This question is a perennial favorite of mine. I get it a lot when I give talks to dentists or in response to papers we write. It reminds me of a question that many people asked in 1910: “Should I get another horse and buggy, or should I get an automobile?” (Disclaimer: I wasn’t there personally.) The early 1900s were a period of transitions in many ways, but few were as significant as the change in how we got around town. Around 1910, the number of automobiles was surpassing the number of buggies. Thus, we started to give up on a way of transport that had been with us for thousands of years. Horses and buggies were relatively cheap, required little training to use and had a (relatively) predictable standard of performance. Consider what we got in return at the time: The term “automobile” comprised a number of technological contraptions whose variety was only exceeded by the number of ways they could break down. Early automobiles were unreliable, non-standardized and had a variety of not-so-intuitive user interfaces.
Sound familiar? I thought so. We are currently in the process of phasing out the tried-and-true method of documenting patient care in favor of electronic dental records (EDR). This is simply a statement of fact, not a value judgment about which medium is better. In 2006 we conducted a study that found that about 1.8% of all general dentists in the US were paperless. In a recent study, which we just submitted for publication, the figure is about 15%. We are not very close to the moment when more dental practices are completely paperless than those who are not. But, we are heading there. The dental profession is voting with their feet.
Whether to go paperless or not is not only a significant, but also a very personal, decision for dental practices. Not only is “going paperless” it a fairly involved process. It also consumes a non-trivial amount of time, money and resources. (We discussed this transition recently in “Transitioning from Paper to Electronic Records: A Process Guide.”)
In my experience, there are at least three factors that play a big role in the decision to go paperless:
- Do you believe that you are better off using electronic than paper records? There are some areas where the computer clearly beats paper – anytime. Just ask any dental office that has lost its records during hurricane Katrina. But, the inverse is also true. Have you ever tried documenting Diagnodent values in an EDR in a systematic fashion? Most EDRs don’t provide structured fields for such diagnostic tests, so you are pretty much left putting them into progress notes. Not a great method for systematic review of these numbers later.
- Do you have the knowledge, skill and energy to take on a major computerization project? Many dentists who have made EDRs work in their office are not just geeks, they are computer geeks. They invest the countless hours needed to learn about their EDR, how to configure it optimally in their practice, train their staff and keep it running.
- Do you take the long-term view with regard to EDRs? EDRs are an emerging, immature technology. Several studies, including ours (see heuristic evaluation and usability of EDRs), have shown that. Cars weren’t perfect in 1910, and neither are EDRs in 2012. Better EDRs are a matter of time, ingenuity and perseverance.
Clearly, there are many other factors influencing whether to go paperless or not. But, one thing is certain: EDRs are here to stay, and will, sooner or later, replace paper. It is up to all of us to make them into a more useful tool for dental practice than they are now.
What do you think about this?
Titus Schleyer, DMD, PhD
Assoc. Professor and Director, Center for Dental Informatics