Thanks so much for tuning into the Becker's Healthcare Podcast.
We're excited today to feature an episode with Chris Grimm, Dr.
Mike Twitchel and Matt Walker.
And thank you so much to our sponsor for this episode,
planet d d s Let me hand it right away to Matt Walker to get us started with a
little bit more contracts and introductions.
Great. Thanks so much. Hi everyone.
Thank you for tuning in to the Becker's Healthcare Podcast.
My name is Matt Walker.
I'm the Chief Customer Officer at Planet d d s Planet DDS is a cloud-based
software solution provider for dental practices. And today I'm joined by Dr.
Mike Twitchel, chief Clinical Officer, and Chris Grim,
chief Information Officer from Family Dental Health.
Family Dental Health is a 33 location, uh,
dental service organization and growing based in South Carolina.
So at this point, I'll uh, turn it over to Dr. Twill for introductions.
Hey, yeah. My name is Mike Twitch. Um,
I graduated dental school in 2006 and was one of the founding doctors of
Family Dental Health and, uh,
practiced until around 2017 and stepped out a full-time practice to,
uh, manage our clinical operations.
And so I have my hands in a lot of different pies and work with our doctors and
mentoring and recruiting and all kinds of that kind of thing.
Great. And how about you, Chris? Yeah.
My name is Chris Grim.
I'm the Chief Technology Officer actually at the Family Dental Health.
I joined Family Dental Health in June of last year in 2022,
uh, after working for a large D s O in the Midwest.
And then for a mid-level, uh, dental supplier, uh, based out of Florida.
Uh, I, I'm currently, uh,
overseeing all the technology operations, the revenue cycle management teams,
and the, uh, data teams at Family Dental Health.
Fantastic. Well, thanks. Thanks for your time guys. And, and today we're,
we're here to talk about something that's near and dear to my heart.
Really important aspect of the journey for,
for dental practices as they migrate to the cloud.
So we'll explore how DSSO leaders can ensure a smooth process in doing that,
in moving to a cloud-based solution to help manage the dental practice and the
growth that you guys are going through. Um, so for the listener,
we'll get to hear from both Mike and Chris about how they researched cloud-based
practice management solutions, uh, what they're implementation,
conversion and user training experience was like.
So that entire onboarding experience and any advice that they have for
DSOs and leaders of DSOs as they explore potential solutions and role the
platform out systemwide to help scale the organization.
So how about we start with you, Chris, in terms of, uh,
maybe sharing a little bit more about why Family Dental Health began
looking for a, a cloud-based practice management solution and,
and the environment that you were in, uh, that you were operating in at,
at the time you, you started that process.
Sure. Uh, so when I met Rob and, and Twitch back in,
gosh, early 2016, 17 along in there,
uh, they were starting to grow their practice and I was working with a,
a large D s O outta Louisville. And one of the things that we stressed to,
um, some of, some of the, the companies who came to us asking for,
for assistance or for advice was that you have to have access to your data
and your data has to be consistent. There has to be a way to, to, uh,
clean that up and,
and mash it with your accounting data and with your purchasing and everything
else. And, and I think they took that to heart. Uh,
and so when they started shopping for a cloud-based solution, I think that was,
uh, one of the things that they were looking for at that time.
They were on several different solutions at the same time where they had been
acquiring practices. Uh,
so they were on Dentrix and Open Dental and Eaglesoft and a couple of other, uh,
random practice management systems.
And they were finding that number one, supporting that was almost impossible.
Uh, training people to move from one office to the other was almost impossible.
Revenue cycle management, you, you couldn't, you know,
you had five different variations of that. Uh, there the data wasn't,
uh, consistent.
So they were looking for one single source solution to be able to, um, to,
to be able to grow upon. Uh, and when Rob contacted me,
or actually when I contacted Rob in June of 2022, um,
that was the first thing that,
that he wanted to talk about was that they had already started negotiating or
looking and, and demoing several vendors. Uh, and, you know,
so they already knew those benefits. They just needed assistance in, you know,
how to make that selection and, and that, so, um,
for us it was kind of a, uh, a natural trans transition.
As we were growing from a,
a group of affiliated practices to a true D S O,
we realized that we needed to have a solution in place that that allowed us to,
to, um, efficiently access that data.
Excellent. And, and as you move to that mm-hmm. , um,
kind of single platform across the group, uh, I guess this question's more for,
for you Mike, um, from your per, from your per perspective as a clinician,
what were some of the things that you were looking for when evaluating, uh,
potential practice management solutions?
Well, I, we do use, um, like Chris was saying,
we use data for a lot of things, not only business practices, but,
but clinical practices as well. And so, uh,
I would piggyback on that and say that our,
our main non-negotiable was direct access to,
to the database.
And a lot of conversations with vendors were almost over before they began
because they didn't offer that. And so we started there. Um,
but then after that, just utter stability was, was a, was a big deal. Uh,
like Chris was saying, we had, we had several different platforms,
all of them on different, um, update schedules, all of them, uh,
being supported. Uh, some okay, some not so good.
And some were having issues with updates they had rolled out. And,
and ultimately a platform that a, that a dental offices uses should work.
I mean, a period like there shouldn't be, um,
you shouldn't have to dance around. Will this update create instability?
Um, it needs to work when you need it to all the time. And that sounds kind of,
I don't know, basic, but it, it's really important. Um,
updates and downtime should be well communicated. You know,
every software has issues now and again,
but that needs to be the exception and not the rule. And, and, um, you know, we,
we checked with some long-term users of the software, um,
had some conversations with, with different customers,
and that was a big checkbox. Um, and like Chris was saying, as,
as we have expanded operations and grown is, is the,
the solution had to be scalable, reasonably pain free, uh,
meaning that the practice, and it shouldn't be an act of Congress to, uh,
add another practice to your database. And,
and Deon checked that box as well. Um,
I also was a big fan and am still a very big fan of, of how Deon handles,
uh,
updates instead of one giant update every couple years that shuts the
system down for a couple of days. And there's a, is a big deal. You know, they,
they take direct feedback from users and create
a roadmap. The roadmap is, is very reasonably transparent.
You can see where the software is going, and they're,
they're looking to continuously improve the software. And,
and that's a big deal. Like the,
the fact that I can log oncon right now and see where the software's going and
see those subjects, um, suggestions and add my, uh, opinion to it, um,
it was a big deal for us.
Great. Um, thanks for that perspective. Uh, you know,
you guys have both mentioned things like stability, scalability,
direct access to the database, so, so Chris,
any other must haves? And in addition to that,
what kinds of questions did you ask vendors when you were looking, uh,
at different solutions?
Um, of course the data, but after that it was interop interoperability.
I wanted to make sure that the automation layers that I needed to add on,
uh, were gonna work with this system. Uh, I wanted to make sure that, you know,
my marketing, my online scheduling, my patient engagement services, um,
as well as any type of reporting, uh,
if I need to do a cash management application that's pushing deposits, you know,
and, and, and feeding back into, uh,
dcon or for revenue cycle management, for automated posting,
for insurance verification, all that,
I'd looked at all of those type solutions inside that
as a total package, uh, to make sure that we weren't leaving anything out.
Uh, and the one that that came up on top obviously was, was, uh, decon. Um,
and then, you know, after that, of course, security, uh, you know,
researching any recent security breaches,
making sure that there weren't anything out there as far as persistent
vulnerabilities and things like that, uh,
that would show up on my radar and cause us issues, you know, down the road.
And then, um, talking to,
honestly talking to some of the other third parties and seeing who they liked
working with, uh, who was, who was the, you know,
the most innovative practice management group out there and that type thing.
Y you know, and building on that, you know,
you've both worked with obviously a variety of vendors over the years.
What are some of the things you like and dislike when working with vendors?
What do you look for? What do you try to avoid?
I think the, um, lemme piggyback on something Chris said, and I think it's,
it's really important when you're shopping for something like a practice
management software,
before you get into vendor asking questions and things like,
you really have to understand your organization, like Chris was saying,
you have to understand what you're looking for in a software and sort of gut
check yourself on that. What are your non-negotiables?
What are things that matter to you that you have to have?
And that can't be a super long list cuz there's nothing out there that's
perfect, right? But you gotta pick a few things that say, Hey,
this is super important to us.
And because then it becomes a nice apples to apples comparisons across
software is that you, you have now a a way I can, I can rule this out,
this doesn't do this or whatever, versus, you know,
if all you're looking for is, you know,
font size and how my clinical notes go in, if that's all you're concerned about,
it's easy to get lost in those details. Um, and,
and what a Salesforce will show you versus what you really are looking for. But,
but after that, you know,
I think the most important thing for us in this process and
and with any vendor, not just software vendors,
is responsiveness and communication. And, and that works both ways.
The organization has to be very responsive as well. Um,
there's a ton of back and forth that go that goes on in this kind of a
relationship and these kind of projects of, of converting, uh, offices over. Um,
and both the practice and the, and the vendor have to be all in. Um,
you have to be able to set a time to set aside time to answer
those calls and, uh, do the, um,
all the steps that sometimes are tedious and, and take time. But,
but to do that well, um,
you have to be focused on it and it can't be just something that you try to
squeeze in in the last 15 minutes of a day or something like that.
And I would add that a vendor, again, all all vendors to a dental, uh,
organization should be patient. These are big decisions.
The bigger your organization, the bigger this decision is, and you,
you need to be able to ask lots of questions, have demos. Um,
like I initially screened a a lot of the software, uh,
by myself or with Chris. And then from there,
once one seen promising,
then we scheduled a second demo with a different group of people to get
different perspectives and, um,
asked different questions that we came up with and,
and they brought some things up that ruled some of the other softwares out.
Yeah, there's so much there, um, that,
that is useful for anybody who's gonna go through this process. You, you know,
you mentioned the, the big decision that,
that this represented for the organization and it, it seems,
it seems to be that, you know, a major pain point,
whether real or perceived is the process of implementing the new solution,
going through the conversion process, training all the users.
And I would say that a lot of d s o leaders have, uh, you know,
a high perception of the risk of moving to a new solution. Um,
so much so that sometimes it's easier just to kind of stick with what you got
and, and stay the course. Um,
so at a minimum there's a lot of change management associated with it. So,
so Chris, you know,
what advice do you have for D s O leaders that are still uncertain
about moving to the cloud? Whether that's the right move for them?
Uh, yeah, you know, I, I think with any software solution implementation there,
there's the, the change management becomes a problem, right? Because people,
people don't want to change usually. Uh, so it has to make sense for them.
Uh, and we were very lucky w with our team that our team was very motivated,
and so it was easy to connect the dots and kind of show them what's in it for
them. Um, and I think the most,
I think for most DSOs the tipping point is, is, you know,
comes when you're trying to manage centralized services and,
and start beginning to realize that connecting those offices is a chore. Uh,
it is getting way over complicated. Uh, it becomes much less secure.
Um, by moving to the cloud, we are able to simplify it,
mitigate some data loss risks, uh,
more easily facilitate those centralized services, um,
re reduce, um, you know, the, the, the attack surface for,
for our security. Um, and so when we looked at those risks, uh,
when we looked at the risk that, you know, from,
from potential loss of productivity, maybe a slowdown of collections, the,
the investment in training and education time, the end results far outweighed,
uh, any potential loss there. Uh, at least for us it did. Um,
and I think, you know, if,
if I were advising another D S O to take a look at this and, and,
and to make that decision, I think honestly training and education is,
is the single biggest mitigation point.
If you can go in and do the change management,
if you can go in and train the teams properly from the start and have
skilled person or skilled people ready that are there to help with the staff,
you know, to support them on day one, have them in the office,
have people in the support office ready, uh, to support the office on day one,
you can reduce a lot of that potential loss by,
by just being there and having them ready. Um, and at least that's what,
you know, kind of worked for us.
Yeah, great advice, um, great advice on the, on the training in particular.
Um, a related question for you, Mike. Um,
how would you define a successful implementation conversion and training
process? And, and as part of that,
is there kind of a logical order of operations that you guys leaned
on?
Like where do you start in terms of de novo versus not or size of practice,
et cetera?
I think the,
ultimately a successful implementation of something of this scale,
you measure it in how little it impacted your normal day-to-day
workflows, right? And, and make no mistake,
it will disrupt workloads like, it, it, it'll, it'll slow you down.
It'll cause some stress. So you can't avoid that. It's, it's unavoidable. Uh,
and, and every aspect of a dental practice is affected by this,
from treatment planning, from hygiene to collections to, uh,
RCM and, and insurance management. I mean, everything is, is touched by it,
right? So planning upfront,
spending a lot of time working through the details is just super,
super important. Uh, and, and I can't echo what Chris said more is,
is we found it extremely important and beneficial
to have people on site, um, as we brought practices online.
And we did not try to do that remotely. Oh, we,
we tried to overkill it is probably a good way to say it. And,
and I think there's tons of different ways of getting from point A to to point
Z on this, like different orders of operations. And we checked them all out. We,
we played scenarios and,
and what's right for your group will depend on your,
your resources and priorities and what you're trying to accomplish and how fast
sometimes you may not have time. We had time as a, an ally on our side.
It wasn't something that we were, we,
we had to get it done by any specific time, you know,
so we looked at trying to do everything at once, even like,
what does it look like to do everything at once? And ultimately, we,
we kept running up the, the training, um,
the training side of that for us was gonna be a big problem.
We didn't have the resources to train every single office, every single team,
essentially all at once. And so we elected to break everything into pods,
uh, containing two to four practices. Um, typically doing, uh,
converting them over and transitioning them over every about, I don't know,
four to six weeks, something like that. Uh,
sometimes it was a little more frequently than that. Um,
we chose to start with a couple of de novos. They were,
they were both practices had been with us a little while,
but we were not gonna convert their data. Um, we were just starting from fresh.
Uh, we thought it would be simpler to do that, to start with. And honestly, we,
that was a still a beta test sort of mentality for us is
if it didn't go well or we really didn't like something about the software,
we could still back up at that point. And it wasn't, we weren't committed.
We didn't upset everybody's Apple card to, to do it. Um, and it,
and it went really well. And, and obviously we, six, seven months later,
we had everybody converted over.
We spent a lot of time talking about the details of the practices
as far as the order. Um, you mentioned big practices, small practices, um,
geographically where they were located to be able to support them. Um, our, our,
uh, management team,
how we could make sure they were there if they had engagements at different for
other non-related things, making sure that they were available, um,
vacations for the practices and the doctors. I mean,
we looked at all kinds of things,
even down to the personalities of the teams and doctors. Um, you know,
every practice has their own own personality and,
and their strengths and weaknesses. And,
and so we tried to really put group practices together that we could
mitigate those and, and make everything work together. Uh,
and I think in intentionality, um, of, of attention to detail is, is super,
super important.
That that's a great checklist of, uh, of factors to consider in the rollout.
And, uh, uh, I, I think there's many DSOs could learn a lot from,
from that list. Uh, changing gears just a little bit, Mike, um,
from a clinical standpoint, if you, if you fast forward to now, you know,
you're using the software, you've gone through that hard process, would,
what would you say in terms of, you know,
has that switch been worth it for you to move to a cloud-based, uh,
common system across all the groups, uh, inclusive of imaging?
Oh, for, for sure. Um, and there's,
there's a lot of benefits to cloud-based things that we already know, like in,
in other areas of our lives, right? I mean, it's ease of access. Um,
minimal maintenance on the dental practice side, the,
the stability of the software itself, you know, but being able,
being able to access, uh,
what you need from wherever you want. Um,
and then I think diving even a little deeper is, you know,
DECOM specifically allows for a lot of security controls on that as well. So,
so, you know, our doctors can have access to, to what they need, uh,
when they need it,
versus you may be a little more restrictive from a security standpoint for other
team members. Um, and, and that by that it sounds crazy,
but that by itself has been huge for our docs.
If your D S O has, you know,
internal referrals moving between practices and even,
even just patients who relocate in the same region and and visit a different one
of your practices,
having their chart follow them and their x-rays follow them. Um,
cuz there's plenty of other softwares out there that have,
have had charts that can follow patients, but typically X-rays are,
are stored on local servers and you have to go to great lengths to make them
viewable across practices and, uh,
all of your imaging being able to follow a patient chart wherever they go is,
is huge. I think it's important to, to note that on the clinical side,
perio charting treatment planning in all of our due diligence, I,
I think most of the softwares do a pretty good job with that.
It's easy to get caught up on a lot of those little details,
especially from a, the clinician side. Um, you know, I,
I put that hat on and oh man, I really like how this looks,
or I really like how this works.
That's where it goes back to that knowing that list of non-negotiables.
What do you really focus on? What's really important for URGO organization and,
and using that as your standard, I think is is huge.
Great. And Chris, um, want you to jump in here. You know,
you're part of a growing D S O I can only imagine the complexities of managing
IT and security for the entire organization.
How has standardizing with a single cloud-based solution helped you and your
team?
Oh, this, this has been a, a tremendous blessing for our IT staff, honestly,
by eliminating a lot of the complexity, uh, of our legacy system,
eliminating offsite data centers, the backup, the disaster recovery process,
uh, removing the V P N connections from centralized services, things like that,
that our, our staff, you know,
devoted a lot of time to maintaining and updating and, and keeping,
you know, keeping going. It,
it's freed them up to work on more optimization projects, right? Uh, so,
you know, the thing you remember is you're, you're not gonna get rid of it,
you're always gonna need it.
It's just now we're able to shift some of those IT resources over to things that
have been long, long, neglected, like, you know, equipment refreshes, uh,
being able to go in and, and do some more, you know, phone drops or add, uh,
add operatories or things like that.
So it lets our IT team focus more on
the rest of it and not so much on servers and,
and imaging equipment and things like that.
So it's been great for them for that. Um, the one thing that, you know,
as we plan our scaling out and growing and,
and adding additional offices and things like that,
it's easier now to plan on how many IT people I need because I,
I don't need the expensive CIS admins and people like that
anymore to support servers and networks.
I just need someone to do desktop support and, you know, printers and,
and routers and things like that. So that much of it is a lot easier. Uh,
and as well as the, the data, uh, you know,
data transfer from 16 different sources now down to just,
you know, accounting and our p m s is much easier. Uh,
so building those systems in, uh, are are much less complicated,
uh, much less likely to break, uh, much easier to, to make sure that we're,
we're maintaining the integrity of that data and, and stuff like that.
So yeah, absolutely. It's been,
it is been a tremendous blessing on both sides of it for this one.
Great. Well, clo closing question from me. Um,
and I'd love to hear both of you chime in on this, but, uh, any advice, uh,
that you would share on how a D S O leader can start the process of
researching different solutions? Uh, what, what's the best.
Way to, uh, to launch into that? I think understanding why you wanna switch,
uh, you know, what do you hope to gain? Is it cost savings? Is it security?
Is it automation? Uh, things like that. And then look,
look for the solution that offers as many of those things under one pane of
glass as possible. Uh,
I think that's one of the things we liked was that we could get a lot of that
wrapped up and not have to have a lot of those third parties, uh,
but then look at what third parties you're left with and, and,
and talk to those third parties and see, you know, who they are,
who they enjoy working with,
who do they feel like their product works the best with. Uh, and so,
and you can learn a lot, uh, from those vendors, uh,
and then talk to other dsso leaders and not just focusing on, you know,
top level leadership, uh, talk to the people that are actually using the system,
talk to the practice managers, the C clinicians, the support staff, uh,
talk to the IT teams. I think you can learn a lot about, uh,
the practice management systems or solutions in that way as well.
Yeah, I, I would, uh, and I think Chris touched on this to start with,
is going back to those non-negotiables. I think that's,
that's your starting place is you have to understand, like he said,
why you're doing it, um, and understand what you have to have. Um,
and it that helps you compare softwares with an objective basis. But,
but it's key to not make that list too long.
There's not a single perfect software out there.
And then I would say start with only a small group of people.
You read as much as you can online watch videos and typical stuff, Google it,
YouTube, everything, and demo everything you can get your hand on,
hands on and, and then focus on those non-negotiables.
And you begin to get that list smaller and smaller.
And then as that list smaller, you start involving other perspectives.
Like tri said, get, get other folks in your organization, um, get,
get people that are in the practices, get hygienists, get assistance,
get doctors, um, and then, you know, it,
it really helps to find some references on the outside of the organization that
can, can help you with that and help you with their decision process.
It was very reassuring when we, when we touch base with, uh,
another group and they,
they had narrowed it down to the exact same two softwares that we had,
and they were able to tell us why they went with Decon.
And it made a lot of sense. And,
and that was very reassuring for our group standpoint to sort of had ended up in
the same place. And so, you know, the, it's,
you just wanna make sure you do your due diligence and, and it's way, way,
way better to, to go through a project this when project like this,
when you can do it and,
and can take your time rather than you're forced to do it on a timeframe and you
have to make a decision, you know, in 30 days or whatever. We,
the entire process start to finish from due diligence to all offices
converted and, and moved on to Decon, which took us about a year. Uh,
it was about three or four months of due diligence and then about eight months
we took to, to move everybody over and doing it that way was,
it was still stressful, but it was not nearly what it, it could.
Have been.
Great. Well guys, I've really, uh, enjoyed this conversation.
I want to thank you for your time. Uh, so I wanna thank, um,
both Chris Grim and Dr. Mike Twitchel of Family Dental Health.
Uh, I'm Matt Walker with Planet d d s.
If you'd like to learn more about cloud solutions from planet d dds,
including Decon, which we've been talking about, uh,
after imaging or cloud nine, please visit, uh, our website,
planet dds.com. And, uh, thanks again for listening.
Thank you all three so much for sharing your insights with us.
And thanks again to planet d d s for sponsoring the episode.