Set It (But Don’t Forget It): Automated Services in the Dental Practice

Mankind has always been interested in figuring out smarter, less laborious ways to get things done. At one point in human history, someone figured out that hunting animals was made easier by setting a trap than stalking them through the woods. In 850 AD, the Persian Banū Mūsā brothers, in their Book of Ingenious Devices, described a number of automatic tools. And in the 21st century, we can automate everything from factory operations to home thermostats, and this includes functions in the dental practice.

Services

The tasks available for automation run the gamut of simple clerical needs to more complex clinical duties. For instance, dental practice management software streamlines any number of a dental practice’s daily tasks. Such software is ubiquitous in dentistry.

“Our cloud-based practice management software, Denticon, offers a number of automations to reduce workloads for dental staff,”Eric Giesecke, Planet DDS CEO says. “To name a few, we have automated reports, appointment reminders, recall appointment reminders, 835 auto-posting, real-time eligibility checks, payment posting, and CareCredit pre-approvals.”

There are any number of functions that can be automated to reduce the pressure on front office staff. DentiMax’s RevPay, for example, streamlines patient communication, automating billing functions.

“DentiMax offers many automated services,” Alicia Dieujuste, Managing Director at DentiMax Software says. “But most recently is our automated texting service, DentiMax RevPay. It will send out a statement link to the patient/head of household for the patient to review their bill and pay online.”

In the clinical area, doctors are assisted by artificial intelligence (AI), helping them perform their tasks faster, more accurately, and more efficiently.

“Overjet assists providers in real-time as they review radiographs by directing their attention to areas of concern,” Dr Terri Dolan, Chief Dental Officer of Overjet says. “Overjet’s FDA-cleared platform uses artificial intelligence to automate the analysis and annotation of dental X-rays, instantly detecting and outlining caries and quantifying bone level measurements.”

And in the event a specialist is needed, that process can also be modernized.

“Refera is a very simple digital referral platform,” Sam Ahani, DDS, founder of Refera says. “We allow a general dentist to fill out a very simple referral form and when they hit send, the patient gets a copy via text and the specialist gets a copy via secure email with no sign up needed. The specialists can now reach out to the patient.”

Advantages

The advantages of automation are straightforward, including taking some of the workload off of clinicians and their team members.

“Staffing is on the minds of many dental leaders, so having software automate processes that would otherwise require dental staff to manually pull or enter data or make numerous phone calls is a key advantage,” Giesecke observes. “Practices can reduce clerical errors and focus more directly on the patient experience. Automating processes can also help reduce employee burnout and turnover. As to cloud-based software, practice leaders have the added advantages of being able to centralize automations across all locations, and they can also support remote working through easy access to data from virtually anywhere in the world.”

“Often times dental offices have to batch statements, print, and mail them,” Dieujuste adds. “It takes a lot of time to stuff envelopes every month and get paper statements out quickly. By sending a statement and pay link via text, they save all the time otherwise spent stuffing envelopes, and it reduces wait time for payments, since the patient can pay right from their computer or cell phone, immediately.”

Another goal of automation is to make routine tasks more efficient, better. For instance, Dr Ahani says Refera solves several problems with the well-established process of referrals. For instance, he notes that:

• Half of patients never follow up with paper referrals.
• Half of the time the specialists never see the referral slip (they don’t see it when the patient schedules and patient doesn’t remember to bring it time of appointment).
• General dentists have no way to track their patient’s progress.
• Often, patients never go to the specialists or come back to the GP for follow-up care.
• When patients fail to follow-up on the referral, that can increase liability for the GP.
• Existing paper referral systems are inconsistent with HIPAA.

By automating that process, he says, inefficiencies and inconsistencies are removed.

He says:

• Specialists can now see every referral they are sent.
• Specialists can call the patients and increase conversion rates, completing treatment much faster.
• GPs have more information and gets the patient back sooner for follow-up care.

• The patient experience is improved.
• There is better documentation (for instance, there is a paper trail showing that the patient was referred).
• Revenue for both the specialist and the GP are increased.
• Time is saved transferring information.

But it isn’t just a simple matter of making processes easier. Automation can also make them better.

“There are many advantages to automating radiograph analysis,” Dr Dolan says. “The first is it gives dentists more precise data to use in their clinical decision-making. Second, it provides objective findings, which can boost both providers’ and patients’ confidence in the diagnosis and recommended treatment. Third, Overjet automatically cross-references the prior 18 months of radiographs with the practice management system to identify potential treatment opportunities and displays them on a Daily Patients dashboard to help clinicians plan their day more effectively. Last, automating radiograph analysis and annotations transforms traditional X-rays into a powerful patient education tool, which leads to greater case acceptance.”

Reticence

Depending on their comfort levels, doctors may or may not be willing to sign over these tasks to an automated system.

“Most dental offices move slowly when adopting new technology, especially where it’s patient-facing and involves cash flow,” Dieujuste says. “The benefit around our technology is that patients can opt out, and a paper statement or other option can always be used – in addition or as a standalone option – for those who are not comfortable receiving text messages or paying bills online yet.”

“In general, I don’t think dentists would have much hesitation about automating many of these manual tasks,” Giesecke adds. “Putting automations in place often grants dentists more oversight and control over how and when tasks are completed, especially those processes that are often not under their control today. I would say 10 years ago, there were more concerns about moving to cloud solutions that offer many of these automations, but today we’re hearing positive feedback from an increasing number of dental leaders as they think of all the manual, repetitive tasks their team completes each month and then realizing that software can take on so many of these tasks. There’s also the added benefit of automated reporting which gives dental leaders more insights into the business side of their practices.”

On the flipside, the automation of some processes gives team members greater power.

“I would say dentists actually have more control over this process with our product,” Dr Ahani says. “They don’t necessarily understand the magnitude of the problem. Many dental offices refer out as many patients as they get per month with no tracking around the referrals.”

Ultimately it is up to humans to approve every aspect of practice operations, especially at the clinical level.

“Overjet is a clinical decision support tool, not a replacement for the clinical diagnosis,” Dr Dolan observes. “It simply gives dentists more data to determine the diagnosis and treatment plan. The dentist maintains full control in developing the diagnosis and then, in discussion with the patient, determines the best treatment plan.”

Obstacles

Not every automated process is without hiccups. As with anything new, there is a learning curve.

“Our product is very, very simple, intentionally,” Dr Ahani says. “I would say the biggest obstacle for us is that referrals have been done with paper for so long. It’s just a change in the way they do something, and that always takes some effort. That said I can’t imagine a world where in 5 years we are still using paper referrals. The biggest obstacle in general is the myriad of software out there, and no one wants to share information with each other. This has resulted in a lot of frustration for dentists and their teams as they must navigate so many different platforms.”

The larger a system, naturally, the more complex and the greater potential for headaches.

“Depending on whether a practice uses multiple applications, data synchronization issues could come up,” Giesecke says. “All-in-one practice management software solutions, like Denticon, allow dental leaders to access a single source of truth for practice data. Aside from that, dentists and their staff should implement best practices for automations. This is an opportunity to work with their software provider to make sure they will receive the training and support they need to optimize automations in their practices.”

A great way to mitigate growing pains, observes Dr Dolan, is to ensure that the automated process meshes well with existing systems.

“The key to successfully automating any system is to have it fit into the existing workflow,” she says. “In the case of Overjet, the dental team still takes X-rays the same way as always, and simply displays them via the Overjet platform.”

Ultimately, realizing how those systems fit into the larger machine will smooth out any rough spots. For instance, Dieujuste says that once the practice understands how the automated system, like RevPay, fits into the big picture, the easier it will be.

“What the dentist may perceive as an obstacle is signing up for a new merchant services provider for online credit card processing,” Dieujuste says. “The truth is, with DentiMax’s RevPay, it’s easy to understand and sign up with flat rate pricing, and they do not have to switch their in-office merchant services provider to do so (unless desired). The training on where to go to upload the statements takes about five minutes in total as well, so there is a very small learning curve since the statements are all automated and viewable at any time.”

Evolution

It’s great when certain processes can be automated, and these processes seem to be getting better with each subsequent update or new system.

“Progressive software companies will continue to find new ways to make practicing dentistry easier through automations, Planet DDS included,” Giesecke says. “Many automations are only feasible with a cloud-based software solution, so as cloud adoption accelerates within dentistry, we see dental service organizations (DSOs) with this infrastructure in place as having the competitive advantage.”

As the world of computing continues to evolve, so too will services for dentists.

“The obvious answer here is the move to the cloud and also the prevalence of DSOs in Dentistry,” Dr Ahani says. “Cloud software is going to ultimately result in a much better experience for users. It’s just going to take some time in dentistry no one wants to share.”

“The dental industry is really starting to take advantage of software and automation wherever possible,” Dieujuste adds. “In the past, this was limited to simple email reminders, but now there are lots of advances involving AI – like detecting dental caries or anomalies on X-rays and images. More clinicians are using these tools as a baseline start to their patient interaction and then layering on what they see, instead of starting with what their findings are and using technology as backup evidence.”

And dentists don’t work in a vacuum. Especially for processes that require interaction with another authority, cooperation will continue to improve systems for everyone.

“Overjet is collaborating with dental leaders including practice owners and insurance carriers to develop new concepts, including the ability to automate insurance claim submissions and receive approval while the patient is still in the chair,” Dr Dolan says. “That would eliminate the frustration of not knowing whether insurance will cover a procedure, and also enable more same-day treatment.”

Not there, yet…

But we are not ready to hand over the keys to the dental practice to robots, just yet. While some things can be automated, others still need time.

“If something can be automated, patients and staff will appreciate it,” Dieujuste says. “The main thing to keep in mind with automation is that some functions still need oversight and to be handled with care. For example, having post-operative instructions automatically get sent to the patient is fantastic for ensuring the patient gets all the information they need after a dental surgery, but nothing can replace the value of a personal check-in phone call to make sure the patient is feeling fine and see to any questions or concerns they have. Dentistry should take advantage of simplifying their workflow, but not lose sight of the human touch.”

“There are aspects of dentistry that require a human touch,” Giesecke adds. “And really, the goal of automating the more administrative aspects of the practice is to free-up more time for dentists and staff to focus on those higher-value tasks. Whether that’s checking in with a patient after a major procedure or taking a few extra minutes to answer questions when presenting treatment plans, automations can help practices provide a more personalized experience for their patients.”

The biggest concern is where humans really need to be involved. There are some things that people just must do themselves.

“I would say in healthcare the answer is probably yes,” Dr Ahani says. “Any process that cannot approximate the human experience should likely not be automated. But with all the technology that’s available now, one can argue that many processes can be improved with automation such as referrals.”

“The final diagnosis must always remain with the dentist,” Dr Dolan adds.

From the first humans who figured out how to trap their food all the way to the robots working on the factory floor, we’ve been striving for ways to streamline our day-to-day tasks. While not everything at the dental practice can or should be automated, there are plenty that can be systematized, and vendors eager to help.