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	Treatment Room Technology Embezzlement

Dr. Lorne Lavine
Dental Technology Consultants
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Treatment Room Technology

Operatory Design

In the past issues of The Dentist’s Network, I’ve explored some of the nuts and bolts of running a modern practice. Having worked with over 800 offices, there’s no doubt that putting technology into the operatories is critical to developing a digital dental office. By placing computers in the dental treatment rooms, not only does that allow the practice to use new technologies like digital x-rays and intra-oral cameras, it also allows for de-centralization of the practice. For example, scheduling, treatment planning, and even collection of funds and insurance submittal can occur chair side if the practice chooses to do this.

However, after working with many practices, there’s no doubt that designing the layout of the treatment rooms and the specs for the technology can be a difficult decision to make. While every room is obviously unique, here are some basic thoughts and ideas to incorporate as you either add or update your operatories:

You should choose your computer systems with the understanding that they will probably last 3 years. This doesn’t mean that the system will stop working after 3 years, but it does mean that with the updates of your practice management software and other software systems, the computer hardware after 3 years will start to choke on the higher software demands. In early 2007, I am currently recommending a Pentium Core 2 Duo processor, 2 GB of RAM, and Windows XP Professional (at least, until Vista is released on January 30th). An equally important decision is the size of the computers. I almost always recommend using a small form factor computer, such as the Dell SFF, for the ops. These smaller computers can fit into much smaller spaces. Be aware, though, that some older interface cards, such as video capture cards, may not fit into these smaller cases.

Another challenging decision for most offices is to choose their monitors. The vast majority of offices that we’ve set up over the past two years have elected to place two monitors in each operatory. There will be a patient monitor that is used primarily to show the patient digital images, TV, DVD patient education, etc. Most offices will choose a monitor like the Samsung 940MW, which has both computer and TV inputs. At the very least, this monitor should have speakers built into the sides or bottom. The second monitor is primarily for use by the doctor or assistant and doesn’t usually need speakers. This monitor should be placed where the patient cannot easily see it, as the information on here is often HIPAA-sensitive, such as the electronic schedule with patient names on it.
Since both monitors will be showing digital x-rays images, make sure you get a monitor with a minimum of 500:1 contrast ratio; the contrast ratio is important for viewing caries on the monitor.
An entire book can be written on monitor placement. In many cases, it will boil down to personal preference. If you want the patient to be able to view their monitor while being completely reclined, then the ideal position will be from the ceiling. There are many options, such as ICW, Flexview, and the Chair Potato. If you don’t need them to see the monitor while reclined, then attaching the monitor to a light pole or a side wall is also a decent option.
When positioning keyboards and mice, make sure you place them in an ergonomic position. For example, you’d never want to place them behind the doctor or assistant’s back if it means that they need to twist around to use them. I always recommend using a wireless keyboard and mouse. A Bluetooth system, such as the Logitech MX5000, will prevent interference from multiple operatories. Some of the monitor mounts, such as the ICW systems, allow you to attach a tray to the bottom of the monitor for ideal positioning. You may also want to consider a keyboard skin that will cover the keyboard and allow for easier infection control.

As you begin to consider the upgrade of your digital systems in the offices, proper planning of the operatories can be critical for long-term success. Not only should you choose your hardware carefully, but the location of those systems is just as important.

Lorne Lavine, DMD is the Founder and President of Dental Technology Consultants. Dr. Lavine holds two prestigious certifications, the A+ Certified Technician designation and the Network+ Certified Professional. These designations demonstrate proficiency in computer repair, operating systems, network design and installation. Dental Technology Consultants provide dentists a full range of services relating to the implementation of technology.
Dr. Lavine can be reached directly at 1.866.204.3398.

Interested in speaking to Dr. Lavine about your technology concerns? Email him at Drlavine@thedentistsnetwork.net
Interested in having Dr. Lavine speak to your dental society or study club? Click Here.

Sally McKenzie, CEO
McKenzie Management
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Embezzlement - Is Your Practice an Easy Target?

Take a minute and think of three other dentists you know. Perhaps they are friends, former schoolmates, or fellow members of your local dental society. Now consider this: One of the four of you has been, will be, or is being embezzled.

In 2004 alone, embezzlement cost American businesses some $660 billion (yes that’s billion with a “b”) and that figure only reflects the cases that have been reported. Fraud and embezzlement frequently go unreported because business owners want neither the negative publicity nor the hassles of prosecuting the offending parties.

While the dollars are big, those businesses being quietly robbed are often small. In fact, the Association of Certified Fraud Examiners reported in its 2006 Report to the Nation on Occupational Fraud and Abuse that small businesses continue to suffer disproportionate fraud losses. “The median loss suffered by organizations with fewer than 100 employees was $190,000 per scheme. This was higher than the median loss in even the largest organizations.” Why are the losses so high in smaller companies? Poor controls and monitoring. Small businesses, such as dental practices, don’t have measures in place to detect fraud.

The most common forms of occupational fraud in small businesses involve employees fraudulently writing company checks, skimming revenues, and processing fraudulent invoices. And the most common fraudsters are the employees you would never suspect, the ones that have you convinced they are the most wonderful and trustworthy people you could ever know.

Be aware of some of the subtle indicators that a thief is among you:

A staff member who is too dedicated, never takes a vacation, frequently works through lunch, and is routinely staying after hours to “take care of a few things” may need to be there to keep her/his scheme going undetected. This employee is devoted indeed, to robbing the practice.
An increase in the number of patient complaints about billing errors could be an indicator that payments being made on accounts are being diverted.
Staff comments about an employee’s erratic behavior or about an employee living beyond their means should not be dismissed. These may well be subtle clues that could indicate theft is occurring in your practice.

In addition to simply being more aware of some of the subtle signs of fraud, implement controls. For example, contact your bank and request all bank statements and notices be sent directly to your home and that all cancelled checks be returned to you as well. Examine all cancelled checks for unusual endorsements. Review unopened monthly credit card statements, deposit slips, and receipts. Look for checks that are out of sequence or written to “cash.”

Write-offs warrant special attention. That’s a common tool for the embezzler to use in putting the theft out of sight and out of mind. Work with your software vendor to implement software controls in which only you have “supervisor” access and staff have “restricted” access. Those designated to have restricted access cannot write off, reduce, or delete transactions such as accounts, invoices, or appointments without authorization.

Review the audit report daily, which shows every transaction entered since the last audit report. Work with your software vendor to configure the system so that employees cannot access or change the practice audit log. Regularly review reports listing all patients whose accounts have been altered or changed.

Separate financial responsibilities. One person should not be responsible for billing, collections, and delinquent accounts. Under no circumstances should the employee making the bank deposit be the one who is responsible for checking the deposit slip that is returned from the bank.

Keep your signature stamp under lock and key, or do away with it entirely.

Remember, honest staff appreciate honest efforts to protect the practice because they will be protected as well. Staff who have something to hide will be uncomfortable and may strongly resist efforts to institute controls or even the mere mention that they take a few days off.

Sally McKenzie is CEO of The McKenzie Company, Inc. a nationwide dental management, practice development and educational consulting firm. Working “on-site” with dentists since 1980, McKenzie Management provides knowledge, guidance and personalized systems that have propelled thousands of general and specialty practices to realize their potential. Sally can be reached directly at 1.877.777.6151

Interested in speaking to Sally McKenzie about your management concerns? Email her at Sally@thedentistsnetwork.net

Interested in having Sally speak to your dental society or study club? Click Here.