The AAO’s complimentary lecture for February 2015 is an online reputation presentation given at the 2014 AAO Annual Session by frequent blog contributor Dr. Greg Jorgensen. Click here to begin watching.
By Dr. Doug Depew
We all know how frustrating it can be to present your proposed treatment to one parent, while the other one is not present, hoping the first one will be able to make a decision by themselves. Typically however, that is not the case. More often we end up depending on Mom to carry home the dizzying array of information to discuss with Dad. And since she cannot regurgitate all you spent your time explaining, all Dad hears from her is the treatment fee, without hearing an explanation for the fee and all the wonderful things about you and your practice. In order to increase our success, screen sharing allows us to have one parent sitting in the room with you and the other virtually participating in the discussion.
Screen sharing software allows users to share their computer desktop with another individual through their Internet connections. When screen sharing, the other party will see what is displayed on your entire screen in real time. It’s the next best thing to meeting with someone one-on-one. Many of us have been on the receiving end of screen sharing with some of our support companies, study clubs, or for educational experiences. How about being the person to initiate it and use it to our advantage in discussing treatment?
Some screen sharing programs are totally web-based, while others may require you to download a small program. Some programs even allow you to sketch or make annotations the remote person can see. Some vendors offer screen-sharing technology either for free or they may have a cost associated with it (per-use, monthly, or annual fee for access). Any cost is usually pretty small and worth it due to some of the extra features such as the ability to record your sessions, and the high quality images and video content you can share. In either situation, you may share patient photos, digital models, patient education videos, and images of similar cases. Although the “no cost” programs may be adequate for many doctors’ needs, there may be some limitations such as:
- You can only share with one other person at a time
- Unable to record the sessions
- Slow and jumpy video on the remote end
- No ability to annotate or mark-up the screen
So how do you go about making this happen for new patients? Well, ideally we would love to have both parents attend the initial consultation appointment. Even though we might suggest such on the initial phone call, for whatever reason, it hardly ever happens. The non-attending parent is left with the main deciding factor being the fee.
Through careful scripting during the new patient phone call, confirmation phone call, and upon arriving for their initial appointment, it may be possible to have both parents actively involved in the initial consultation. With some preparation, the second parent can be at work, in front of a computer, and be ready for a call at the appointed time. Screen sharing works best if you are on the phone with the person while sharing your screen. Once the oral exam is finished, simply have Mom call Dad from her cell phone, put him on speaker, and then have him log in to your chosen screen sharing web site by giving him the necessary access code.
In doing so, you are often able to help the parents make a decision at the time of the exam, when they otherwise would not have been able to. In the case a parent is not available at the time of the exam, you can either record that portion of the appointment and make it available to them, or make an appointment to screen share at a separate time. Screen sharing potentially can save both time and money. A second appointment is not needed, there is no need to travel, and it is much more effective explaining things using visuals than to do it verbally.
Screen sharing is also quite helpful in collaborating with our colleagues such as a patient’s general dentist or other specialists. Whether it is reviewing your treatment rationale for a patient’s dentist or navigating around different views of a cone beam CT in real-time, this technology makes it much easier to explain concepts and make joint decisions.
Screen sharing can help enhance communication by sharing information that simply cannot be done just over the phone. And if a picture is worth a thousand words, a video is certainly worth a million words. Screen sharing is a cost effective and convenient way to share our findings with a parent or colleague.
As with all things technological, the number of providers is constantly changing. A simple Google search will show several you can evaluate, many with free trials. Some of the more popular that seem to have staying power are:
By Steve McEvoy, Technology Consultant
We are seeing a fast spreading outbreak of a new virus called CryptoWall affecting many practices. Similar to the Cryptolocker virus that emerged last year, this virus seeks to encrypt all your precious data on your computer, and hold it for ransom (asking you to send them $500 USD in Bitcoin to get the decryption key).
What makes this virus so alarming is that as of a few days ago ZERO out of nearly 50 antivirus programs were able to detect it. None.
How to protect yourself
Eventually the Antivirus programs will catch up and learn how to detect it, but at this point in time you need to rely on your own wits and acting responsibly.
So far the virus has been arriving as an attachment to an email message (usually a ZIP or PDF file). We’ve seen it claiming to be airline ticket confirmations, monthly statements from the power company, shipping receipts, etc. Avoid ANY email with attachments that you are not 100% expecting. If you receive an email that you are unsure of – DON’T OPEN IT – and contact the sender by other means and confirm that they did send it to you. Reading the email doesn’t infect your PC, only opening the attachment will.
Signs that you are infected
The virus needs time to tackle the encryption. The longer it goes undetected, the more of your data it can encrypt. You will notice the PC running much slower than normal (since it is using the computers processing power to encrypt your files). You may see files named DECRYPT_INSTRUCTION.TXT and DECRYPT_INSTRUCTION.HTML on the desktop, documents, pictures, mapped drives or any location where you have data saved.
What to do if you suspect an infection
Open the DECRYPT_INSTRUCTION.HTML file and note the time remaining to decrypt your data (they only allow you a short period of time to send them the money before they destroy the data permanently). Once you have that information TURN OFF THE PC. The longer it remains online the more data it can encrypt. Do not attempt to run scans and clean the system, this only buys it more time to encrypt data. Do not connect any external drives to restore backups of data as it will attempt to encrypt your backups when it sees the drives. Contact your IT person IMMEDIATELY for their assistance in recovery.
- Universal Acceptance: Faxing is almost universally accepted by insurance companies and dental offices, while some do not accept emails. These fax numbers are also typically easier to locate in business directories.
- Security: Due to the point-to-point nature of fax protocol, attempts to intercept data will typically cause the transmission to fail. Therefore, faxing is generally considered secure and meets HIPAA requirements for electronic transfer of data.
- Legally Binding: The receiving machine must properly acknowledge that a fax was successful. This means that the message can legally be considered received, which is different than most other forms of electronic communication, such as email.
These benefits mean that the capability to fax is still important in the modern orthodontic office, but it does not necessarily mean a fax machine is needed. Fax machines function well, but requires a modest initial cost ($45 to $200+) and the ongoing expense of an additional phone line (~$20/month). Although it is possible to avoid an additional line by attaching a switch to an existing voice line or using a dual ring, these methods are not as consistent as a dedicated line. This option is straightforward, but are there better modern options?
Yes! Moving from traditional faxing to IP faxing (also known as internet faxing or FoIP – Fax over Internet Protocol) offers numerous benefits and less cost! It allows an orthodontic office to remove the extra phone line, get rid of a fax machine, and still utilize all the previously mentioned benefits of faxing. The switch to IP faxing has occurred slowly because previous IP faxing protocols did not interact well with traditional fax lines. However, modern protocols (T.37 for store-and-forwarding or internet faxing, and T.38 for real-time faxing) have greatly improved reliability. Options for moving to IP faxing include purchasing software for a computer or a VoIP server, buying a FoIP/VoIP server, buying an IP fax machine, or using a 3rd party online provider. All these options have certain advantages, but purchasing any equipment or software for the office will incur higher up-front costs and may need ongoing service.
Personally, I feel that most orthodontic offices should consider internet faxing using an online provider. This keeps startup costs low and requires no additional equipment (assuming you already have a computer and internet access). There are a large number of companies to choose between, so I would suggest looking into HIPAA-complaint companies with positive reviews that offer a good price for the volume of faxes sent by your office. Some providers even allow a small amount of online faxing for free (e.g. eFax, faxzero), but some of these accounts may be disabled after 30 days of inactivity. Our office currently maintains a plan for $3.49/month and $0.05 per minute of faxing (Faxage), and our monthly bill has never exceeded $6.00 – much less than the cost of a phone line. For a slightly higher base fee ($6.59/month), some companies offer integration with Dropbox, Outlook, and Google Drive (e.g. Ring Central). Overall, these online services typically offer the following advantages:
- An online portal where all incoming and outgoing faxes are stored.
- Faxing using traditional email with an attachment. (NOTE: this is sent securely from the online service, but will have the limitations of email while being emailed to the service). A receipt is emailed back when the fax is successfully sent.
- The ability to directly save the file to the computer and upload into practice management software without printing, keeping the practice paperless!
- Higher quality images than traditional faxes with the ability to print on any desired printer at your office.
- The ability to use multiple workstations to send and receive faxes.
There are two potential downsides to consider when switching to IP faxing. First, it is very easy to create a fax number, but it may take more work to maintain a current number. Second, these services typically provide T.37 store-and-forwarding faxing – meaning they hold the fax in a queue and it may take 1-2 hours to send. If these concerns are not issues for your practice, consider looking into IP faxing to inexpensively and conveniently handle your faxing needs.
Recently, a number of AAO members have received a letter from the Motion Picture Licensing Corporation (MPLC) regarding the alleged improper showing of movies in waiting rooms or other areas of the members’ orthodontic offices. The most common letter received is a strongly worded offer to enter into a licensing agreement with the MPLC in order to avoid paying a hefty penalty for future violations.
The AAO has explored the possibility of a group purchasing discount that would cover all AAO members with the MPLC, but has not yet reached an agreement. Concomitantly, the AAO is exploring other arrangements that would allow members to offer certain videos at a much lower cost than a typical licensing agreement with the MPLC, which costs approximately $340 per year.
Below are some frequently asked questions and answers regarding the MPLC and the display of movies in orthodontic offices:
Q. Is the MPLC a legitimate organization? Its letter seems like a scam attempt.
A. The MPLC is a legitimate organization and is at least one of the licensing companies for a number of large media companies, including Disney. It is not a governmental body. It has been known to use tactics that could be described as aggressive with potential customers.
Q. Can I show DVDs of movies in my office?
A. Yes, but you have to have a license to do so. The MPLC and other similar vendors offer umbrella licenses for a set yearly fee. Any showing of a movie that is intended for an audience larger than family or friends, without such a license, constitutes a public performance in violation of the US Copyright Act.
Q. I received a letter from MPLC stating that I am in violation of the law for showing movies without a license, but I don’t even have a TV in my office. Where did they get their information?
A. A number of orthodontic offices have reported that they have received the letter, but are puzzled because they do not have TVs in their offices. It is unknown how the MPLC gathers its information relative to which offices show such movies without a license.
Q. I have been showing movies. What are my options?
A. You need to either stop showing the movies or buy a license. Continuing to show the movies without a license puts you at substantial risk for a large penalty—anywhere from $750 to $150,000. Willing infringement, or continuing to show the videos after you have been notified that you are in violation, carries the highest penalties.
Q. Does the MPLC license cover every movie?
A. No. If you buy a license from MPLC or one of its competitors, you should verify with the company which videos you are allowed to show in your office.
Q. Can I simply put my TV on cable/satellite and broadcast CNN, Nickelodeon, the Disney Channel, etc.?
A. You need to check the contract you have with your cable/satellite TV provider to make sure you have the proper service. Service listed as “residential” typically restricts public performances—i.e., showings for an audience larger than family or friends.
Q. Can I stream movies or TV shows from Netflix or a similar provider?
A. No. Netflix and its competitors restrict usage to personal use.
There are several quick and easy technologies available to help you update your office without breaking the bank. Two of my personal favorites are thin clients and dual screens. I believe that the thin client workstation is the most underappreciated and underutilized tool in many people’s IT toolbox. A thin client is a mini-computer about the size of a paperback book that depends on an external server to perform its computations. Most of us are used to working on fat clients, which is simply another name for a personal computer that does all of its own computations. Simply put, if a fat client was to lose its network connection it could still function on its own, but if a thin client loses its network connection, it is dead. Why would you want a mini-computer that can’t function without a network connection? Two words: cost & scalability. Thin clients cost half as much as a traditional computer and due to their size can be placed just about anywhere. Because they take their orders from a central server, they can be swapped out with ease and don’t require reprogramming. Adding workstations becomes easy instead of a chore and allows you to scale your practice upwards as it grows. I personally use Wyse (now owned by Dell) thin clients and link them to my primary server using Microsoft’s Terminal Services. The latest thin clients even contain graphics cards which allow you to support multiple monitors and 3D imaging software. The capabilities of thin clients have slowly blossomed under the radar and should be considered by any orthodontist looking to add workstations.
The idea of dual screens may seem simple but it’s vastly underutilized within orthodontic offices. Though there is a period of adjustment the efficiency and productivity of your team members will increase once they begin using dual monitors at their workstations. Though many offices have placed dual monitors in their doctor’s personal office they sometime underestimate the benefits of equipping their administrative and clinical teams with the same technology. Having the ability to keep imaging software up on one screen and management software up on another is indispensable in my mind. Most computers and thin clients support dual screens and those that don’t can be easily retrofitted to support them using an inexpensive PCI card. There’s also no reason to settle for just two monitors. If two is good, then at some workstations, three or four screens may be even better.
By Dr. Greg Jorgensen
Rio Rancho, NM – www.gregjorgensen.com
If it hasn’t happened to you, it will. You are going to get a bad online review. You can’t please everyone no matter how hard you try. Even if you have 99% of your patients who are delighted with what you and your team do, you are bound to have someone who thinks you are too expensive, too busy, or whose treatment is taking too long. Unfortunately happy patients rarely go online to report their experience on their own. Upset patients always seem to find time. At the 2014 Annual Session in New Orleans I will be addressing the topic of managing your online reputation. There are four basic steps in my approach.
First, identify the sites in your locale that have reviews for orthodontic practices. There are dozens of review sites online, but there are a few main ones that will show up if you do a search for orthodontists in your community. You should Google yourself and your colleagues and see where reviews already exist. Once you have identified these main sites, verify or claim your page so that you are in charge of it. Not only does this allow you to edit the information about you and your practice, it also gives you the ability to respond to bad reviews when they appear.
Second, a good offense is the best defense. Although happy patients rarely write reviews on their own, they can be encouraged to do so. When you identify a raving fan, ask them to put their praise in the form of an online review. In addition to personal invitations by you and your staff, there are also companies that specialize in asking your patients to review you. You want to make sure that you have good reviews in place BEFORE bad ones show up. Nothing looks more suspicious than a bad review followed by four good ones within a week. Consistently appearing good reviews helps dilute the effect of a bad ones that occasionally show up.
Third, monitor review sites looking for new reviews, both good and bad. You can do this manually or hire a service to do this. Another benefit of claiming your business as mentioned previously is that some email you when a new review appears. Google Alerts are emails that Google sends you when it detects that your name or practice has been referenced on the web. These alerts are free and provide another way for you to know if someone is talking about you.
Lastly, respond to all reviews about you both good and bad. If you get a bad one, try to identify who wrote it. Attempt to correct whatever caused the bad review and see if the author will remove it. When you respond, be humble, informative, and kind. Potential patients will judge you not only for what the bad review says, but also how you respond to it. If the review is true, use it as a teaching moment in your next morning huddle.
Online reputation management is a necessary activity for all practices. Join me in New Orleans as I share more information on this constantly evolving aspect of our online world. See you there!
Many Practices are starting to seriously look at whether using a Cloud based Practice Management app would be beneficial. But most aren’t clear about the issues they should be evaluating.
- A Discussion of what the Cloud is.
- Why does any of this Cloud stuff matter to an Orthodontic Practice?
- What forms can benefits materialize within your Practice?
- What are the key questions to be asking vendors? Some of them are:
- How can it save Money? A key discussion in determining if the benefits are worth it.
- How to work out of the Cloud might be right for your Practice. Some situations will be no brainers, and others may need more careful evaluation.
Rio Rancho, NM – www.gregjorgensen.com
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.