Are You Ready for the Dental Electronic Health Records Revolution?

Next Generation” dental electronic health records (EHR) are quickly and dramatically changing the landscape for how dentistry is conducted. Patient care, communication, and clinical workflows are ever changing. Accountability and reimbursement models are looking markedly different because of the ability of this technology. And the growing concern over HIPAA and practice liability are coming to the forefront.

The federal government has EHR incentive programs that provide up to $63,750 per eligible dentist for implementing certified technology. And the

state of Minnesota, as a precursor of things to come on a national level, has just introduced an EHR mandate backed by state

legislation. After having recently conducted the first dental EHR workshop for the Minnesota Dental Association, I was pleasantly surprised at the large turnout and numerous questions posed by dentists eager to learn more about how they will be impacted.

The question is “Are you prepared, as new dental graduates, to adopt next-generation EHRs with success or failure?” Most dental students and postgraduates don’t think about preparing to select, purchase and implement dental software until it’s too late. Whether you plan on starting your own practice or joining a dental group, you will be put in a position of having dental software vendors who WILL have the upper hand, beating down your

doors trying to get your business. And the frustrating part of all this is that with the explosion and exponential growth of dental software technology including electronic health records and imaging software, this is fast becoming the lifeblood of any practice. The proper evaluation, purchase and implementation can be a factor in a practice or dental group’s future competitiveness and profitability.

acquire and implement technology for over 12 years, I have seen numerous times when groups assume the new kid on the block, i.e. the recent graduate, being brought up in a tech-literate world, has the skills needed to lead evaluation and acquire and implement technology for over 12 years, I have seen numerous times when groups assume the new kid on the block, i.e. the recent graduate, being brought up in a tech-literate world, has the skills needed to lead evaluation and

In terms of graduates who choose to join an existing group practice, from my experience after having helped practices

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selection of new software technology such as next-generation EHRs. When I talk to these folks, they very much feel that they are put between a rock and a hard place. They’re expected to be the technology “go-to” resource in the practice, while at

the same time having to deal with getting their feet wet in the world of patient care as a brand-new provider. And, do you want to be that new dentist who is partially responsible for making a bad software decision and costing the practice tens of thousands of dollars?

When it comes to dental software for your own practice, the skills needed to be successful become much more daunting. Not only do you need to have the skills to evaluate and select the right software for your practice, but now you need to deal with purchase and acquisition, as well as implementation. And don’t kid yourself that your dental practice attorney will always have the skills to structure and negotiate a dental software contract. Some will have that ability, but software contracts take very specialized experience that many healthcare attorneys don’t necessarily have. It’s your money in the ultimate success or failure is on you. So, the more you can understand about the contract you are about to sign, the better. Or, how about having the skills to get a good deal, to get the best price, and not get taken advantage of by the vendor?

I remember speaking at a conference about how to evaluate, select, purchase and implement an EHR system. Afterward one of the providers came up

to me and proclaimed:

“I went to school for years to learn how to provide quality clinical patient care. No one prepared me for having to deal with software vendors and technology companies. With everything to think about, and everything that can go wrong, sometimes this reminds me of my recent experience building a new house”

Step 1 – Be in Control of the Evaluation and Selection Process

You could do any number of things to help you choose the right EHR, including:

Spending hundreds of dollars at Starbuck’s on triple-shot espressos while

surfing the Internet, reading opinions, comments and testimonials hoping that one vendor will rise to the top.

• Communicate your needs, priorities and expectations
• Buying your colleagues expensive lunches in exchange for their thoughts and opinions about EHR systems.
• Provide for side-by-side, applesto-apples vendor comparisons
• Document vendor commitments and promises from a legal standpoint
• Having each of the 50 vendors you’re considering buy you lunch and then get brain overload your brain with hundreds of competing features. • Wasting hours sitting through unmanaged vendor demonstrations – with no clear end game or objectives – where the vendor shows you what he thinks is important, doesn’t answer the important questions and keeps trying to close the sale

Best of all, soliciting RFPs from various vendors doesn’t cost you anything, but a little “sweat equity.” Because RFPs require vendors to prepare customized proposals, the process gives you a good idea of which vendors are serious about working with you and which can best accommodate your needs. The RFP can cover a number of areas, and at a minimum should include:

1. A vendor profile consisting of a laundry list of quantitative measures, such as financial information, customer base, staff breakdown (R&D, support, etc.), product maturity, etc 2. A list of your prioritized “must have” and “nice to have” EHR features. For example, electronic treatment plans and protocols based on diagnosis might be a high priority, but patient online access to their records may be low on your list.

When it comes to dental software for your own practice, the skills needed to be successful become much more daunting.

What is the problem with these methods? You walk away more confused than ever with time ticking away, patients to see and a business to run. This usually leads to a poor EHR selection, one that’s based on sheer exhaustion and a need to “just get it done.” Worse yet, you just shut

3. The underlying technology (Is the technology standard or proprietary? Will it grow with your practice? Can

it interface with other systems?).

4. A description of implementation, training and support processes (this could be a big differentiator).

down, and you never make a decision. I’ve had clients ask for help after looking at EHR systems for two or three years. They laugh about the fact that they’ve

Once you analyze vendors based on their RFP responses, you can reduce the list to a short handful, leading to the next step: vendor demonstrations.

become “professional EHR researchers.” Of course, this is in addition to their day job as a clinician. The good news is there’s light at the end of the tunnel if you choose to follow a proven technology selection process.

The biggest mistakes are often made with vendor demonstrations. Instead of exercising your control over the demonstration, the vendors are left to run the show, spending more time than necessary showing features that might not be your priority, and not showing features that are critical to your practice. This scenario

Let the vendors do the heavy lifting and utilize a powerful evaluation tool known as the Request for Proposal (RFP). RFPs are important because they:

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can be prevented by going into a vendor demo with clear objectives, a set timeframe, a list of the clinical encounter scenarios that you typically see, and precise knowledge of what’s important to you and what you want to see demonstrated.

In addition to addressing your issues and concerns, vendors should also exhibit certain “soft skills” such as the ability to understand your needs and demonstrate what you ask for, a desire to engage you by asking questions,and a willingness to think outside the box and deviate from their prepared script.

Conversely, be wary of those vendors who exhibit red-flag behaviors, such as one sided conversations, or discussion of solutions before they understand your needs. You’ll know this is happening if you feel that the vendor is exclusively in “sell mode.” The liberal use of technical

jargon to impress or confuse is a red flag. And, watch out for vendors who make

promises about future features, as these might not materialize. If the vendor exhibits these behaviors, politely excuse yourself.

Where Do You Go From Here?

Congratulations. If you followed the above tips, hopefully you will have selected the best electronic health records system for your needs along with a suitable vendor partner. However, there are a number of steps along this journey in order to make sure you are successful. Making sure you get the best price, negotiating a favorable contract and assuring a successful implementation are all necessary steps to get to your final goals. These topics will be covered in follow-up

articles, but in the meantime, with these tips, you are at least prepared to go forth and level the playing field with vendors by taking control of your dental electronic health records evaluation and selection.

Note - All tips described above are applicable not just to dental electronic health records selection, but also to dental software evaluation and selection in general. ■

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In addition, Mike has been a member of the Certification Commission for Health Infor-

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mation Technology EHR vendor certification workgroup (CCHIT), and has helped a number of state programs acquire EHR technology. He has been involved with the federal EHR incentive program from inception and was a member of various regional extension center advisory committees. As co-chairman of the Best Practices advisory committee for EHR Contracts, Mike was instrumental in developing standards for structuring software contracts and pricing used nationwide. He is working with the ADA on dental software interoperability and clinical data exchange.

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An accomplished author and columnist Mike

writes on EHR and dental software topics regularly for industy publications and websites. Mike is the founder and editorial director of DentalSoftwareAdvisor.com a trusted, and objective online resource on all matters related to dental software. Mike is also the Founder of the LinkedIn group Dental software, Electronic Dental Records and Electronic Health Records. Mike can be contacted at MikeU@DentalSoftwareAdvisor.com

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