How the cloud improves practice for dentists, patients

2020 05 11 16 14 0851 Computer Cloud 400

The cloud is a game changer for dentists and their patients because it saves time, money, and physical space, according to one dentist. Also, many dentists are already using the cloud even if they don't consciously recognize it.

For those who are unfamiliar with it, the "cloud" is software and services that run on the internet as opposed to locally on a computer. Most cloud services are accessed through a web browser or an app.

Using the cloud, information is accessible anywhere on any device as long as it's connected to the internet. Examples of consumer cloud solutions are Google Drive, Apple iCloud, Dropbox, and more. In the dental industry, there are cloud-based practice management systems, medical health records, and apps.

Dr. Joe Willardsen, a cosmetic dentist who runs True Dentistry in Las Vegas, primarily uses Dropbox at his practice to organize patient files as well as photos. Because physical storage space isn't an issue, Willardsen and his employees can take numerous photos: extraoral, intraoral, smiling, not smiling, etc., and they can communicate with dental labs more fluidly.

Gone are the days of sending SD cards or films back and forth. With the cloud, Willardsen can jump on a call with a dental lab and mark up images, take notes, and collaborate in real time as opposed to emailing back and forth, which can be time-consuming.

Dr. Joe Willardsen, a cosmetic dentist from True Dentistry in Las Vegas.Dr. Joe Willardsen, a cosmetic dentist from True Dentistry in Las Vegas.

"With Dropbox, my lab tech can access images at the same time. It just makes it easier," he said.

The cloud also enables teledentistry because Willardsen can log in from home and manage emergencies. If a patient calls and says, "I have a broken tooth," Willardsen can use the cloud to reference photos he has on file, x-rays, and other information, such as previous dental work. It provides him insights on how best to serve the patient.

Additionally, a patient can send a photo of their broken tooth from home, and without going into the office, Willardsen can assess the patient. He can let his staff know what to be prepared for when the patient comes in: a broken filling, a new crown, or something else.

"Oftentimes in emergencies, we're squeezing the patient in, and if the staff is already prepared for the patient, that cuts down on wasted time," Willardsen said.

Also, because the diagnosis was made in advance, someone from True Dentistry can go over the fees, what insurance will cover, and any other pertinent information before the patient has stepped foot in the office. In other words, the cloud creates greater efficiency for dentists and patients.

The focus on efficiency and reaching underserved communities is where the cloud really shines, according to Dr. Courtney Chinn, MPH, an associate chair of the pediatric dentistry department at New York University (NYU) College of Dentistry and a clinical associate professor.

Unlike True Dentistry, NYU doesn't use Dropbox to store images -- it has a customized, cloud-based service and a cloud-based electronic health record. The existence of the cloud has allowed NYU to explore teledentistry.

In 2016, NYU was awarded a five-year grant to establish a new faculty development program to improve the delivery of community-based oral healthcare training. The U.S. Department of Health and Human Services' Health Resources and Services Administration awarded Chinn a $1.3 million grant. Coupled with private funding, Chinn and his colleagues created community-based teledentistry programs.

Dr. Courtney Chinn, MPH, associate chair of the pediatric dentistry department at NYU College of Dentistry.Dr. Courtney Chinn, MPH, associate chair of the pediatric dentistry department at NYU College of Dentistry.

"We have a pilot now where nurse practitioners are picking up the camera and taking images. We're seeing how that system can actually work to facilitate care," Chinn said. "The way I'm using [teledentistry] is in dental safety net settings, not necessarily traditional practice."

Nontraditional places include school-based clinics, where a nurse practitioner or dental hygienist will take a full set of x-rays and get the medical history of a child. Using the cloud, a dentist can review all of the images and make a diagnosis asynchronously while still getting paid for their time.

"The best thing is the chair time is dedicated toward the most needy kids but also the most procedurally efficient procedures so that we're saving time," Chinn said.

In other words, the kids who need access to a dentist make an appointment, but the ones that don't stay home. This cuts down on no-show rates, which can be as high as 35%. Fundamentally though, teledentistry is made possible through technology, yes, but also a cultural shift, according to Chinn. Embracing teledentistry means recognizing dentistry can take place outside a brick-and-mortar building.

"The attitudes toward cloud and teledentistry specifically changed a lot with COVID, because suddenly, we didn't like waiting to take all these images until we could go to the dental office, and suddenly, everyone was OK with adopting the risk when the office was pretty much shut down," Chinn said. "We've gone into a new season of how we look at COVID and ... things are opening up again [but teledentistry has remained], and I think that's how innovation usually happens. We're put in a situation where we are forced to change and then we realize 'Oh, we can adapt to this.'"

Some dentists may worry they can't conduct a proper exam unless they can touch a tooth, but the research shows that's not true, according to Chinn. "How many times have you looked in the mouth of a screaming kid, looked away, and said, 'Wait, what did I see?'" he said. With a good series of images, the information is already there, ready to be referenced at any time, which is also something Willardsen appreciates.

"Being able to use the cloud enables me to see and assess details I may not have been able to previously," he said. "We can't remember everything about our patients, as much as we would like to. That's why we have files and charts and notes. Being able to access information quickly at our fingertips takes a lot of anxiety out of our job, because there's nothing worse than when you get asked a question about a patient and you don't know the answer and can't get to the answer quickly. Being able to access that information and give competent responses and answers takes a lot of anxiety out of our work."

Using the cloud doesn't have to be scary or overwhelming. If dentists feel that way, Willardsen suggests familiarizing themselves with the program(s) they like, asking colleagues for suggestions, and learning from other people. His most important tip, however, is, "Don't forget the password."

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