by Andrew Trosien, DDS, MS

How one orthodontist chose his time-managment system

Andrew Trosien, DDS, MS

In terms of practice efficiency, there are few things as important as patient appointment scheduling. There are several different scheduling “philosophies” to choose from, but for me, for a schedule to function at its most efficient it must first of all allow for the elimination of dead time. It must also require the orthodontist to be in only one place at one time, accommodate the appointment needs of the practice, and be easy to use.

Although it’s possible to schedule patients with an appointment book and a pencil, it’s immensely easier to accomplish it a computer. I’ve been practicing since 1997, and I have always used a computer. The first practice I was in used OrthoTrac. After that I moved on to a practice that used Ortho2’s One Touch, and today I am using Ortho2’s ViewPoint. Because I like technology, and because I need to keep the practice running efficiently, I periodically investigate other software vendors to see if there is something better out there.

Doctor-Time Scheduling

No matter what software I might use to schedule, it’s important to me that the software allows for doctor-time scheduling. By doctor time, I mean that each appointment type exists as a coalesced block of 5-minute intervals. Each 5 minutes can be further broken down into individual minutes, 90-second intervals, or some other small amount of time.

The block is the length of time the patient is in the chair and the assistant is working with him or her. Within each block there is a portion dedicated to doctor time and usually broken up into the smaller time intervals. Then, each day in the week is a template of all of the appointment types, distributed so that the needs of the practice are met, in terms of how many appointments of each type need to be seen in a week. Each column corresponds to a chair or assistant, and no appointments are overlapped within the column. Reading across the schedule horizontally, the smaller time intervals that correspond to the doctor do not add up to more than 5 minutes, indicating that the doctor is not supposed to be in more than one place at a time.

Because of my need for doctor-time scheduling, there are many scheduling programs that I cannot use. Many general dental programs don’t allow for doctor-time scheduling, or do not allow for 5-minute or smaller time intervals. Anyone who has not used doctor-time scheduling with small intervals tends to think that it leads to the doctor running around like a lunatic trying to keep up. But in fact, since the schedule is able to accurately reflect what the doctor and staff actually do at each appointment, rather than trying to round the appointment time up or down to fit an arbitrarily larger time interval, it allows for a pretty relaxed pace. No matter if the practice follows doctor-time scheduling or not, the schedule must be divisible by 5-minute blocks because orthodontic appointments are short and require that level of granularity. To me, this is a requirement for scheduling software.

Changing Time

The first time I made a voluntary switch in practice-management software was in 2002, when we decided to move on from One Touch. At the time we investigated a number of different systems. We eliminated those sold and supported by large corporations because we were concerned about support and longevity of our investment. And that is another of my requirements for software: that it be owned and supported by a company that is large enough to stick around, but small enough so that it will not be insignificant in the company’s vision.

At the time I liked ViewPoint, Dolphin PM, and TOPS. Since I am a long-time Mac user, TOPS was an attractive option (and continues to be to this day), but we were concerned at the time about having to run a PC for some things and a Mac for others. Really, that left us with Dolphin PM versus ViewPoint.

At the time, no one had Dolphin PM installed, so we had to rely on asking the two companies what their strong points were and what the other’s weak points were. There were a few differences. For instance, Dolphin could not edit a patient’s chart info on the fly: You had to go to a separate “edit” window to accomplish that.

We ended up going with Ortho2. Through working with the company I have discovered what has become another requirement for me: I trust the company and feel that it has solid business ethics.

Support System

In the past several years, we have spent an unbelievable amount of time on the phone with the tech support divisions of the various software and hardware companies that we work with. It doesn’t take too many calls routed to Bangalore, India, or too many minutes on hold listening to “Queen of Hearts” before understanding my next two criteria: Tech support should be handled by people who know the software, and minimal wait times are a necessity.

What’s Next

Going forward, I think that the software that schedules patient’s appointments will change in a couple of fundamental ways. First, stand-alone scheduling software will go the way of the dinosaur. In the modern, technology-driven orthodontic office, scheduling a patient is intrinsically tied to so many different things that it is practically a requirement that the software be part of a larger practice-management suite. Patient appointment-reminder phone calls, text messages, and e-mails; practice statistics reports; and online patient access to records, finances, and appointments all require much more than a simple scheduling program. That means that another important criteria of the software is this: It must be part of a larger suite of practice-management utilities to be its most useful.

Along with that, as more and more technology shows up in our offices—such as cone beam software, marketing software, and others—it is increasingly important that our software be able to cross-populate data fields or fully integrate with these other pieces of software. For instance, in our office we recently installed an iCat cone beam machine. The software that takes the scans, iCatVision, does not integrate with any practice-management system. So even though I have a patient’s information in my computer, and even though the patient is scheduled for an appointment, I still have to retype their name, patient code, and birthday. Eventually, the PM software companies will integrate with the cone beam vendor software, and this won’t be an issue. But it’s pretty clear that the next criteria for a scheduling program be the ability to seamlessly integrate with third-party software.

In the next month or so our practice will be switching practice-management software again. We will be moving to the new Ortho2 Edge software. I’m sticking with Ortho2 this time around for three reasons:

  1. Its tech support has gone above and beyond in helping me with any questions I’ve had. There have been a few occasions in the past few years where I’ve had a question about whether I can make a report with certain fields, or how to do certain things, and I’ve sent an e-mail to the company after hours or on the weekend, and have been pleasantly surprised to see a response very soon afterward. No waiting for “the next business day.” I doubt this is always the case, but a little goes a long way.
  2. The company has been very open with its customers about what we want to see in future editions of the software. Since the vast majority of orthodontic software is not written by orthodontists, having an open ear to our desires is exceptionally important in getting a product out that meets our needs.
  3. The new Edge software is pretty cutting-edge (hence the name, I suppose). It is not merely a rehash of old ideas. This last point is important not because its current practice-management system is bad, but because I think it is important for any company to innovate and push the development of its product to new levels.

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So, in summary, there are a bunch of different things that scheduling software can do, but to me the decision of which to get has more to do with what it is. I’ve put the important traits of the software and the company that supports it in a list below for easy reading. To my mind, scheduling software should do the following:

  1. Allow for the elimination of dead time;
  2. require the orthodontist to be in only one place at one time;
  3. accommodate the appointment needs of the practice;
  4. be easy to use;
  5. allow for 5-minute or smaller building blocks;
  6. be owned and supported by a company that is large enough to stick around, but small enough to not be insignificant to the company’s vision;
  7. be supported by a company that is trustworthy and has ethical business practices;
  8. have tech support from people who know the software;
  9. limit tech support wait times;
  10. be part of a larger suite of practice-management utilities;
  11. seamlessly integrate with third-party software;
  12. go beyond the minimally required support;
  13. listen to customers about what is needed for future releases; and
  14. Be innovative and forward-thinking.

Andrew Trosien, DDS, MS, is in private practice in Tracy, Calif, and is co-director of La Clinica de la Raza Orthodontics in Oakland, Calif. He is also an assistant professor of orthodontics at the University of California at San Francisco. He can be reached at