Should dentists adopt electronic dental records?

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:

  1. 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.
  2. 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.
  3. 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

6 thoughts on “Should dentists adopt electronic dental records?

  1. Dr. Schleyer, isn’t it true that electronic dental records are not only more expensive than paper, but that they are also more dangerous for both dentists and patients?

    D. Kellus Pruitt DDS

    • Dr. Schleyer, why have you not responded? It would appear that you are hiding the dangers of electronic dental records from dental patients out of selfish interests. Am I right?

  2. The two most prudent questions American consumers should ask concerning any expensive, life-changing purchase are: “How much does it cost?” and “Is it safe?” Even the FTC recognizes that transparency is a must for fairness in the marketplace. Yet in dentalcare, patients are most at risk of harm by EDRs because they are intentionally kept uninformed of their danger by stakeholders. Thanks for posting my questions, Dr. Schleyer. That’s progress.

    As a practicing dentist and potential electronic dental records customer, I’ve repeatedly asked logical questions about cost and safety to others promoting EDR adoption, and have been mostly ignored. The few who have argued that EDRs offer dentists savings over paper dental records have never been able to provide data supporting the claim. In fact, when the former CEO of the widely-respected CR Foundation made a reckless proclamation that EDRs offer dentists a “high return on investment” in a Dentistry iQ article in November, he was fired within days, and co-founder Dr. Gordon Christensen took over as CEO.

    As for safety – nobody claims EDRs are safer than paper dental records. More alarming still, though the frequency of data breaches from healthcare facilities is said to be at “epidemic proportions,” and doubling every year, stakeholders who are promoting them are not taking the responsibility to warn dentists and their patients of the rapidly increasing risk of financial and medical identity theft.

    Did you know that stolen medical identities now bring $50 each while social security numbers only bring $5? When medical histories are stolen, they are often imperceptively altered to reflect the thief’s allergies rather than the victim’s. Like keystroke errors, that life-threatening danger simply never occurs with paper dental records.

    So if EDRs are indeed more expensive than paper dental records, aren’t the stakeholders, who stand to gain power and/or profit from their sales, bound by business ethics as well as common decency to warn customers to expect an increase in cost to provide care? And how much do you think HIPAA compliancy adds to the cost of dentistry? HHS isn’t saying.

    And if the EDRs are indeed more dangerous than paper dental records, and dentists fail to routinely warn patients to watch for unexplained changes in their digital medical histories, isn’t that counter to the tenets of the Hippocratic Oath?

    D. Kellus Pruitt DDS

  3. Hello. I am here to provide some insight into scanning dental records… Scanning your dental records and putting them on your server gives you the ability to have multiple people view a chart, annotate a chart, add to the chart, and is also a Business Disaster Recovery Plan. If you are backing up your files daily, you will NEVER lose your business files to FIRE, WATER DAMAGE (burst pipe, flood, fire hose), VANDALISM, SABOTAGE, TORNADO, etc. as compared to keeping your paper files which would be lost.
    CLAIM: “But I have a fire proof file cabinet!”
    ANSWER: Is your cabinet able to survive a meltdown fire and building colapsing on it? Is your file cabinet water proof from the fire hoses. (ever try reading a water logged document stuck together and smeared?). Is your file cabinet smoke proof? (paper darkened/dirt on records)…How about those OLD FILES you have in paper boxes stacked up in a storage room? What about disgruntled employees who vandalize/sabotage your files before they leave… that’s why you digitize your dental records…TO BE SAFE AND HAVE PIECE OF MIND! We can help Dentists or Doctors within a 110 mile radius around Pittsburgh, PA to get it done for you at a very very resonable cost. We do free tests of your records and a free demonstration that can be easily implemented and integrated with your current system and can access your content from either the desk top interface or web browser. We can do a 40 minute demonstation to show you what it looks like, what it can do, and provide you with a good faith estimate of your needs. If you are serious about POSSIBLY digitizing your medical records (even your X-rays), please call Mike at 412-562-0296. Thanks.

  4. Mike, I’m a few months late in responding because I just came across your reply.

    Did you know that loss of dentists’ records due to floods and fires was NEVER an important issue until EDR stakeholders like yourself ran out of better rationalizations? Face the facts: electronic dental records are both more expensive and more dangerous than paper dental records.

    Sorry I missed your reply.

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