By Dr. Doug Depew
Acworth, GA

We all know how frustrating it can be to present your proposed treatment to one parent, while the other one is not present, hoping the first one will be able to make a decision by themselves. Typically however, that is not the case. More often we end up depending on Mom to carry home the dizzying array of information to discuss with Dad. And since she cannot regurgitate all you spent your time explaining, all Dad hears from her is the treatment fee, without hearing an explanation for the fee and all the wonderful things about you and your practice. In order to increase our success, screen sharing allows us to have one parent sitting in the room with you and the other virtually participating in the discussion.

Screen sharing software allows users to share their computer desktop with another individual through their Internet connections. When screen sharing, the other party will see what is displayed on your entire screen in real time. It’s the next best thing to meeting with someone one-on-one. Many of us have been on the receiving end of screen sharing with some of our support companies, study clubs, or for educational experiences. How about being the person to initiate it and use it to our advantage in discussing treatment?

Some screen sharing programs are totally web-based, while others may require you to download a small program. Some programs even allow you to sketch or make annotations the remote person can see. Some vendors offer screen-sharing technology either for free or they may have a cost associated with it (per-use, monthly, or annual fee for access). Any cost is usually pretty small and worth it due to some of the extra features such as the ability to record your sessions, and the high quality images and video content you can share. In either situation, you may share patient photos, digital models, patient education videos, and images of similar cases. Although the “no cost” programs may be adequate for many doctors’ needs, there may be some limitations such as:

• You can only share with one other person at a time
• Unable to record the sessions
• Slow and jumpy video on the remote end
• No ability to annotate or mark-up the screen

So how do you go about making this happen for new patients? Well, ideally we would love to have both parents attend the initial consultation appointment. Even though we might suggest such on the initial phone call, for whatever reason, it hardly ever happens. The non-attending parent is left with the main deciding factor being the fee.

Through careful scripting during the new patient phone call, confirmation phone call, and upon arriving for their initial appointment, it may be possible to have both parents actively involved in the initial consultation. With some preparation, the second parent can be at work, in front of a computer, and be ready for a call at the appointed time. Screen sharing works best if you are on the phone with the person while sharing your screen. Once the oral exam is finished, simply have Mom call Dad from her cell phone, put him on speaker, and then have him log in to your chosen screen sharing web site by giving him the necessary access code.

In doing so, you are often able to help the parents make a decision at the time of the exam, when they otherwise would not have been able to. In the case a parent is not available at the time of the exam, you can either record that portion of the appointment and make it available to them, or make an appointment to screen share at a separate time. Screen sharing potentially can save both time and money. A second appointment is not needed, there is no need to travel, and it is much more effective explaining things using visuals than to do it verbally.

Screen sharing is also quite helpful in collaborating with our colleagues such as a patient’s general dentist or other specialists. Whether it is reviewing your treatment rationale for a patient’s dentist or navigating around different views of a cone beam CT in real-time, this technology makes it much easier to explain concepts and make joint decisions.

Screen sharing can help enhance communication by sharing information that simply cannot be done just over the phone. And if a picture is worth a thousand words, a video is certainly worth a million words. Screen sharing is a cost effective and convenient way to share our findings with a parent or colleague.

As with all things technological, the number of providers is constantly changing. A simple Google search will show several you can evaluate, many with free trials. Some of the more popular that seem to have staying power are:

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

By Matthew Larson, DDS, MS

In 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 3^rd 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.

There are several quick and easy technologies available to help you update your office without breaking the bank.  Two of my personal favorites are thin clients and dual screens.  I believe that the thin client workstation is the most underappreciated and underutilized tool in many people’s IT toolbox.  A thin client is a mini-computer about the size of a paperback book that depends on an external server to perform its computations.  Most of us are used to working on fat clients, which is simply another name for a personal computer that does all of its own computations.  Simply put, if a fat client was to lose its network connection it could still function on its own, but if a thin client loses its network connection, it is dead.  Why would you want a mini-computer that can’t function without a network connection?  Two words: cost & scalability.  Thin clients cost half as much as a traditional computer and due to their size can be placed just about anywhere.  Because they take their orders from a central server, they can be swapped out with ease and don’t require reprogramming.  Adding workstations becomes easy instead of a chore and allows you to scale your practice upwards as it grows.  I personally use Wyse (now owned by Dell) thin clients and link them to my primary server using Microsoft’s Terminal Services.  The latest thin clients even contain graphics cards which allow you to support multiple monitors and 3D imaging software.  The capabilities of thin clients have slowly blossomed under the radar and should be considered by any orthodontist looking to add workstations.

The idea of dual screens may seem simple but it’s vastly underutilized within orthodontic offices.  Though there is a period of adjustment the efficiency and productivity of your team members will increase once they begin using dual monitors at their workstations.  Though many offices have placed dual monitors in their doctor’s personal office they sometime underestimate the benefits of equipping their administrative and clinical teams with the same technology.  Having the ability to keep imaging software up on one screen and management software up on another is indispensable in my mind.  Most computers and thin clients support dual screens and those that don’t can be easily retrofitted to support them using an inexpensive PCI card.  There’s also no reason to settle for just two monitors.  If two is good, then at some workstations, three or four screens may be even better.