When dental offices ask me, “Why would we want to go paperless?”, I respond, “What is your definition of paperless?” I find there is a common misconception about paperless versus chartless. After a few more Q&A’s, both the Doctor and the team begin to understand they can move into a true ‘chartless environment’ rather than a ‘paperless office’. (As long as you continue to receive information – referral intro letters, post op letters, etc - from other dental practices that are not chartless, a paperless office is not a realistic goal.) 

If your practice has decided to move into a chartless environment, there are several things you need to do prior to actually making the leap that will greatly increase your chances of making a smooth and successful transition.

Planning, preparation and training are key to a successful switchover, and also ensure the least amount of stress for you and your team. Below is a list of the items that should be in place before you choose the Designated-Day (D-Day) for going chartless.   

Planning

Have a discussion with your team about your desire to step into a chartless environment.  Set up a road map as to what needs to be accomplished, by when. Talk with your specialist doctors to determine how you will handle information given and received from them. Decide who will be responsible for implementing each area. 

Ensure all related technology has been implemented

Take time to really review your options for the technology you will need to help you achieve your chartless goals. Below is a list of the technology most dental offices need to have in place:

1. A good Practice Management Software Program
2. Digital X-Ray
3. Intra Oral Camera
4. Imaging Software
5. Patient Education Software
6. Scanner
7. Electronic signature pads.
8. Customizable software, which will capture signatures for those additional forms that most practice management software, will not.
   
   Examples: Informed Consent for Digitizing Evidence, Consent for Treatment, Financial Arrangements, Patient-Office Agreement, Dental Facts Material Sheet, Patient Refusal of Treatment, etc.

Preparation

Do a chart audit with your existing charts to determine what, if anything, you want to scan into your Practice Management software. This needs to be done not only to determine what you are going to scan from your existing charts, but more importantly, how will your computer software handle what was previously stored in a chart? Because eventually all your new patients will not have a chart to store information in, you will be using the computer.

Note: It doesn’t have to be all or nothing at first with your existing patient charts. You can always access their paper charts if needed, especially if you have decided not to scan every existing patient chart.  

Training

It is vital to dedicate time during this process for additional training. Think of everything you would pull out, or refer to, from a patient’s physical chart. If it is in the chart you can find it.  Now you need to know how your computer software will handle it.

Have a clear understanding of how your software program handles the following:

• New Patient Information
• Health History- new and updated
• Dental History Questions
• HIPPA - Existing and New Forms
• Copies of Insurance Cards
• Basic Charting Software
• Existing Conditions- The new patients initial chart
• Hard Tissue
• Soft Tissue Exams
• Perio Charting – to educate the patient and documentation to Insurance Co.
• Outside Work – update your charting to reflect what was done by a specialist outside of your practice.
• Treatment Planning (clinical)
• Clinical Notes – progress notes
• Referral Tracking
• Referral request
• Outgoing Lab Case Tracking
• Returned Lab Case Tracking
• Prescription Tracking
• Letters and Images from Specialist

Once your office has a clear understanding of how to deal with the items above, implement a:

• chartless system for your New Patients; and continue with a
• chart-based system for Existing Patients, only to refer to

Do this for a short period of time, until you and your team are fully comfortable with the chartless process. You’ll be amazed how smoothly the transition can be when the right planning and preparation are in place!

What's stopping you from going chartless?

When I ask doctors and team members why they hesitate to go chartless, I hear several common areas of concern.  I address nine of the most common below.

Issue #1: What do I do if my computer is not working when I come into the office?
Related issue #2: I finally have a sound network environment. I am concerned that adding more technology may cause computer challenges again.

Answer: Dental offices are not alone here. I understand the frustrations everyone feels about computers working or not working, or about adding additional technology to a stable environment. Most hardware suppliers recommend you upgrade your computers every 3-5 years to allow for optimum usage and speed. I fully support this recommendation because the reality is that whatever you buy today is, unfortunately, already on its way to becoming obsolete.

This is true not just for computers, but for all technology. If your computers are more than 5 years old, they are very likely costing you more time and money to maintain than to replace.

Also, be sure you have a sound back-up system in place and that it is running correctly. Off-site back-up systems are also a good option.

Issue #3: How do I get everyone trained to do the same thing?

Answer: Getting your current team trained in moving to a chartless environment is critical to your success, and adequate time must be devoted to it prior to ‘the move’. As a team the office needs to allocate specific times each week to learn how your software handles issues listed above. In the process of doing this be sure to not take on too much at one time so that you can fully implement and understand each task before you take on another.

Issue #4: What about team turnover?

Answer: For new team members, there are two crucial things to have in place, a lead person and a written standard operating procedure. The lead person is so the new team member has someone specific that is not only training them but also quizzing them. This lead person is also someone the new team member can refer back to when they have questions. Having written standard operating procedures is key. New employees have a ‘road map’ to help them get up to speed with the technology quickly and accurately, without taking inordinate amounts of time away from other team members to provide training.

Issue #5: What do I do with my existing charts?

Answer: Keep them for reference only. There may be a time that you need to refer back to them.

Issue #6: What do I do with the patient information that is stored in the charts?

Answer: Earlier in this article I suggested you do a chart audit. After doing this you will then be able to determine what, if anything, you need from the chart to be scanned into your Practice Management Software. Ask yourself this: if you had to pay $5 for each piece of paper you have scanned into the software system, would this affect your decision on how much to include? The answer, of course, is typically “yes!”

Just remember, once you determine your Designated Day (D-Day) for going chartless you will not make up any more charts for your new patients. Everything will be stored in the computer.

Clinical issue #7: Will I have to duplicate my work?

Answer: For reassurance only, many offices will at first enter information into the chart and into the practice management system. Those who have dedicated specific training time to the process of going chartless do this for a very short period of time only before they become 100% confident in the chartless system.

Clinical issue #8: Will it be more work than what I am doing right now?

Answer: In the beginning it does feel like more work, however this is really just ‘the training curve’. In my experience offices that have gone chartless are unanimous that they would never go back to paper charts and often feel that they have become more detailed with the clinical notes in the computer verses what was added into the chart because they have a template to fill out.

Clinical issue #9: Will I have time to do everything?

Answer: Yes, understand that the time it takes to fill out your chart will be replaced by filling in the blanks, (template) for your progress notes that your practice management software will ‘ask’ after you have posted your work.

There are also some real advantages moving to a chartless environment.  One of those that stand out loud and clear to me is the amount of time spent looking for a misplaced chart, not only to pull for the next day’s schedule but also to file all the information received in the mail.

Think about it… if you were chartless all you need to do is make sure your computer is in working order.