Operatory of the Future

Thomas K. Hedge D.D.S., F.A.C.E.
Pending Publication

A description of the "operatory of the future" always includes an integrated computer work station complete with management software, CD or DVD based patient education software, image manipulation and storage software, video camera input through a video capture card and digital radiography. This workstation is networked with computers throughout the office so images and information can be shared with other operatories, the front desk staff, and management. Sounds perfect, doesn't it? Unfortunately, we do not live in a perfect world.

A computer network that runs management software only, usually functions without too many problems. Each new application that we add to the network has the potential to add complications and conflicts, as we shall soon see.

Let me relate to you some of the trials and tribulations we have encountered in building our system. The system currently used in our office has Dentrix software powered by a Gateway 233 mhz Pentium II server with 196 megs of RAM. There are nine workstations connected through a 12 port hub. Image F/X software is connected to the network through a Gateway Destination system with a 31" monitor and in infrared keyboard and mouse. This processor is in our primary operatory where we do our clinical consultations that often include digital photographs, intraoral views, and imaging.

A Kodak DC20 digital camera modified by Lester Dine for dental photography and an Accucam video camera with a Flashpoint video capture card are inputted into the Image F/X software through the TWAIN driver inputs. These images are stored on a four gigabyte harddrive in the Gateway Destination system.

Is this beginning to start to sound complicated yet? We have only added the camera's and imaging software to the Dentrix management software so far. In order to integrate the images from the camera's into the Dentrix patient image file requires a software patch from Dentrix at a cost of $600. I forgot that we even had this until right now because it is a hassle to use. It is easier to store all of the images in ImageF/X.

I'm sure some of you are thinking that the hardware and software people will set this up so I won't have to worry about it. Maybe. maybe not. No matter how well set up, something, sooner or later, will fail or crash, often freezing up or bringing down the whole network. Usually re-booting everything will solve the problem for now. But it will happen again and someone has to diagnose it. Who better than the doctor. if he knows the system. Even if you could find a reliable hardware service, it is unlikely that they could show up on a timely basis and solve the problem without disrupting your day. After the sale was complete, I found that my Dentrix salesperson would not even extend me the courtesy of returning my phone calls. No help there.

I hope that the trend that I have noticed is not pandemic, but I have noticed a pattern with hardware technicians. It seems that a free spirited "Trekie" type in his early twenties shows up a two pm for an eight am appointment. They usually seem to know what they are doing and all is well when they leave at 11pm. They let themselves out with the key that you left for them at 9 pm after getting tired of waiting. The next morning you find that everything works perfectly except that none of the workstations will recognize a printer. Coincidence? We've all been there.

Let's add DVD patient education software with it's own screensaver and digital radiography. The complications and problems will only get worse.

Could the high tech Guru's be wrong? Would it be simpler and less expensive to break up these systems into separate and independent components.

Let's look at integrating the DVD player for patient education and the intraoral video camera together connected to a television monitor. Intraoral video camera signals, when converted to digital with a video capture card deliver a diminished image on a computer monitor. The analog signal to the television monitor is clearly superior. The disadvantage to this set up is that you cannot store these images on the computers hard drive to share with other workstations and future viewings. How often will you actually retrieve images? Before I had the capability, I thought that it would be quite often. It turns out that I almost never pull up the images again.

If I do need or want an image to be stored on the computer's harddrive, I find that it is easier and of better quality to take a 35mm image with my Yashica Dental Eye II and scan it into Image F/X using a $300 Hewlett Packard slide scanner.

Both intraoral video cameras and DVD ROM patient education systems are best and most easily viewed on a television monitor. I have used both in this manner in the past and found it to be preferable to our current computer based system. Connections from the device to the television monitor are direct, bypassing the computer and all of it's pathways. Changes in the input to the television monitor involve pushing a button on the front of the monitor versus several mouse clicks of opening and closing windows with the computer. It is also easier to save images using the foot pedal with the camera/television system than to have to click a mouse with the camera/computer system. A foot pedal allows a single operator to capture images. Two operators are necessary with the computer based system because you cannot retract and hold the camera while clicking a mouse.

Am I considering switching back? You bet. It will depend on how much it will cost me.

If I were to start over, I would place a television monitor at the patients feet to the right. Strapped to the bottom of the monitor would be a DMD intraoral video camera and a Toshiba DVD player. CAESY software would be played on the DVD player. The cost of the first operatory would be $4800. Subsequent operatorys would cost $3300 due to the licensing cost for CAESY being covered in the first operatory. I would recommend this set up for doctors and hygiene operatorys. To the left of the patient, I would place the computer and monitor. This is our assistant side. This allows the assistant to review the schedule, billout procedures, and schedule appointments. If digital radiography is included, it would reside in the computer on the assistants side. A computer and monitor would cost $1200.

This brings the ultimate operatory of the future to $6000 for the first and $4500 for each one thereafter.

I feel that this is a very small price to pay for the "Operatory of the Future".

I wish that I could scrap it all and start over. I know exactly what to do now. You have the chance to do it right the first time if you haven't already incorporated these technologies into your practice.