Have you ever received a call from a patient with symptoms a few days after a recent visit and reviewed your notes and x-rays to determine a recommendation for treatment? Better yet, have you had hygiene only days and reviewed radiographs the next day for your recall patients?
In both of these scenarios you have essentially done an asynchronous teledentistry evaluation. Recently there has been a realization by dentists across the country that they can leverage technology to adapt to the changes caused by the pandemic. Being nimble and adapting to the pressures of the pandemic can give practices a chance to emerge using new and exciting tools.
In this post, we’ll define asynchronous teledentistry and show how it is being used today in offices throughout the country.
What is Asynchronous Teledentistry?
Asynchronous teledentistry is the transmission or storing of diagnostic information using secure software for the review of a dental practitioner to evaluate a patient’s condition or render a service at a different time or place from when the diagnostic data was captured.
This is commonly called Store-and-Forward Teledentistry and has been endorsed by the American Dental Association since 2015. Asynchronous teledentistry can be performed in a number of different ways depending on the type of services, types of imaging you require, and the type of software you adopt.
Here are the five common types of asynchronous teledentistry exams that are being used in response to the pandemic according to many consulting and webinar clients.
- Limited Evaluation (Triage)
- Hygiene Recall
- Post Op
- Case Presentation
- Orthodontic Checks
A few roadblocks you may encounter are that organizing and communicating asynchronously requires some planning. The most obvious problem is that currently all dental visits are organized in a schedule view and asynchronous “visits” don’t really fit that solution.
Most dental offices start by putting the asynchronous exams from the previous day on their schedule the following day. These are then reviewed and completed throughout the day. In many states there is even a time limit on how long the dentist has to complete the asynchronous examination.
The second hurdle is that communicating with your team using messaging systems or emails is ineffective and not reliable. The regular office workflow of sticky notes and in-person interactions do not work.
What is needed, is a way to organize patients and track their status through the office workflow. A cloud based solution for this is optimal since teams may be located in different locations and access their tasks at different times.
Another requirement is an effective way to communicate about specific patients in a way that the conversation is not “lost” in a thread or inbox or placed in the clinical note. There are similar tools used in business and project management such as Slack, Asana, Trello, and Microsoft Teams. The issue with these systems is that they are not built for healthcare and many do not provide HIPAA compliance.
Why is Asynchronous Teledentistry Important?
A majority of providers and patients have an initial conception of teledentistry as a live, interactive “FaceTime” visit. This is why there were a slew of tech companies scrambling to come to market with a video-conference solution for online dental visits.
This is a reasonable reaction for dentists, since they relate to a hands-on or face-to-face type of interaction with all of their patients. The idea of having a “visit” with a patient when there is no patient to even talk to is a very alien concept.
Compare yourself to how radiologists “see” their patients.
A separate healthcare provider sees that patient in person and gathers diagnostic data through questions, palpation, and imaging then sends it for review to the specialist.
If you graduated from dental school within the last 10-15 years you would probably agree that much of your understanding of treatment planning and didactic courses were based on a case that you had to review with no actual patient present.
In recent years, most dental schools have moved to what are called objective structured clinical examinations (OSCE). These are examinations that are very similar to the structure of an asynchronous teledentistry examination. That is why newer dentists that are both taught in this way and are comfortable with emerging technologies are more likely to adopt teledentistry.
Why use asynchronous teledentistry?
What makes asynchronous teledentistry exams important is that, unlike synchronized exams, the patient and the doctor do not have to align their schedules.
Patients are pleased that checkups are 10-20 minutes shorter now that they aren’t waiting for their dentist to hop over for a hygiene check. The power is in the efficiency and predictability of an asynchronous exam.
The asynchronous exam can be predictable by making sure a standard set of data is collected every time a patient is seen.
In the case of a hygiene recall, the hygienist completes bitewings, anterior periapicals, and additional periapicals on any tooth with symptoms or suspicious lesions.
All adults have updated perio charting, including a detailed soft tissue evaluation and documentation.
Finally, a full orthodontic series of photographs followed by intra-oral photos of any suspicious or symptomatic teeth is conducted.
Many practices have started using 3D intraoral scans to supplement their teledentistry exams.
The most important piece of the asynchronous data collection however, is the detailed note template that the hygienist completes for every visit. A standard set of detailed and purposeful questions, combined with imaging, can provide for great and predictable results.
A synchronous examination that relies on the dentist asking questions of the patient in real time can be unpredictable and not achievable in terms of scheduling and coordination.
This topic was brought up in a recent Health IT webinar by Nathaniel Lacktman, a partner and healthcare lawyer at Foley & Lardner.
He explained the reach of asynchronous uses of telehealth. “Just because there is an interactive video conference doesn’t inherently make it any higher quality, from a medical perspective, than a really dialed-in asynch(ronous) interaction coupled with diagnostic data.”
He continued, “A really well thought-out protocol for a dynamic asynchronous questionnaire and relevant medical information removes the pressure of the patient to vomit up everything immediately during the five to 10 minutes that they have”.
The unfortunate thing is that because dentists aren’t introduced to these new concepts or weren’t taught them in dental school, they can’t picture new approaches. You might be surprised that some of the services you already provide are only a few steps away from some form of teledentistry.
If you still need answers, reach out to our partners at Access Teledentistry. They have resources and webinars available for free. Remember that there is more to teledentistry than a synchronous Zoom call with your patient from their cell phone.
You can have predictable outcomes and more efficient visits that take less time using asynchronous teledentistry. If you want to find out more about how Healier can help with your asynchronous teledentistry exams, contact us today.