Paperless Operation & The Role of Management Software
Author: Charles A. Lewis
"To optimize efficiency, entities that deal with vast amounts of information and records must ultimately find better ways of managing and storing data. That is why paperless operation will eventually become the standard for all health care providers."
The above excerpt was taken from a paper written by this author in October 1991. Although it took a few years, the term ‘paperless’ is now becoming a popular buzzword in the health care industry. As a result, more and more health care providers, including orthodontists, are now talking about converting their practices to use mostly electronic records: hence the expression ‘paperless operation.’ The terminology became popular after enactment of the Health Insurance Portability and Accountability Act of 1996 (‘HIPAA’) and its recognition of the values of replacing paper records with electronic ones. Here is what the U.S. Department of Health and Human Services says about electronic records:
“The economic arguments become more compelling as the medical system shifts from predominantly paper to predominantly electronic records. Improvements in computers and networking mean that the costs of gathering, analyzing, and disseminating electronic data are plunging. Market forces are leading many health care providers and health plans to shift from paper to electronic records, due both to lower cost and the increased functionality provided by having information in electronic form.”
When doctors are asked what going paperless entails, few if any can provide completely accurate answers. Many orthodontists tell colleagues that their offices are paperless when all they are actually doing is electronic treatment charting. Operating a paperless practice involves much more than just doing treatment charting electronically; it requires eliminating other paper records and systems wherever possible.
The purpose of this article is to provide an overview of the different components of paperless operation and to communicate the limits that still remain. The dominant role that practice management software plays in paperless operations will also be discussed.
Paperless Operations
Let’s begin by asking this important question: Is there such a thing as a totally paperless orthodontic practice today? The answer: No, there is not. Remember, being totally paperless means that electronic functions have replaced all those involving paper. However, some of the procedures still required in an orthodontic practice preclude the complete elimination of paper usage at the present time.
Here are the practice records and functions that can be completely paperless – if all the systems and equipment are in place and everything is carried out correctly:
Most orthodontists and their staffs would readily agree that financial records and demographics are easily computerized and many practices have been using electronic scheduling for years. Several would also agree that treatment charts, plans, notes, etc. can be kept in electronic form . . . if the right management software is used.
However, when it comes to the remaining functions and records that are listed as capable of being paperless, a good number of doctors and staff members will question whether it is possible – because of their management program. The reality is that incorporating the previously listed diagnostic records into the patient record is relatively easy using integrations with digital cameras and imaging/ceph programs, digital radiology, and 3D electronic models with their accompanying software. Using a scanner, existing photographs, cephs, x-rays and even plaster models can be scanned into the management system for daily utilization.
Internal office communication features (Intranets) are uncomplicated and should be a basic part of any good management software. The same can be said for the patient’s medical questionnaire, which can be completed electronically by patients or a staff member. An inexpensive signature device puts the patient’s electronic signature on the questionnaire, making it completely legal to maintain electronically.
Producing monthly management reports can be a paperless function by using management software that automatically and permanently saves them to the hard drive. The reports can then be available for viewing on the screen, or for printing, any time. An additional benefit is that, in addition to all the reports being permanently retained on the hard drive, this information is also included in each daily and monthly backup of the system. While the report data cannot be changed, adjustments can be made to correct errors and the adjustments can be automatically detailed and documented in a separate report.
Paperless / Partially Paperless Operations
These are the functions that can be either paperless, or partially paperless, depending on whether the right systems and services are in place:
■ Billing
■ Insurance claims
■ Letters & other communications
Patient billing can actually become a paperless function by using a combination of electronic fund transfers and electronic patient billing. Companies such as OrthoBanc make it possible for patients to make their monthly payment through automated deductions from their checking or savings account, or a charge to a credit card. No statements are sent and payments are collected by OrthoBanc and automatically deposited into the orthodontist’s bank account. Through an interface with OrthoBanc, the management software can then automatically record the transaction in all the appropriate places in the patient’s financial record. Electronic patient billing is where the practice contracts out the billing function to a company that provides such services. The management program electronically transmits the billing data to the company, which then prints and mails the statements to patients. Although this isn’t a true paperless transaction because statements are being sent, it is a paperless function for the orthodontic office. Since most doctors still do their own billing via the management system, billing is listed in the partially paperless category.
Electronic insurance claims are common and eliminate the printing of paper claims. At this time, not all insurers accept electronic claims, although eventually they will be forced into doing so. Some clearinghouses offer a service whereby all claims are submitted to them electronically by the management system and they produce any necessary paper claims and mail them, which could make this a paperless function for the orthodontic office. As it is with electronic patient billing, few doctors are presently outsourcing this function.
Increasingly, communications between the practice and patients are taking place electronically via E-mail, automated telephone programs, interactive websites, etc. Still, until such time as everyone has an E-mail account or other means of receiving written electronic communications, it will be necessary to continue printing and mailing letters to patients, billing parties, referral doctors, etc. Despite this constraint, a management program that is truly designed for paperless operation will automatically store electronic copies of every letter produced, in the patient’s file, eliminating the need to print copies for the patient record. The letters are then available for viewing, or printing if necessary, at any time.
Management Software
Operating in paperless mode means that, except for actual patient treatment, the management software essentially controls practice operations! Unfortunately, scores of doctors are going to learn that their current management software is not capable of such operations. Even the brief overview of paperless and partially paperless functions in this article should make it clear that the management program must be designed with such operations in mind; they won’t just happen by accident.
Critical functions for paperless-capable orthodontic management software include:
ü Total systems integration
ü Have all the capabilities of the Windows operating system
ü Stability
ü User definability
The single most important capability required of the management program is integration. Simply put: If the software does not allow integration with every ancillary system used by the practice, and interface with the outsourcing services it uses (such as electronic fund transfers), it cannot ever operate a paperless practice! The software should also provide integration with whichever products the doctor chooses.
Most orthodontists take it as a given that if they purchase Windows-based management software it will have all the capabilities that Microsoft puts into that operating system. Regrettably, that is not the case! At least three well-known Windows-based orthodontic management programs only allow the opening of one patient record (Window) at a time. Why is this so important? When every patient record and function in a busy office is controlled by the management software and only one of those records or functions can be used at a time, the staff will quickly learn the real meaning of the word frustration. Having to close the record being worked on in order to be able to open a different one to answer the questions of another patient, is both inefficient and time consuming. The ability to quickly and easily switch between multiple patient records and screens, as Windows was designed to do, will allow the office to be much more productive.
Stability becomes an even more important factor in practices operated in paperless / near paperless mode. If the system ‘crashes’ the office is, for all intents and purposes, ‘shut down’ until the system is back in operation.
In paperless / near paperless operations, the management software controls an ever-increasing number of the practice activities. For that reason it is very important that the program be as user-definable as possible so it can be adapted to the way that practice likes to operate. Otherwise, the practice must conform to the operational ideas of the programmers that developed the software.
Summary
Eventually, paperless and/or near paperless operation in all orthodontic practices is inevitable. Many practices already operate in such an environment; some using 20+ workstations in the office. This article has attempted to provide orthodontists with a brief overview of what these operations include, as well as the absolutely critical role that management software plays in making them possible. Although converting to a near paperless process is not overly difficult, it should be done only after careful planning and a diligent evaluation of the management software that will be used. Orthodontists who are just beginning a practice have a unique opportunity to begin their practice in near paperless mode and, because of the efficiencies and cost effectiveness involved, should give it serious consideration.
About the Author: Charles A. Lewis is the Chairman and CEO of CPI Technologies Corporation and CEO of its subsidiary companies; Advanced Ortho Systems, LLC and Advanced Dental Systems, LLC. He has many published articles on paperless operations and practice automation. Charles lectures at seminars and colleges on increasing practice efficiency through paperless operation and on Internet-based delivery of management software. Orthodontists can contact him at 877.803.4412.