Dyani Gaudilliere, DMD, MPH, Chief, Section of Dental Medicine & Surgery, Stanford University School of Medicine and Advisor, Laguro.com
Competing Forces of Access and Efficiency in the Dental Industry
Dentistry is a unique field of medicine that has remained external to many of the advances and changes that have affected healthcare in general. For this reason, the cost of dental education has risen and the ability of new dentists to stay afloat in their early years of practice has diminished. On the other hand, these pressures make the time right for the dental industry to adopt technological advancements and changes to the work culture that have transformed our traditional views of the workplace: cloud-based solutions and space-sharing.
In my role as a hospital dentist and dental oncologist in an academic health center, my team and I work together to care for patients, and we share our consult, procedure, and electronic health record (EHR) space with all branches of medicine. In this model, there is virtually never a chair, hospital bed, or operating room that is empty, and the hospital is a bustling, productive space. I can access the health information of my patients on an encrypted phone or computer wherever I am and seamlessly share my treatment information with the patients’ interdisciplinary care team. The patients even have direct access to their physicians’ and hospital dentists’ notes and test results through an online platform.
Contrast this with the traditional private practice dentistry model where EHR is stored on a local server, communication with a patient’s physicians is labored, and, importantly, chair time is only utilized by a dentist or two who are likely burdened by heavy loans, high pressure to turn a profit, and perhaps the need for at least an occasional vacation. This model discourages providers from taking on higher-risk patients or those with lower paying insurance, translating to either low access for patients or high costs to treat their dental disease.
"Cloud-based, virtual office solutions for EHR would allow non-practice-owning dentists to follow their own patients in a modern chair-sharing dental delivery model"
The Opportunity for Dentistry to Adopt Technology-based Solutions
I am a firm believer that dental hospitalists and hospital-based outpatient dental services are crucial for the safety and efficiency of communication with the entire healthcare team for patients with high-risk medical conditions. The separation between oral and overall health is artificial and often creates undue risk due to a breach in information flow between physicians and dentists. However, the non-hospital-based community dental model can learn from and possibly improve upon the model used by our physician colleagues in healthcare centers.
Cloud-based, virtual office solutions for EHR would allow non-practice-owning dentists to follow their own patients in a modern chair-sharing dental delivery model, not unlike the health center model. Whether I am treating a patient in their hospital bed, in the operating room, or in the outpatient clinic, the information about what I learned from their history, exam and how I treated them is accessible by me and the patient’s care team. With cloud-based EHR in dentistry, providers would know immediately when their new patient’s broken crown was placed, or whether their patient is taking Fosamax for osteoporosis but forgot to list it in their medications at their dental visit, both of which are crucial pieces of information.
The concept of shared chair space, which follows from the cloud-based virtual office, is as exciting and promising for patients as it is for dental providers. This concept is far from new in other industries, such as car-sharing and home-sharing. Chair-sharing in dentistry follows a similar model. It has as many, if not more, kinks to work through for adoption, but it also has the potential for huge payoffs for everyone involved. The cloud-based virtual office obviates the necessity for a non-owner dentist to utilize the existing office’s EHR solution (which they will not be able to access outside that office), and it allows the dentist to bill directly to their patients’ insurance without owning their own office. It also allows the owner dentist to maximize their efficiency and lower their overhead by renting out their extra chair time, without the commitment of hiring long-term associates.
The future of dentistry
A modern vision for dentistry would combine the technological advances seen in health care centers with the autonomy and freedom of the private practice dentistry model to maximize efficiency, increase patient access, and lower patient and provider costs. Larger dental treatment centers with central sterilization, shared staff, and chair utilization on-demand could cut the high cost of practice-buying for new graduates and the high overhead of practice owners. This model would also give providers the ability to work on their own schedule and increase the possibility of after-hours work, preventing patients from taking time off work for their dental visits. Patients could have easier access to their own EHR and could schedule appointments on one app-based system with information and reviews on all the providers in their area with open chair time. Patients could also benefit from transparent insurance and billing protocols.
In an era of endless technological possibilities and examples of successes in almost all industries, dentistry is ripe for a transformation. By combining a cloud-based virtual office platform with dental chair, equipment, and staff sharing, dentistry would no longer find itself stuck in the rut of crippling start-up costs and rising overheads. Dentistry would benefit from the health center model of clear communication between providers as well as permanence of and access to EHR. Most importantly, the community at large would have better access to dental care as the increased efficiency translates to lower costs of treating dental disease.