SCHEDULING
In a private practice, the scheduling system has to consider the doctor, the patient and perhaps the assistant and/or the column or chair. In the university, we have to add the resident to the above list. ViewPoint has fields for the orthodontist, the family dentist, the referring party, the assistant and the office all of which are unlimited in number. In a university setting, we need to decide how to "trick" the system so, e.g., the attending = orthodontist, the resident = the family dentist and the assistant = assistant. We have set this up in different ways at various universities and can customize this feature so that it does just what you want. The main implication is the way reports are affected.

Another issue in designing the scheduling system for the university has to do with the fact that the attending can only be in one place at one time. Imagine Dr. Scholz entering the clinic of 42 chairs at 9:00 AM on Wednesday and being needed by 30 residents all at the same time! While this may seem to be an absurd example, SLU does have 42 chairs and an equal number of residents who on occasion are all present in the clinic at the same time. We solved this by using color coding to identify attendings so there is a bright visual on screen when appointing patients to avoid this problem.

FINDINGS
ViewPoint has a feature we call findings. It is a series of fields that are totally user definable and unlimited in the number of categories and responses. This feature is used in three ways:

1. Its data can be merged to the insurance form
2. Its data can be merged to the word processor and on the way can automatically be translated into parent vocabulary and/or dentist vocabulary.
3. The data can be sorted using Boolean logic to find any number of patients meeting specific search criteria. So if a resident wanted a list of treated patients who were Class I, with overjet and overbite of so much, were female, who started treatment between ages 11.6 and 14.8 and who went at least four months past their expected treatment time, one pass on the database would provide the list. This will be the major use of the findings feature in a university setting.

Two issues come to mind in deciding what your departments finding page should look like. First, how will it be used which will define specificity and who will design it?

On the subject of specificity, and example could be how we want to record the amount of overjet in a given patient. Should we record negative, normal, a little bit, a lot and severe? The problem with this approach is that it will not produce a good list of cases as when I record the response as a lot, you might use the severe response. The advantage is that our response list will be short and easy to use. If we go toward more specificity, like -5-3mm, -1-0mm, 1-3mm, 4-6mm our response list increases and will be more difficult to use. To further complicate the matter, some may want to be really specific like -5mm, -4mm, -3mm etc. this will make the list extremely long and quite difficult to use.

The who will design it issue is most important as if the users are not involved in the design process, they will not use it. What has worked is that a committee of faculty, residents and perhaps staff come up with a draft of what they think should be done and circulate it to all faculty and residents for input and comments. Only after everyone has agreed on the design should it be implemented into ViewPoint.

SOLOING
Here are my definitions of "soloing". Soloing means a resident sees a patient assigned to an attending without any attending seeing the patient during a visit. Semi-soloing means a resident sees a patient and an attending does see the patient but not the attending assigned to that patient. Both of these problems exist in most of the orthodontic departments I have visited and two things are of interest. First, when I ask the Chairperson or Clinic Director or Program Chair if the residents do such a thing, I typically get a very positive "no". Secondly, few programs have a bullet proof system of tracking this problem so we don't really know if it goes on and if it does, to what extent. I have seen the system in which the attending must sign the chart but this means the charts have to be collected and reviewed and many times this is where it fails.

I recently visited a program and asked the Chair if his residents are soloing or semi-soloing and got a "no way" response. But in conversing with several second year residents who had just been transferred the patients previously treated by the now graduates, I got a very different answer. Each student reported that they had several patients that had not been seen by any attending for a full year! I think you will agree that this is a significant problem and needs to be addressed.

ViewPoint has a very nice electronic treatment plan and chart capability which can be used to track this problem. Using a fingerprint reader, a resident could "sign in" so the computer knows who is entering data. When the attending sees the patient, he/she could fingerprint into the system and note that the patient has been seen. At present, an audit of treatment chart entries would be necessary but I think the day is coming when ViewPoint could include this information in a report.

UNIVERSITY REPORTS
During my tenure at UCSF, a common problem was collecting the information to know that the patients I had with each of the residents was being seen in a timely fashion and progressing well in treatment. Now that the computer has arrived, we can do this quite easily. Ortho II has designed a university report which can be printed with one pass on the data base and distributed to attendings and residents. It looks something like this and the fields can be changed if a program wants different information.

This report can be sorted by resident so they can see a summary of how their patient care is progressing.

THE DEAN'S SYSTEM
Almost every dental school I have visited has a school wide computer system that I call "The Dean's System". Some are built in house while other schools use off the shelf programs intended for use in every department. The most commonly used are the Axium and Windent programs. The problem with these non-orthodontic applications is that while they try to some extent to be department specific they never get there so the orthodontic department has to undertake some form of double entry to accomplish the tasks missed by the dean's system. The most common missing element is the subject of findings noted above. I have never seen a dean's system able to deliver the same results that a properly designed ViewPoint findings list can produce. Other areas include scheduling, the electronic treatment chart, word processing and image integration.

A very common "brick wall" I find at dental schools is that the Dean (or whomever the decision maker may be) won't allow another program to be used in the school. While there may be some logical reasons for this policy, some are illogical and can be solved. The most common problem foreseen is "lack of control" by the powers that be and this is usually in the financial arena. It seems that the Dean may have to report to the auditors about the financial performance of the entire school in a meaningful fashion. Therefore reports from all departments in the same format would be desirable so they can be shown in detail and summarized. There are two ways around this problem. First, let the school collect the orthodontic department fees and use the dean's system to do this. We need to be careful as if the school's collection staff is not effective, we have to be able to know it and then be able to do something about it. Another solution we used at North Carolina is that the Ortho II and dean's system programmers put their heads together, collaborated and built a bridge between the two programs. The end result is that the money is collected in the orthodontic department, both for the clinic and faculty practice operations, posted in ViewPoint then uploaded into the dean's system at night. The end result is control is maintained by the orthodontic department and the dean's reports all have the same look.

IMAGING AND RADIOGRAPHS
This issue can be very problematic but doesn't have to be if it addressed correctly. Let's assume for discussion that you are using ViewPoint, an imaging program and we have a direct or indirect digital radiography system. The objective is to be able to interface with imaging which in turn is interfaced with radiography so a resident or faculty member can easily view digital pictures and radiographs on a screen located in the clinic. ViewPoint is interfaced with imaging so clicking on the smiling face in the patient's record opens the imaging program and images can be viewed. Radiographs are no so easy. Typically, a patient panorex or ceph is exposed and stored using the proprietary software that is provided by the radiography system. Generally, the dean's system is interfaced with the radiography software so a student can get to the image from the dean's systems patient record. But not from ViewPoint! The resident has to find the proper record either through the dean's system or the radiography system, export it to a convenient server in a suitable format then import it into the imaging system so it can be accessed from ViewPoint. At least part of this step can be automated with a bit of programming by the dean's system programmers. The step would be to ask the technician after exposing and saving the image if this image would like to be exported as well to the "ortho server". If the response is positive, the system would save the file on a computer convenient to the residents for importing into the imaging system.

THE BIG PICTURE AT THE UNIVERSITY
Having spent twenty years at UCSF as a faculty member in the orthodontic department, I think the only thing that allowed my survival was the fact that I could return the next day to private practice and get things done efficiently without having to put up with the bureaurocracy offered in the university setting. My last ten years at UCSF were under the chairmanship of Bob Isaacson, one of orthodontics leading educators in my time. When we were puzzled by something going on at school, Bob would query, "How do we do this downtown?" Many times this answered the question about how we should do something at school. It further developed my image of what an orthodontic program should offer its residents and that is an environment that closely resembles "downtown". Our office has a computer and flat screen at every chair, electronic treatment chart, a great interface to imaging so I can show Mom the panorex and send an electronic referral to the oral surgeon for removal of the third molars. Every workstation is Internet capable and firewalled. Why should the university be any different?

Click here to view the Ortho II policies on software donations to orthodontic departments.

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Page last updated on Thursday, May 15, 2008 10:01 AM.