5 Tips to Optimize your Voice over IP Phones

By Matthew Larson, DDS, MS

voipMany orthodontic offices have made the switch to Voice over IP (VOIP) phone systems, where calls are transferred over an internet connection as opposed to traditional phone lines (public switch telephone networks – PSTNs). When I first switched to a Voice over IP Phone system, I mainly considered it a cheaper phone option that could better handle multiple office locations. However, here are a few other advantages I have found to these phone systems:

1st: Phone numbers are not tied to a physical phone line at a certain location. This is probably the largest benefit of Voice over IP, but it can be a challenging change when people are used to traditional phone lines. This means that a call to your main office number can ring at any or all of your office locations at the same time (or a totally separate call center!). It means that once a call is answered, additional incoming calls are still shown as calls to the main number – they do not roll over to another line. It means that while multiple calls are being handled, someone else can still place an outgoing call using the main office number. We still keep a separate phone number for each office location for advertising, but it greatly simplifies how many phone numbers are utilized. One other great benefit is that cell phones can support Voice over IP calling, so they can become an integrated part of your phone system. On my phone, I can either dial normally using my cell number or dial using my Voice over IP app that will show up as a call from my office. This means you can have staff easily forward calls from a dentist or you can return emergency calls without anyone realizing you are calling from a cell phone.

2nd: Phones can be integrated with your computer. This can include things like click to dial from internet browsers or your practice management software, and pop up notifications on your screen of who is calling. Please note that the integration with practice management software definitely depends on the practice management company and the Voice over IP provider. One tip is that some companies use TAPI (Telephony Application Program Interface) for integrating the phone and computer, which will typically work with on-premise systems but not always with cloud-based systems.

3rd: Scalable. This along with the lower initial costs are why I would absolutely recommend new practices to look at Voice over IP as a phone system. There are no large initial costs with many Voice over IP systems if you look at a cloud-based option and there are no large costs to update the system as you grow. Also, adding a satellite office to the system is as easy as adding additional phones/users and adjusting a couple settings.

4th: Cloud Based management. Have to close the office for a snow day (yes, I’m from Wisconsin)? Add a message from home. Forget a holiday message when the office is closed for a long weekend? Add it from home. Staff doing recalls on a non-patient day? Track the number of outgoing calls from your house. Current Voice over IP systems typically make it very easy to switch call-flow, change messages, and view reports online. While these often can all be done with a traditional phone system, I never utilized them because they were difficult to find. Now I will look back at call volume and missed calls at different times and different days of the week to ensure we have the staffing to answer calls well.

5th: Handling call flow. This is part of cloud based management but important enough to mention separately. This type of system is very flexible, so carefully think through how you would want calls answered in an ideal world and you can likely adjust the system to make it happen. For instance, if you want team members responsible for checking in and out patients to only answer the phone if someone else is not free, have their phone ring only if it’s not answered after 2-3 rings. When our satellite office is open, we find it better to have that number ring only at that location first, but we still open it up to all phones in our main office before it goes to voicemail because we want the call answered if anyone is free!

Some final benefits are how easy it is to upload new hold music or marketing messages to the phone, to record calls, and to email a voicemail transcript or audio file. Regarding cost, most companies advertise around a 40% reduction in overhead by switching – we found slightly less than that but it did reduce cost.

The only negative to Voice over IP is reliability. It is dramatically better than it was 5-10 years ago, but due to its inherent nature of NOT being a dedicated phone line, it is typically not quite the equal of traditional phone lines. Insufficient internet bandwidth may still lead to dropped calls or poor call quality. Overall, though, our Voice over IP system has allowed our office to more effectively manage calls at our office locations.

Google My Business

By Dr. Doug Depew

unnamedGoogle my Business is another way Google has made it easy for us to let prospective patients know about the level of care we offer. It complements your website by giving your practice an identity and presence on Google. If you previously used Google Places for Business or Google+ Pages Dashboard, you may not have noticed it, but your account has already been automatically upgraded to Google My Business. The information you provide about your practice in Google My Business will appear on Google Search, Google Maps, and Google+ to those searching for an orthodontist.   And if you had multiple Google+ Pages they will all show up on the Google My Business Dashboard as long as they are associated with the same email address.

The Google My Business Dashboard makes it easy to manage multiple locations from one central webpage. All you have to do it go to https://www.google.com/business/ and sign in using your email address and password associated with your previous Google+ Pages. From your Dashboard, you will be able to do a number of things.

Locations
For each of your locations, you can add, edit, and verify your practice information. This includes your practice name, phone number, website, and hours.   When you do so, it will automatically update as well in Google Search and Google Maps. For each of your locations, you can easily add pictures of yourselves, your logo, the exterior of your office, the interior of your office, and any other photos you feel will help others learn about your practice. When people search Google, they can learn a lot about you before even going to your website. From your Dashboard, you can also post directly to your Google+ Pages.

Reviews
In the Reviews section, you can see all the reviews patients have posted about your practice. The best part of this is that you can respond to those reviews. Experts in this arena recommended that we respond to at least three reviews a week. This can be to thank patients for especially kind compliments, but more importantly, we should promptly respond to any reviews that are less than stellar. Since negative reviews may inaccurately reflect the level of care you give, it’s important to attempt to set the record straight. In doing so it’s important to thank the reviewer for their feedback and respond in a way that is generic without referring directly to that patient’s experience in your office and their treatment details. Author Helen Overland stated “Respond to reviews, don’t let them sit. If someone sat outside your store telling people about your bad service, you would address it, right? So don’t let people sit outside your virtual door on Google Maps telling people about your bad service without addressing it. Addressing complaints is just good business.” And Google My Business makes it easy to do so.

Insights
In the section called Insights, you can learn how people are finding out about you, from what type of device they are viewing your profile, their demographics, and much more insightful information that may help in your marketing efforts. You can also see viewer activity trends such as how many people call your office from your Google profile, how many click to your website, and how many are asking for directions to your office.

Google Analytics
No longer do you have to log in separately to Google Analytics to see viewing trends on your practice website. This is now right there within Google My Business.   Google Analytics will tell you a lot of useful information such as how many new viewers, how they found your website, viewer demographics, length of their visit, and page views. Having this information on hand can help you in tweaking your website for the most effective and useful visits for prospective patients.

Adwords Express
Like many things Google, Google My Business is free to use. If you choose to make Google ads however, that’s a paid function. These are the ads that show up on the top or right side of a Google search. And Google My Business allows you to manage your Ads from your Dashboard since they should be under the same email.

Virtual Tour
From your Google My Business Dashboard, you are able to learn about how to incorporate a Virtual 3D tour of your office onto your Google listing. These can also be placed directly onto your practice website.

Going Mobile
By downloading the Google My Business app, you can perform most of these functions right from your mobile phone.

I have personally found Google My Business to be a great tool in my efforts to monitor and improve our practice’s online presence. It has consolidated many functions into one place, saving time and energy. I encourage you to look into it and see how it can help you.

 

eOrthodontics

By Dr. Anthony M. Puntillo, DDS, MSD

Dr.-Puntillo-PictureIt was not that long ago when we all relied upon our friendly postmen and postwomen for the delivery of our letters. Today the United States Postal service is scaling back mail operations in favor of package delivery, and the majority of our written communication is transmitted electronically. Is the delivery of healthcare, and particularly orthodontic care, headed for a similar fate? A Computerworld article, cited research by Deloitte, which projected 75 million of 600 million appointments in 2014 with general practitioners would involve electronic or eVisits¹. “Electronic visits or telemedicine are comprised of electronic document exchanges, telephone consultations, email or texting, and videoconferencing between physicians and patients. The vast majority of eVisits, according to Deloitte, are likely to focus on capturing patient information through electronic forms, questionnaires and photos.” In the state of Texas, new legislation has opened the door for physicians to be compensated for remotely providing care to children through a video connection to the school nurses’ office². Market forces including an expansion of access to care, increased efficiency, and financial incentives are driving all of these changes. Just as eMail though has not completely eliminated the need for our postal service, eVisits are not likely to eliminate the need for all direct patient to physician interaction. However, there can be no denying that technology is changing the manner in which healthcare is delivered and our specialty will not be immune.

It may be hard to conceive how we will remotely align teeth. However, the 1999 introduction of digitally created tooth moving clear aligners (Align Technology, Inc.) opened the door to the Orthodontic digital age and fortunately or unfortunately that door cannot be closed. Recently, while attending an orthodontic meeting overseas, I noticed a new company that seemed to be garnering a great deal of attention, Dental Monitoring (dental-monitoring.com). This company claims to be the “first monitoring solution in orthodontic care.” Patients capture their tooth movements with their smartphones and orthodontists can remotely monitor and direct treatment via an app. Whether or not this company is the first is irrelevant. It will certainly not be the last. The same efficiencies and cost advantages that eVisits offer physicians in the general practice of medicine also apply to orthodontic practices. To be clear, I am not advocating that remote care is better or even desirable. The purpose of this blog is to raise our members’ awareness and open discussions regarding technological changes in our profession. In the last 20 years, we have incorporated electronic patient records, CBCTs, intraoral scanners, and even 3D printing into our practices. As we all adapt to the expectations of the Millennial Generation what will our practices look like 20 years from now?

1. Almost one in six doctor visits will be virtual this year. Computerworld: Mearian, L. August 8, 2014.
2. Law could bring remote doctor visits to schools. The Texas Tribune: Rocha, A et. al., August 23, 2015.

Windows 10 – Should I Wait?

By Steve McEvoy, Technology Consultant

steveMMicrosoft has recently released the latest version of its operating system (OS) for PCs – Windows 10 (let’s call it WinX).

This is the first time Microsoft is offering the upgrade for free to existing users of Windows 7 and 8 (until July 2016 – and maybe longer).   They are intending to make upgrades to their OS less of a big deal in the future, giving it away and moving to a more automatic update format.   Apple and Android have been following this model for years.   It’s a good idea for the most part – keeping your OS up to date means it has the latest security & features.

WinX Notifier

Screen Shot 2016-03-21 at 4.47.51 PMMany of you may have seen a little notifier popping up on your PCs prompting you to reserve or upgrade to your free copy of WinX now.   With great joy and vigor many of you have done just so.   But is this a good idea? Staff clicking on it can trigger a disaster if this isn’t thought through.

Upgrading any Microsoft OS in the past has typically been an ordeal. You have to consider several things before you undertake an upgrade:

  • Will the new OS have drivers that support my hardware (video card, sound card, etc.)?   Often they don’t for older hardware (even systems a year old may not have drivers). Checking with your hardware vendor in advance is a good idea (for example going to the support website for Dell or HP and look to see if WinX drivers are available for your PC).
  • Will it work with all my peripherals?   Often you need specific OS drivers from Vendors to make these work.   Check with your vendors in advance to be sure they are available for things like:
    • Printers
    • Document Scanners
    • Signature Pads
    • Credit card scanners
    • X-Ray systems (this is usually a HUGE problem – they lag far behind)
  • Will the applications I own work on WinX?   You need to check with each vendor in advance if they full support WinX. Many don’t immediately after the initial release (and still aren’t as of this writing).
    • Practice Management software (like Dolphin, Orthotrac, Dentrix, etc.)
    • X-ray system software (like Romexis, Cliniview, Anatomage, etc.)
    • Antivirus software (most need upgraded to support WinX)
    • Backup software
    • Even Microsoft Office (older versions are not fully supported)
  • Will I have to retrain my staff? The changes in the user interface often give less adaptable staff fits.

Initial reviews of WinX are mixed. They’ve added some new features (Cortana assistant and the new Edge web browser) – most of which don’t matter to a Dental Specialty Practice.   They’ve changed the look and feel of the Desktop and Start Menu system yet again (the Metro interface is gone thankfully).   As with any new version of their OS, lots of little problems are being discovered as it rolls out to millions of users.

What would I do?

Screen Shot 2016-03-21 at 4.48.02 PMMy stance is typically to wait out the initial release and let others debug the 1.0 version. At the time of this writing Microsoft has released build 1511 (which is essentially Service Pack 1), and this generally marks the ‘safe to go in the water’ if you’re interested.

For your Home I’d say the risks of upgrading are pretty low if you have fairly recent hardware and you might want to give WinX a try. I’d still take time to confirm if your peripherals (like your printers) are compatible.

For the Practice I would recommend waiting until there was a compelling reason to change. I believe it’s easiest on the staff if ALL the PC’s in the Practice are on the same version so they have a consistent experience and don’t have to keep adapting.   If you were getting all new PCs, I’d seriously consider making the change. If you have a fleet of Windows 7 PCs that are working fine, I wouldn’t bother.

If you have your heart set on jumping in, involve your IT person. They can do the checking for you and advise you on a pathway and any bumps in the road that might be expected.

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.

HIPAA: Encryption is NOT Required…What?!?

By Charles E. Frayer[1], JD, MS, HCISPP, CIPP, CIPM

Introduction
cfrayer
No, that headline is not a misprint. Contrary to common assumptions—and what many email encryption providers may tell you, Congress, in its infinite wisdom (stop laughing, please) decided that the Health Insurance Portability and Accountability Act (HIPAA) should not—and, therefore, it does not—require the use of encryption to secure your patients’ private medical data (aka, electronic Protected Health Information or ePHI).

WARNING: IF YOU STOP READING NOW AND SIMPLY DECIDE THAT YOU DO NOT NEED ENCRYPTION, YOU MAY WAKE UP ONE DAY TO THE WORST FINANCIAL AND PUBLIC RELATIONS NIGHTMARE IMAGINABLE. SO, READ ON…

Required vs. Addressable: What’s the Difference?
In HIPAA, Congress adopted two types of implementation specifications—“required” and “addressable.” Those labeled “required” must be implemented or it will be deemed an automatic failure to comply with the HIPAA Security Rule. On the other hand, those labeled “addressable” must be implemented only if, after a risk assessment, the covered entity (that’s you, if you’re a Health Care Provider, a Health Plan, or a Health Care Clearinghouse) has determined that encryption is a reasonable and appropriate safeguard for managing risks to the confidentiality, integrity and availability (CIA) of ePHI. A brief sidebar about the CIA triad: confidentiality protects against unauthorized disclosure; integrity protects against unauthorized modification or destruction; and availability protects against disruptions to access and use of ePHI. Okay? Now, back to our story…

However, if you determine that encryption is not reasonable and appropriate (think about this carefully), then you must document your rationale for that decision and do one of the following: (a) implement an equivalent alternative to encryption that is reasonable and appropriate; or (b) if safeguarding ePHI can otherwise be achieved, then HIPAA even allows you to choose not to use encryption or any equivalent alternative measure, provided that you also document the rationale for this decision.[1] Shocking, isn’t it? Yes, Congress effectively (is that an oxymoron?) allows you to do nothing, provided you can and do back it up.

Now, if you’ve thought about that carefully, you’re probably wondering something like, “What if HHS audits me and they don’t agree with my carefully documented rationale for deciding that encryption is not reasonable and appropriate to protect my patients’ private medical data?” Perfect question! And therein lies the problem. It is difficult (impossible?) to even imagine a situation for which it would be “reasonable and appropriate” to decide not to use encryption to protect ePHI (remember, that lowercase “e” stands for “electronic”). So, even though HIPAA does not literally require encryption, it effectively requires encryption because there is no reasonable and appropriate alternative for protecting ePHI.

In other words, when it comes to using encryption to protect ePHI, there is little (if any) difference in Congress labeling it as “addressable” rather than “required” because not using encryption is simply too risky for your patients’ ePHI and, therefore, even riskier for your business.

Encryption: HIPAA’s Data Breach Safe Harbor
Under the HIPAA Breach Notification Rule, there are essentially two types of ePHI—unsecured (i.e., unencrypted) and secured (i.e., encrypted). Under HIPAA, every breach of unencrypted ePHI requires you to provide time-bound notifications to: (1) affected patients; (2) the Secretary of HHS (i.e., the federal government); and/or (3) prominent local/state media outlets. This, of course, will put you at risk of federal and/or state investigations, fines, possible lawsuits, and the worst kind of public relations disaster imaginable, which will almost certainly result in lost business.

But there is good news…no…GREAT NEWS!!! Under the Breach Notification Rule, encrypted ePHI that is “breached” (e.g., lost, stolen, or accidentally/intentionally sent to the wrong recipient) is not considered a breach at all because ePHI that is encrypted cannot be read or otherwise used without the key(s) required to decrypt it. Consider some of the risks of emailing your patients’ ePHI unencrypted versus sending it via encrypted email, as follows:

Screen Shot 2016-02-18 at 4.27.19 PM

So, if you use it, encryption is your lawful HIPAA-endorsed safe harbor against everything you want to avoid in the event of a breach of ePHI. Going back to our previous segment, even if you somehow came up with that rarest of all situations—where using encryption to protect ePHI was not reasonable and appropriate, you still need to use it because doing so gives you a complete “out” when the worst of all possible ePHI scenarios—a data breach—occurs (i.e., you get to simply walk away).

In summary, although HIPAA does not literally require encryption, Congress nonetheless has effectively mandated its use because (i) it is all but impossible to think of a real-world situation where encrypting ePHI is not reasonable and appropriate; and (ii) if you choose not to use it, you are exposing your business to a plethora of regulatory, legal, public relations, and/or financial risks that are easily avoidable—by simply using encryption.

[1] Charlie Frayer is a Michigan licensed attorney and Florida Authorized House Counsel serving as General Counsel and Chief Privacy Officer at Protected Trust, LLC, the leading provider of Simple Email Encryption with 24×7 free and unlimited support via phone, email, and chat.

[1] See: 45 CFR § 164.306(d)(3) detailing the difference between “Addressable” and “Required” implementation specifications at http://www.ecfr.gov/cgi-bin/retrieveECFR?n=sp45.1.164.c#se45.1.164_1306;

45 CFR § 164.312(a)(2)(iv) labeling encryption and decryption as “Addressable” at http://www.ecfr.gov/cgi-bin/retrieveECFR?n=sp45.1.164.c#se45.1.164_1312; and
the HHS HIPAA Encryption FAQ at http://www.hhs.gov/hipaa/for-professionals/faq/2001/is-the-use-of-encryption-mandatory-in-the-security-rule/index.html

When Less is More, Regarding Radiation

J-Martin-Palomo-Headshotby Juan Martin Palomo DDS, MSD

We all know Cone Beam Computed Tomography (CBCT) by now. It allows a non-invasive, usually less than 10-second capture of the craniofacial anatomy, which is able to create all possible traditional 2D radiographs, giving far more diagnostic information. Probably the main mentioned reason of why it has not replaced the traditional panoramic and cephalometric radiographs in clinical orthodontics, is radiation. Depending on the settings used, it could expose the patient to more radiation than that of a ceph and pano. The radiation would still be considered low, according to the American College of Radiologists, and is less than the additional annual cosmic radiation that somebody living in high altitudes, such as Colorado, receives, but nevertheless, more than a ceph and pano. But this is no longer the case, for a while.

Most major CBCT manufacturers have now a low-dose scanner in the market, which allows the 3D image to be captured, with less radiation than a panoramic radiograph. It givless is more Palomoes a complete 3D image, where a pano, ceph, and complete 3D view can be used, for less radiation than that of a distorted pano. How is this possible? The answer is “capturing technology”.

When a low dose 3D image is captured, the scanner does not go all 360 degrees around the patient’s head. Sometimes it is just 180 degrees. The 3D image is basically a combination of several static images (radiographs) taken while the scanner rotates around the patient’s head. In a low dose option, the number of images captured are less than 200, as opposed to the usual 300-600. When a panoramic radiograph is being taken, the x-ray beam is “on” the whole time, beeping, while going around the patient’s head. In a low dose CBCT scanning, pulse technology is used, so the x-ray beam is only “on” for a fraction of a second while taking a quick image, turning itself “on” and “off” automatically, resulting in a total radiation exposure of about 2 seconds.

All this in combination with low radiation settings, results in total effective radiation to the patient in the teens or low twenties, compared to high twenties for a pano. And in this numbers game that is effective radiation, the suggested safety threshold is 30 microsieverts. Anything below 30 microsieverts can be considered low, and fair game.

Now for the very necessary disclaimers. This does not mean that because we can get to less than 30 microsieverts we should scan everybody. Zero is still less than 30. So if a radiograph that can answer the question clinically posed has already been taken, retrieve it and do not take an additional one. If no radiograph is necessary, don’t take one just because you can. But if a radiograph is needed, and a low dose CBCT is an option, I would have a hard time justifying a ceph and pano, as opposed to a low dose CBCT. And to take a pano or ceph before taking a low dose CBCT would also be unnecessary additional radiation to the patient.

The low dose CBCT alone has more than sufficient image quality for what we need in orthodontics. I have seen images from several manufacturers, and this is clearly a situation where less radiation to the patient is also more information to the doctor. What better win-win that this can we ask?

Have You Talked to Your Telecom Vendors Recently?

By Anthony M. Puntillo DDS, MSD

Dr.-Puntillo-PictureMany of you have no doubt seen the television commercials announcing the merger of AT&T and Direct TV. This merger is just another sign of the digital transformation the United States telecommunication industry is undergoing. This transformation is being driven largely by an insatiable consumer desire for data and bandwidth. If you have transitioned your practice to digital, and many have, chances are high that you discovered your office hard drive was full and needed to be upgraded. Furthermore, single location practices are becoming more rare and it can be challenging to access all of this additional data when and where you need it. This issue is even more pronounced in the increasing number of practices that utilize 3D CBCT machines, as the DICOM files generated by these machines can be as large as 700 megabytes.

My practice consists of four office locations, three doctors, and three CBCT machines. All our locations are networked to a single sever and all patient data is securely accessible at each location and externally via a virtual private network (VPN). Our Voice over IP (VoIP- see Dr. William Engilman’s post from May 2012) telephone system connects all our offices and staff seamlessly. To make all these systems work we require stable bandwidth and lots of it. That bandwidth comes at a significant monthly fixed cost for our practice. Recently, in an effort to make sure we were getting the most for our money, we asked our IT consultant to review our contracts and plans with all our telecommunication network providers (i.e. AT&T, Comcast, etc.). Their review found that by bundling some services (i.e. phone, internet access, etc.) additional bandwidth, and subsequently improved efficiency, was available for a similar monthly cost. In the cellular world, companies such as AT&T, Verizon, T Mobile, and Sprint are investing heavily in infrastructure upgrades. These upgrades are being used to offer consumers deals that were unheard of just 12 months ago. If you have not reviewed you offices telecommunication vendors and plans within the last 12 months, I would encourage you to use the slower time in your office this fall to do so. You may find significant cost savings or improved services are also available.

Nanotechnology: From Small Scale to Great Innovations

By Dr. Celestino Nobrega

dr Celestino Nobrega 2007Are you prepared for the amazing benefits and innovations that Nanotechnology will shortly bring to orthodontics? Richard Feynman (http://www.feynman.com), an American theoretical visionary physicist, introduced Nanotechnology as a science that embraces the capability to see and to arrange atoms and molecules according to a particular convenience or goal.

Nanotechnology involves the development and utilization of structures, devices, and systems that have properties and new functions due to their small size. A nanometer is one-billionth of a meter. For reference, consider that there are about 25,400,000 nanometers in an inch, and a single sheet of paper is about 100,000 nanometers thick.

The NNI (National Nanotechnology Initiative) is a U.S. Government research and development initiative that is focused on delivering the shared vision of “a future in which the ability to understand and control matter at the nanoscale leads to a revolution in technology and industry that benefits society.” NNI is chartered to develop a framework for sharing strategies in order to support nanoscale projects. Common goals, strategies and priorities are now being drawn for distinct science fields, such as biology, engineering, chemistry and, of course, materials science. With this support, nanotechnology R&D is taking place in academic, government, and industry laboratories across the United States.

As Orthodontics progresses into a refined science and with the support of technology advancements, unimaginable results can be achieved in the near future, especially when our specialty can leverage nanotechnology innovations such as selective biosensors. The oral cavity can be considered as an important source of information that could be extremely helpful not only for orthodontic treatment, but also for early stage diagnosis and monitoring of systemic diseases. It’s largely known that the exhaled human breath contains several Volatile Organic Compounds biomarkers (VOCs). Accurate detection of these VOCs can provide essential information for the diagnosis of those diseases. For example, Acetone (CH3COCH3), H2S, NH3, NO, and Toluene can potentially be used to evaluate diabetes, halitosis, kidney malfunction, asthma, and lung cancer, respectively.

Breath analysis, pH level and temperature data can be captured and processed by multiple sensors and could potentially reduce the medical diagnostic costs for patients suffering from chronic illnesses. In addition, patients’ quality of life could be improved. For example, diabetic individuals could possibly benefit from using non-invasive nanostructured hemitubes Silicon-doped (WO3) films to sense acetone exhaled breath levels, which can eliminate painful and invasive fingertip pricking.

As I observe the emergence of recent technology advancements within orthodontics, I can envision a future of innovative orthodontic portable devices that can accurately capture, track and transmit these previously mentioned biological signals.

In this category, we can include the exciting new innovation of dental movement acceleration devices (periodontal tissue activation by vibration). Along with achieving their primary objective of delivering pulsatile forces to accelerate tooth movement and to reduce treatment time, these devices could also be used to capture intra-oral data through the action of nanosensors and wirelessly transmit this information to personal mobile devices and laptops. The remotely collected data can be stored on the cloud to create an intelligent system for support of clinical decisions. This robust wireless communication and database creation has the potential to support multiple users throughout the orthodontic treatment process:

  • Orthodontist: electronic health records (EHR) enrichment; treatment plan refinement according to patient features; suggestions for treatment plan improvement according to case’s evolution; warning signals and alerts to monitor patient’s general and intra oral health.
  • Patient: real time communication with the Orthodontist or their staff through smartphone connection; treatment status check; sharing treatment experiences with other potential patients; automatically get FAQ answers.
  • Companies, industries and laboratories: helpful database for new products designs, services and needs.
  • Scientific research: Database for systematic reviews, Meta-Analysis.

So, are you prepared for “small” technology and big changes?

 

 

Sending Sensitive Patient Data via E-mail

Foto-StudOnBy Dr. Andreas Detterbeck

The communication between clinicians via E-mail is fast, easy, cheap and widely used. But sending an unencrypted E-mail is as safe as sending a postcard. So, numerous parties have full access to E-mail-correspondence at all time. Violations against the patient privacy could cause dramatic consequences – depending on national laws, some of these solutions may even result in prosecution of the clinician (see HIPAA).

There are many commercial solutions to encrypt your communication, but if you are firm and experienced in using computers – you should at least know how to download and install software – there is no need to rely on any company. You don’t have to worry about high fees or losing your correspondence if your preferred encryption-business crashes. In this blog I want to suggest a few ways how to encrypt your E-mail communication easily and (almost) free of charge:

screenshot

Encryption of E-mail Communication by S/MIME
If I don’t want that my mails can be read by anyone except the receiver of the mail I have to convert the text in some sort of coded or encrypted form. Because it is not easy to invent an encryption of your own and sharing that idea with your communication partner a standardized tool would be very helpful. And this is where the Secure/Multipurpose Internet Mail Extensions (S/MIME) come in: S/MIME offers encryption and signing of E-mails in a standardized and reproducible way. Most current E-mail programs and free Webmail providers support this process.

Subsequent I will give a step by step introduction how to implement S/MIME in your mailing process:

  1. First of all you have to make sure you are using an E-mail program with S/MIME support (Mozilla Thunderbird, Microsoft Outlook and many more)
  2. Next you have to buy or even just create a certificate from a big commercial or non-commercial certification authority (CA). You may find some references here.
  3. Now comes the hardest step – but don’t worry you’re almost done:
    Deposit this personal-certificate in your E-mail program with S/MIME support. This process is very different depending on which program is used. Here are two useful how-to-links for the most common software:

Microsoft Outlook
Mozilla Thunderbird

  1. Users who have completed these steps are then ready to send digitally signed E-mails and receive encrypted messages (You sign a message when you want to prove that the mail comes from you and no modification of the text has been done during the transit).
  2. If users want to send encrypted E-mails of their own – and not only receiving encrypted mails – the receiver needs to have an S/MIME certificate, too.

For security reasons, your user certificate will normally remain valid for one or two years and is available from the CA for a small fee or even free of charge.

Conclusion
Maybe you think this sounds all strange to me and way too much work is required. There has to be an easier, less cumbersome solution.

But we don’t have the easy solution yet.

Of course you can pay a company for securing and encrypting your communication, but what happens if the company is insolvent or they decide to wind down the operations. What happens to your documents? There are providers that will allow you access to your data, but this may not be the case for all providers, so make sure this is the case before you sign up.

For use in daily clinical practice, I definitely recommend E-mail encryption by S/MIME. It is an IT standard since 1995 and a long term support is presumably. At least the corresponding doctors should have any form of secure communication.

Do not forget: The use of cryptography before sending patient data via E-mail is mandatory! If you are not sure how to encrypt your E-mail communication it is better to relinquish sending private patient data via the internet.

This blog-entry is based on:

Electronic transfer of sensitive patient data.
Detterbeck A, Kaiser J, Hirschfelder U.
Int J Comput Dent. 2015;18(1):45-57.
http://www.ncbi.nlm.nih.gov/pubmed/25911828