Electronic Dental Record

(EDR)

Farren Hurwitz

Health Choice Network, Inc.

Today’s Objectives

Best Practices

Lessons Learned

How IT may apply to your program

Program success

Business models

fiscally responsible

not lose money - maybe even make money

make money = increasing services

contribute services to community

expansion of facilities

maintain market competitiveness

Profit

Mission/Fiscal Responsibility

No Money

No Mission

On the cutting edge If you are not on the edge, you are taking up

too much room

Reality!

“Today’s office without Information Technology

is like yesterday’s office without Electricity”.

“Today’s Practice without an Electronic Oral

Health Record is like yesterday’s office without a

Copy Machine”.

Is an Electronic Dental Record

System Right for your Dental

Program?

Will pushing less paper increase access

to care and improve quality?

OR…

EDR - Components

Medical / Dental History

Charting – soft tissue / hard tissue lesions

Alerts

Progress / Clinical Notes

Treatment Plans

Prescription Writing

Appointment Scheduling

Digital Imaging – radiographs (periapical and panoramic), intra-oral clinical photography

EDR COMPONENTS

Multi-Office Access

View Patient Chart ePrescription writer Digitizing Paper

Progress notes Patient Scheduler

EDR/ EHR Integration Objectives

Maintain one billing/collections and A/R system

Ability to run UDS and practice management reports from one system

Limit the amount of training required Staff already familiar with Practice Management System

Core functions and processes will not change from a practice management perspective

Easily provide clinicians with the tools not present in the Medical Manager / Intergy system – Clinical Charting

Ability to view patient’s dental/medical information from anywhere in the organization including medication list

EDR – Technical Requirements

Enterprise level Microsoft SQL Server

Additional Citrix Server Licenses

Dentrix Enterprise Software

Bi-Directional HL7 Interface – Dentrix &

Intergy (Practice Management)

EDR - Demographic Interface Real-Time Demographic Outbound Interface from Intergy to Dentrix

Families stored in Intergy appear as families in Dentrix

Demographic info only: name, address, phone, Sex, DOB, SSN, Account and Chart Numbers

All updates occurring on the Intergy side and fed instantly into the Dentrix system via the HL7 Interface

Reduces errors when maintaining patient demographic information; only one system for adds and edits

HCN assisted with development and testing

of the HL7 Interface between the medical

and dental software

HCN is the first Medical Manager / Intergy

and Dentrix client to have a bridge between

both systems

Development of Dentrix Interface

EDR – Training Levels

Train the Trainers – Dentrix trainer – 3 day training seminar for 12 instructor participants

End User Training – ½ day focused training for provider and dental assistants

On-Going End User Training – to be incorporated as part of the existing two week new employee training

EOHR –Go-Live Requirements

Upgrade data lines from ISDN (128K) to

full T1 (1.5Mbps)

Cisco 1720 router

Cisco Wireless Access Point(s)

Tablets with Wireless Network Cards

EOHR – Dentrix - Family File

Family

Demographics

from Outbound

Interface

COMPLETING MANUAL PRESCRIPTIONS

Determine med to prescribe

Check for contra- indications

Front of Chart

Medication List

Problem List

Write prescription in progress notes

Write prescription on medication list

Write prescription On Prescription Pad

COMPLETING ELECTRONIC PRESCRIPTIONS

Determine med to prescribe

Create prescription in Prescription Writer

Prescription sent out wirelessly & electronically

Allergies

Drug interactions

Drug-Disease interactions

What EDR does for our Patients

• Access to records off-site

o Outreach efforts

o School health services

• E-prescribing with

o Drug to drug interaction

o Allergy interaction

o Purchase convenience

22

What EHR does for our Patients (cont.)

• Enhances the

professional experience

for the CHC visit

• Ability to generate a

personal health record

• Disaster recovery

23

Confirming appointments the day prior to

minimize “No Show” rate

Strategies in EDR Implementation

• Discovery…The most important step in Implementation

– Provider Work Flow (8 hours)

– Patient Work Flow (8 hours)

– Perceived Work Flow (8 hours)

• Empower the users to succeed, provide the necessary tools

& access that will guarantee success

• Take the time to set up the database correctly the first time

Strategies in EDR Implementation

• Training types Web vs. Point of Care

• Create a “Steering Committee” that will navigate

the implementation & roll out. Include the correct

individuals including Dental Director, Providers, &

Support Staff.

• Steering Committee should meet monthly and

discuss needs, modifications, & best practices

• Budget for Integration. Extremely important to

include HL-7 associated costs into your initial

budget. **Don’t forget both sides of the interface

puzzle**

Integration… Why?

• Poor communication among medical and dental

providers

• Duplication and inconsistency between the medical

record and dental record

• Lack of adherence to best practice guidelines that

indicate a dental component

• Structural barriers that make it hard to coordinate

medical and dental communication and care

• Improved Patient Safety

• Meaningful Use Requirements

Integration…Why?

• Transparency of real-time health information across

medical and dental providers

• Improved clinical decision making

• Improved patient outcomes through prevention,

early detection, and proper intervention

• Accurate, thorough, and legible documentation

• Reduced medical and dental errors

• Creation of a single consolidated health record

• Reduced costs to both providers and systems

Integration Challenges

• Medical E.H.R. Vendor won’t play nice

– Make them… Hold your E.H.R. Vendor

accountable

– Give them clear attainable deadlines

– Will be extremely difficult with vendors such as

NEXTGen, Success EHS due to modular based

EDR.

• Get them talking. Schedule & coordinate

meeting with Henry Schein & your EHR

vendor.

Strategies in Adoption

• Understand & accept that there are many types of

users, staff, & providers in your organization. My

favorite types are:

– Give up and be engulfed by the wave

– Try to run away from the wave

– Hop on and ride the wave and enjoy the experience

• Training- Web training is not all that! Don’t rely

solely on web training. Rather utilize a combination

of web & point-of-care training.

• Become one with the Dentist…. Learn the lingo!

Strategies in Adoption

• Provide weekly 10 minute “Snip IT” during the

provider & staff meetings. Teach them something

new, re-focus on something forgot.

• Provide adequate access & connectivity i.e. each

operatory & provider office

• Conduct a true Network/Telecom Assessment on

bandwidth. (SpeedTest.net) is NOT sufficient.

• Provide adequate hardware i.e. Digital Sensors,

PSP Plates, Digital Pano etc.

• Ask for money! HRSA, State, Local, Federal

What FQHC’s Are Struggling with Today

• Disparate Systems- Direct access to Medical

EHR for prescription history, allergies,

medical history, and scanned information

• The Struggle “To Use or Not To Use”

• Clinical reporting & outcome measures

• Cost of going digital. Digital Sensors & Digital

Pano.

• Becoming the step child behind medical

What FQHC’s MUST Have

• Direct access to Medical EHR for prescription history,

allergies, medical history, and scanned information

– HL-7 Interface

– API Interface

• Better Clinical Outcomes & Reporting Capabilities

• Quick & easy reporting from the NEW DXONE clinical

note module. Exporting notes to Excel and then

querying the data is a band-aid

• More scalable, more cost effective, turn key, imaging

solution

Tips & Tricks # 1 Using Flip Tabs &

Schedule Blocks

Tips & Tricks # 2 Use your Clinical

Notes to capture PSR

Tips & Tricks # 3 Using Digital

Imaging at the Point of Care

TIPS & TRICKS # 4 CREATING APP.

CHECK LISTS

Tips & Tricks # 5 Use your Hot Keys

Tips & Tricks # 6 Using Continuing

Care to improve “NO SHOW” rate

Life Before the Computer Before the Computer - an application was for employment;

a program was a TV show; a cursor used profanity;

a keyboard was a piano;

memory was something that you lost with age;

a CD was a bank account;

if you had a 3 1/4 inch floppy, you hoped nobody found out!

And if you unzipped anything in public, You'd be in jail for awhile!

Log on was adding wood to a fire; and

Hard drive was a long trip on the road; A mouse pad was where a

mouse lived; And a back-up happened to your commode!

Cut - you did with a pocket knife; Paste you did with glue;

A web was a spider's home; And a virus was the flu!

I guess I'll stick to my pad and paper;

And the memory in my head;

I hear nobody's been killed in a computer crash;

But when it happens they wish they were dead!”

Questions and Answers