Category: Office Trends

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.

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.

3D Printing and Orthodontics

By Dr. Christian Groth

As we move towards the 2015 AAO Annual Session in San Francisco many of us will be making check lists for items to investigate at the exhibition hall and lectures. Anybody who has attended recent meetings has seen that intraoral scanners are a hot topic. Every year new products are being released, or updates to current systems are offered. Intraoral scanning has opened the door for additional technologies within (and outside of) the orthodontic office. Dr. John White wrote a very informative blog post in February talking about the use of intraoral scanning for same day consultations (click here to read it). As more people are offering clear aligner therapy (including general dentists and the mail order aligner system that we all know about) it is time that we differentiate ourselves as orthodontic specialists. One way in which we can do this is to incorporate 3D printing into our daily practices.

3D printing, also known as additive manufacturing, is a process by which a physical object is created from a digital file (check out a video of 3D printed models here). There are several different types of 3D printers available that range in price from a few hundred dollars to almost one hundred thousand dollars. They all have one thing in common: they build models layer-by-layer with a build platform that moves vertically. The smaller the layer thickness the better looking the model will be. The four most popular types of printers are: Fused Deposition Modeling (FDM), Stereolithography (SLA), Digital Light Projector (DLP), and Polyjet Photopolymer (PP). Without getting too technical here is how each basically works. FDM involved heating up a thin strand of plastic resin that comes off of a spool and is deposited in layers as thin as 100 microns. SLA and DLP technologies are similar in that they utilize a vat of liquid, photosensitive resin. When the light hits the resin it is cured and platform moves to enable the next layer to be cured. The different between SLA and DLP is that SLA uses a single laser point to draw an image whereas DLP uses a projected image to cure a whole layer simultaneously, which allows the printing process to move faster (think of this as the difference between drawing a picture and stamping a picture). PP printers are probably the most popular in dentistry and use inkjet technology (yes, just like your desktop printer). Liquid resin is jetted out of nozzles in an extremely accurate fashion and cured by a UV. Layer thickness of SLA, DLP, and PP printers can be as low as 16 microns (for your reference the average piece of paper is 100 microns thick).

While the technologies differ between printers what truly sets them apart is the quality of the parts. Cheap printers are made from cheap parts that can degrade over time and result in inaccurate models. It is truly a case of you get what you pay for. So if you are in the market for a 3D printer to be used in your practice, buy the best one that you can afford.

3D printed models can be used for anything in the orthodontic office.   The most practical use is for retention and relapse treatment. A major downside to stone models is that they are often destroyed during the retainer fabrication process. 3D printed models do not get ruined and can be used as many times as necessary for retainer fabrication. Imagine being able to print a model, make a clear retainer, and mail it off to a patient who is away at college. What a service you have just provided to your patient and they never stepped foot in your office! Pairing 3D printing with one of several software programs available allows us to create sequential setups/models for minor tooth movement. By controlling the process we control the overhead and thus have the ability to pass these savings on to the patient. Another great service that we can offer our patients if they have a lapse in retainer wear.

Whatever your practice is like there is a place for 3D printed models in it. While you will pay a little bit more for the physical model, the longevity, versatility, patient excitement, and ability to virtually eliminate alginate impressions from your practice will pay off in the end!

The Digital Generations

By Anthony M. Puntillo DDS, MSD

Dr.-Puntillo-PictureThe majority of the U.S. Workforce today is comprised of three generations:  Boomers (1946-64), Xers (1965-80) and Millennials (1981-99), each generation with its own unique set of characteristics.  The American Association of Orthodontists (AAO) now reports that more than 51% of its membership is composed of Gen Xers and Millennials.  By virtue of their birth timing Xers and Millennials, including myself (1966), were the first generations to grow up with computers in their homes.  Although Gen Xers differ from Millennials in many ways, technology is now ingrained into nearly every part of both generations’ lives.  For those Xers and Millenials that also happen to be orthodontists, this attachment to technology includes not only their personal lives, but also their orthodontic practices.

Over the last few years, my blog posts have centered on the discussion of a “Digital Orthodontic Practice.”  A digital practice must include not only the management and record keeping aspects (paperless) of our offices, but also clinical diagnosis and tooth alignment functions.  In this post, I want to highlight the current opportunities for moving digital in the clinical portion of your practice.

Diagnosis:

The clinical care for most orthodontic patients begins with a diagnosis and a treatment plan.  Given that Kodak is now only a shell of the company that it once was, I think it is safe to say most orthodontic practices are now taking digital photographs, instead of film, as part of their diagnostic records.  The recent 2014 JCO study of Orthodontic Diagnosis and Treatment Procedures1 found that more than 91% of the respondents used digital radiography, 69% used CBCT either routinely or occasionally, 41% used digital models and 28% used intraoral digital scanners.  Additionally,  the American Board of Orthodontics (ABO) recently announced that all initial models for their exam must be submitted in a digital format.  While the JCO survey included a relatively low number of respondents (n=135), I believe the findings are indicative of the Electronic Health Record (EHR) movement in all of the health care profession.  This movement, aided by government mandates and subsidies, has now breached the threshold level.  The train has left the station.  If you and your practice intend to stay relevant over the next decade, you absolutely need to be utilizing digital diagnostic records.

Tooth Alignment:

As our profession transitions to a digital diagnostic record norm, some are looking to move beyond diagnosis to digitally construct tooth aligning appliances.  In 1999, Align Technology opened the door to digital orthodontic tooth alignment with the introduction of the Invisalign system.  The system at that time relied upon traditional dental impressions, but today intraoral scanners and 3D printing have allowed for the elimination of the impression procedure.  Whether it be Align, or any other current Clear Aligner option, a digital model (.STL) of a patient’s dentition can be captured with a scanner, the teeth can be aligned using computer software, and treatment appliances (clear aligners) can be fabricated by machines based off of the digital “plan”.  Furthermore, this process can now also be utilized for patients using traditional bonded brackets.  Custom brackets along with custom bracket placement jigs and custom wires digitally planned and robotically bent are possible.  In large part because of costs and the learning curve, the digitization of clinical orthodontic procedures has not yet been completely accepted.   However, as the techniques become more refined, we should expect the cost to include them into our practices to decrease and implementation by the tech savvy Xers and Millennials to accelerate.  If you are an Xer or a Millennial, and have not already incorporated digital tooth alignment into your practice, you should be planning to do so in the near future.  If you are a Boomer, and potentially less comfortable with technology, you need to consider if you can afford to ignore this change.

Creating an esthetically pleasing and stable smile, can be a bit like designing and constructing a building.  In a recent conversation with a Boomer architect friend of mine he described the digital changes his profession has undergone.  My friend reported that my office, built in the year 2000, was one of the last buildings he drew by hand.  All of his projects now are digitally designed using 3D CAD technology, allowing him to plan and visualize the end construction result more effectively.  The transition in the architectural profession took time and learning.  Change is never easy.  However, as my friend now approaches the end of his career, he finds the “old” way inefficient and less accurate.   Whatever generation you were been born into, I encourage you to embrace the digital change our profession is in the midst of.  I am certain a digital orthodontics will ultimately benefit you and your patients.

1Keim Et.Al. 2014 JCO Study of Orthodontic Diagnosis and Treatment Procedures, Part 1: Results and Trends Journal of Clinical Orthodontics 2014; 48:10 pages 607-630.

Google+ vs Google My Business

3872b46By Dr. Greg Jorgensen
Rio Rancho, NM

There is no question that the Google search engine is THE search engine of choice in today’s online world. When you want to find something on the web, you “Google” it. The most current statistics estimate that 90% of all online searchers used Google in 2014. Yahoo and Bing each attracted about 3% and the remaining 4% was divided up between several less widely accepted search engines. Google is king and if you want your orthodontic practice to be found, you must focus your SEO efforts on being optimized for Google.

Google has two other services that bear the Google name but may be less understood by orthodontists. Those two are Google+ and Google My Business. One is VERY important to every business and the other may not be around a year from now. Let’s take a look.

Google+ is Google’s version of Facebook. Like Facebook, you can post photos, statuses, and videos. Acquaintances are grouped into Circles which represent groups of people with something in common. Their version of the Timeline is “The Stream.” Google+ has a useful communication feature called Hangouts which allows group texts and video chats. Over 500 million users are registered on Google+ (compared to Facebook’s 1.3 billion), but the average interaction is only about 7 minutes per month. Its biggest strength is its tight integration with Gmail and YouTube which are very popular online services. Because it is so similar to Facebook without offering any real advantage, many on the “inside” feel that like several other Google attempts at a social network, Google+ is on its way out.

Google My Business is Google’s version of a Facebook business page. (It has formerly been named Google Places and Google+ Local.) Like a Facebook business page, there are pictures, a description of the business, hours, form of payment, a map, and reviews. A Google My Business listing is like a full page ad in the yellow pages in years past, and it is completely free. The one big advantage that Google My Business has over a Facebook page is that this listing is presented as the primary search result whenever someone performs a local search for an orthodontic practice in your area. The types of keywords that make a search local include business names, zip codes, addresses, phone numbers, and neighborhood names. Although patients may be able to search for your business within Facebook, most will just Google your name and find your Google My Business page.

In the interest of time and return on investment (ROI), which if either of these platforms is important for orthodontists? First and foremost, you MUST have a listing on Google My Business. When someone searches for an orthodontist in your community, Google will look first for your Google My Business presence. It must be complete, accurate, and attractive. Next, you should concentrate your social network efforts primarily on your Facebook business page. Zig Ziglar said, “Fish where the fish are.” The fish are on Facebook. There are conflicting opinions on the value of Google+ for an orthodontic office. The service is owned by Google and we all want to “stay in their good graces.” As for ROI, however, I personally haven’t seen any at all.

Virtual Setups Using Intra Oral Scanners for Same Day Consultation

IOScan_exampleBy John White DDS, MSD, ABO

Having been in orthodontic practice for 35 years, I’ve seen a lot of changes in all aspects of orthodontic care.  Most changes have been totally under our control and are merely choices. Whether you choose to use self-ligating appliances or not impacts your mechanics but not really your ability to produce an excellent result. Most cases do not require a CBCT to adequately diagnosis or treatment plan to achieve that same excellent result. Robotic orthodontics, also known as pre-bent appliances, have benefits and drawbacks, but once again are unnecessary for creating that “perfect smile”. Most of us have never done more than dabble in lingual appliances; without any loss to our practice. And while clear aligner therapy has probably the greatest (potential) impact on the traditional delivery of orthodontic care, there are plenty of very successful orthodontic practices that presently don’t use it at all or only on a limited basis.

That being said, competition in the market place has changed significantly, from the outside. We can’t rely on the “gold plated” referrals from our GP colleagues like we once did. Second opinions are becoming the norm. We have one chance to develop a relationship while we present our treatment “design”.  We deal less with patients and more often with consumers.  Where we used to do exam / records / consultation on separate visits, the sequence has evolved for many of us into a single visit. We used to show our beautifully finished cases with plaster models and photos, or cut and pasted smiles from the AAO smile library and so forth. Today’s consumers want more.

The advent of CAD/CAM treatment planning and design software is changing all that.  We now have the ability (and even possibly the responsibility) to do virtual treatment planning, trying out options and alternatives with accuracy and predictability. The ability to customize everything about treatment from the beginning goes beyond the capability to modify and adapt the otherwise generic prescriptions and archforms of the past to match the particular patient’s needs.

Tens of thousands of patients have seen their clear aligner predictions or pre-bent setups. This is changing the exam and consultation process. Patients are becoming aware that we can show them what their teeth will look like post treatment. An interactive approach to smile design and occlusion function is not only possible but a significant advance in marketing and patient appreciation of what goes into their treatment plan beyond just straight teeth.

For purists, one of the leaders in CBCT scanners is currently beta testing 3D integration of IO scans with CBCT imaging and computerized jaw tracking.

There are stand-alone software that permits visualization and treatment planning of IO scanned data, and some IO scanners come bundled with similar software.  Some scanners are not only able to directly scan to aligner companies, but also come bundled with “Treatment Simulator” software.

While I am invested primarily in a single technology, I routinely use several of these and am doing trial runs of others. The learning curve is not terribly steep for any of these. And they all work.

The logistics of same day exams with IO scan and treatment simulation becomes the biggest hurdle.  We do an office tour ending with a CBCT (with face scan) and photos, if the IO scanner is available and the patient has time, we do an IO scan. This combination takes 30-40 minutes (as opposed to 20-25 without IO scan). While we review CC and get acquainted, everything is loaded.  The treatment simulation is run in the background (the 3 treatment algorithm choices are preselected).

After we have reviewed my diagnosis we look at the treatment simulation and start moving teeth to reflect my recommendations and patient wishes.  This not only increases patient engagement but shows that I am intimately involved in the treatment design, not just letting the computer treatment plan for me. It helps explain tooth size discrepancies and why IPR may be necessary (even on extraction cases). We can measure expansion and torque requirements and cuspid inclination. And it is especially useful for pre-restorative setups; visualizing spacing and vertical setup, bonding undersize laterals, etc.. Multiple treatment scenarios can be done to help illustrate trade-offs in compromise cases.

Not only is there improved communication with and education of the patient/parent, but a unique understanding of the case above and beyond the “Old Days” where I fondled a set of soaped and polished study models or CR mounted models.

Finally, we can re-establish our reputation with consumers as the experts in orthodontics by using and properly explaining to them the benefits of this technology.

Improve your Communication through Screen Sharing

By Dr. Doug Depew
Acworth, GA

sharingiconWe 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:

  • Join.me
  • Beamyourscreen.com
  • GotoMeeting.com
  • Mikogo.com

 

 

 

Tossing the Fax Machine and Embracing Modern Faxing

By Matthew Larson, DDS, MS

Matt LarsonIn the modern world, hearing the dial up noise of a fax machine represents a technological step back in time.  However, the widespread use of faxing will likely continue for the following reasons:

  • 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.

What is “Big Data” and How Is It Related to the Practice of Orthodontics?

Dr.-Puntillo-PictureBy Anthony M. Puntillo DDS, MSD

Have you heard of the term “Big Data”?  My guess is that for many orthodontists the term is likely a bit like the term “The Cloud.”  They may have a general idea of the concept, but are not entirely sure how it is or will be important to them.  In fact, there is a strong relationship between the two terms that I will discuss later in this article.  First, however let’s look at “Big Data” by itself.  According to Wikipedia “Big data is a blanket term for any collection of data sets so large and complex that it becomes difficult to process using on-hand data management tools or traditional data processing applications.”

In 2009 the United States Congress passed the American Recovery and Reinvestment  Act (ARRA) which included the Health Information and Technology for Economic and Clinical Health Act (HITECH).  [For a detailed summary of this legislation please see Kirt Simmons blog posting from July 9, 2012 “The Electronic Patient Record: How it Affects the Private Practitioner”]. One of the requirements of HITECH is that full implementation of electronic health records (EHRs) for all patients is required by 2016.  The requirements of this act specifically pertain to healthcare providers who participate in the Medicare and Medicaid programs.  That means that currently few dentists are covered by this mandate.  However, this does not mean that we are not being affected.  Since 2009 doctors and hospitals across the country have spent billions of dollars, with the help of government subsidies, converting paper based systems to electronic digitally based health records.  These new digital systems are now collecting vast amounts of valuable data related to patient care.  Much of this information was collected before the legislation, but in a paper non-standardized format that was not easily aggregated and retrievable for meaningful analysis.  The value of all of this collected digital data is only beginning to be fully understood.  Big Data from all healthcare providers is being aggregated and programs to analyze the data are being used to improve the quality, safety, and efficiency patient care.  Hospitals are examining treatment protocols and doctors are making better informed treatment decisions based on the previous care of thousands of similar patients.

As I stated earlier, the EHR requirement of HITECH does not specifically pertain to most orthodontists so why is this important to us?  Many orthodontists have or are now also in the process of converting their practices to paperless systems (without the assistance of the government money).  Several of the orthodontic specific software vendors offer cloud based systems and here is where “Big Data” and “The Cloud” come together.  The aggregation of data from hundreds or thousands of individual private orthodontic practices into cloud servers is beginning to open the door for data analysis (mining).  Just think about how valuable that information can be to our patients and practices.  Most of the research studies published in our journals today involve treatment samples of less than one hundred.  The biannual Journal of Clinical Orthodontics Practice Study generally relies on the input for a few hundred survey responders (out of a possible pool of more than 8,000). Wouldn’t it be helpful for us to know the most efficient type of Class II corrector based on the actual metrics collected from the previous care of thousands of patients treated in practices all across the country or the globe?  Wouldn’t the knowledge that your treatment times/appointments vary significantly from the national or regional averages be useful? There is little question that access to “Big Data” analytics will offer our profession the opportunity to improve treatment quality, safety and efficiency for our patients just as it is beginning to do for the other fields of healthcare.