By Anthony M. Puntillo DDS, MSD
In August 2014, I wrote an introductory article for this blog entitled “What is Big Data and How is it Related to the Practice of Orthodontics?” As more orthodontic practices move to the digital collection of orthodontic treatment records (EHRs-photos, models, radiographs, treatment history) and more of our data is being stored in the “cloud”, there is a tremendous opportunity for us as a profession to access that data for the betterment of our patients and advancement of our specialty. Over the last ~3.5 years, however, there has been little visible traction by our researchers and leadership on this front. Meanwhile, there should be no doubt that corporate entities (DSOs and orthodontic vendors) understand the value of our data. Check out the recent cover article for Fortune Magazine (“Tech’s Next Big Wave: Big Data Meets Biology” -3/19/2018). The article notes that “The quest to retrieve, analyze, and leverage (medical) data has become the new gold rush.” If orthodontists are to hope to have any influence on how orthodontic treatment is delivered in the future, management of our patients’ data will be crucial. Technology has sped up every aspect of our lives. We must now start to give this issue the attention it desperately demands. But where should we begin?
If we are to tackle this challenge, there are many complex questions that will need to be answered. Our patients’ privacy is not the least of these. Even with our busy professional and personal lives, I imagine it has been hard for most to miss the recent public flogging of Mark Zuckerburg and Facebook. Both he and his company were taken to task by Congress and the media when they revealed that the personal data for 87 million of their customers had been inappropriately accessed by an outside research company. As a result of these disclosures, politicians are threatening regulations for their industry – think HIPAA for Silicon Valley. There are more than 2.5 million people who annually seek orthodontic treatment. As we look to find the best ways to utilize our patient’s treatment data to improve their care, we must make certain that it is being done in a way that is respectful of all patients’ privacy. While privacy may be where we start, there are other, even more difficult issues that need to be addressed.
The complexity of the Big Data issue will require the input from the brightest minds both from within and from outside of our profession. To that end, the Great Lakes Association of Orthodontists has put forth a resolution to this year’s American Association of Orthodontists House of Delegates. Resolution 18-18 GLAO (http://hod.live.aaoinfo.org/resolution2/18-18-glao-big-data-task-force-and-records-repository/) requests that our Association President appoint a Big Data task force. I would encourage you to review the resolution and let your representatives (HOD Delegates) know your feelings. While this issue is certain to require a significant investment of time, talent and financial resources, we cannot afford to leave this investment to outside sources. Those who control the data will control the future.
By Matthew Larson, DDS, MS
In the current economy, satellite offices are frequently utilized by orthodontists to increase their area of draw and patient base. Most orthodontists and consultants feel that the additional income offsets the additional overhead expense, but managing multiple office locations clearly requires more effort than maintaining only one location. However, current technology has helped make managing multiple locations easier. One dramatic example that most orthodontists now utilize is electronic charting, so that patient information is easily available at all office locations. Here are a few other tips and tricks to consider:
- Centralized/Cloud-Based Documents: Most offices ensure that all patient information in their practice management software is either on a centralized server or cloud-based, but many offices are not as attentive to all of their supporting documents. Your satellite office should be able to run exactly like your primary office if desired. It is relatively easy with current technology to ensure all computers have access to centralized training manuals, patient handouts, and current projects. More limited access can be setup for the doctor and select staff to access more confidential information. Multiple methods can be used to achieve this, such as a shortcut to a shared document folder on the server (if a terminal server is used at the satellite office) or online cloud-based storage such as iCloud, Google Drive, or Dropbox. Please note that iCloud and Dropbox are not HIPAA compliant and Google Drive requires some adjustments to be HIPPA compliant, so these are not ideal solutions for PHI. The goal is that each practice location should have electronic resources in the same location for easy reference and there should be little to no effort to keep them synchronized.
- Mileage tracking mobile apps: Deducting business mileage or tracking business miles on the company vehicle can provide a nice tax savings, but maintaining an accurate ledger to satisfy the IRS can be difficult. Multiple mobile apps are available to help keep an accurate log of business miles, such as Mileage Log+, MileagePad, Auto Miles, and Triplog. Some apps will automatically track when you are driving and then miles can be categorized later. Most allow you to export spreadsheets or expense reports for a nice end-of-year summary. Prices are generally under $10.
- Remote locks and thermostats: I may be slightly biased since our practice is located in Wisconsin, but having a remote thermostat to ensure that heat is turned down when we are not at our office and that the office is warm when we arrive really helps staff morale at the start of the day! Also, there are coded locks available for your front door that allow you to remotely issue one-time use codes for contractors to access the building. Multiple permanent codes can also be set, which allows you to monitor who is entering your office. For example, cleaning staff can be given a unique code so you are aware of when they are onsite. These generally are a few hundred dollars to install, but avoiding extra trips to let in contractors or paying for additional heating/cooling bills can make it worth the expense.
- Phone lines: Phone systems are a much larger topic, but it is worth at least briefly mentioning that having lines ring at only one location and going to voicemail if they are not answered is outdated. For offices with multiple locations, some type of VOIP system should be strongly considered, which allow lines to be answered and transferred independent of geography. Even with a traditional phone system, look into the additional features offered by the phone company. Generally, lines can be forwarded on certain days of the week and calls that are not answered in a certain amount of time can be forwarded to the other office (assuming the other office is staffed).
Overall, managing a satellite office can be less stressful using current technology, but some effort must be spent up front to design the correct systems and to implement them.
By Anthony M. Puntillo DDS, MSD
Have you heard of the term “Big Data”? My guess is that for many orthodontists the term is likely a bit like the term “The Cloud.” They may have a general idea of the concept, but are not entirely sure how it is or will be important to them. In fact, there is a strong relationship between the two terms that I will discuss later in this article. First, however let’s look at “Big Data” by itself. According to Wikipedia “Big data is a blanket term for any collection of data sets so large and complex that it becomes difficult to process using on-hand data management tools or traditional data processing applications.”
In 2009 the United States Congress passed the American Recovery and Reinvestment Act (ARRA) which included the Health Information and Technology for Economic and Clinical Health Act (HITECH). [For a detailed summary of this legislation please see Kirt Simmons blog posting from July 9, 2012 “The Electronic Patient Record: How it Affects the Private Practitioner”]. One of the requirements of HITECH is that full implementation of electronic health records (EHRs) for all patients is required by 2016. The requirements of this act specifically pertain to healthcare providers who participate in the Medicare and Medicaid programs. That means that currently few dentists are covered by this mandate. However, this does not mean that we are not being affected. Since 2009 doctors and hospitals across the country have spent billions of dollars, with the help of government subsidies, converting paper based systems to electronic digitally based health records. These new digital systems are now collecting vast amounts of valuable data related to patient care. Much of this information was collected before the legislation, but in a paper non-standardized format that was not easily aggregated and retrievable for meaningful analysis. The value of all of this collected digital data is only beginning to be fully understood. Big Data from all healthcare providers is being aggregated and programs to analyze the data are being used to improve the quality, safety, and efficiency patient care. Hospitals are examining treatment protocols and doctors are making better informed treatment decisions based on the previous care of thousands of similar patients.
As I stated earlier, the EHR requirement of HITECH does not specifically pertain to most orthodontists so why is this important to us? Many orthodontists have or are now also in the process of converting their practices to paperless systems (without the assistance of the government money). Several of the orthodontic specific software vendors offer cloud based systems and here is where “Big Data” and “The Cloud” come together. The aggregation of data from hundreds or thousands of individual private orthodontic practices into cloud servers is beginning to open the door for data analysis (mining). Just think about how valuable that information can be to our patients and practices. Most of the research studies published in our journals today involve treatment samples of less than one hundred. The biannual Journal of Clinical Orthodontics Practice Study generally relies on the input for a few hundred survey responders (out of a possible pool of more than 8,000). Wouldn’t it be helpful for us to know the most efficient type of Class II corrector based on the actual metrics collected from the previous care of thousands of patients treated in practices all across the country or the globe? Wouldn’t the knowledge that your treatment times/appointments vary significantly from the national or regional averages be useful? There is little question that access to “Big Data” analytics will offer our profession the opportunity to improve treatment quality, safety and efficiency for our patients just as it is beginning to do for the other fields of healthcare.
Steve McEvoy, Technology Consultant
The first thing I check when I start to work with a new Practice is their backup. Most Practices have something in place, but more often than not I find the single most important piece of data is being missed – the Practice Management Database. Imagine if your Server crashed and you had to use your backup to recover all your precious data, and at the end of the recovery your IT person explains “There you go, it’s all restored – oh – except for your Practice management data that is lost forever!” Your Practice would be severely impacted and the financial loss would be enormous. Taking 4 minutes to read the rest of this article and then pass it along to your IT person.
Most backup routines merely come along and make duplicate copies of files sitting on your hard drive. Imagine creating a Microsoft Word document. First create a new blank Word document and save it to your desktop. Open it, type a few new paragraphs, but you leave it open and don’t save it to the hard drive. If you run the backup right now, the backup will catch the new empty document that is saved and completely misses the newer data still in memory (but not saved to disk yet).
Many Practice Management programs (such as Dolphin, Orthotrac and Ortho2 for example – listed alphabetically) use a sophisticated database called Microsoft SQL Server. Backing up SQL Server needs a special technique. Just like in the Word document example, SQL Server is always open and keeps the latest changes to your information in memory or log files. If you just come along and ‘copy’ the database files you won’t have anything useful to recover with (bad news!). This is usually what I find is happening, people are running backups but aren’t realizing they need to take extra steps to backup the SQL database.
The Practice Management companies know about the challenge and all of them have documented solutions for you to follow. The problem is who actually reads the manuals? This is a case where you (or your IT person) needs to. Ask your IT person directly “Are you properly backing up the Microsoft SQL Server database that my program uses?” If they don’t know for sure the answer is ‘yes’, the simple solution is to ask them to call the support team of your Practice Management Software company and ask for a little advice. They will have a solution:
- Dolphin has a ‘Safe Backup’ solution that can run automatically as part of your end of day or end of month
- Orthotrac has a database backup routine that can be set to run automatically and keeps copies of the database for each day of the week.
- Ortho2 has a database backup application that can be setup to run as often as you like.
You’ll notice in my descriptions there are a lot of ‘cans’. You have to be sure these are setup and working. Make sure the backup files that these routines make are then swept up in your routine file copy backups. In a crisis, these backup files can be recovered from your regular backup and then the SQL database can be restored.
If you use a Cloud based Practice Management you don’t have to worry, they are doing it for you. If you use an Internet Backup the same problem can exist. Many Internet backup companies like Carbonite.com and Mozy.com don’t normally backup SQL databases, so you should check this out since your SQL database is your most important piece of data worth backing up. Personally I would recommend you take an extra step – make your own SQL database backup in addition to the one you configure with the Practice Management Software. Microsoft SQL Server includes the ability to schedule SQL backup jobs on its own, and I would recommend that you setup two backups (one at noon, one in the evening). Two backups are better than one!