Resources | Articles | January-February, 2002

Ontario Dentist - January/February 2002

Your Charting System - The Overlooked Asset

by Timothy A. Brown, A.L.A., Michael Gommerman

With the advancements in modern dentistry today, it is hard to keep up. New technologies such as intraoral cameras and digital X-rays are becoming commonplace in many practices. While these items are definitely costly, they are often considered to be a worthwhile expense because they can lead to increased productivity.

In the process of continually updating your dental office's technology, it is understandable that the charting system would often be overlooked. However, the benefits of a complete and thorough charting system are numerous and, in fact, can offer as much benefit as the above-mentioned, high-tech items.

Today it is more necessary than ever to maintain thorough and accurate records. Informed diagnosis and treatment management of patients both rely on a comprehensive medical history. Also, legal requirements such as the Health Care Consent Act mean that patients must be informed when any treatment is proposed. And as always, the profession is under the close scrutiny of the Royal College of Dental Surgeons of Ontario, all of which seems to be increasing the awareness of many dentists, who now realize the importance of comprehensive records, and that a review of their existing record system may be worth considering.

Despite the reasons for thorough documentation, there are many obstacles that make it difficult for an office to incorporate a change as potentially disruptive as adopting a new charting system. After all, each dentist practices dentistry differently, and it is a difficult task to find a charting system that not only meets all of the legal requirements, but is one you are comfortable using.

After visiting many dental offices, we have been faced with many objections to the introduction of a new charting system, such as the cost associated with changing over, the time necessary to make the change, patient compliance, and the investment in the current system. Consider some of the following issues and determine for yourself whether a change would be appropriate in your office.

COST

Objection: "It will cost me too much money to change the entire system."

It is true that a new system will cost you some money. A new system can range anywhere from $1.50 to $3.50 per chart, depending on whether you go with a generic chart or a customized system. That is the initial purchase, but there are additional costs such as the labour associated with converting everything over. While the dentist has the responsibility of keeping abreast of any updates or changes to a patient's medical history, practically speaking, someone ÷ usually the receptionist ÷ has to set up the charts and administer the forms to the patients. This task can take up a significant amount of their time. However, when put into the proper perspective, $1.50 to $3.50 is not a large investment in the welfare of any particular patient.

In our experience, one of the more frequent comments from offices that have changed their charting system is that they have actually seen an increase in productivity. Due to the thoroughness of the new charts, the dentist is able to inform the patient more effectively as to the risks, material effects and side-effects of any proposed procedure or medication. As a result, the dentist is cast in a more professional light, and the patient's acceptance of a proposed treatment plan is likely to be stronger. If viewed from this perspective, the purchase can often times be justified.

Although a patient's charts must be up to date, regardless of the system currently used, changing your charting system can also be seen as an investment, and it is for this reason many consultants and brokers agree that a complete and thorough charting system can increase the goodwill value of your practice. If a practice is up to date, and there is little that needs to be improved, it becomes more saleable and will therefore attract a higher price.

TIME

Objection: "It will take forever to change everything over to a new system."

This is one of the most frequent objections we hear. There is no doubt that adopting a new charting system means a significant amount of disruption to the practice. Setting up the new charts for the patients, administering the new, more thorough health history, learning the format of the new charts - these are all reasons why offices shy away from making a change.

Perhaps the largest fear to overcome is that of the dentist having to learn the new format of the charts, as well as the concern that it will take forever to complete the forms. Each dentist is accustomed to writing things down in a particular order. However, it typically does not take more than a week for the practicing dentist to get accustomed to the new format, and once mastered, many offices find it actually takes less time to record more information. Due to the efficient check box format of the new charts on the market today, there is less writing required, and it is also more efficient to retrieve information.

PATIENT COMPLIANCE

Objection: "It will take forever for my patients to complete the health history and they will not want to reveal all of this information."

What most offices find is that it takes between 12 and 18 minutes for their patients to complete the forms. And while it is true that some patients will object to disclosing more medical information, according to our informal research, what most offices find is that less than two per cent actually do. If the forms are presented properly, the likelihood of any patient objections will be minimized. When the patient is informed of the possible consequences of simply having their teeth cleaned, they begin to realize the dentist is the professional and that there is a purpose behind the questions. For instance, an uninformed patient is unlikely to comprehend the subtle, yet important medical connection of undergoing hip replacement surgery with having their teeth cleaned.

INVESTMENT IN CURRENT SYSTEM

Objection: "I have a lot of money invested in the system that is already in place, and changing would require not only new cabinets, but new files as well."

Over the years, you have invested time and money in your current system. However, the old wallet-type charts and pouches still being used in many offices have become obsolete. What most practices find is that these systems do not hold the amount of information required today, and consequently, start to tear and fall apart. The ability to keep all of the pertinent information with these old systems becomes more difficult, and some offices start to store information such as X-rays in other locations. The RCDSO mandates that this information must be readily accessible, therefore, keeping it all in one organized place is strongly advisable. All information pertaining to the patient's treatment should be kept with their chart. A larger file folder capable of accommodating all of the X-rays, including a pan - and which also has the capability of making the retrieval of information much more efficient - is desirable. The amount of information this type of system can hold gives it a distinct advantage over the older systems.

Despite the number of offices still using outdated charting systems, many are either considering changing, or are currently undergoing a change to a more thorough one. If you are changing systems, remember that the records must be maintained in accordance with existing record keeping requirements. And before you dismiss the possibility of new charts for the office, consider this last point from a patient's perspective: When choosing a dentist for your family would you not rather go to one that is very thorough?

If you answered "Yes," then maybe it's time to consider a change in your charting system to ensure it enables you to provide that level of service.

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