Dental Technology And why you should care

By: Brennon Dean

A few months back we worked with Gaby Loria, a research manager and video producer at SoftwareAdvice.com, on an article detailing the current trends in software in the dental industry. Now, Dr. Jen is typically the author of our blog, however, in this particular instance, technology is more of my wheelhouse. While we have built our practice together from the ground up, and everything from flooring to nitrile glove selection has been a joint decision, my day-to-day job is actually in designing and implementing technology to solve business problems. In other words, I'm a computer geek that happens to work side-by-side with an amazing dentist.

Working with SoftwareAdvice got me thinking that, as in most industries where the end product isn't technology, very little focus is typically placed on it. Sure, when you walk into a dental office you see a computer behind the desk that presumably does something relatively important, the brochure said they use the latest technology, and you can watch “The View” on the toe monitor at your feet—and this is about the point at which most people stop caring. However, both from the clinician's perspective as well as the patient's perspective, I think this is a mistake and I'll explain why you should care.

1. Older systems are more expensive

It's often said that dentistry is the most entrepreneurial of all healthcare, and I believe this to be true. The dental industry is very competitive, and compared to traditional health insurance, dental insurance reimbursement, or the amount of money insurance companies actually pay the doctor, is extremely low. In order to mitigate the amount of money a patient then needs to pay out of pocket to receive proper healthcare, costs of running the business need to be reduced. As an aside, the business-minded out there might say, “But wait! You can also increase revenue!”, and while this is true, this is far more limited due to what I consider the key phrase here: “proper healthcare”. Hypothetically, if you are already seeing the maximum number of patients you can see in a day, there are very few ethical ways to further increase revenue. With that said, while there are multiple ways to decrease costs, from using cheaper materials, outsourcing billing, or using overseas labs, I feel that a majority of these have a negative impact on the patient as we touched on in a previous article.

This is why technology is important. An incredibly high standard of patient care can be maintained, while also maintaining competitive pricing, through increasing efficiency. If I don't need employees to spend all day calling to confirm appointments, hand writing notes into paper charts, and developing film x-rays, I can pass those cost savings to patients without sacrificing quality. Ultimately, like any industry, technology drives down prices, and that's good for the people using that product or service. This also has the benefit of making things a lot more convenient for you—if you have the option to text your dentist or to confirm your appointment and pay your bill with your iPhone, why not?

2. New technology is better and safer

To quote The Dude from The Big Lebowski, “Yeah, well, you know, that's just, like, your opinion, man.” The reality is, aside from being easier and faster, you can see things on a digital x-ray that may be missed on an old film x-ray, or in other words, they're just diagnostically better.  Additionally, digital x-rays can reduce radiation exposure by 70% over conventional film x-rays, and they continue to get better by the day. Digital x-rays are better in just about every way, with the caveat being they are a bit larger physically speaking. However, this continues to improve and I don't feel it's a particular issue these days. Unfortunately, there's still a reluctance to adapt to the times, with many continuing to use film x-rays. Whether this is due to the capital costs associated with upgrading or a reluctance to learn a new system, the end result is a less optimal outcome for the patient.

Other advancements come in the form of intraoral cameras, which allow you, as a patient, to see what a dentist is seeing in your mouth. (While this doesn't guarantee everything is on the up and up, it certainly helps). In the past you essentially had to just take a dentist at their word about what was going on back there. Now you can see a high definition image of your molar and have it explained to you exactly what needs to be done and why it is needed. Materials and composites used in dentistry have also improved dramatically from the days of yore in which a silver filling was your only choice, and while specialized equipment can often be needed to allow their use, these composites offer greatly improved adhesion, longevity, and esthetic qualities. The list goes on and on, from digital scanning, improved imaging software, 3D printing, improvements with in-office milling, and further advancements continuing to happen daily. In short, with all things being equal, you absolutely will receive a better end result with newer technology.

3. Your privacy and security

People joke that when it comes to the security of our patient data, I act like the NSA is after us. I once refused to let an auditor in as it was an unexpected visit and, as a rule, I don't allow anyone to rummage around and take pictures. The company requesting the audit called me to confirm the individual's identity, but I insisted on calling back through their main line to verify the authenticity of that caller. This process ultimately took too long for the auditor, who left, leaving the company that sent her a little unhappy with me.

Protecting the privacy and security of our patients and their data is ultimately far more important to me than an unhappy auditor, and for good reason. It's reported that over a fifth of patients withhold health-related information from their doctor out of fear of a data breach, and I can't really blame them. Medical records continue to be one of the most widely sought after forms of stolen data, easily outpacing the value of a credit card on the black market by factor of ten. In 2013, 43% of all identity theft was related to medical identity theft, and because dental practices tend to be small businesses, they are increasingly the target of these forms of attacks, being less equipped to fend them off. Personally, I feel this area is a huge blind spot for a lot of practices. Dentists will invest hundreds of thousands of dollars in the latest computerized mill and CBCT, but fundamental security principles are ignored while they proudly display their server rack in an unlocked closet with a beaming smile.

With respect to the above, ironically, according to the CDA it's low tech physical theft that's the primary way in which these data breaches occur, with employees frequently the actual thief. Now, on a personal note, of course we trust our employees, otherwise we would never allow them in the practice. With that said, we also tightly restrict access and institute physical security measures in order to prevent these sort of breaches. Even if the employee is completely blameless, if a username and password ever becomes compromised, we need to be certain that our patients are protected. We also encrypt all data with 256 bit AES encryption. This is a standardized encryption specification used by large corporations and governments alike. I'll spare you the math, but using a brute force method to decrypt this data, on current computer hardware, would take longer than the current age of the universe. If someone were to physically gain access to and steal computer hardware, the data would theoretically be worthless gibberish.

In other instances, it's poor IT practices. For example, in 2015, 151,000 patient records were compromised due to a company allowing outside access to their server. Outside access is certainly a convenience, however, it needs to be properly implemented. This situation could have been avoided with proper two-factor authentication and encryption of the database. Generally speaking, most dentists are working with other small businesses to fulfill their IT needs—typically it's the same guy who is installing their speakers, who may not always be up to the task of securing such sensitive data. As a result, and somewhat understandably, responsibility for security is thrust onto the big players. Why not? They're large companies selling software to tends of thousands of dentists, and should have the funds and expertise to provide this service. Unfortunately, one of the largest in the dental software realm was recently fined by the FTC over inaccurate claims that patient data was encrypted. This came to light after 11,000 patient records from a dental office were shared online and were left there unencrypted for four years before being reported.

If the software development companies can't be relied on for this, what should be done? Unfortunately, the response from the industry at large has primarily been in the form of insurance. By insurance I literally mean insurance policies in the event a data breach occurs. Naturally, this isn't particularly comforting to a patient, because as a victim of data breaches myself, I'd rather things be done right in the first place instead of the token two years free credit monitoring that is used to say “sorry”. Ultimately, dentists needs to understand and invest in their information systems just as they do their clinical ones in the form of education and professional assistance; admittedly, it's a lot for a dentist to do, but it's also important.