Digital X-Ray scanning technology is changing dentistry.

In fact, it’s significantly reducing the amount of time a patient needs to spend in the dentist’s chair.

“It’s a significant time saver for people,” says Dr. Deryl Dangstorp, one of a growing number of tech-savvy Canadian dentists who have invested in a system that enables them to design their own crowns on a computer and then build them in their dental clinics, rather than sending them to a lab to be done.

Using this system, a crown can be done in a single visit, instead of the customary two or three.

“It’s the same technology that the dental labs are using,” the Regina-based Dangstorp said. “But this is the dentist’s version.”

Dangstorp was quick to point out that he still uses the services of a dental lab, as well. For example, he can’t build crowns with metal, so he continues to send those out to be made.

The crowns made at Dangstorp’s dental clinics start off with a square block of porcelain or ceramic glass.

“A few years back, there was only one manufacturer and one kind of block. Now there’s nine types of blocks, and there’s four different manufacturers,” he said.

While the system isn’t currently the norm in dental offices, it’s continuing to grow in popularity, Dangstorp said.

“It’s not a new idea,” he pointed out. “The first idea was thought of in the late ’80s. The problem was the idea was ahead of the technology. The computers weren’t as fast. Scanning wasn’t as accurate. The software wasn’t as advanced as it is now.”

“Today’s improved scanning accuracy, camera accuracy, improved processing speed on the computer, are all now pulling this idea forward,” he said.

Regular software updates make it easy to keep up with the latest advancements, Dangstorp said.

“It’s like anything else — we’re moving away from hand-to-eye, man-made and moving more to the computer,” Dangstorp said. “We’re scanning the tooth. We’re designing it on the computer. We’re tracing the margin with the computer.”

The process Dangstorp uses to build crowns, from beginning to end, requires a 1 1⁄2- to two-hour appointment. But the patient is actually only being worked on for about 30 or 40 minutes of that time. While waiting for their crown to be designed, milled, baked and glazed, patients can either watch TV, read a magazine or even get some work done.

At the end of the appointment, the restoration is complete and the patient can eat right away,

Fitting dental appointments into busy schedules can be challenging, Dangstorp conceded. So the fewer visits required, the better for most people, he said. Because patients from rural areas often have to travel a considerable distance to get to dental appointments, they particularly seem to appreciate only needing to make one trip to the dentist to get a restoration done, Dangstorp said.

“It’s convenient. But it also makes a great crown,” he said.

Dangstorp, who has two dental offices in Regina and one in Emerald Park, has invested in two systems that allow him to build his own crowns: the E4D, which is made in the U.S., and the Cerec, which is the European version of the same thing.

“With this system, you come in once. We prepare the tooth. We then scan the prepared tooth. And then we design your crown right here in the office on the machine. And then we mill the crown out, try it on and adjust it, make sure it fits, glaze it, cement it. And then you’re done,” Dangstorp explained.

“The traditional crown, you come in, you get your tooth prepared. You get an impression. You get a temporary (crown). You come back in two weeks. You may be frozen up again, have the temporary taken off, try the crown on. If it fits, great. If not, it’s back to the lab. Make another one. Come in again,” he said.

The new system totally eliminates the need for a second appointment.

Even if, for some reason or another, the first crown that’s made doesn’t fit, which Dangstorp said is very rare, another one can be made right away, while the patient is still in the chair.

For those who don’t relish the idea of having their mouth frozen several times, or who tend to gag when traditional impressions are done, this is a more tolerable option, Dangstorp suggested. The new system is popular with both patients and dentists.

“It allows us to control it from beginning to end. We design it; we make it,” Dangstorp said.

“It’s a process that’s getting better as time goes on,” he said. “It’s a little faster, a little more accurate, a little easier.”

Price wise, it’s virtually the same as the traditional method of building crowns, he added.

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In a recent Managing Partners’ Roundtable, we talked about the costs of digitizing all of a firm’s files. One partner suggested that failure to do so might result in malpractice allegations. This is an interesting concept; one that I don’t believe has yet been examined.

Pros and Cons of Digitizing Files
The cons of digitizing are that it is expensive and time-consuming. Lawyers must forsake billable time to help determine which files matter and which can be “cleansed” and tossed. Files must be taken apart to be scanned. Decisions have to be made on what hard copy to toss now, what to keep and for how much longer.

The pros of digitizing are the reduction in amount of real estate needed to store files, the lower cost of occupancy resulting from a conversion, and the ability to search files electronically by keyword.

The decision on what to keep and what to toss after digitizing is crucial. Failure to keep clients’ files safe is a failure in the overall duty to act competently in the best interests of clients. The rules and specific time periods for storing or destroying client files vary by jurisdiction. Some states require a lawyer to securely store a client’s files for 10 years after completion or termination of the representation unless the lawyer and client make other arrangements.

How to Digitize Your Files
Several years ago, a Chicago law firm began a digitizing process by scanning documents through a photocopy machine. Their contract provided for payment only when paper was copied and printed, not just scanned. Thus, this process had limited cost. Disabled people were employed to do the work, enabling the firm to do well by doing good. The firm realized a lower cost of labor than would have resulted in using its own personnel. The entire process was conducted in the evening so that the firm’s normal workflow was not disrupted.

The Benefits of Digitizing Files
Scanning documents as searchable PDF files in an ongoing records’ retention and management program is an excellent way to meet ethical document retention requirements and manage the huge number of documents required in litigation. Scanned documents are searchable electronically in compliance with the federal rules of evidence. Lawyers increasingly use software programs that search for key terms in electronic documents and classify those documents accordingly – a process that used to be extremely time-consuming and expensive with paper.

If documents are scanned, they can be produced and analyzed faster in the discovery process. The electronic files are just as valid as the paper ones and much easier to access and manage. Be sure to keep copies of the scanned electronic files in several locations as an added layer of security. You’ll have more space in your office and you’ll have a searchable file database, saving both time and money.

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With the advent of EMRs and the government’s stimulus benefits, doctors are slowly but surely incorporating them into their practices.

According to trade journal Fierce EMR, The government has increased the benefit this year to encourage more physicians to adopt EMR in their practices.

Currently only 30 percent of primary-care physicians and 20 percent of hospitals have installed some form of electronic medical records, according to the story.

The benefits to the physician are many. When a doctor uses an EMR, he immediately has access to the most recent, relevant patient history without manually reviewing paper patient charts.

This can help the doctor make informed decisions when treating, such as what tests need to be ordered, as well as medication management. EMR  systems can also give the doctor reminders and alerts, i.e., if a prescription drug is contraindicated. This is a huge cost-saver both in time and money.

As a patient advocate, the most obvious benefit of the EMR is increased patient safety. –To learn more, read Jacqueline O’Doherty’s full article at Hospital Impact

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But despite the slower pace, considerable growth did occur in 2010. Kalorama Information publisher Bruce Carlson said more growth is expected in 2011 and beyond.

“We think that while progress was made in physician adoption and in vendor sales, there is still a lot more potential,” he said. “There are still a considerable number of physicians who need to be fully functional and hospitals that have to improve their stage ranking.”

Indeed, three quarters of healthcare executives surveyed for the HealthLeaders Media Industry Survey 2011 said they are looking at timely compliance with meaningful use.

Double-Digit EMR Growth Expected This Year

Kalorama survey results show physician usage of EMR near 50%; reimbursement checks have been issued. As new systems are sold, companies will still earn revenues from existing clients in servicing and consulting, and Kalorama expects between 18%-20% market growth for the next two years.

Kalorama’s report — EMR 2011: The Market for Electronic Medical Record Systems – showed EMR growth rates of 10% in 2009 and 13.6% in 2010, lower than the 15% growth that Kalorama had predicted for each years. The research firm attributed the slower growth rate to hesitation by physicians confused about meaningful use guidelines.

Kalorama’s forecast for 2011 assumes that EMR usage will continue to increase, as hospital EMR adoption will encourage physician adoption, current EMR Stage 3 hospitals will purchase more advanced systems, and current EMR owners will upgrade.

Penalties to Force MDs to Install & Upgrade

Carlson said the threat of penalties in 2015 in the form of reduced CMS payments for those that do not engage in meaningful use of electronic records will force doctors and hospitals to make upgrade decisions.

“The stick is stronger than the carrot when it comes to the (American Recovery and Reinvestment Act) incentive-penalty equation,” he said. “We continue to believe that and we think it’s the industry’s consensus as well. While the policy already picked up those oriented towards technology, the penalties will force conversion and upgrading in the future. And those decisions will happen in the next two years, before the penalties kick in.”

(source: HealthLeaders Media)

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After investigating itself for almost a year, the Justice Department reported to the National Archives and Records Administration that it is concerned by improper record management procedures that could potentially hamper the agency’s effectiveness.

The department’s finding, which it delivered to NARA in February, appears to close a troubling case of lax records management by a federal agency. Officials at NARA accepted the explanation of the Justice Department’s chief records keeper of why thousands of e-mails vanished when they were needed for an investigation and closed the agency’s examination of the matter.

The investigation underscores the importance of preserving records, and it highlights shortcomings in the way agencies are handling the shift from paper records to electronic formats. Earlier this week, NARA released a report based on the self assessments of 270 federal entities. The survey indicates 95 percent of agencies “are at high to moderate risk of compromising the integrity, authenticity and reliability of their records.”

Failure by government agencies to properly maintain important records is widespread, NARA reported. In 2009, it established an annual requirement that all federal agencies subject to the Federal Records Act perform self assessments and report the results to the National Archives. NARA has legal authority to oversee and inspect agencies for compliance with laws and regulations that govern the disposition of official records.

The DOJ identified 28 records mismanagement incidents that remained unresolved at the end of 2010.

Others include improper handling of:

• Defense Department “documents related to torture”
• The Homeland Security secretary’s briefing books
• Consumer complaint letters to the Federal Trade Commission
• Food stamp records
• Security and Exchange Commission records
• White House e-mails
• Electronic records at the Labor Department
• Defense Intelligence Agency employment records
• FBI papers

One danger posed by lax records management is that agencies won’t be able to efficiently carry out their missions, said Paul Wester, director of NARA’s modern records programs.

Wester also worries “records that have enduring value in documenting the national experience” will be lost, that agencies won’t be held accountable for their actions and that citizens’ rights may be violated.

Records include “books, papers, maps, photographs, machine readable materials, or other documentary materials regardless of physical form or characteristics.”

That’s a vast assortment of stuff, considering all of the letters, brochures, messages, websites, reports, testimony and other communication government agencies generate.

Wester said ultimately, about “2 percent to 3 percent of all federal records have permanent value and need to be transferred to the National Archives.” According to NARA’s survey, much of the time that’s not happening.

“Based on how agencies conduct their business today, we are particularly concerned about the continued preservation of and access to electronic records,” Wester said in an e-mail.

Databases, geographic information and Web content all may be electronic records that are important enough to preserve, he added.

“Electronic records are particularly challenging because of the volume that the federal government generates, as well as the incredible number of different formats of electronic records that agencies have, and the complexity of the formats,” he said.

To complicate matters further, many agencies don’t have full-time records managers and most don’t conduct annual evaluations of their records management.

When it comes to electronic records, many agencies resort to “inefficient and ineffective print and file practices” for preservation purposes, NARA said in its report. Others rely on IT system backups for record preservation even though backups are intended as an emergency retrieval system not as permanent storage.

In a federal workforce of 4.6 million military and civilian employees, there are only 3,174 records managers and “NARA believes that this number is actually lower,” the report said.

NARA recommended it and U.S. agencies “should explore, test, and if effective, deploy automated solutions to manage records and information.”

(source: NextGov)

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We hear from doctors on a daily basis that they too are struggling with a decision that involves a lot of back and forth: whether to invest in a Meaningful Use solution this year, or wait.  The concern is that the new Congress is making threats about defunding the HITECH Act. What if doctors invest in meeting Meaningful Use requirements, only to get shorted out of promised incentive funds because Congress pulls the plug?

A hard-hitting InformationWeek article makes a great case for why doctors shouldn’t worry. The article’s top reasons:

• Even if House Republicans pass a law to cut funding from the HITECH Act, the umbrella legislation that covers Meaningful Use incentives, the Senate probably won’t pass it – and President Obama would just veto it, anyway.
• Incentives are paid out yearly until 2014; after which, payment reductions kick in. If funding is cut, it will likely be for those who adopt meaningful use later during the incentive period. 2011 is the year to reap the most incentives – up to $21K this year alone.
• It’s the twenty-first century, folks. We now know that IT Health technology cuts costs and improves care, incentive programs or not.

On this last point, Chuck Christian, CIO at Good Samaritan Hospital, especially agrees. He stated to InformationWeek: “We’re not doing this because we think we’ll get a windfall, we’re doing it because it’s the right thing to do.”

But he’s aware the program’s funds have an expiration date. “If you’re late to the game, you’ll get a reduced amount. There’s a finite bucket of money, when it’s gone, it’s gone,” Christian said to Information Week.

The article also points out that transitioning to electronic health records – the core of Meaningful Use – has typically been a bipartisan goal. We expect it will be again, once the current political posturing runs its course.

Our conclusion: we believe securing Meaningful Use funds is by far a sure thing- checks are already in the mail for early adopters- and an even better bet for providers that invest in a low-cost solution.

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The state of West Virginia, among the nation’s state sources of forestry used to make paper, is going green.

State Treasurer John Perdue announced last week that the West Virginia Division of Unclaimed Property will eventually eliminate all paper records by scanning all its existing paper files and converting them to digital images. The system used at the agency will convert and store paper records that take up space in the office, as well as electronic images that confirm a claimant’s identity before a check is issued by the division.

“Since taking over as Treasurer in 1997, I and my staff have tried to implement new technology whenever possible,” said Perdue in an interview with the Charleston Daily Mail. “This is an extension of that effort, one that adds efficiency to government and establishes a back file for a claimant, one that does not involve reams of paper and multiple boxes.”

Deputy Treasurer Dwight Smith said that all paper received in the office will now be scanned “coming through the front door,” so new paper doesn’t accumulate. Smith added that electronic images received will also be stored in its new scanning system.

The office now maintains a warehouse to store boxes off site, an inconvenience to staff who need to access files throughout the day.

“This way, we can pull up a person’s claim history automatically and the whole file will be there.” said Sullivan. “It’s more secure, eliminates paper and saves on supplies. We’re happy. This has been a goal we’re glad to get accomplished.”

After all its current files are scanned and electronically stored, the office will securely shred all claimants’ paper information.

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Guest blogger Janet Karasz, Canadian author of Plato’s Gnat, provides an enlightening commentary on the future of paper and the evolution of the records manager.

I’ve been thinking how technological advances such as photography, the internal combustion engine, television, and portable electronic devices such as the iPad and MP3 forced radical change to affected  sectors (artists, draft horses, radio and paper publishing).

The sectors mentioned above have faced massive change. They had to adjust their purpose in order to survive. Radio lives alongside it’s more technologically advanced cousins, carving out a niche for itself. We still see draft horses…much reduced in population…in parades. An “artist” today is another beast entirely; giving over reality to the camera and redefining itself. We will see a radical change to the print industry in my lifetime, thanks to the new portable devices. But books will remain as an ornament, a novelty. Newspapers will shrink; expanded content will have to be referenced online.

So what does this mean for the profession of Records Management? Are the skills honed for paper transferrable to the information world? Are we true Information Managers, ready to tackle a virtual world of information? I worry that there is so much focus in my industry on security and protection; cautionary tales about the new technologies. We must not forget that our primary task is to help our business find what they need, when they need it. Can we blame business if they question our value when there is no apparent intervention of the Records Manager to access their information? Could we marginalize our own profession by presenting ourselves as a barrier rather than a support to daily business?

The skills I see as being replaced or made obsolete by the new technologies include packaging by file, indexing and classification, and sorting. Perhaps I will expand on these later.

The skills the information world will continue to demand include disposition (regular disposals to extend the life of our assets, remove clutter, and reduce risk). An emerging support is to assist users in effective self indexing and searching. We will be needed during the transition to the “paperless” office, to help businesses define their information assets.

The lesson from radical change is that we must be flexible as a profession, take note of emerging needs, and be prepared to redefine ourselves to the new world.

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For years as responsible, law abiding adults, we’ve kept hard copies of virtually everything in filing cabinets, folders — safely hidden away until we need it again.

Pack rats though we may be, we may never go looking for our beloved paper documents until we either move to another home or experience some other life-changing event (in fact, only about 10 percent of us actually do go through our paper records on a semi-annual bases, according to leading records management surveys).

Maybe the reason we’re so captive by paper is we take solace in the knowledge that our documents are ALWAYS there. Filed away. Just in case. But in an American society that’s beginning to shun paper as environmentally incorrect at the same time our living quarters and workplaces are shrinking to accommodate a more eco-friendly environment, paper scanning is becoming a more commonly-accepted way to permanently preserve personal and business records.

Should It Stay Or Should It Go?

One of the biggest barriers to document scanning and paper purging is deciding what documents should be kept in electronic form only. With all the advances in online data storage and back-up devices, there are still some paper records that should be kept out of an abundance of caution.

Here’s a good rule of thumb when deciding which paper documents should be kept on your thumb drive and out of your filing cabinet. If the paper relates to a life, death or life-changing situation, scan it and keep it. Anything else you’ve got filed away can be confidently scanned, electronically archived and shredded afterward.

Some of the most common paper documents that should be left filed in hard copy include:

• Deeds to real property
• Leases of real property (can pitch after statute of limitations in your jurisdiction has run)
• Titles and/or leases of personal property tracked by the government (cars, boats, etc.)
• Passports (most recent one is probably enough unless you have a unique situation)
• Birth certificates
• Marriage certificates
• Divorce decrees
• Death certificates (obviously not yours, but any family members’ you may have in your possession)
• Social Security cards
• Any immigration or naturalization documents
• Any documents issued to you by a court or as part of litigation
• Any documentation related to a government benefits program (Medicare, Medicaid, unemployment, etc.)
• Actual financial instruments (stock certificates, bonds, etc.)
• Contracts where you are the one getting paid

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The “agent of the future” will be more successful and efficient in a paperless office. Paper isn’t going away completely, but you can free up space and access information much faster when you turn paper documents into digital files.

Furthermore, scanning your documents allows you to respond to clients and colleagues faster, get organized and put an end to office clutter. All of which helps you save time and money while giving you more time to make money in the process.

There are a variety of ways to go paperless. Some REALTORS® utilize the scanning function of their office or home printer for convenience scanning. But in today’s world of REOs and the increasingly heavy document load that contracts, appraisals and other transaction paperwork places on agents, scanning a batch of multi-page documents, page-by-page, eats up a lot of your time, begging for a more specialized solution.

Have you ever had to fax a contract to the bank, only to have it rejected because the image quality was so poor? Worse yet, you try to scan with your home printer, realize that the process is going too slowly and then end up driving to the office to use a high-speed scanner? It’s obviously not the best use of your time. How can you scan efficiently, cost-effectively and with the kind of speed you need? The answer is most often found in the neighborhoods you’re selling: Professional scanning companies.

A dedicated document scanning company can be the difference-maker for you as a real estate professional. It can enable your goal of a paperless office and deliver speed and efficiency benefits like these:

1. Save Time – Scanning, sending and sharing information all happens quickly and productively.
2. Get Organized – Declutter your work space, free up your filing cabinets, eliminate lost documents.
3. Save Money – Lower your storage costs and concentrate on what’s important—building buyers and sellers rather than managing paperwork.

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