PreViser - the official blog

PreViser launches Refer-A-Friend program

2009-06-15T10:23:00.000-07:00

Reward your friends, Reward yourself!

Refer a Friend and you both save: When your friends subscribe, they get their second month of unlimited use free, and you get TWO months’ free unlimited use! We appreciate our customers who introduce us to new customers, and we want to say thank you with this bonus.

Refer easily: The link below will launch an email to us so you can send us the information we need to contact your friend and introduce them to PreViser.

Refer a friend now!

You may wish to alert your referred friends that we will be contacting them, so they’ll know what to expect.

Refer with confidence: We appreciate you sharing PreViser with your friends and colleagues, and we will protect their details just as we protect yours – we never share names and contact info (without first getting your express permission for a specific purpose, such as a reference).

Refer as often as you’d like: You can save with every referral, and there's no limit to how many friends you can refer! The savings add up fast.

PreViser lecture at Business of Dentistry 2009

2009-05-18T10:51:00.000-07:00

PreViser CEO Carl Loeb will be presenting next month at the Dentrix Users' Conference, "Business of Dentistry."

Program title: "Evidence Based Optimization of the Hygiene Department"
Date: Friday June 12, 2009
Course Description:
PreViser Corporation has developed proprietary methods for the precise calculation of periodontal disease risk and severity, as well as oral cancer and caries risk. The use of this technology, now integrated with the Dentrix system, has the potential to significantly increase practice productivity while dramatically enhancing patient outcomes. With PreViser, a patient population is easily characterized by their oral care needs, and when implemented fully, allows a dental practice to focus practice resources on the patients at highest needs, and consequently of greatest economic value to the practice.

Mr. Loeb will address the practical aspects of the use of the PreViser system on the modern dental office. Impacts on patient compliance, case acceptance, loyalty, insurance reimbursement, productivity and clinical outcomes will be discussed in depth with practical suggestions on the best ways to take advantage of a powerful new capability offered to Dentrix users.

More information on the conference is at: http://www.businessofdentistry.com/index.html

Not a Dentrix user, or not attending the conference? We can schedule a webcast to go over this material with you - contact us to request this.

Graph of Tooth Loss over 15 years by PreViser Risk Score

2009-05-06T10:51:00.000-07:00

This graph shows the percentage of teeth lost over a 15-year period, absent treatment, as predicted by PreViser risk scores (see our research published in the Journal of the American Dental Association, May 2002). This becomes quite a compelling image for your patients to look at when they know their risk score and you are recommending treatment to prevent this kind of outcome. We've prepared a printable sheet for you to show to patients with this graph, and would be happy to email it to you, branded with your practice name if you wish - request this graph now.

Simple scripts available

2009-05-06T09:50:00.000-07:00

We've developed some simple example scripts for conversations you may have with patients about PreViser or related topics - things like how to introduce a patient to PreViser, how to explain their perio disease description, etc. These are meant as samples for you to use in your own style, but we've had good feedback that these clearly summarize and communicate great points to make with patients. We'd be happy to send you these scripts by email - ask for the free scripts today!

Interceptive Medicine: the Paradigm Beyond Preventive Medicine

2009-03-13T11:59:00.000-07:00

By Dr. Randy Nolf, from Feb 16, 2009.

The cost of medical care is spiraling toward a crisis, and is perhaps already beyond crisis. The rise toward 20% of the gross domestic product is unsustainable and seriously jeopardizes the U.S.A.’s ability to compete in a global economy.

How can we control it? One way is to control utilization and the cost of utilization, by rationing care and reducing fees. Have less providers and technology than demand, forcing extended waiting times. Make insurance authorization difficult and time-consuming. Artificially lower fees. This would control costs by choking down utilization, and is obviously not a desirable means to that end.

Another approach is from the “need” side. Lower the demand for utilization by lowering the need for advance reparative procedures. “Prevention”? I don't think so. Prevention has severe inefficiencies and is fraught with potential for overuse, minimizing the return on investment and it doesn't inspire most patients to take action based only on a variable “risk guess” of a future possibility. For instance, inflammatory periodontitis will have a different diagnosis or explanation from different doctors and hygienists. One office doesn't even mention it, another says there's "bone loss or a pocket", another says "there might be a problem, we'll watch it," and then there's the office that paints a picture of dire consequences of bone loss tooth loss and potential for heart disease with increased risk of dementia. If I was the patient, I'd keep shopping until I found the diagnosis I liked. An alternate concept to “prevention,” to lower cost of care while improving quality, is Interceptive Medicine. To intercept means “to stop or interrupt the course, progress, or transmission of.” Metrics are required to standardize quantification of the present state of disease, and to accurately, objectively and reproducibly score the risk of progression or onset of the disease.

There is a definite distinction between prevention and interception. Prevention is like crop dusting: i.e., treating 100% of the plants on hundreds of acres to protect the 20% that will get bugs. Simplistically, we may think of a car. Prevention could be changing the oil every 500 miles. It will almost certainly increase the life of the engine over not changing the oil, but is rarely necessary or cost-effective beyond standard maintenance intervals...unless you're running the Baja. The trick in medicine is to identify all those patients who are the medical equivalent of “running the Baja.” These patients are on a trajectory to onset or progression of disease and can be treated interceptively when appropriately identified.

The delivery platform for Interceptive Medicine is established, proven reliable, and delivered globally by the PreViser Corporation. The first disease entity to be addressed with this analytic system is inflammatory periodontal disease.

Interceptive medicine is the next logical progression of medical care, not more high-tech, high-cost, and invasive repair. The paradigm requires easy-to-use, inexpensive, computer-driven, objective, reproducible programs to score disease severity and risk. Simple numeric scoring will enable physicians of all specialties, plus auxiliary staff such as nurses, nurse practitioners and physicians assistants, to uniformly assess disease. Once uniformly scored, "best practice" treatments can be uniformly applied and outcomes measured. This is not possible with the current system, and yet the technology exists for disease specific tools to be quickly developed and rapidly deployed.

Consider the impact of applying the concept to cardiovascular disease, which causes more deaths than all the cancers combined. Annual costs of cardiovascular disease, including indirect costs, are $450 billion in the U.S. and $300 billion in Europe. It is estimated that effective interceptive measures could lower the costs of treatment by 30%. That's enough to grab policymakers' attention, even in this day of massive multi-hundreds-of-billion-dollar bail-outs.

Dentists may well lead the way to this new era of healthcare by adopting PreViser disease management practices, and establishing a policy of practice-wide perio diagnosis and risk assessment. Costs are minimal and rewards are high for both patient and doctor.

Cost containment will be a theme in medicine and dentistry for the foreseeable future. It will be far more palatable to drive containment from the need side than to be forced to accept utilization control measures set by government or insurance companies with the primary measure being reduced expenditures.

Dentists have a choice: they can lead this parade or be left to sweep up after the elephants.

PreViser and Oral Cancer

2009-03-11T09:35:00.000-07:00

By Carl Loeb, PreViser CEO, March 10, 2009.

PreViser’s oral cancer risk analysis calculates a score on a 1 to 5 (very low to very high) scale. It takes into account various types of tobacco usage, levels of alcohol consumption, cancer history, and other factors to determine relative risk levels.

Many PreViser practices are now utilizing additional diagnostic technologies like Vizilite™ and Velscope™ that incorporate luminescing technology to assist in the identification of lesions that may escape identification under white light illumination.

Where these additional diagnostics represent an additional cost to the patient, it may be useful to link the decision on whom to recommend the additional procedure to the individual’s risk level for oral cancer. This may be an approach that makes sense to the patient who has to pay for the diagnostic.

The approach is simple. Here is the language that appears on the PreViser oral cancer risk patient report:

Enhanced screening for oral cancer using technology designed for the purpose may be recommended by your dental professional. An examination with enhanced diagnostics may be repeated at 3 to 5 year intervals when risk is 1 or 2. A 2-year frequency may be recommended when risk is 3 or 4, or for those who are sexually active and may experience exposure to Human Papilloma virus. Patients at the highest risk level, which is 5, may have an enhanced examination annually. Should these examinations indicate suspicious lesions, further tests including biopsy may be indicated.

This recommendation refers only to ‘Enhanced screening,’ that is, additional diagnostics and not the standard oral cancer evaluation that is presumed to be included in every periodic oral evaluation.

This simple approach can significantly increase patient acceptance of the need for additional diagnostics because it connects the diagnostic to the individual risk level of the patient.

For more information on PreViser, or to schedule a private webcast explaining the technology to you or your staff, please contact us.

PreViser Corporation and MacPractice Announce Cooperation Agreement

2009-03-01T23:38:00.000-08:00

Press release from Feb 23, 2009.

MOUNT VERNON, Wash., and LINCOLN, Neb., Feb. 23 -- PreViser Corporation (previser.com), a world leader in risk and disease analytic software designed to enhance treatment planning for patients affected by oral disease, today announced a cooperation agreement with MacPractice, Inc. (macpractice.com), the nation's leading provider of dental practice management software running on the Macintosh computer platform. The agreement will involve cooperation in joint marketing and promotional activities and the integration of PreViser analytic technology into MacPractice DDS 3.6, making MacPractice the only native Mac-compatible practice management software to integrate the PreViser toolset.

PreViser CEO Carl Loeb noted, "While Macintosh users represent a subset of computer users, they tend to be technically adept users who welcome innovation. We are very excited about the opportunity to work with MacPractice in showing users of their software how PreViser can help enhance practice revenue, increase productivity, and enhance clinical outcomes while increasing patient satisfaction and loyalty."

Read the full release here.

A Radical Idea

2009-01-28T00:07:00.000-08:00

by Carl Loeb, PreViser CEO

PreViser disease analysis software assigns a numeric score for disease risk and a separate score for disease severity to patients based on standard clinical observations. The risk score is on a 1 to 5 scale from very low to very high risk, and the disease score on a 1 to 100 scale from health to severe periodontitis throughout the dentition. Based on a sample of assessments, PreViser routinely provides dentists with a Practice Analysis Report (PAR) that projects the entire patient population onto a matrix of risk and disease categories. Detailed information on the PAR and how you can have one generated for your practice can be found on the PreViser web site at http://previser.com/Dentists/PAR.htm. The illustration below is a sample of such a risk/disease matrix from a California practice with 720 adult patients aged 30 and older:

This particular practice has 165 patients at very low or low risk (risk score 1 or 2) and exhibiting Mild Periodontitis (disease score 4 – 10), and 62 patients with Moderate Periodontitis (disease score 11 – 36) and moderate risk (risk score 3).

In most practices a set amount of time is allocated for a hygiene appointment – typically 1 hour or so. But does this make sense from the standpoint of either patient needs, or practice productivity? Some PreViser dentists think not, and have begun to modify the duration of the hygiene appointment based on the PreViser scores. For example, a patient with a PreViser score of 1 – 3 might receive a 35 minute appointment for a CDT 1110 adult prophylaxis, while a patient with a PreViser score of 4 – 10 with Mild Periodontitis would receive a 45 minute appointment for a CDT 4910 perio maintenance, and so on. What is the productivity impact of such an adjustment of appointment time to match patient need as determined by their PreViser score? Here’s a quick comparison for the practice described above:

Different practices may have different thoughts on the ideal appointment time for each set of patients in a given diagnosis grouping, but it is hard to argue that finding more time for patients at higher needs will contribute to better outcomes. And, with a time savings of 15%, an opportunity to increase hygiene revenue by 15% exists without adding a single hour of hygienist wages, or any material overhead.

Worth thinking about...

For more information, contact carlf@previser.com .

PreViser Periodontal Protocol Metrics

2009-01-15T16:38:00.000-08:00

Note: click on the charts to see a larger image of each. Ask us here and we'll send you free copies by email of these and other protocols involving PreViser.

PreViser Periodontal Protocol - for Recall Patients

2009-01-15T16:34:00.001-08:00

PreViser Periodontal Protocol - For New Patients

2009-01-15T16:09:00.000-08:00

What is PreViser?

2009-01-15T00:41:00.000-08:00

By Dr. John Martin, PreViser CSO

PreViser’s technology provides information that dentists and hygienists use to manage periodontal patients and triage recall.

PreViser’s technology may be beneficial to a dental practice that wants to provide the best care and service or increase revenue or profitability. Dental practices achieve these results by incorporating procedures, policies, and protocols based on metrics of the practice derived from the routine use of PreViser’s technology. The key is PreViser’s unique and objective scores that accurately describe the periodontal condition of a patient. The PreViser scores simplify the explanation of the patient’s periodontal condition and how it has changed over time. This is easily understood by patients as they are already familiar with scores like blood pressure, blood sugar, and blood cholesterol. A result is more patients committed to treatment and simplified communication within the dental practice. Some reasons why dental practices that use PreViser provide the best care and service with positive gains in revenue and profitability include establishing score-based protocols to manage patient care and metrics to measure results.

To assist a dental practice in the use of PreViser’s technology the following documents and resources have been developed and are available:

PreViser Periodontal Protocol.
Periodontal Charting and Radiograph Protocol.
Dental Coding for PreViser Assessments.
PreViser Periodontal Protocol Metrics.
An extensive library of videos that explain the most important issues related to PreViser use is available online at: www.previser.com/demo.html.
Customer service representatives are available by phone and e-mail.
Answers to frequently asked questions (FAQ) are contained within the computer application and online at: http://www.previser.com/FAQ.html.

The information contained in the documents is provided as a guideline. Each dental practice is advised to establish guidelines, protocols, and procedures specifically for the dental practice and its patients.

To assist a dental practice in the management of a periodontal patient the following reports are available when a PreViser assessment is completed:

A report is created for the patient, which includes:

PreViser scores with a description of their meaning and a graphical display of the scores over time, when applicable.
A comparison of each clinical measurement that describes the patient’s periodontal condition compared to normal.
An optionally printed non-inclusive list of possible treatment interventions stack-ranked by treatment effectiveness based on scientific evidence for each clinical condition.

A report is created for the patient’s clinical record, which includes:

PreViser scores and a graphical display of the scores over time, when applicable.
The clinical observations that were entered into the PreViser system.
A non-inclusive list of possible treatment interventions stack-ranked by treatment effectiveness based on scientific evidence for each clinical condition.
A range of recall intervals based on scientific evidence for the patient’s scores.

A report is created that correlates a patient’s clinical condition and recent history to published referral guidelines.

The information contained in these reports is provided as a guideline. Clinicians are advised to diagnose and plan treatment based on the patient’s objectives and clinician’s professional experience and judgment.

PreViser’s technology is scientifically validated and has been reported in several well-respected peer-reviewed dental journals. Our complete list of publications is available upon request. A partial list of publications is available at:
www.previser.com/CorporateInfo/ScientificPapers.html.

Sample patient and clinical reports as well as a practice analysis report are available at:
www.previser.com/Dentists/SampleReports.html.

For more information please visit our web site or contact us at:
PreViser Corporation
20849 Cascade Ridge Drive
Mount Vernon, WA 98274
Phone: 888.854.0007
Web site: http://www.previser.com/
E-mail: info@previser.com

Establishing Value with your Hygiene Patients

2009-01-07T23:38:00.000-08:00

By Carl Loeb, CEO PreViser Corp.

More than ever before, your patients are aware that the health of their gums has potentially significant impacts on their overall health and well being. In fact, in a recent survey conducted by Dental Products Report (http://www.dentalproductsreport.com/articles/show/dpr1208_tr_perio-survey ), 64% of responding dentists noted an increase in the awareness level of their patients to the periodontal disease-systemic disease connection. Yet in the same survey, 71% of responding dentists characterized as "Somewhat" to "Extremely Difficult" the task of getting patients to comply with recommended therapy or home care instructions. Can you imagine trying to run a successful restaurant if you found that 2/3 of your customers thought it "extremely difficult" to convince themselves to order from the menu?

What explains this gap between knowledge of a problem (gum disease = poor overall health), and a reluctance to accept periodontal therapy by patients? We think part of the answer is that many patients have a remarkable ability to disconnect themselves from their oral health in a way they would never do when it comes to skin care, clothing, their finances, or other important aspects of their life, and we’ve all seen patients like this - the impeccably dressed person, well groomed but with appalling oral hygiene.

But there is probably another equally important and associated factor that is at work, and that is the difficulty dentists and hygienists have in demonstrating the value of the hygiene services they render. After all, periodontitis generally doesn’t hurt, although the treatment frequently does. In many cases, patients feel about the same after therapy as they do before, so it’s not too surprising that they are sometimes hard to convince when it comes to accepting treatment.

PreViser provides a simple, but very effective solution to both of these problems. PreViser reports convert periodontal disease risk and severity to simple to understand numbers, so that patients can instantly understand their relative level of oral health, making the disease pretty difficult to ignore. When disease scores improve as a result of therapy, the patient has the simple proof that you are making them healthy. Add improved communication on the implications of gum disease on other systemic conditions and you should find what other PreViser offices find – better case acceptance, better compliance and enhanced patient loyalty, translating into improved health outcomes, and a healthier practice as well.

For a short video that expands on this concept, you may find this link of interest:

http://video.previser.com/establishingvalue/default.htm

Sign up to receive our newsletter

2009-01-07T23:22:00.000-08:00

Are you receiving The Byte newsletter from PreViser? This monthly email newsletter keeps you up to date with what PreViser is working on, where we'll be, helpful tips and insights for users. Sign up here. If you wish, click to ask us to send you the three most recent newsletters.

Communicating effectively to periodontally stable patients with PreViser

2009-01-07T22:46:00.000-08:00

By Carl Loeb, CEO PreViser Corp.

PreViser measures the severity and extent as well as the risk of periodontal disease. These measurements are expressed as numeric scores, which make them easy to track over time, as well as serving as an effective means of communicating to patients their disease status, and any changes in that status since the last examination. In addition to the PreViser numeric scores, patient and clinical reports also describe disease severity and extent in words, for example, "localized moderate periodontal disease." Active therapy followed by conscientious periodontal maintenance can take a patient with a very high PreViser disease score to a much lower score, but once bone loss and tissue destruction has occurred, we can never return that patient to perfect health - i.e., a PreViser score of "1".

One question that has been asked by users is what to say to a patient that has been treated and is now stable, but still generates a higher disease score and a written description of severity and extent that still indicates the presence of disease? After all, these users ask, haven't we made these patients "healthy" and if so, why doesn't PreViser reflect this? The answer lies in the nature of gum disease. Like periodontal disease, diabetes can be controlled, but the underlying disease of diabetes remains. Patients with periodontitis who have been treated and currently have no inflammation may still have prior bone loss, and will likely return to a deteriorating state if not maintained appropriately, and PreViser scores and the severity and disease descriptions are intended to reflect this reality.

As a result, our advice to users is to tell a patient who is now stable - which will be reflected quite accurately by stable PreViser disease scores - that they have been made as healthy as they can be, but that careful monitoring, good home care and routine periodontal maintenance in the dentist's office are necessary to maintain that status. For example, a patient may begin therapy with a disease score of 65 and a severity and extent description of localized severe periodontal disease. After therapy that score might be reduced and stabilized at 24 with a severity and extent description of generalized mild to moderate periodontal disease. This patient can be told, "Well, we've been able to reduce your scores from 65 to 24, but if we are going to keep them there, we'll have to stay on a schedule of routine maintenance." In addition, clinicians may choose to de-select the printing of treatment recommendations when the patient report is produced. This is done on the very last screen, just before you transmit the clinical data to PreViser for analysis.

To further reduce any confusion on the subject of how PreViser scores and disease descriptions relate to periodontally stable patients, we will also be modifying the reports in the near future as follows:

To clarify that a patient's PreViser score is an accurate measure of severity and extent but may not reflect stability, we are adding the following language to the disease description (change in italics):
Unless Stable and Without Inflammation, this score would suggest Localized mild and moderate periodontitis
To clarify that the treatments that would be appropriate for a patient with active disease described by the scores and the description may not be appropriate for patients who are now stable, we are adding the following language to the Active Intervention You May Need section (change in italics):
Active Intervention You May Need, unless Stable and Without Inflammation

Recognizing the excellence of your care in bringing diseased patients to optimum health is an important element in encouraging continued compliance, and we hope these changes will bring that message home more clearly to patients.

Questions about this or anything else? Please contact us and we'll be happy to answer them.

Note: this article originally appeared in PreViser's The Byte newsletter in December 2008. The report language changes described were made 12.23.08 and are now visible on all PreViser reports generated after that date. ---PreViser Support