Introduction
Dental Service Organizations (DSOs) are transforming the landscape of dental care by providing scalable management solutions for dental practices. However, one significant challenge remains: efficient and effective record management. This white paper explores why it would be beneficial for DSOs to enhance their record management processes and argues that artificial intelligence (AI) represents the best course of action to achieve this improvement.
The Challenge of Record Management in DSOs
Clinician Time Constraints
Doctors are already under significant stress, often working under the pressure of meeting productivity targets set by DSOs. Naturally, they prefer to focus on clinical care rather than administrative duties. Time spent on tasks outside of clinical chair time is frequently perceived as an added burden, contributing to a reluctance to engage deeply with record management. This reluctance can lead to incomplete or inaccurate records, posing serious legal and operational risks.
The Digital Workflow Dilemma
While digital workflows offer numerous benefits, they also present significant challenges, particularly in record management. The process of organizing, labeling, and enhancing digital records is time-consuming and labor-intensive. Key tasks such as image labeling, record arrangement, photo enhancements, and corrections require meticulous attention to detail and significant time investment.
Cephalometric Analyses
Cephalometric (ceph) analyses are a standard of care according to the American Association of Orthodontists (AAO). These analyses involve detailed tracings that can take up to 15 minutes per case and require substantial expertise. Given their complexity and time requirements, ceph analyses add another layer of difficulty to the record management process.
Legal and Operational Risks
Failure to maintain proper image acquisition and record management exposes practitioners and DSOs to potential legal risks. The standard of care mandates accurate and thorough record-keeping, and deviations from this standard can lead to legal exposure. DSOs, due to their size and financial position, are particularly vulnerable to such legal challenges.
A recent case in California (Superior Court of California, 2020) is a stark reminder of the importance of safeguarding patient records. It exemplifies how the absence of crucial records (such as cephalometric X-rays and analyses) can lead to adverse outcomes. The court ruled against Dr. S due to the destruction of evidence, highlighting the significant consequences of inadequate recordkeeping practices (Marc Leffler, DDS, Esq. March 7, 2023, ProMed Dental, 2023).
Another example of the high risks of not abiding by the standard of patient record keeping is the case of Robison v. Arizona State Board of Dental Examiners (2015), Dr. Brent Tyler Robison faced penalties for inadequate patient records, including missing treatment notes and diagnostic films, such as cephalometric X-rays. The court upheld the Board’s findings that his incomplete records fell below the standard of care, leaving patient treatments unjustified and compromising legal defense. The court determined that the absence of cephalometric images and analysis, along with other documentation gaps, constituted unprofessional conduct.
Further, most recently, CADP (www.cadp.org) have made it a requirement to record ceph analyses and tracings in order to comply with the criteria for plan compensation: (https://secure.uhcdental.com/content/dam/dental-benefits-provider/secure/pdf/CA%20DHMO%20Dental%20Provider%20Manual_20240918.pdf)
Enforcing Record Management Standards
A cornerstone of proper dental recordkeeping, especially in orthodontics, is the inclusion of cephalometric images and analyses. These diagnostic tools comprehensively assess a patient’s facial and dental structures, aiding in accurate diagnosis and treatment planning. According to Orthodontics: Current Principles and Techniques, Sixth Edition (2017), cephalometric imaging is integral to treatment planning and serves as a critical benchmark for orthodontic care.
The absence of such records can be considered a breach of the standard of care and may lead to legal repercussions. By maintaining a comprehensive record of cephalometric data, dental practitioners can ensure optimal patient care and mitigate potential legal risks.
Enforcing proper record management protocols across multiple providers within a DSO is inherently challenging. The reasons mentioned above—time constraints, complexity of tasks, and the need for expertise—make it difficult to ensure consistent compliance with record management standards.
The Role of AI in Record Management
Automating Image Management and Labeling
AI can automate the process of image management and labeling, significantly reducing the time and effort required from clinicians. Advanced algorithms can accurately label images, organize records, and ensure that all necessary information is captured and stored correctly.
Enhancing Photos and Correcting Errors
AI-powered tools can perform photo enhancements and corrections automatically. These tools can adjust alignment, cropping and sizing, ensuring that images meet the necessary quality standards With minimal human intervention.
Streamlining Cephalometric Analyses
AI revolutionizes ceph analyses by automating the tracing process. AI algorithms can analyze cephalometric images accurately and instantaneously, reducing the time required per case from 15 minutes to mere seconds. This automation not only saves time but also enhances the consistency and accuracy of analyses.
Legal Safeguarding
By ensuring that all records are properly managed and meet the required standards of care, AI helps safeguard DSOs from legal risks. Automated systems minimize the chances of human error and ensure that all documentation is thorough and compliant with legal and professional standards.
Boosting productivity
AI and automation significantly reduce the need for time-consuming, off-chairside record-keeping tasks that dentists often find monotonous and that offer little productivity value to the business. By reducing the manual workload, AI allows clinicians to focus more on patient care and clinical duties, thereby enhancing overall efficiency and satisfaction.
Conclusion
The need for improved record management in DSOs is clear, given the legal, operational, and clinical implications. However, the traditional methods of enforcing these standards are prone to failure due to the significant time and expertise required. AI offers a robust solution by automating key tasks, ensuring compliance with standards of care, and mitigating legal risks. By embracing AI, DSOs can bridge the gap in record management, allowing clinicians to focus on what they do best—providing exceptional patient care.
- Dr. Zeev Abraham, DMD, MS, MSEd, MSc, Senior Lecturer at Tel Aviv University
- Dr. Joe Cordahi, DDS, MS, MBA, Oral and Maxillofacial Radiology Resident, UT Health San Antonio