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The great paper debate: what does it mean for a business to truly go "paperless"?


To be or not to be ... paperless, that is. Many doctors and their teams believe they are paperless right now. Most likely, those practices are actually chartless and not paperless. What is the difference, you ask? That, my friend, is the Great Paper Debate.

In order to understand being chartless, let's take a look at what having a chart means. The paper in a chart might consist of patient demographic information, a tooth chart for existing procedures, future treatment and a perio chart for probing. It may contain a paper ledger for procedures and monies attached, insurance forms and information. This paper chart may also have a pocket or sleeve for x-ray film and photographs of our patient. Over time this chart can become quite large and difficult to store.

To become chartless, we must get rid of this paper chart and all the information in it. To do this most offices have a computer network or system and integration. Integration is a buzz word right now and means many things to many people. Webopedia defines integration as the creation of links between previously separate computer systems, application services or processes.

Basically, integration means all of your computer systems and applications are able to speak to each other. You can achieve this goal with a good practice management program or a PMP. Within a PMP you will find an electronic appointment book, a file for the patient's demographic information, a ledger for the money and insurance, and a tooth chart for existing procedures, future procedures and perio charting. You can also add a digital imaging system for x-rays and photos or intraoral photos. Integration means all of those components can talk to each other and exchange information. No more paper in the chart, ah ... chartless.

Let's move on to being paperless now. You may have noticed that being chartless has more clinical information. Paperless moves us more to the front office area and the paper generated there. In a practice management program there will be an electronic appointment book and the ledger for monies. Both of those modules are front desk driven. However, the appointment book should be used throughout the office.

That relieves some paper weight at the front, but what about the paper that the patient has? This is where 98 percent of dental practices today are not paperless. Many offices today hand the patient paper, then scan it into a file in the computer or in the PMP, then shred the paper Although this is a paper reducer, it is not paperless.

It might be easiest to understand this concept by following the paper trail. Typically this is how paper works in a dental office now. The new patient calls the practice and makes an appointment. At this point one of two things happens:

1. The office may mail out the patient forms and hope the new patient fills them out and brings them back into the office on the first visit day; or

2. Once the patient arrives they are handed a stack of paperwork to fill out. This stack can include demographic information, Medical/Dental History form, HIPAA forms and perhaps a financial policy.

The patient completes the forms and returns them to the front office, where a team member manually types them into the PMP.

At this point the team member may make the paper chart we discussed earlier or the team member will scan all paper into the computer. Some of those documents must follow the patient to the clinical area. For example, a provider will need to review the medical information, medical alerts and allergies, and then sign off on them making them legal documentation. The provider may on occasion make notes to those documents as well.

Once the dentistry is completed, the patient and the paper return to the front desk. If this is a paper chart it is usually filed away. If the paper was previously scanned into the computer, it may be shredded. There is the paper trail.

Now follow the paperless trail. The new patient calls the office to make an appointment. The front office team can now suggest the patient log on to the office website to fill out all of their forms using a keyboard and mouse. The patient is not going to print out paper, all the forms they need to fill out will populate their home computer and they will use a keyboard and mouse to enter all the information. Now their forms are done. The patient will come to the office for the appointment and our team at the front desk will hand them a tablet pc. The patient will sign in to the tablet.

Once they have signed in, they will see a review of the information they filled in at home. If there are any changes they can make them right there on the tablet. The program will now start prompting the patient for signatures on the forms. If the patient chose not to go on line and fill the forms out there, when they come in for their appointment, they are handed the tablet pc and instructed to sign in, then fill out all the forms and add signatures to them, making them legal.

Once the patient is done filling all forms out, the tablet goes back to the front desk. Now you can sync the information the patient filled out on the tablet back to the PMP. Once all forms are done, the patient is headed to the clinical area. The doctor can have a tablet in the back as well. Providers can pull all electronic forms up on the tablet to review them, make any notes and then sign off on them, making them legal. Once the dentistry is done, the patient goes back to the front office to finish up the appointment. No paper. This is paperless.

Practice Management Programs are very accepted and used by most dental practices today. Doctors and their teams are becoming chartless everyday. The term and the ideology behind going paperless is not as accepted today. However, my goal is with more time and more education, the same doctors will be ready to go paperless as well.

Let's stop the debate over paperless or chartless. Let's start talking about a partnership, Paperless and Chartless. That sounds like sweet harmony for everyone.

Laci L. Phillips is a divison member of Paperless Technologies as well as a speaker and consultant for Lois Banta Consulting. Laci brings 15 years of experience in the dental field, which includes both clinical and administrative aspects from being a chairside assistant in a government funded health care clinic to a practice administrator for a boutique practice in Phoenix. Her responsibilities included project management for new office buildings, consulting on technology purchases, and training teams to implement new technology. She has also held positions with Dentrix Dental Systems and Hi Tech Digital Systems.
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Author:Phillips, Laci L.
Publication:The Dental Assistant
Geographic Code:1USA
Date:Mar 1, 2009
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