EHRs and You

by Mary Govoni, CDA, RDA, RDH, MBA

Most of us know that health-care providers must implement electronic health records (EHRs) this year in order to continue receiving the same level of reimbursement from Medicaid and Medicare. While not every dental practice is a Medicaid provider and even fewer practices provide Medicare services, there are still many reasons that dental professionals should be paying attention to these new standards and preparing themselves for an eventual transition.

In the absence of any concrete laws or guidelines regarding EHRs for dental care, what I recommend to practices that I consult with is the adoption of robust practice management and clinical software. By going chartless and using a reputable system to do so, practices can put themselves in a better position to adapt to whatever changes may be ahead.

Accuracy, Security, and Efficiency

Even if the government and insurers had nothing to say about digital recordkeeping, there are still many compelling reasons for practices to adopt such a system. One primary reason is accuracy. For example, when a hygienist is working with a perio chart in Eaglesoft clinical software, all the necessary adjunct information about bleeding points, mobility, and anything else related to the periodontal diagnosis can be easily clicked on, rather than having to be written out by hand. Furthermore, from a business standpoint, practices that are not using digital records along with a modern backup service are putting themselves at significant risk – just one fire or flood away from losing their records forever.

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At some point in the future, when the SNODENT codes are finalized, dental offices will not only be using procedure codes for treatment but also will be billing for dental services with a diagnostic code as well. While this has been done in medicine for quite some time, the practice is still new to dentistry.

Once this system is put into place, electronic clinical records will be even more important, providing a much more efficient system in which the dental professional can simply enter a procedure code and then attach the appropriate diagnostic code and modifiers. Indications are that major clinical software systems such as Eaglesoft will have "smart" features that look at the codes being entered and suggest the appropriate modifiers.

So, for example, if a patient comes in with periodontal disease, he or she would be given a diagnosis of periodontal disease with modifiers used to further describe the condition -- localized or generalized; mild, moderate, or severe; etc. Depending on the information entered, the software will be able to automatically pull up the appropriate documentation to go along with each diagnostic and procedure code.

Any practice that is considering a move to a chartless system should involve the entire team in the selection process. Each member of the team brings a fresh set of eyes and a fresh perspective to the issue, and often a hygienist or assistant can raise some very valid points that the dentist may never have considered if he or she were making the decision on his or her own.

With all team members involved in the process, practices have a much greater chance at hitting the ground running in their transition and at making themselves well equipped for a future with EHRs.

Mary Govoni, CDA, RDA, RDH, MBA, is the owner of Mary Govoni & Associates, a consulting company based in Michigan. She is a member of the Organization for Safety, Asepsis and Prevention. She can be contacted at mary@marygovoni.com or www.marygovoni.com.


How hygienists can be advocates for technological change

As hygienists know, many practices tend to be slow adapters when it comes to new technology. But the advantages of implementing an electronic system are too great to ignore at this point, and will be even more critical in the future with the increased push for EHRs. Hygienists can actually be very strong advocates for the adoption of clinical software; in most practices, hygienists and assistants are the primary users of these systems. If dental team members invest the time and effort into getting acquainted with software systems and determining what kind of features will be most useful and efficient for them, they can make a very persuasive case to the dentist.

I encourage hygienists to look for opportunities at state, regional, or national dental meetings to collect information from software vendors and to discuss with them how software can help their practices work more efficiently today and be better prepared for the future demands of EHRs.

When examining software systems and vendors that can help a practice navigate through the future of electronic records, there are several criteria dental professionals should keep in mind.

The first is the availability of a flexible training program. One of the frequent challenges I see with practices is the failure to dedicate enough time and resources to training after the acquisition of new software or technology. While today's software programs are becoming ever more intuitive and user-friendly, practices should still be prepared to dedicate time to training for the entire team. This not only helps with the initial implementation of the software, but can also educate team members on more advanced capabilities of the software that they may not have considered using. At any level of training, practices should look for software that makes modules and videos available on demand.

An initial session with a trainer is of course valuable, but most staff members only retain so much information from those intensive trainings. With on-demand training modules, staff members can reinforce and build on what they've learned in person, or a new team member can quickly get up to speed with the system despite having not been at the initial training. Companies such as Patterson Dental readily provide this type of support with their Patterson Technology Center (PTC), which provides technical training and support to more than 80,000 customers nationwide. Their goal is to resolve any situation with one call.

Clearly, the perio charting capabilities of a software system will be of the most interest to hygienists, so I encourage them to thoroughly investigate these features when considering various software systems. Learn what kinds of manipulations can be performed within each system, and attempt to get a general picture of its ease of use. A good software system will have an interface that is easy to learn and that will allow the user to become proficient with it quickly.

Another key consideration when choosing a software system is its compatibility with existing hardware, or a practice's willingness to update hardware that is out of date. For example, practices should confirm how much RAM is necessary to run imaging software. In addition to this, if a practice does not already have hardware in the treatment rooms, they must determine where it will be located so that it is easily accessible.

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