Digital laboratory prescriptions

By Neal Kravitz

With the incorporation of intraoral scanners and 3D printing, orthodontists now need a digital method to replace their paper laboratory prescriptions. This CTech blog reviews the benefits of digital laboratory prescriptions and the steps necessary for their implementation. The workflow challenges of submitting digital prescriptions will also be discussed.

The essential function of digital laboratory prescriptions is to allow an orthodontic practice to communicate with their in-house or commercial laboratories. These prescriptions can also have attached digital files, such as JPG, PDF, and STL. Now, the orthodontist will be able to send a digital prescription along with the patient’s digital scan and any pertinent records immediately to their laboratory technician.

Digital prescriptions offer numerous benefits. Primarily, they standardize the laboratory process, which is particularly helpful in a multi-office practice. Other notable benefits include managing all prescriptions, storing prescription data, and improving communication with the laboratory technician. 

The two methods currently available for submitting digital prescriptions are: (1) to log-in to your laboratory’s website portal and submit the digital prescription directly or (2) utilize a third-party digital prescription software, such as a EasyRx.

EasyRx

EasyRx uses a universal digital prescription form that can be submitted to any connected laboratory.  Laboratory connections are made during the initial setup, but other laboratories can be easily added later. If EasyRx is not yet connected with a desired laboratory, they can be emailed an invitation to sign up for a free account through the software.

The software creates digital prescriptions from prescription templates stored in its Universal Library. These templates include a digital illustration of the appliance, which can be customized by adding or removing parts through drag-and-drop (Figure). Comments also can be added to the digital prescription to provide additional instructions to the laboratory technician.

An office can easily add prescription templates for its preferred appliances by emailing handwritten prescriptions to a customer representative. For example, an office with a particular Herbst design can create a new prescription template with a saved digital illustration. This further facilitates standardization and delegation of the prescription submission process.

This software does more than simply create digital prescriptions, however, it also prepares the STL file for 3D printing (hollowing and basing the digital model), tracks laboratory shipments including to commercial aligner companies, and creates prescription invoices.  It was developed in 2013 originally to help manage an orthodontic laboratory, but has since been reengineered for use in private practice.

EasyRx is a web-based application hosted on the Amazon Web Services cloud platform. It is compatible with both Mac and PC computers, and operates on all major Internet browsers. Most importantly, EasyRx integrates with all practice management and intraoral scanner software, including: Dolphin, CS OrthoTrac, Cloud9, topsOrtho, Oasys, iTero, TRIOS, Carestream, and EnvisionTEC.

Getting started and Challenges

To start a digital prescription, the software program is accessed through the patient’s digital file in the practice management or imaging software. An office that uses Dolphin, for example, can launch the program from the Integrations tab on the left side of the screen. Data sharing between these systems is seamless, and the patient’s information is automatically loaded into the digital prescription. 

Submitting digital prescriptions, however, has some challenges. The submission is often delegated to a technician who may select an incorrect template, which may then cause the wrong appliance to be fabricated and delivered to an office.  More commonly, the technician simply forgets to submit the digital prescription, as there is no plaster model to serve as a physical reminder.

To ensure the correct prescription is selected in a timely manner, an office can create a template prescription for every variation of an appliance, and then submit the digital prescription immediately after the intraoral scan. An estimated six months should be given for an office to become proficient with digital prescription submissions.   

Conclusions

Digital prescriptions are a bridge between the intraoral scan and the appliance fabrication. Whether an office owns a 3-dimensional printer or not, digital prescriptions are a necessary progression in the new digital laboratory workflow.

Boy, Did I Just Dodge a Bullet!

By Dr. Greg Jorgensen

(Although you may be more tech-savvy than my mom, you may still work with an older doctor, team member, or relative who could benefit from this story.)

I was seated in church when I got the call from my 80-year-old mother. She said, “Boy, did I just dodge a bullet!”

When I asked her what happened, she explained that she was surfing the web looking for a recipe when a “loud warning” popped up on her screen. It said something like, “Your computer has been infected with a virus that could destroy your files. Call Microsoft support immediately at 1-222-333-4444 (not the actual number).”

She said that the message was accompanied by a “blaring siren” that scared her and that no matter what she tried, she could not close the alert popup. Worried about losing her files, she quickly called the “support line” number on the screen.

The voice on the other end of the line identified himself as a “Level 7” Microsoft technician. He told her not to worry, that her files were safe and that he would solve her problem. She dutifully followed his instructions which allowed him to remotely connect to her computer. She was so proud that she was able to follow his instructions without my help. After several minutes of watching windows open and close on her screen, he told her that everything was now working and her files were safe. He also notified her that she didn’t have antivirus software installed and that for a one-time fee of $699 she could purchase lifetime support and protection from future attacks. Not wanting to go through this again, she read him her Discover Card account number over the phone.

Upon hearing her story, I immediately had her disconnect her computer from the Internet and shut it down. I explained that she had been scammed and that everything the “technician” told her was a lie. It took me over an hour to convince her that he was not legitimate. Once I had her laptop disconnected from her WiFi, I started damage control. I tried to log on to her retirement account website and found that it had already been locked down because of multiple attempts to log on using the wrong password. I found the same to be true for her bank account. I assume that the scammer had obtained login information from her browser history.

We immediately called all of her financial institutions and credit card companies to lock down her accounts. We were even able to get Discover to stop payment on the “support fee” she paid. My mom didn’t lose any money, but the inconveniences she’ll face over the next month or two will be a big hassle.

When I asked her why she didn’t call one of my siblings or me like she usually does when she has computer issues, she said that the siren scared her and that she trusts Microsoft (even though she was browsing the Internet on her MacBook and wasn’t even using Microsoft software!) She also thought she was safe because she placed the phone call rather than received it, even though she got the number from the fake alert. In review, my mom made three glaring mistakes – 1) she called an unverified number, 2) she helped them log onto her computer, and 3) she gave them her credit card number.

This “phishing” technique is just one of many being used by scammers to steal from less-than-tech-savvy people. The appropriate way to get out of this situation would have been to simply choose “Force Quit…” under the Apple Menu or right click on the taskbar in Windows and choose “Task Manager.” These options would have allowed my mom to close the browser along with the ominous alert popup. Had she done this, the scammer would not have even known she saw the alert message.

A quick review of safe surfing practices with your team or relatives should include the following recommendations:

  1. never click on a link that arrives in an email unless you are 100% sure that it is legitimate and you are expecting it (don’t just trust the name on the email…scammers can hack your friends’ email accounts).
  2. never open an attachment that arrives in an email unless you are 100% sure of its origin and are expecting it.
  3. never call a phone number supplied in an email or alert box (instead, look up the support number yourself if you feel you need to call). Be leery of any email that arrives unexpectedly or doesn’t look or feel right. If you aren’t certain, don’t click, open, or call.

Thin Clients in the Orthodontic Office

By Aaron Molen, DDS, MS
www.MolenOrthodontics.com

56xx copy03-resized-600.jpgI 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 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?  One word: scalability.  Due to their size they can be placed just about anywhere; plus, 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 thin clients, (now owned by Dell), 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.  To get the best performance newer thin clients, like the Z90, should be loaded with Windows 7 RTE and then coupled with a server running Remote Desktop Services 2012 R2.  When using higher end thin clients though the cost can increase per client making thin clients a great option for larger multi-location practices looking for scalability but may not offer as many benefits to a single-location practice versus traditional fat clients. There is no question though that the capabilities of thin clients have slowly blossomed under the radar and should be considered by any orthodontist looking to add workstations.