You have a Document Scanner in your Pocket

By Steve McEvoy, Technology Consultant

Many orthodontic practices strive to be paperless, and part of that equation is dealing with paper that comes into your practice from external sources.   Referral slips, insurance cards, drivers licenses, transfer cases, etc. Dealing with these typically involves using a scanner of various types.   In the old days, there were large ‘flat bed’ scanners.  More recently, there are highly effective ‘bread loaf’ and ‘wand’ style scanners that take up considerably less space.

What you might not realize (until now), you are probably carrying around a document scanner in your pocket.   Your smartphone, that Apple or Android phone many people carry typically has an epically good camera in it.

“Ahh, he’s going to tell us to just take pictures with the camera” might be what you’re thinking. You could, but then you have a collection of random JPEG images, probably stuck on your phone.   I’d like to direct you towards a genre of document scanning apps for your phone, ones that do more than take a picture. Microsoft Office Lens, Tiny Scanner and CamScanner are a few to mention. I use CamScanner (because someone recommended it to me) and will describe how it works in this article, but you can look at all your options as they will tend to offer the same features. You can find the CamScanner app as a feature limited free version (or splurge the $2 for the full version) in the Apple App Store or Google Play Store.

Scanning a Document

Once installed, CamScanner (CS) is simple to use. Open the app, click on the Camera icon, take a picture of the paper, ID card, or whatever you need to scan. The magic comes next.

The first super cool part is that CS will deskew the image.   When we take a picture, we are rarely perfectly centered above the document, rather we are probably at some weird angle and even the document we are scanning might be wrinkled or skewed.   CS automatically tries to find the edges of the document in the picture but allows you to quickly tweak its results by dragging the corners of the frames.

Once you tap the check mark icon, it will stretch the image back to its original real life square proportions (deskewing). Depending on your settings, you can also have it adjust the contrast and colors to make it more readable.  I use the default setting that converts the image to a high contrast black and white image, allowing it to make very small file sizes (which are good for saving and transmitting over the internet). You can, of course, change this to save in color.

Once you’ve scanned that item, you can continue and scan more that will be compiled into the same document at the end, page 1, 2, 3 etc. Obviously, you won’t want to scan 15-page documents this way, but a page or two is an ideal use.   This is a feature you can’t do with just taking photos with your camera, CS is building a multi-page document for you.

Getting the PDF from your Phone to your Computer

After you are done scanning, your next concern is how to get the document out of your phone and to where you want it. In a practice, you might want to be able to add it to a patient’s chart. At home (and this is GREAT for using at home) you might want to save receipts for tax purposes, scan those monthly bills or other filings.   CS gives you several methods for moving the document:

  • Cloud based storage like Dropbox and Google Drive
  • Sending the document to yourself as a PDF file attached to an email
  • Text, Bluetooth, and most any other file transfer technique your phone can muster

Sending the document as an email has been the best for me.   I can email it to myself, or to a colleague that is dealing with the patient. Maybe you send them all to Scans@YourPractice.com. When you choose this option, it prompts you for a file name for the PDF document.   You can add a subject line and a blurb of text to your email, but I usually just type in the most minimal info here “Steve McEvoy Signed Consent” or something like that, enough so you have a clue about what the document attached to the email is for.

A copy of the scanned documents is retained on the phone. You’ll need to eventually do some housekeeping to clear them off periodically, but that’s up to your style.

When you open your email, the document will be simply an attachment and you can save it to your computer or server like any other scanned PDF in your practice.

A Note about TWAIN

CS and these apps are not TWAIN compatible (an industry standard for software applications to operate scanners directly), meaning that your management software can’t directly start the scanner and import the result.   The Bread Loaf and Wand Scanners can typically do this (since they are attached to your computer), but the phone is an island so you’ll need to do the save and import steps noted above (which most Practice Management companies also support).

A Note about HIPAA

Keep in mind that if you are using these apps to scan patient records, it likely is PHI (protected health information) as defined by HIPAA.   As such, you’ll need to consider your risks and how you’ll keep that data protected.   It’s really easy to encrypt your smartphone (see this other CTech article on how), and you may want to consider using an email method that is encrypted as well.   If you are just emailing expense receipts and documents to yourself, there is no requirement for this.

So pull that phone out of your pocket, download an app, and get rid of that paper on your desk!

2017 Winter Conference – Technology: Balancing Profit, Lifestyle & Patient Care

By Dr. Doug Depew

The 2017 AAO Winter Conference is quickly approaching. Our theme of this year’s meeting Technology: Balancing Profit, Lifestyle and Patient Care.  It promises to be a meeting filled with information for both newer and established practices to help make those tough decisions on what technology is important to use in our practices and when we may wish to invest in it.

The meeting will begin with keynote speaker Jack Shaw.   Mr. Shaw is a world- renowned technology futurist who will be discussing how cutting edge and disrupting technologies will change the way we do business and run our practices in the coming years.

IT guru Steve McEvoy will be answering some of those pesky questions we all have about computer hardware, effective and cost-efficient data backup, and security.   In the ever changing world of computers, what you hear at this meeting will certainly be different than what Mr. McEvoy would have talked about even a couple of years ago.

On Friday afternoon we’ll have a lively discussion by Drs. Greg Jorgensen and Neil Kravitz regarding building our practices through social media, websites, and Internet marketing. Their success in these areas has been paramount in growing their thriving practices.

Saturday morning will begin with Dr. Aaron Molen sharing his experience and thoughts on bringing emerging technology into our practices to help create more efficient and more comfortable patient care.

We’re excited to have Drs. Ed Lin and Christian Groth discussing how to integrate some of the latest technology hardware into our orthodontic practices. This includes workflows for using CBCT, Scanners and 3D Printing.

The conference will conclude with Chris Bentson and Charles Loretto with a discussion on how technology can affect the value and profitability in our practices. This should help answer the question about at what stage of practice a doctor might consider investing in advanced technology.

The location for the meeting is at the gorgeous Marriott Harbor Beach Resort and Spa in Ft. Lauderdale, Florida. The dates are February 10-11, 2017. The schedule is organized in a way to allow some time for afternoon recreation.

There will be plenty of time allotted for attendees to ask questions of the speakers to be sure all bases are covered.   To learn more and to register, visit https://www.aaoinfo.org/meetings/2017-winter-conference-technology-balancing-profit-lifestyle-patient-care

Smartphone-based orthodontic monitoring: the big brother in our patient’s mouth

by Domenico Dalessandri, DDS, MS, PhD

Screen Shot 2016-03-11 at 11.06.09 AMNowadays almost all of us have a smartphone and we use it hundreds of times during the day checking incoming e-mails, surfing through the web and sharing our thoughts and pictures online within our social communities. This is the “permanently online” era and our patients ask for immediate information supply and assistance request satisfaction.

Since sometime orthodontists have used text messaging apps like WeChat or WhatsApp to communicate with their patients, to remind them the next visit, to solve an emergency or replying to a late doubt, or even checking the oral hygiene status or the cooperation level with removable appliances. There is a growing evidence in the literature showing the efficacy of these “App based” monitoring protocols in ameliorating oral hygiene and reducing treatment duration, bracket bond failure, and failed or late attendance [1-2].

Commercial interest regarding patient monitoring has also increased progressively and nowadays there are few apps especially designed for this purpose. In all these systems the orthodontist has his own dashboard on reserved area in the company website that can be used to invite patients to download the app in their smartphones and to visualize their smile pictures.

SmileTrackerTM (TP Orthodontics) also allows visualizing a time-lapse video, based on daily pictures taken by the patient during the monitoring, of the treatment progress. Furthermore this app has a rewards-based system in order to keep patients engaged throughout the monitoring and it also allows them to share their progresses through their own social profiles.

Dental Monitoring® allows patients to take smile pictures every 2 weeks in case of fixed orthodontic treatment or even every week for invisible aligners treatments. Doctors can also ask for a supplementary exam whenever they want, sending through their personal homepage a specific invitation that is forwarded by e-mail to the patient. This system requires doctors to send patient dental impressions before monitoring begins, because it utilizes a specific algorithm that allows calculating teeth movements based on pictures 3D matching and superimposition on the initial virtual models. For this reason patients are required to take 13 pictures for each exam from different angulations focusing on both single arches and on their position in occlusion. Three more pictures are required for patients treated with invisible aligners, in order to check each single aligner fit. This system, apart from calculating through the algorithm tooth by tooth displacement as mesial/distal, intrusion/extrusion, retraction/advancement, rotation, inclination and angulation variations, provides pictures observation by an orthodontist that looks at oral hygiene level, aligners fitting, possible presence of teeth abrasion, decays or brackets failure, sending a warning to the treating orthodontist in case of any unexpected event.

Could these systems become important tools allowing us to improve our treatments efficiency and quality? Is it credible that “virtual” appointments could in some occasions substitute the traditional “physical” appointments? Will our patients be available to be continuously controlled by this orthodontic “big brother”?

It is hard to foresee the future. The possibility for patients, especially if they live far from the orthodontic office, to save time and money by reducing the number of visits having the same, or even a better, accuracy in treatment progress control, can be universally recognized as positive factors fostering the diffusion of these systems.

Are we ready for this further step forward along the digitalization path of our beloved orthodontic specialty?

1: Zotti F, Dalessandri D, Salgarello S, Piancino M, Bonetti S, Visconti L, Paganelli C. Usefulness of an app in improving oral hygiene compliance in adolescent orthodontic patients. Angle Orthod. 2016;86:101-7.

2: Li X, Xu ZR, Tang N, Ye C, Zhu XL, Zhou T, Zhao ZH. Effect of intervention using a messaging app on compliance and duration of treatment in orthodontic patients. Clin Oral Investig. 2015 Dec 2. [Epub ahead of print]

Domenico Dalessandri qualified in Dentistry from the University of Brescia, Italy, where he received specialty training in Orthodontics. He obtained his PhD from the University of Torino discussing a thesis entitled “Cone Beam Computed Tomography: accuracy and reliability”. He received a research fellowship in “CBCT applications in Orthodontics” by the University of Trieste. Currently he is Adjunct Assistant Professor at the University of Brescia.

He has additional clinical research interests in: indirect bonding; self-ligating braces; use of mini implants and miniscrews; lingual orthodontics; Invisalign; cleft lip and palate; impacted teeth; 3D technology and virtual treatment planning; CAD-CAM; corticotomy and piezocision.

Simplifying Management of Satellite Offices

By Matthew Larson, DDS, MS

Matt LarsonIn the current economy, satellite offices are frequently utilized by orthodontists to increase their area of draw and patient base. Most orthodontists and consultants feel that the additional income offsets the additional overhead expense, but managing multiple office locations clearly requires more effort than maintaining only one location. However, current technology has helped make managing multiple locations easier. One dramatic example that most orthodontists now utilize is electronic charting, so that patient information is easily available at all office locations. Here are a few other tips and tricks to consider:

  • Centralized/Cloud-Based Documents: Most offices ensure that all patient information in their practice management software is either on a centralized server or cloud-based, but many offices are not as attentive to all of their supporting documents. Your satellite office should be able to run exactly like your primary office if desired. It is relatively easy with current technology to ensure all computers have access to centralized training manuals, patient handouts, and current projects. More limited access can be setup for the doctor and select staff to access more confidential information. Multiple methods can be used to achieve this, such as a shortcut to a shared document folder on the server (if a terminal server is used at the satellite office) or online cloud-based storage such as iCloud, Google Drive, or Dropbox. Please note that iCloud and Dropbox are not HIPAA compliant and Google Drive requires some adjustments to be HIPPA compliant, so these are not ideal solutions for PHI. The goal is that each practice location should have electronic resources in the same location for easy reference and there should be little to no effort to keep them synchronized.
  • Mileage tracking mobile apps: Deducting business mileage or tracking business miles on the company vehicle can provide a nice tax savings, but maintaining an accurate ledger to satisfy the IRS can be difficult. Multiple mobile apps are available to help keep an accurate log of business miles, such as Mileage Log+, MileagePad, Auto Miles, and Triplog. Some apps will automatically track when you are driving and then miles can be categorized later. Most allow you to export spreadsheets or expense reports for a nice end-of-year summary. Prices are generally under $10.
  • Remote locks and thermostats: I may be slightly biased since our practice is located in Wisconsin, but having a remote thermostat to ensure that heat is turned down when we are not at our office and that the office is warm when we arrive really helps staff morale at the start of the day! Also, there are coded locks available for your front door that allow you to remotely issue one-time use codes for contractors to access the building. Multiple permanent codes can also be set, which allows you to monitor who is entering your office. For example, cleaning staff can be given a unique code so you are aware of when they are onsite. These generally are a few hundred dollars to install, but avoiding extra trips to let in contractors or paying for additional heating/cooling bills can make it worth the expense.
  • Phone lines: Phone systems are a much larger topic, but it is worth at least briefly mentioning that having lines ring at only one location and going to voicemail if they are not answered is outdated. For offices with multiple locations, some type of VOIP system should be strongly considered, which allow lines to be answered and transferred independent of geography. Even with a traditional phone system, look into the additional features offered by the phone company. Generally, lines can be forwarded on certain days of the week and calls that are not answered in a certain amount of time can be forwarded to the other office (assuming the other office is staffed).

Overall, managing a satellite office can be less stressful using current technology, but some effort must be spent up front to design the correct systems and to implement them.

How Does Your Website Look on Your New Tablet Computer?

By Dr. Greg Jorgensen
Rio Rancho, NM – www.gregjorgensen.com

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Not long ago it was acceptable to have one website layout that looked good on a 800 x 600 pixel computer screen. Even though monitors got bigger with time, our original websites looked just fine with a little empty space to the sides of the main content. As smartphones became more popular, it soon became clear that we would need to have a mobile version of our website too. Many companies began selling mobile websites as separate products or add-ons for our current sites. Nowadays however, our websites are being accessed by an unlimited number of devices with various resolutions and screen sizes that make separate versions of our content all but impossible. What is the answer?

A new approach to web design called “responsive web design” provides the solution. Older coding techniques only allowed designers to choose the number of columns into which the content would flow. As the screen resolution changed, the columns would get wider, narrower, or not change at all. Have you ever pulled up a website on your smart phone and the text was too small to read until you zoomed in several times? Even with variable width columns, most standard websites looked lousy as screen resolution was pushed to the extremes on both ends.

Modern responsive web design takes a completely different approach. Responsive web design detects the device on which the website is being viewed and changes the format and layout of the webpage too look most appropriate on that device. A responsive website might have five columns and a detailed navigation bar when viewed on a 23” monitor but only have one column and large buttons for navigation when viewed on a smart phone. The same website can be coded to detect when it is being viewed on a tablet and offer touch navigation rather than commands buried in cascading menus.

Responsive websites offer many other advantages in addition to just looking better on multiple devices. First, since you only have one site to maintain, keeping your content up to date is much easier (imagine having to update a desktop version, a laptop version, a tablet version, and a smartphone version separately). Make changes in your hours or staff biographies on a responsive website once and the content is updated on every device! Another advantage is that the search engines love sites that are easier to read. They keep track of “bounce rates” (how long a reader stays on a page before moving on to something else) and use them to determine how good the content on that site is. When a potential patient searches for an orthodontist in your area, Google says “The readers who look at this doctor’s site stay longer and therefore his content must be better.” If your site is easier to read, your SEO will be better.

If you would like to see a responsive website in action, check out the Microsoft site at www.microsoft.com. Resize your browser window and watch how the information changes. Not only will the layout change, but the amount of information and way that you navigate it also adapts. If your website needs a refresh or you’re thinking about a new one, make sure that your designer uses responsive web design.

Is Your Smartphone Working for You?

By John Graham, DDS, MD
How smart is your smart phone? Really, does it do more that text, gather emails and check Facebook updates? While there are many apps that can help market your orthodontic practice, many smartphone users continue to severely underutilize their phones as a tool to help understand their patient base.

Google Analytics, the famous, free and powerful web analysis engine has the ability to alert you via text message when any number of actions related to your website happen. Two of the actions that I monitor on a daily basis are website visits and website traffic sources.

Having two practices in two states is demanding enough, following trends on both websites can be nearly impossible without Google’s help. Google Analytics helps me to know how many people are visiting my website each day, and where they are coming from. For example, I have “triggers” set up so that I receive a text message every time a set number of people visit my website. I have a 20, 30, 40 and now thankfully, a 50 visitor count trigger. Every time one of those metrics is reached on each of my websites, I get a text message letting me know. What a way to brighten my day! I also receive a text each time an individual arrives at my website from the Invisalign doctor locator. An almost unlimited number of alerts can be set to inform you of your websites activity. This information is absolutely critical in assessing marketing budget allocation and is EASY to get without doing any work! Your smartphone and Google do it for you.

To set up Google Analytics, simply login to your Google account (or create one if you haven’t already done so) and navigate to Google Analytics. Set up your Analytics account by following the instructions on the introductory page. The most critical aspect of setting up your Analytics account is getting the computer code that Google needs for analysis embedded on every page of your website. This is easy to do, you simply copy the code provided and email it to your website provider and have them insert the code on every page. Most every website administrator is accustomed to doing this with Google Analytics.

After the code is inserted, Google will test it for you to determine if all is well. Once Analytics is running on your site, you can navigate to the custom alerts section and set up any number of alerts that can be sent to your smartphone or to your email account. The easiest way to learn how to do any of this is to look it up on YouTube.

As the Google Analytics team is fond of saying – Happy Analyzing!

Incorporating Tablet Kiosks for Your Patients

By Jeremy M. Albert, DMD, MS

As a self-proclaimed technology addict, I would like to proudly say that I own three iPads.  Unfortunately my 3 daughters (ages 10, 6, and 3) are always using them way more than I am playing games, watching videos, and talking with an animated giraffe named Gina.  My point is, tablets like the iPad are thoroughly integrated into mainstream culture and entertainment.   To today’s youth, interaction with them is second nature and the preferred method of computing, gaming and entertainment.  Keyboard and mouse?  Video game console and controller?  Portable DVD player?  No thanks, we’ll take our multi-touch screen and thin tablet design.
Now, thanks to the low price point of tablets (whether they be iPads, Google Nexus, Kindle Fire, Microsoft Surface etc.) and vendors that supply commercial grade cases and wall mounts that are available to purchase online, your tablet of choice can become a patient entertainment mecca for around $500 per set up.   Video games, educational activities, movies and cartoons are all at young people’s fingertips to keep them occupied while they wait for their orthodontic appointment or for their sibling to get their braces adjusted.   It used to be that to get a durable patient entertainment system wall-mounted in place, you could easily expect to spend $3000-5000 dollars for one set-up that only came with one game included.   Now you could set-up an iPad room on that budget and be the talk of the town as the trendy, fun orthodontist.
Making your own tablet kiosk starts with getting a sturdy lockable case or ‘enclosure’ to protect your tablet.  Internet vendors abound to offer these products, such as TabletEnclosures.com, NClosures.com, or ArchelonEnclosures.com just to name a few.   Just Google or Bing ‘tablet enclosures’ and check it out.   Then select a compatible wall-mount to attach it to, either one that is fixed horizontally or vertically, or a ball-socket type that allows free movement of the tablet for games that require movement to play.   With the massive amount of games in the iTunes App store and Android Market, you can stock an impressive amount of games on your tablet to entertain patients with their game type of choice (puzzle, action, sports, etc.)   Plus, most of these games cost less than $5 and can be installed on multiple machines!
Other than patient entertainment, tablet kiosks can be useful for other purposes too.   Most orthodontic imaging programs and patient education programs also have tablet versions of their products.   Mount one in your toothbrushing area to display videos on proper oral hygiene and decalcification risk.   Show a parent how an expander works.   With the ability to censor access to the tablet’s functions and limit internet access strictly to your practice’s website, tablets are a great way to safely provide a portal for patient entertainment.   Lastly, apps can help you gain Facebook and Twitter followers and provide easy to access spot for parents to leave Google or Yelp reviews for your practice (although Google can be touchy with reviews gained through kiosks—just FYI).
In summary, tablet kiosks offer an inexpensive and highly versatile way to incorporate technology into your practice and put it directly under the fingers of those tech-hungry patients in your practice.  With entertainment likes games and videos along with patient education opportunities, secured and wall-mounted tablets would make an excellent addition to your high-tech orthodontic practice.

Is Your Website Mobile-Friendly?



Author: Dr. William D. Engilman



Mobile computing promises to change everything for consumers, from the way we pay our bills to the way we shop, plan, and commute. The wide array of mobile communications devices and the latest new mobile applications mean that it’s imperative for orthodontists to make sure their websites are ready for mobile devices.
Making Your Way on the Mobile Web
The mobile Web is here to stay. In the same way you look to the Web for valuable services, you also need to provide value for your potential customers.  Do you know how your existing website displays a mobile browser?  If not, you might be in for an unpleasant surprise! 
The mobile-friendliness of your Web page can either move you up or down in the mobile search engine rankings when people look for your services (but not necessarily you specifically) using a mobile browser.  Mobile browsers don’t always handle JavaScript, Flash or even cascaded style sheets (CSS) correctly. Sometimes they don’t handle them at all.

If your website has a lot of Flash animations, or makes heavy use of CSS, understand that the mobile user won’t find these helpful or attractive. In fact, these elements could actually drive mobile users away from your business.

You don’t have to redesign your website completely to accommodate mobile users, but rest assured, some changes are in order! Your web server can deliver information to your visitors based on how they view your site. Make a simple modification that allows your Web server to detect a mobile or traditional browser, and the server can issue one layout for visitors with desktop computers, and another layout for users with smartphones.

If you manage your own Web site, and you’re good with HTML and basic computer programming, you can modify your existing site relatively painlessly by setting up a “mirror” domain for mobile users, and adding a little bit of code on your main site that detects and responds to the type of browser a request for information is coming from.

If you have someone else design your website, let them know that you want to make your site mobile-friendly. These modifications are simple, and can even be tailored to deliver content to specific mobile devices if you want to add that level of detail. If this sounds complicated and/or expensive, here’s the best part: it’s not.

This small change will both improve your mobile search engine rankings and your customer service deliver at the same time.

Don’t dismiss your search engine position as unimportant. When someone is looking for a local orthodontist, you have a much better chance of making contact with the searcher if your practice is listed on the first page of the search engine results. Only dedicated searchers reach the second page of search results, and virtually no one at all sees Page 3.  If you’re listed on Page 4 of the local search results, new patients who are actively looking for your services will only see your competitors.

A mobile friendly website will be a big help to the mother who’s looking for your office phone number while she’s driving, or the new patient who’s not sure how to find your office.  It also preserves the function of your Web site for the user whose browser is prepared to take it all in.

What goes into making a mobile friendly page?  Mobile browsers are big on simplicity, so standard HTML and plain text are king. Forget long URLs, JavaScript, Flash animations, anchored images, scripts and all of the other things you may have added to your site to make it eye-catching.  Smartphones have decent data rates – 1 Mb/s or better, but a graphics-intensive Web site will deliver a quick beatdown to a mobile browser.

So, is your page mobile-friendly? The World Wide Web Consortium (W3C)’s mobileOK Checker will assess your website and tell you just how mobile-friendly your Web site really is (or isn’t). Visit:

Enter your website’s URL and the mobileOK Checker will rate your site in terms of critical, severe, medium and low failures in specific categories. The mobileOK Checker looks for standard HTML, page size, how much network support a visitor needs to view your page, and mobile-friendly page design.

If you’re worried that your site won’t look good after making these changes, think about this: mobile users (who use very small display screens) prefer fast, accurate information over aesthetics every time. Simple sites decrease the mobile browser’s download time and improve the mobile user’s experience.  In the end, meeting the user’s needs is what it’s all about.