Emailing Letters to referring dentist

[hwhtara]

Does anyone email letters to their referring dentist? How do your doctors view and approve said letters? Also do you send encrypted with add-ins for the charts?

[sundberg101]

Our letter is populated with information from the questionnaire that is completed by our TC during the consult. When we set up the letter template in OrthoTrac we have several "stock" paragraphs that are interchangeable based on whether or not the patient is going into to obs, treatment, pending, or a referral to a specialist. I just add/subtract as needed. I also have a "question" in every questionnaire for "other comments".  This is where the doctor or TC can write a pt specific note/narrative that includes any information not covered in the questionnaire or information that the doctor wants relayed to the DDS office. I make sure that there is a spot in every letter that is populated by a questionnaire  for these custom comments. 

In our office we found that if the doctor is signing off on every post consult, start of treatment letter, and/or end of treatment letter they would sit for weeks, he would change something in every letter and it would take 5-6 drafts before we got them sent out more than a month after the patient was seen. After many months of him expressing frustration about all the letters he had to do I finally proposed a "just the facts" type approach on the majority of our letters and semi-annual progress reports to our patients dentist's utilizing four specific questionnaires (consult,obs, progress, and debond). 

Two years ago I started contacting each dentist office when a letter was needed to be sent to them to determine if they would prefer receiving the letter via email or not. We now email 90% of the letters. We recently incorporated Protected Trust but are having issues with letters not being sent via encrypted email within the Word Processing module. It is only happening when we are Printing the letter and the box to "Send via associated email address" is checked. Our IT company is working with OrthoTrac and Protected Trust to figure out why.

[sundberg101]

We have since found out that the issue with our emails being printed through the word processing module are not being automatically sent as encrypted mail is because our emails are created with outlook but ran through G-Suite (google mail). Apparently because emails sent through the word processing module are set up to process/run in the background the "regular" outlook mail window doesn't pop up like it does when composing a letter to a patient or dentist via the imaging program or patient information page. 

As such we have to send the letter to a virtual printer called "send as Protected Trust email" which then opens up a webpage on Protected Trust, we then have to enter the DDS email address (haven't found a way to do this without using two computers because if I try to do it on the same computer I'm using it causes an error in the orthotrac rolodex and I can't open the outside dr info via the wrench while in the word processing module). We then have to enter a subject line, enter the body and signature line/logo because none of that pre-populates from Outlook before we can then actually send the email. 

It takes so long that it is very tempting to just send unencrypted but that's a major no-no.  We use the G-Suite for routing out Outlook email/calendar through because of issues with how outlook downloads messages when a email in/outbox may be accessed from various computers.

[hwhtara]

We can email directly from the chart, our protected trust is loaded into our outlook and once you initially enter a doctor office email into the system and have it set up it is good to go. We don't really have issues with the protected trust, which is good for us but we are trying to figure out the best way for the doctors to review and approve the letters before sending.

Have you saved them into a file on your desk top with NOVApdf then emailed them that way as an attachment? I can understand how frustrating your problems are, technology improves our lives but definitely challenges our nerves at times!

[sundberg101]

We have created a folder on our server (we are not on the cloud version of OrthoTrac) called "Doc's Letters"  and a shortcut to the file on the doctor's computer desktop. After posting a letter I open it up for basic editing/cleanupwhere I make sure address and basic info is there and/or add in red text any notes, prompts, or reminders the doctor may need for his letter. I then click the "Save As" button and save a copy to the "Doc's Letters" folder. I then put a post-it on his computer letting him know there is a letter waiting for him to review and save the OrthoTrac letter as "not ready" to print which puts it in the In Review queue. He does his editing and then lets me know when he is done. I then open the letter from the In Review queue, go to the Doc's Letters folder on the server and copy/paste the version of the edited letter into the copy of the letter in OrthoTrac. I then do any final editing/cleanup on the letter and print like normal from OrthoTrac. Once that's done I go back into the Doc's Letters folder and delete the copy of the letter there. 

It's a convoluted process but we found it works and I can "pace" the number of letters for the doctor. We do use questionnaires and templates but there is still a bit of editing that must be done. We streamlined our letters process by standardizing progress letters, debond letters and initial band/bond letters to the dentists and have imported the doctor's signature into the letter template. Our progress and debond questionnaires have a comment section that the doctor can jot down specific comments for me to include in those two letters and send without having to print and have him personally sign. He edits and signs and customized letters and the post consult letter. The letter that we send to the dentist informing them that their patient actually started treatment is sent the day they start. It basically says that our patient started treatment today, what type of treatment, what modality (traditional or Invisalign), expected completion date, and a paragraph about OH, invite them to contact us with questions, and a thanks for their referrals. Since it's so "generic" the doctor allows this one to go out without any review by him. 

[hwhtara]

Thanks for your insight! We are in the process of making that transition. I have found most dental practices are wanting to stream line these forms as well. It is so cost effective and a huge time saver! I would love to see an example letter you have done as well as your protocol or steps the doctor follows. We do not want to loose precious clinical time to change this process so I am really interested in how you avoided that! 

[tallarob]

I'm not familiar with Protected Trust, but we use a company called Aspida for our encrypted emails.  They are at www.aspida.us.  You have to setup an email address through them and then, utilizing Outlook, all you need to do is include the work encrypt or encrypted anywhere in the email or subject and it will encrypt the email.  The recipient will set up a password in order to view this and any future emails from you.  I have a stored signature that I use that has the word encrypt in it.  If I don't need to encrypt I use another signature without the word.

I like that it works with Outlook.  Other options I looked at required you to send through your browser.  Sending x-rays was a pain because you had to first export them to your desktop or other location and then import them into the browser.  Using Dexis, I can export imaged directly into Outlook and send very effortlessly.

[mistyeverman]

We have a set of letters for each doctor - their last name is incorporated into the name of the letter.  Throughout the day, they review their own letters and email them to the doctors themselves.  The doctors may also include a personal note to the referring dentist or specialist in the body of their email, if they so choose. 

[ydillon]

Good Morning Tara,

Several practices e-mail letters to referring dentists through the Post and Print function of Word Processing in Orthotrac.  Once letters are posted and edits are made, doctors can access  letters from the "Under Review" section in Word Processing, it gives them the option to edit or approve a document prior to e-mailing or printing it.    If you are looking to implement email encryption, Carestream Dental  has a partnership with a third party company, Protected Trust. Protected Trust provides email encryption through the use of an Outlook add-in. For more information Protected Trust can be contacted directly at 800-876-1422 or visit https://www.protectedtrust.com/partners/carestream/ .

[hwhtara]

This is how we send non-encrypted emails to patients and have started using Protected Trust for encrypted emails. So I understand the process of using the word processing. I guess  my question is more towards guidance on actually implementing it with the doctors as we have several in our office. What protocol do people follow? How do people prompt the doctor to look at letters? Especially since doctor time is valuable and all the letter go into one file when posted. 

[ydillon]

Orthotrac does not have an alert or specified process to notify doctors there are letters awaiting approval.  There is not a standard process that we recommend or all offices follow.  I've seen practices where doctors set aside a specific time of day, some set aside a certain day of the week to check for letters that need editing or approval by a doctor or in some instances the staff alerts the doctor as soon as a letter is posted. The process truly varies from practice to practice.   

[hwhtara]

That is what I assumed practices were doing but I was hoping for any kind of tips or guidance from those that are currently doing it. I want to try to utilize Orthotrac to the full capability and not miss out of benefits of technology!