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Why every office needs to be digital

Issue: Summer 2009
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Back in the late 1980s, the very first digital radiography systems and intraoral cameras were released onto the market. Although adoption of these systems was slower than expected, there have been numerous other changes as well. The vast majority of practices are now computerized and use Windows-based practice management software. Many systems that were once paper-based have now moved into the digital realm. However, there are still many practices that have not realized the benefits of a digital practice. According to Dental Equipment and Materials and Dental Products Report, only 44% of offices have computers in the operatories and fewer than 25% are using digital radiography.

The latest buzzword to enter the dental lexicon is “paperless.” Most offices agree that developing a paperless dental practice is an ideal goal. However, this goal is very challenging to achieve. I’m not a huge fan of that term, since all offices still require paper, but I do think that developing a “chartless” practice is much more obtainable and realistic. The challenge for any office is to understand which systems can be changed into a digital format, what the advantages of digital systems are over the older systems, and how to go about choosing the best digital systems for the office. This article will address all of those issues.

Phosphor Plates

Some people consider phosphor plates to be positioned between scanners and direct sensors, but these systems are actually very highly developed and produce diagnostic- quality images. The plates are “scanned” in a special machine that is basically a laser that reads the phosphor plates. The system must be attached to a computer that is running software compatible to it. The main advantages of phosphor plates are their similarity to film. They are as thin, and often thinner, than film packets. The staff can take images with the same RINN kits and methods that they use for film, they take the plates to a centralized “processor” to “develop” them, and they mount the images afterwards. The one difference is that the mounting occurs in software templates, not cardboard or plastic mounts. Also, unlike direct sensors, the plates are relatively inexpensive, which is wise since they typically must be replaced after 300–400 uses.

On the downside, the plates are easy to scratch and although they theoretically can last through those 500 uses, damage will normally require that they be replaced more frequently. Phosphor plates have less resolution, in-line pairs/mm, than sensors. This would not make a difference when viewing images on a typical 15″–17″ monitor, but it can make a difference if you are magnifying the image to a great degree or printing out images that are larger than 8″ x 10″. Also, because of the steps needed to get an image, the time needed to take phosphor plate images is very close to the time needed for film.

Direct Sensors

Direct sensors are silicon-based receptors, often encased in protective coating, that mimic the size and shape of PA film. These sensors, which are either CMOS or CCD, are connected to a thin cable that runs from the sensor to some device that would then connect to the computer. The sensors range in size from about 3 to 8 mm. The main advantages of sensors are speed and image quality. Images taken with a sensor appear almost immediately on the screen, making them the ideal choice for offices that do a lot of endo or implant procedures. They are comfortable, sturdy, and have excellent resolution; many can produce a highly diagnostic image when used with the proper software.

On the downside, they are thicker than film, and have cables running off the sensors, which some patients don’t tolerate well. Also, they are not inexpensive—a #2 sensor can range in price from $5,000 to $14,000.

 Data Backup

In the past, the choice of which type of media to use was fairly easy to make. Back in the days of DOS, 1.44 MB floppy drives were more than adequate and all the data could be stored on a single disc. As servers became a part of smaller offices, many computer technicians were installing the systems that they were familiar with in the corporate world: tape drives. A large number of practices are still using these drives. Unfortunately, I do not feel that these systems are appropriate for the majority of offices. First, the software and methods for verifying the backup are confusing to many dentists and staff. It is all too common to have a server fail and then the office discovers that their backups have not been properly run for months, and in some cases, the tapes have become corrupted. Second, I have yet to see an office that has more than one computer (the server) with a tape drive. One of the goals of the backup is to have a quick-and-easy method to restore the practice’s data and get the office running with minimal downtime. If the server crashes, and the only backup is on a tape, that tape will have minimal value since there is no other computer in the office that is capable of reading the tape.

 Recommended Protocol

To effectively backup the practice’s important information, there are a number of factors that need to be taken into account:

  1.  Automatic–As the databases increase in size due to imaging and other data bloat, the time needed to backup increases. Although the process should be easy to perform, busy dentists and staff often don’t have the time to wait for the backup to finish. Some offices can circumvent this by backing up during the day, but many practice- management and image-management programs lock the data that is open, thus preventing the copy from occurring until all workstations have logged out of the software. In my opinion, the best backup is one that happens automatically, every day, with little to no input from anyone in the office.
  2. Easy to setup and verify–The key concept here it to use software that makes it simple to establish the timetable for the backup and to make it easy to see if the backup was completed. We recommend a complimentary software program called Karen’s Replicator, which allows you to establish the backup time for every day of the week (and exclude the weekends if you prefer), and will show a screen as soon as the backup is completed—and will indicate if the backup was successful.
  3. The right media–As I discussed, tape drives are not the ideal any more. Re-writeable CD-ROM drives were an option for a short period of time, but their 750 MB capacity limits their usefulness in most dental offices. Rewriteable DVDs are an option for offices that don’t use any digital imaging (they can record close to 5 GB of data), but are relatively slow. The best option for most offices are external hard drives. These drives typically have from 80 to 250 GB of storage, use an easy-to-use USB interface, and are light enough to be carried in a bag or briefcase.
  4. Backup Protocol–I suggest that offices have a minimum of two external drives, one that is onsite, and one that is offsite, so that there is always at least one copy of the most recent data away from the office. I also suggest that a copy of the server’s data be copied to at least one workstation to allow for another level of security.

As practice’s continue to digitize data that was once part of a paperbased system, it is vital to have a well-designed system to not only backup this important information, but is easy to implement and verify on a daily basis.

Tying it All Together

There’s no doubt that most offices require guidance in choosing and implementing these systems. One of the best resources for this is your local Sullivan-Schein Sales Consultant. These specialists have a complete understanding of not only the different systems, but also which ones will work well together. They will gladly work with any office to properly sequence the addition of the various systems to minimize your downtime and make the transition as smooth as possible.