By Dr. Gary Kaye
Making decisions on when to add a particular technology to the practice has become a task that confronts dental practitioners more and more frequently. The technology is often expensive and how we make those evaluations is varied and often irrational.
My experience in almost 20 years of private practice has taught me many things, one of which is that the impulsive reasons for acquiring the technology often end up being expensive mistakes (both in time and money). The same can be said about deciding not to buy something because of an irrational reason (which, incidentally, can be more costly in the missed opportunity, benefit to patients, or any number of other factors).
Figure 1. We have developed many systems in all areas of our practice that help us achieve our goals. For technology acquisition decisions, we developed the Kaye Technology Acquisition Scorecard (KTAS; Figure 1), a list of all the conceivable variables or factors that have to be considered in the decision with a score for each one.
We are taught many skills in our education but few of us have received any formal training in general decision making. In clinical dentistry the decisions we make are driven by very rigid guidelines on when to treat or when not to treat, then what and how to treat. These are evidence-based and grounded on sound scientific principles. It would be inconceivable and downright unethical to make a clinical judgment—a decision—based on some irrational motive. However, we live in a world where technology is moving at a rapid pace and the benefits of technology are all around us. There is often a “wow” factor associated with new technology that is so utterly compelling that it drives our decision to buy it. Dentists, have become very good at jumping on the “wow” factor of technology, buying something, and ending up with a piece of equipment that gathers dust in a corner somewhere in our offices. Most of the technology utilized in our private practice in New York City has helped put us into the top 1% of solo practices nationwide, driven efficiency, and given the team phenomenal tools to perform at the highest level but, most importantly, is that it has provided our patients with benefits they would otherwise not have received. Our patients are the heart of our practice, so if they benefit from a particular technology, then it will weigh positively on whether that technology should be adopted.
The Kaye Technology Decision Scorecard can be used in any practice setting to determine if the time is right to implement CAD/CAM
We end up with an overall score, a number, rather than a hunch about whether to go ahead with the technology or not. We tested the scorecard and looked back at decisions we had made in the past and it has been remarkably accurate and reliable as to how those decisions turned out. For example, a number of years ago we bought an air abrasion system and stopped using it long before we came close to amortizing the equipment. Had we used the technology scorecard, we would have come up with an overall score of 375 against it and only 210 in support of the decision. The scorecard is very practice-specific so two different practices using it for the same technology could arrive at different scores and hence different decisions whether to adopt a technology or not. On the other hand, in 2001 we added digital impressions and CAD/CAM into the practice. Unlike air abrasion, it worked out very well. The retroactive scorecard of instituting CAD/CAM would have been 335 to 246 in favor of CAD/CAM. By 2009, CAD/CAM had become an integral part of our practice. At that time, the technology had advanced and we faced the decision of whether to upgrade to a newer version of the same system, but there was now a competitive CAD/CAM system available in the E4D Dentist™ system by D4D Technologies in Dallas, Texas. The Kaye Technology Decision Scorecard is also very useful when comparing different products, and based on the overall scores, 335 for E4D and 246 for the upgrading our existing system, we decided to purchase the E4D Dentist system.
Figure 2. Summary of the Kaye Technology Acquisition Scorecard.
Why CAD/CAM?
The Kaye Technology Decision Scorecard can be used in any practice setting to determine if the time is right to implement CAD/CAM. Based upon all the benefits of the technology and the success of more than 10,000 practices that have adopted CAD/CAM, the technology scorecard will usually come up with a positive result, indicating that the benefit of acquiring CAD/CAM exceeds that of not acquiring it. The next step is to determine which product or company to go with. It is here that the KTDS excels. By using the scorecard, a true side-by-side comparison can be made. Another way of looking at the KTDS is as a series of 30 questions that should always be answered when selecting a technology product. The scorecard has the flexibility to accommodate additional variables should the clinician deem them to be significant as well as ignore variables that are not considered important for a particular decision.
How the Kaye Technology Acquisition Scorecard works
The KTAS looks at numerous factors and divides them into four broad categories: clinical use, product features, service, and support plus a variety of business issues that relate to the practice management. Each of these categories is divided into subcategories that are assigned an importance value of 1, 2, or 3 to the subcategory as it pertains to a particular decision. For example, if we are looking at a piece of technology that we will depend upon for critical functions in our treatment, then the service response time if it malfunctions takes on a higher level of importance in our decision so we assign an importance value of 1 to the subcategory of response time. Then for each subcategory we assign a “positivity” score between 0 and 10, with 10 representing the highest positivity for that subcategory. For example if the distributor of the technology has a good track record, then for quality of who handles it under service and support we assign either 7 or 10.
The spreadsheet is set up to calculate weighted scores for each category and two overall scores, and then a graph displays the results (Fig. 2). We use the difference in the two overall scores to drive our decision. The larger the difference between the two overall scores, the more compelling the decision in favor (or against) the technology becomes. If the scores are very close then that will obviously be indicative that there is not much of an overall benefit or detriment to acquiring the technology.