As soon as the management of a dental practice expands beyond one location, the technological challenges related to information management can become daunting. This is especially true if one considers that a big part of the value proposition of multiple locations is the ability to scale resources. For example, if a single location office has six employees, an accountant, and a bookkeeper; a second location should not require six new employees and twice the amount of time by the accountant and bookkeeper.
Yet, not only is it common to see practices unable to take advantage of the value of scale, added work is often created when managers attempt to evaluate the organization as a whole - manually creating reports that combine the results of the two locations, attempting to evaluate information that has been input differently, managing patient records when patients go to each location, etc. Not infrequently, managers throw up their hands, and let each practice run on its own, as two individual, unconnected practices.
Why is it so difficult to realize the advantage of scale in dentistry? Other businesses do it all the time. The answer revolves around the fact that most dental information management systems are designed to run a single practice, often utilizing a proprietary database. When a second office is opened, even if the same practice management software is used, it is very difficult - sometimes impossible - and very expensive to get the databases to communicate with each other. So, the manager has the challenge of managing two islands of data, and often, the only practical solution is to manually combine the data into a separate system - like a spreadsheet.
As in other industries, there is dental information software, which is designed to run large, multi-location groups. This type of software - often called enterprise software - is most often used by businesses producing multi-millions in revenue, and who can afford the expensive software, maintenance, and networking costs.
Fortunately, a cost-effective solution to this problem has existed for other small to mid-sized businesses for over six years, and, for the last two years, has been thoroughly tested and is now available for the dental industry. While this type of solution is ideal for small to mid-sized businesses, it has recently begun to make a stir even at enterprise-level businesses.
We will discuss the solution at the end of this article. For now, let's examine the information management challenges that confront any manager of multiple locations.
Challenge 1: Consolidated Reporting
As mentioned, consolidating meaningful information among multiple, independent databases can be challenging, frustrating, and expensive. Even when there is some level of success, the overall package of reports falls way short of managers' wants and needs. Usually, the reports are at the highest level. Even a single level of drill-down is often impossible.
There is a truism in information management: If you attempt to store the same data in two locations via separate inputs, it is only a matter of time until the data sets won't match. For example, if you pull data out of one practice management system and merge it with information from another system, it is likely that at some point, the information in your reporting system will not match the information in your practice management databases. This may happen for a number of reasons: human error, timing issues, program issues, data type mix-ups, and many more.
Challenge 2: Scheduling
Common scheduling among multiple locations is often so difficult that it is never even attempted. This is unfortunate, because sharing (i.e., distributing) front desk tasks among locations is probably the best scale advantage that exists.
Challenge 3: Provider Management
Unless a database is designed from its inception with multiple-office management capabilities, provider management - whether dentist or hygienist - becomes difficult, especially if the same provider works in more than one office. Even with some of the elegant software tools, which allow databases to talk with one another, a provider will be identified as two separate providers, if he or she works in two different offices. Provider evaluation, then, requires a manual compilation of the data.
Things can get very complicated - and very manual - if the provider works in multiple locations, and his or her compensation methodology is different in one or some of the locations. This is especially true for specialists, if the practice provides specialty care.
Challenge 4: Insurance Management
Ideally, scale should add efficiency and savings to insurance management across an organization. If the databases are stand-alone islands, however, the advantages are lost. All insurance company-related data must be individually input into each information management system, duplicating the same effort in every location. Fee schedule entry must be duplicated in each location. Insurance payment data cannot be shared among the locations.
Challenge 5: Patient Information and Records
For most multi-location practices, some patients inevitably end up visiting more than one location. This might happen because of an emergency, a schedule change, or a specialty visit. This scenario creates the cascading effect of a patient being entered as a patient in two separate databases, billing taking place from two different locations, insurance information located in two different locations, accounts receivable potentially located in two locations, etc. If the patient had treatment in two locations in one month, he or she will receive two bills.
Of course, unless a physical file is transported between locations, medico-legal issues arise. Does the patient need to fill out a new health history? Do new x-rays need to be taken? Do new consents need to be signed?
Challenge 6: Patient Communications
If a patient accesses more than one location, there is a high potential for right-hand-not-knowing-what-the-left-hand-is-doing patient miscommunication. The patient may well end up being contacted by more than one office.
Miscommunication aside, patient communication, also known as internal marketing, should be one of the advantages of multi-location office. A consolidated marketing effort should offer the multi-location practice a competitive advantage over smaller competitors.
Challenge 7: Office Administrator Functions
Stand-alone information systems require each office to perform its own administrative functions: patient billing, insurance management, accounts receivable management, supply vendor management, etc. Essentially, this requires an office administrator at each location.
The golden ring for multi-location practices is the ability to move all non-treatment related tasks out of each office. This would produce a tremendous increase in efficiency and decrease in expenses, but more importantly, it would allow the remaining staff to focus on patient satisfaction and quality of care.
Challenge 8: Internal Communication Issues
For many multiple-location practices, the only internal communication tool is the telephone. Some awkwardly use email. A few of the larger groups utilize a sophisticated intranet system.
No matter the tool, the challenge is to integrate communications and documentation of communications into the daily work flow of each location. This goes for all communication, both internal and external.
Challenge 9: Network Management
Most dental offices require network support for computers and networks. For most multi-location practices, this amounts to at least doubling the support with two offices, tripling the support for three offices, etc. Depending upon the size of the organization and the locations of the practices, multiple support companies may be required to keep the technical infrastructure in working order.
With multiple locations, standardization also becomes a key issue. Offices operating on different software versions, operating system versions, computer equipment, etc. can quickly become an expensive nightmare.
Network management is also significant when adding new offices. Besides the costs of hardware, software, and equipment, communication links and configuration can turn into a bottle-neck in new practice roll-outs.
Challenge 10: Scalability
The concept of business-process scalability is important in any aspect of multiple office ownership, but it is especially key in IT management, and it is critical to success if rapid growth is anticipated.
What is scalability? Simply, it is the ability to successfully and repeatedly replicate a process in more than one location. For example, if you have a successful hiring process, you will want to replicate it in all locations. It is not "scalable," if it requires the intuition of a single individual for its success.
IT scalability includes hardware and software capabilities, networking, support issues, training, and data consolidation requirements. Since IT set-up can often be a bottle-neck in new office roll-out, "ease of deployment" can also be added to the list of scalability requirements in a growing organization.
Challenge 11: Cost
Hardware and software choices should be able to produce reasonably predictable costs. Right? The costs are predictable only if you are satisfied with the hardware and software capabilities as-is, never outgrow those capabilities, and never redirect the business-flow process of the practices.
Additionally, without careful network planning, communication and storage issues can rapidly threaten the financial success of an otherwise well-thought-out project.
Solutions
As mentioned above, enterprise-level client-server solutions currently exist. Quality Systems, Inc. (QSI) dominates this segment.
Middleware solutions also exist. Middleware is a type of software that functions as a conversion or translation layer. It is also a consolidator and integrator. Custom-programmed middleware solutions have been developed for decades to enable one application to communicate with another that either runs on a different platform or comes from a different vendor or both. Today, middleware solutions are common, and Citrix is probably the best known.
A third solution that other industries have used for over six years to bring enterprise-level capabilities to small and medium sized businesses is Web-based software, also known as software as a service (SaaS). The new form of software-as-a-service was spearheaded by Salesforce.com (CRM), which developed a customer relationship management and sales force automation application.
Since Salesforce.com made its mark, several other successful SaaS companies have arisen, and now, SaaS applications are available to dentists. The company in the forefront of SaaS in dentistry is PlanetDDS with its Web-based application, Denticon (www.denticon.com).
Besides the tremendous cost savings that SaaS offers to multi-location practice management, its biggest value is that all the organizations data resides in a single database, which can be viewed - with the proper security clearance - at anytime, by anyone in the organization via an internet connection. There is no need for duplicate entry. Consolidated reporting is instantaneous. The internet is the network, which alleviates tremendous networking costs, makes the application infinitely scalable, and allows for rapid deployment. Appointment schedules can be seen and appointments made across the entire organization. Provider results can be evaluated across the entire organization. Patients can be followed across the entire organization. And finally, common administrative functions no longer need be limited to on-site.
William B. Jackson, DDS is Vice President of Business Development at Planet DDS, Inc. He can be reached at
bjackson@planetdds.com.