Filing the Fillings


Michael H Rich describes how micros can improve dental health

Using any kind of computer in a dental practice neatly divides itself into two compartments: use in the office, which is comparable to using a micro in any small business, and use for clinical records. This latter use involves a far wider concept than ‘ordinary’ business use as the software is highly specialised and, as will be described below, needs the use of combined graphics and text on the screen to be fully effective.

Before the advent of the microcomputer there was very little hard/software available for the dentist to be able to introduce computerisation into a dental practice.

What there was was in the nature of a large ‘mini’, complete with the necessity for an air-conditioned ‘cubicle’ for the CPU which used fixed/removable hard disk cartridges. This, of course, allowed a multiuser facility but in the context of a small dental practice was far too expensive to be cost-effective.

Minicomputers are still available for dental practices; they are smaller in size as well as being slightly cheaper in price, and the suites of software with these systems do a reasonable job of helping the dentist to run his practice. The argument about being cost-effective still applies and thus they are for the larger practice only.

The micros of the Apple/PET/Tandy variety (and this list is by no means exhaustive) have, of course, opened up the world of computerisation for the small business, and it should be realised that a dental practice is precisely that. Many of the available software packages for running such a business can be applied to a dental practice. The management of accounts can be dealt with in a standard manner, as can stock control; although a practice employing half a dozen people hardly needs payroll software!

What distinguishes the dental practice from a small business is the clinical aspect of treating patients and the paperwork that this generates. When examining patients a dentist records the clinical information derived from the teeth in a form consisting of various shapes to designate types of cavity, fillings present, teeth to be extracted, dentures present and a variety of other conditions. This pictorial representation of a mouth is easy to scan and assess and is an internationally standard method. To record this information in written form, although suitable for a standard database software package using routine file handling procedures, would be very long-winded and would mean abandoning the standard procedures used.

There is software available for use on micros which does do this graphic charting of the clinical conditions in a mouth and this is allied with space to write clinical notes of treatment to be done, or which has been done. This is often conjoined with a suite of programs which will price the work done, whether under the NHS or privately, and will produce bills for patients and carry out the usual reconciliation with payments, aged debt analysis and so on. The software will often include a facility for routine recall of patients at a standard time interval and this raises the other major aspect of the application of computerisation of a dental practice – the appointment book.

It is necessary to realise that anything other than the appointment book in a dental practice is capable of being replaced or renewed in the event of a complete disaster, eg, a fire. To take an extreme example, if the premises are totally destroyed one can set up a tent with a telephone line outside the front door and with a list of patients due one can reconstruct records and re-schedule appointments until the premises are fully functional again. Without this book a dentist might as well go home. Consequently a dentist has to consider very carefully whether to commit this vital aspect of his/her practice to an electronic form which may be subject to the vagaries of an irregular power supply, corruption of storage media and the sundry other faults which can occur. To back up one’s records every time a fresh appointment is made or one deleted from the ‘book’ would be counterproductive in terms of time even though it is essential if the possibility of either missing a vacant time slot or double-booking is to be avoided. An actual appointment book can be kept in a fire-proof safe for peace of mind.

In addition to this, the software available at present for this function will only display, at best, one day per VDU screen (some only half a day) per dentist. A good receptionist can keep a visual image in mind of the black spaces in an actual book and can turn a page to ‘bring up’ a whole week at a time much quicker than any software can on a screen.

To go back to the function of computerisation of clinical records, one has to realise that for this to be fully effective there has to be a terminal and screen in each surgery with central mass storage as well as a terminal, etc, at the front desk. This again raises the question of cost: even using micros for only two surgeries and reception on this basis with, say, 10Mb storage will put the cost towards the five-figure mark, which becomes very expensive in the context of a small dental practice. The actual storage figures for dental records with chartings for each patient may be in the range of 500-700 bytes per patient per course of treatment and this multiplied by approximately 3000 patients per dentist gives some idea of the basic storage needed to keep clinical records. Details of treatment have to be kept for at least two years after completing a course of treatment and this, allied with all the other office functions needed, suggests that the 10Mb mentioned above could be a conservative estimate for a practice containing three or more dentists.

The other main problem concerning dentists at the present time is the possible computerisation of the NHS claim form FP17. This is a complex form which has to be filled in accurately so the dentist can be paid by the NHS. It contains details of the patient; name, address, clinical charting grid, a minimum of seven different dates to be filled in and various other details. Software has been written to cope with this so it can be printed out after the data has been put in from the handwritten clinical notes. The problem with this is that the slightest change in the format of the grids, etc, on the FP17 would mean rewriting this software. A suggestion has been made that the central collating body for these forms could use ‘light pens’ to read any printed codes produced by any printer, enabling a dentist to use whatever internal record system is desired. This problem still has to be resolved and will depend on whatever change in method of remuneration of dentists may be applied in the future.

The only other main office function for which a computer is often used and not yet mentioned in connection with a dental practice is the use of word processing. This is not generally a great necessity in a dental practice. Recalling patients every six months is often a feature of a dental software package and would incorporate a print-out (hard copy) format.

In summation, one can state that the small system with a couple of disk drives, screen and printer (not necessarily of letter quality) with a good database software package at about £3000 is a viable proposition for even the single-handed practitioner. The limitation of use to office procedures only is still worthwhile, even solely on the basis of eliminating lots of pieces of paper. Clinical records require considerable mass storage, sophisticated software and even provision in the actual surgeries to accommodate the extra terminals needed.

First published in Personal Computer World, April 1983


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