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
Profit
fiscally responsible
not lose money - maybe even make money
make money = increasing services
contribute services to community
expansion of facilities
maintain market competitiveness
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
ePrescription writer
Multi-Office Access
View Patient Chart
Patient Scheduler
Digitizing Paper
Progress notes
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
Development of Dentrix Interface
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
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
Medication List
Front of Chart
Determine med
to prescribe
Check for contraindications
Problem List
Write prescription
in progress notes
Write prescription
On Prescription Pad
Write prescription
on medication list
COMPLETING ELECTRONIC PRESCRIPTIONS
Determine med
to prescribe
Allergies
Drug interactions
Create prescription
in Prescription Writer
Drug-Disease
interactions
Prescription sent out
wirelessly & electronically
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