of responding orthodontists indicated that they were currently entering treatment charts on the computer.

People are often reluctant to alter their methods of doing things until they are provided with evidence of the benefits that will be derived. So, for those orthodontists who are still unaware (or unconvinced) about the many advantages of digital treatment charting, I‘ll use this article to explain some of them.

¹ Keim, R.G.; Gottlieb, E.L.; Nelson, A.H.; and Vogels, D.S. III: 2005 JCO Orthodontic Practice Study, Part 1: Trends, J. Clin. Orthod. 39:641-650, 2005.

Advantages of Digital Charting

• Easily customizable
• Eliminates the storage and ‘pulling’ of charts
• Charts are available on any networked office computer
• Backing up electronic charts is easy
• Long-term record retention is easier and less costly

Easily customizable. Using the right software, digital charts can be effortlessly customized to be suitable for the different treatment methods used in orthodontics. For this reason, your system can have a variety of charts that are specific to particular treatment methods. As an example, trying to use a chart designed for treatment with wires and brackets doesn’t work too well if you are using a removable appliance system such as Invisalign. So, you can create an aligner treatment chart that accommodates that appliance. With charting customized for your treatment methods, data entry is greatly simplified.

Our company’s software makes customization a simple process. Although we provide several charts (designed by various orthodontists) that most doctors seem to really like, these charts can also be easily altered to meet your specific demands. Our most popular aligner charts were jointly designed with a client who speaks internationally for Invisalign and those charts were featured in a 2007 article in the Journal of Clinical Orthodontics (‘JCO’). ² In introducing the article, JCO Technology Editor W. Ronald Redmond, DDS, MS included these remarks:

"Today, Advanced Ortho Systems is ideally positioned to provide treatment chart options because it is one of the few true 'online' orthodontic management systems. The company can easily customize your programs, including your choice of charting systems, because the software resides not in your office, but on remote 'server farms'."

² 'The Cutting Edge: The Aligner Treatment Chart' Author: Mark J. Perelmuter, DMD, MS. Journal of Clinical Orthodontics Volume 41: Number 04: Pages (217-220) April 2007.

Eliminates the storage and ‘pulling’ of charts. Digital charts, including all related images, are a part of the patient record in your practice management system. Therefore, you can eliminate all the shelves and space required for storing them, as well as needing a staff member to ‘pull’ the charts for each patient visit and then re-file them later.

Charts are available on any networked office computer. If you have a local area network (‘LAN’) in your office, the digital treatment charts are stored on your file server, along with all the other electronic patient data. This makes the charts available on any computer on your network. Our company’s Internet Program Delivery clients access their charts and other patient data by simply logging onto the servers in our datacenter. With a computer and an Internet connection, secure HIPAA-compliant data access is available from anywhere in the world. As a result, if you receive an emergency call about a patient while you are at home, or on vacation somewhere, the complete record is instantly available for your review.

Backing up electronic charts is easy. If you are using paper charts, you had better hope that your office doesn’t experience a fire, flood, hurricane/tornado, etc! Those who use electronic charts and records can easily avoid being put into a position where their patient records can be irretrievably destroyed by one of these events. Offices with a LAN should do a data backup at the end of each business day and then take that backup off site. Another method is to have a trusted company do automated daily backups of your data and then securely store it for you. (For our LAN clients, our company recommends the services offered by Electronic Data Protection, LLC http://www.electronicdataprotection.com/. EDP offers both short-term and long-term data storage and your data is immediately available to you when needed.)

These backups are unnecessary for our company’s Internet Program Delivery clients because their data is constantly backed up on various servers and storage devices, and in multiple locations. In the event of a natural disaster, all they need is a PC or Mac and an Internet connection to login and begin using their system with all its data.

Long-term record retention is easier and less costly. If you are using paper charts, consider the following questions about patient records and their retention; answers were provided by the American Association of Orthodontists (‘AAO’). ³

What Constitutes Patient Records?

The AAO's answer was: "These records include, but are not limited to, charts, x-rays, models, appointment books, correspondence to and from the patient, phone records, medical history forms, the patient contract, the signed informed consent form and interoffice memos relating to the patient."

How Long Should Patient Records Be Maintained?

These three key points were provided by the AAO in response to this question:

• "At a minimum, patient records must be kept for the applicable statute of limitations period. This period is the time within which an action may be brought for malpractice, and varies on a state-by-state basis. Generally, these periods range from five to 15 years."
• "Although the need to maintain records should be balanced against the practical aspects of such storage (i.e., costs, space, etc.), the best approach is simply to retain the records indefinitely because of the valuable information the records contain." [Emphasis added]
• "The practical difficulties of maintaining records indefinitely can be minimized by transferring some of the records to microfiche or, in some cases, videotaping the models."

Consider this: If you need to convert your patient records to an electronic format in order to reduce the long-term storage costs, space required, etc; why not just use electronic records in the first place?

³ The answers to these questions were furnished by the American Association of Orthodontists (‘AAO’) and are viewable on the California Association of Orthodontists' website. (The information was accessible as of September 4, 2008 and was found at http://cao.aaomembers.org/practice/records.cfm.)

How Do I Convert from Paper Charts to Electronic Charts?

First and foremost, make sure that your practice management software will meet your particular requirements regarding orthodontic treatment charting. The second step is to actually design all the treatment charts that you want to use in your practice. The second step is to decide which conversion method you want to use. The two most popular conversion methods are:

·         Gradual

·         All-at-once

Gradual conversion. This is typically achieved by choosing a date on which you will begin electronic charting and, from that date forward, all new patient charting will be done only on the computer.

For existing active patients (or those on recall), there are two options:

1. Leave the current charts in paper format; and/or
2. Gradually scan their records, images, even models, into the system using a flat-bed scanner.

All-at-once conversion. This method is normally accomplished by choosing a date on which to begin scanning all the aforementioned records for active (and recall) patients into the system. And, effective on the date the scanning begins, start using electronic charting for every patient whose records have been scanned.

With either of these methods, once the above has been completed you can decide whether or not you wish to gradually scan all the other patient records into the system to make their long-term storage easier, and less costly.

Summary

Even in this brief overview of electronic treatment charting vs. using paper charts, these key advantages should be very clear:

1. Electronic charting makes it much easier to have charts that are adapted to all the different treatment methods used in your practice.
2. Digital charting greatly contributes to office efficiency by (A) eliminating the storage and ‘pulling’ of charts and related records; and (B) making the patient charts available on any computer on your network. For instance, if a referring doctor calls about a patient he/she has referred, you can immediately answer questions by accessing the records anywhere in the office that you have a computer; no more hunting for a chart.
3. The safety of your patient records is greatly enhanced, and made easier, if electronic records are used. Whether your staff does a daily data backup that you take offsite, or if you use an outside service to do automated backups and storage, you will have copies of your records no matter what kind of natural disaster might occur in your office.
4. Digital records are very cost effective. This is especially true in regard to the long-term retention of patient records required by law and/or recommended by the AAO. Substantial savings are also achievable by eliminating the space required in the office for storing paper charts, images, x-rays, models, etc.

In addition to all the above, keep this in mind: The United States, and the rest of the world, is moving toward adopting electronic health records (‘EHRs’) for use by all healthcare providers. The time is not too far away when EHRs will be mandatory – not voluntary. So, if you have software that makes possible all the advantages that have been listed, why wait to start using these more efficient, cost-effective methods in your practice?

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