The High Cost of Doing Nothing Part 3: Going Paperless


Subtitle: Who’s got the chart?

Many practices treat their computer system and software like buying an expensive car that can perform at a really high level and just parking it in the driveway. It has the potential to do so much more than what you are asking it to do.

Many years ago, Omer Reed said, “If it has been done, it is probably possible.” Well, IT has been done in a multitude of practices. In fact, in Australia, most have been paperless for over a decade – yes, a decade!
IMG_2585On the other hand, in the U.S, we still enter way too many practices where the computer is simply being used for scheduling while a full wall of ugly paper charts is somewhere close by. They are looming like a monster, consuming time and resources and creating chaos and confusion, while the lowly computer, with it’s hidden potential, sits and waits…and waits to vanquish the foe.

There are many compelling reasons for moving to a paperless practice. I’ve combined my thoughts with those expressed in an article by Sandy Roth over a decade ago to address all the excuses against and reasons for going ALL PAPERLESS.

Let’s first examine the excuses we hear for NOT making the full leap:

1. It’s too time consuming (translation: cost and hassle). Baloney.  We would argue that nothing that you purchase for your practice equals the savings you will discover from going fully paperless. Investing the time necessary to fully learn the software and train staff is no different than the time required to learn how to use the digital xray equipment or other clinical tools you have integrated.

2. Not enough space. Baloney again. Flat panel displays and wireless keyboards with wireless networking can fit into almost any treatment area. And what about ipads that can fit in drawers and can be readily available? No excuses here.

3. Fear of losing data or compromising data. If its good enough for the Federal Reserve Bank it ought to be good enough for a small business like a dental practice. If you don’t trust storing or backing up your data on the Cloud, perform a double backup of your data every day and store one set off site. It can happen seamlessly without supervision. No excuse here.

4. Legality and HIPPA. Triple baloney. That problem has been solved and we would submit that digital documentation trumps written notes any day when it comes to litigation.

5. Staff doesn’t want to do it. Too bad! There is such a thing as outgrowing a team. Technologically resistant staff are obsolete staff. If the job requires learning a new skill, that is the requirement for continued employment. Living in the dark ages is not acceptable in a modern dental practice.

6. Too much trouble. A learning curve for any new system or task is to be expected, so build that into your budget of time and energy. Give yourselves a break as you’re integrating any new concept into your practice and you won’t be disappointed.

Now that I’ve tackled the objections, let’s outline the benefits in more detail:  

1. Information is available to everyone on the team – simultaneously. When you work with a paper chart, the only person who can access the information is the one with the chart. In a paperless, computer-driven practice, data can be accessed by every terminal on the network. The dentist can be planning treatment and the patient care coordinator can be entering financial arrangements. The assistant can be charting and the business assistant can be sending the insurance claim for processing. The telephone receptionist can be looking up the date and time of the next scheduled appointments while the facilitator is looking at the notes regarding previous conversations with the patient. (I know – some software systems haven’t quite figured out how to let you do this and I say, shame on them!)

2. Writing notes takes longer than typing them into the computer and are likely to be less complete. When tasks are easier, they are more likely to be done and to be done consistently. Notes taken on the computer are almost always more complete, and people report that they get into the habit of writing notes on the computer pretty quickly. AND THEY ARE LEGIBLE!


3. The computer is easy to find…charts cannot be counted on in that way.They have a way of going missing. Who has the chart? Did the
doctor take it home? Is it buried somewhere in his black hole office? Does the hygienist have it? Has the business manager held onto it for collections purposes? Where can it be?
When a patient calls in to cancel, or with an urgency, or to ask an insurance or billing question, having instant access to the chart on the computer can save huge amounts of time and provide important history to address the call in an expedient and appropriate way.

4. Tired of bringing an expandable briefcase or box full of charts home? You can tap into your computer off-site and access patient information.

5. Handwriting and legibility is no longer an issue.

6. No more confusion about where the information is. No more asking if it is in the computer notes or in the paper chart. No question of whether information goes on the green sheet or yellow sheet. And no more routing slips. Information is stored in logical and consistent places on the computer and everyone knows where to find it.

7. Saves trees.

8. Eliminates the ugly, untidy chart wall.IMG_2584

9. Records of insurance submissions are kept on-line so no riffling through stacks and piles of paper to find what you need.

10. Miscellaneous information is easily scanned into the database, so
letters from and to referring dentists, notes from the patient, signed financial agreements and authorizations can be kept handy and easily accessible.

11. One-write systems. Write it once and its done. No writing things on the chart, on the route slip, on the day sheet, in the notebook that is kept in the front, in the display board in the lab and the log of lab cases. It’s enough to drive a person crazy. No wonder there are so many mistakes and so much confusion in so many practices!

12. Information is power. When more information is collected, recorded, retrieved and reviewed, the practice runs more smoothly, relationships with patients are stronger, confusion is minimized and misunderstandings are headed off at the pass. Less confusion, misunderstanding, mistakes, and angered patients equal less legal vulnerability as well.

If you were to visit a fully paperless practice, you would see the impact it has. Team members are more prepared, more informed and more involved in patient relationships as a result. Information is more accurate and more likely to be recorded. When it is recorded, it is more likely that team members will look for it. As a result, information which is gained is actually used and the relationships with patients are more successful.

Find out exactly what it would take for you to eliminate the paper and plan to GO FULLY PAPERLESS before the end of the year. Circle the date on the calendar and contact me for your Going Paperless White Paper and to arrange a team teleconference to get started.


We Need More Help at the Front Desk!


We Need More Help at the Front Desk!

Why is it that team members in the non-clinical roles, often referred to as the “front desk staff”, complain about the amount of work they have to do and always seem to be stressed out? Here are a few of the comments we hear all the time:

The people in the back don’t understand all the stuff we have to do”.
“How can I do the insurance when I keep having to answer the phone?”
“We never get caught up.”
“I’m constantly having to stop what I’m doing to take care of a patient. Then when I come back to it, I forget where I am.”

We have a couple of theories about the traditional front desk configuration and why it sets most teams up for failure.
THEORY 1: The front desk isn’t the area in which the dentist works. He or she doesn’t fully understand the challenges the staff is faced with and is less likely to know how the systems work against them, not to mention the outdated equipment and software challenges. For instance, many practices have only made a partial transition to paperless charts, making the practice dependent on two systems (paper and  computer), which makes locating information more difficult, causing duplication and increasing the chance of error. The dentist rarely understands the challenges this poses for the team. (This is a subject in itself!)DISCONNECTED

THEORY 2: People who work in this arena often develop tunnel vision and have difficulty
seeing new ways to structure their work. The result is that the front desk staff keeps doing the same old things in the same old ways, and not doing any of them at optimal level.

THEORY 3: When the non-clinical staff complains long enough, the dentist usually breaks down and adds another person to the team to do the same things the other team members are doing, creating more confusion, more errors and even less efficiency and effectiveness – not to mention more overhead!

So, what’s the answer? Consider separating the tasks into two areas of specialty and assign the responsibilities to the individual who has the right skill sets. Let’s look at the responsibilities of the non-clinical staff and how those duties break down.

There are three distinct areas of focus in every practice – what we call the A-B-Cs :

A – Administrative:

Responsibilities that support the business of the business. They are related to paper and tasks – not patients. They can occur “behind the    scenes” and in most cases, are not ones that must be addressed in the moment.
The key in this role: to be EFFICIENT with THINGS.

Just some of the responsibilities that might fall under this heading are:
– review chart entries at dayʼs end to balance against deposits
-insurance pre-authorization, submissions, review and followup
-opening and sorting mail with distribution to appropriate person
-entering payments from mail and over the counter
-printing receipts for patients
-monthly statements
-daily deposit
-monthly and annual closing and archiving
-organizing invoices and packing slips before matching to statements for payment
-payables entry in accounting system
-preparation of a/p report for dentist review and approval
-preparation of checks for dentistʼs signature
-mailing signed checks
-inventory of office supplies
-purchase of office supplies and patient amenities
-errands as assigned
-maintenance of office equipment and machinery
-computer system oversight and IT
-maintaining patient amenities (ie: coffee station, water, etc)
-hourly upkeep of patient washroom and reception area
-implementation of marketing, promotion
-communication and follow up with the lab
-communication and follow up with vendors
-planning continuing education
-planning meetings

These responsibilities require focus, attention, detail, someone with self-direction and organizational skills -an analytical thinker.  This same concept can also be applied in the clinical area of the practice – responsibilities associated with sterilization, operatory preparation, inventory and lab duties. They are all essential to providing patient care but occur independently of patient care.

B – Behavioral:
Depositphotos_24330021_mThis arena has to do solely with the business of our patient’s business and is often the most overlooked area. These responsibilities often occur with patients and are focused on patient care, connection and communication. While some of the duties require planning and preparation, events often occur in the moment, can not be predicted and must be responded to in real time. This job requires an individual with big picture thinking. The best people are those with sensibility, grace, maturity, empathy, curiosity, good listening skills, confidence, good command of language, and the ability to think on their feet.
The key in this role: to be effective with PEOPLE.

The responsibilities that most often fall under this heading are:

-working with new patients from initial telephone call through treatment planning
-supporting patients in the moment whether on the telephone or in person
-urgency triage and establishing clear expectations with urgency patients
-maintaining oversight of patients in process – those for whom treatment has been
recommended but not yet completed
-organizing and managing the “lost souls” project – those for whom treatment has been
recommended and have dropped out of sight
-handling fees and financial arrangement discussions that are not properly handled
-addressing patient complaints and issues in a timely manner
-ensuring that patient interests and concerns are clearly understood by all
-supporting patients by helping them price-test their treatment options
-ensuring that all patient-contact staff are prepared behaviorally for patients before they
-identifying patterns and trends with patients as they occur
-maintaining oversight of the schedule and making appointments as necessary
-managing patient correspondence and followup
-coordinating non-clinical aspects of care with specialists and referrals
-internal training on communications and patient relations
-connecting with referral sources, public relations, networking

C – Clinical:
Depositphotos_24330067_mEvents related to the delivery of care. Commands most of the focus of the practice and is often the most up-to-date area. Requires the attention and oversight of the dentist/business owner. Removes the dentist/owner from constant oversight of the two other areas, making it even more important that self-directed, well-matched, highly-effective people are placed in the non-clinical roles.

As you can see, the non-clinical staff is responsible for two of the three critical areas of the practice. These staff members are often asked to perform both Administrative and Behavioral roles simultaneously while the responsibilities are very different from one another and require different skill sets.  It becomes clear that when we ask them to assume both roles, they are split between two very different responsibilities, making them choose in the moment which is more important. This usually creates more problems, and sets them up for failure, making them less effective or efficient in either of these areas.

It is our opinion that when you separate the Administrative from Behavioral roles and hire/assign responsibilities based upon strength in one of these two areas, you encourage deep competency, similar to your competency in the area of dentistry. Each person performs at a higher level when they are focused on only one arena and they become more successful than if they were asked to do everything with less effectiveness.

This is not to say that a person who is assigned administrative responsibilities can’t support the one who is responsible for patient connection by answering the phone, welcoming patients or checking patients out when necessary. There are always exceptions. Some practices opt for a third person to act as a greeter or to handle phone triage and appointment scheduling. Remember, the goal is to encourage deep competency in their skill set and prevent team members from performing in areas where they are not as skilled.

This concept may require you to think differently about the individuals, skill sets and responsibilities in your practice. A good exercise for each of your non-clinical team members is to have them make a list of their duties and determine whether it is administrative or behavioral (we hope you aren’t asking them to also perform clinical roles too!). Ask them to assess how much of their work load is in each of these arenas and discuss how roles might be shifted to better serve this new model.

Take home message: You most likely don’t need more people serving in a non-clinical role – you just need the right people, with the right skill sets, in the right positions, which creates a better, more efficient and effective systems.

A caveat here – you may discover that you have team members who share similar skill sets leaving you with no one to serve an administrative or behavioral role. This may be the eureka moment that explains why certain problems keep occurring in your practice.  This process may also cause you to consider restructuring your non-clinical staff altogether. We can help you consider your options and sort through the implications of making changes to better serve the practice and your patients.