Alright.

So welcome, everyone. I am Sheela Roth, head of clinical education at Pearl. I am so thankful to be joined by doctor Rubinstein and Haley AI from our wonderful partnership with Curve.

This is going to be an exciting webinar, hacking dentistry, cybersecurity essentials for dentists. Those are the things that we don't want to worry about, and we want to worry about before, it's time. So very concerning issues, but we're lucky to have doctor Rubinstein walk us through lots of tips and tricks here. This webinar is designed really to kind of explore how tools like AI, cloud based systems, analytics, and different techniques can help elevate practices and also being mindful of how to mitigate any kind of exposure and risks. So as dentistry continues to evolve at an unprecedented pace, many of us find ourselves wondering, how can we embrace innovation without compromising our patient's privacy or a patient's reputation?

So that's exactly the question we're going to tackle today.

I want to, again, thank everyone for joining us. And, Haley, if you'd like to say a quick hello from our curve team, we'd love to have you introduce yourself, and then we will turn this over to doctor Rubinstein.

Yeah. Of course. Thank you so much, Sheela. So my name is Hailey. I'm a product specialist here at Curve. We're just happy to be involved today, and thank you guys for having us.

Excellent.

So we're going to be diving into all of these benefits and challenges that come with adopting this technology and workflows, especially when it comes to protecting sensitive patient data.

To help us navigate this very crucial conversation, I am honored to introduce our speaker, doctor Mitchell Rubinstein.

He chairs the technology committee for the New York State Dental Association and helped coauthor their HIPAA compliance course. So he knows this topic inside and out. He has served as the education director for the New York City I'm sorry, New York County Dental Society for about five years and is still deeply involved in ADA standards and committee for more information.

He's teaching at a research facility, and he's also in his practice. So very exciting to have him here. Whether you're curious about AI security risks or looking for real world strategies to keep your data safe, Just trying to figure out how to build patient trust. You came to the right place. So, doctor Rubinstein, we're excited to learn from you. We'll have you take it away.

Alright. Thank you. I'm gonna share my screen now. Let's see.

You tell me if I You're all set.

Looking good?

Looking good.

Okay. Terrific. Wow.

Alright. Thank you, everybody. I'm really glad that you're all here. We spend a lot of time, doing dentistry, and so sometimes we get tired of it, and we don't take the time we need to go and educate ourselves on on new stuff.

I I I subject to that myself sometimes, so I I applaud you all for tuning in when you could be doing something else. I think you're gonna get a lot out of this, and I'm I hope you're gonna enjoy it. I I know I'm gonna enjoy it. So let's get started.

We're gonna talk, about a lot of things that are misunderstood in dentistry. Specifically, today, we're gonna talk about cloud based computing and artificial intelligence, some of the most important things that are happening, not only in dentistry, but pretty much everywhere now. And there's an information revolution going on, and, we wanna be part of it. We wanna be part of it in in a safe and productive and efficient way.

So who am I, and why should you listen to me about any of this stuff?

I mean, Sheela just explained a little bit of what else I do, but I wanna AI, for the most part, I'm a practicing dentist. I practice dentistry four days a week in my practice in New York City. I do some of these other things also.

I chair the technology committee for the State Dental Association, and, I'm on the standards committee for the ADA particularly.

But I talk to a lot of dentists about things that they are going through with technology. And so I've I've learned some things by suffering through them the hard way myself and some from other people's problems as well. So I'm gonna share that with you a little bit today.

I wanna say a heartfelt thank you, to the people at Pearl and at Curve. These are, companies that I've been working with for a couple of years now. They are my own practice management and imaging, people. And, this was before I was lecturing with them, and they have no input whatsoever into the content of this, program, but they are supporting it, and I I have, nothing but gratitude for them. So thank you very much.

I do use these things running my practice, and you're gonna see why in a minute. So it's the twenty first century now. Actually, I don't I gotta qualify that because we're twenty five we're a quarter of the way through. It's twenty twenty five. It's the quarter of the way through the twenty first century.

It's a time of rapid technological change in dentistry.

And I like to say that ev whoever you are, wherever you are, whatever kind of dentistry you do, everything is different in dentistry than when you graduated. And it doesn't matter if you graduated three years ago or thirty because things are changing so fast that you have to keep up even if you're a recent graduate.

Everything we work with now has a microprocessor and and a screen. Almost everything we work with is connected in some manner to the Internet.

There's very little excuse now for losing track of information.

The information that we have really should be available to us everywhere we need it and not available to people who shouldn't get their hands on it. That is something that we're approaching, as being a real, you know, possible outcome for us.

All these things that we have now I mean, we're using routinely things like CT scans. A lot of us are producing and milling our own restorations in our office, whether we're using, different types of laser, soft tissue lasers. You're gonna see the common thread in these pictures I'm showing is their screens everywhere. Even our microscopes are connected to, computers so they can record the information for use later.

Quietly, I like to say it's happened quietly over a period of time without a lot of fanfare.

The basic nature of our practices, of our business as dentists has changed.

And And sometimes people your elevator pitch. You know, you're in a elevator and somebody says, hey. What do you do? You know?

What's your answer to that? What business are you in? Dentists will often say, oh, I'm in the I'm in the tooth business, or I'm in the tooth fixing business, or I'm in the smile business, or I'm in the oral health business. But today, for real, and I wanna change thinking on this a little bit, we're not whatever it is, that's not all it is.

You're not just in the tooth business.

Okay? Dentistry today, it's really an information business.

And that's not just sort of a slow in AI. I mean, that's for real. Everything we do, it's the most valuable thing in our practices.

The information that you have about your patients, about their care, about everything to do with how you take care of them, I call it the those are the crown jewels of your practice.

It's the only thing that's really irreplaceable.

I mean, your your lasers, your cone beam CT machines, they're all really expensive, but, they can be replaced. The information, if you lose track of it, can't be. Okay? Whether you're interpreting an X-ray, whether you're educating your patient about something, communicating with a specialist, writing a prescription or a clinical note.

The information is the important thing that must be you must keep track of if you're gonna be able to properly take care of your patients. It's a common denominator.

We need it in the right place at the right time, and there's so much of it.

We need it sorted out for us because there's a huge volume of it. Having too much information is a problem also. I'm gonna so what I'm AI do is I'm gonna tell a little story. I like stories. This is a campfire, but it's a it's a video of a campfire. It's not a real AI, about why exactly, the information is so important. And I'm gonna tell a story about something that we think about from the past, which is the I'm gonna air quote the golden age of dentistry.

That was a time decades ago when dental school didn't cost that much.

There weren't any, PPOs stealing half your production and so their CEO can fly around in their in their own jet. There was no HIPAA police hunting you down AI, like in the matrix, like their agent Smith.

There are no venture capital firms back then buying up practices and conglomerating them into these giant, giant Frankenstein monster DSOs.

Basically, everything was really nice. It was wonderful to be practicing in the golden age of dentistry until you actually needed to do some dentistry.

And then in retrospect, it wasn't so great. Wanted to take an X-ray, or you wanted to send a patient to a specialist or take a photograph, and your office looked kinda like this. And this might be a little bit of an exaggeration. I mean, maybe it didn't look exactly like this. But in this picture, you'll see an office that has no screens.

No computers, no keyboards, no tablets.

If some if there was a mouse in your office, you called an exterminator.

That X-ray that you need, because you're doing an endo, took ten minutes to develop, eight to ten minutes. And if you missed the apex, it was another eight to ten. If you wanted to copy these, transmit them anywhere. If you wanted to send them to a specialist, if you wanted to share them with a patient, that information was almost almost lost if it was sitting in a paper chart.

Okay? And information loss is a real problem for us because it means that stuff that we should know, we don't. And although we could do pretty good dentistry on a minute to minute basis, keeping track of things, it was something we weren't that great at back then. Because, I mean, if you think about now, it happens slowly over time, but the information that we need to manage now, your patient demographics, you know, clinical records and treatment plans, credit cards, insurance information, patient's medical histories, and on and on and on.

Radiographs, CT scans, photographs, if you're doing scans for your, for restorative dentistry, all of that is stored in a computer somewhere now. Okay? And like I said, I'm gonna say it again. It's the crown jewels of your practice.

Because if you walked into your office and you have all this on a server in your office and that server was gone or it had been hacked or it had been god forbid there was a natural disaster and and that stuff is gone and not backed up properly, it's irreplaceable.

And you probably have a lot of it if you're like most dentists on a server in a closet or under your desk somewhere.

In my, like, second ten years in dentistry, we were really moving things into the into servers in our office as more of things got, computerized. We really started computerizing in dentistry just the business and financial side of the practices.

Computers in the operatories didn't come until later with digital X rays and scanners, intraoral cameras, things like that.

But the redundancy in the backup of this, this was actually one of my first server setups. It was in a closet.

But I was responsible for backing this up and making sure it was properly backed up, and so was my IT company. I have a good IT company, but they're still limited in their resources, and I'm only one small practice.

Most of us who still practice this way don't think of the server as a major weakness, but it is. Okay? For most of us, it is.

Several major compromises, breaches, hacks of dental practices. There were a couple of major incidences that came literally through the server, through the IT company that was compromised. In other words, the dentist didn't do anything wrong, but the IT company being compromised gave access to the dentist server, and everything was either compromised by ransomware or stolen, or it was a breach in some way that had to be reported as a HIPAA violation.

A lot of this is through remote access, which many of you use, to get into your computers after hours, but there there are better ways.

Okay? There is a revolution technology that's going on right now because not only of the amount of information we have to deal with, but the importance of having it right where we need it when we need it.

We need access to the information. We need it at our desks, iPads, kiosks. We have in our practices now. This is my scanner. I have a cart that rolls around. It's connected to the rest of my office, through a wireless connection, even on our phones.

Okay? I this is what I have on my phone now. On the left is my schedule. In the middle is, clinical notes and imaging. On the right is communications with a patient if I need to text them something. I have access to that anywhere. I'm walking down the street, and I get a call from a patient who has an appointment halfway through the day, and they forgot to get their premedication, and they're gonna have to cancel the appointment.

Between Seventh Avenue and Sixth Avenue walking down the street in Manhattan, I can get that prescription to that patient so they can go pick it up and still make their appointment. That's the opposite of information loss. That's the information being where it needs to be. Okay? So this information transformation I'm talking about, there are a couple of technologies that are related to each other.

The first is, what's called broadly artificial intelligence.

And the best part about both of these types of technology, cloud based, cloud based operations as well, is that you're already using them. You may not be using them in dentistry, but if you're using, Gmail, if you're using Siri, if you're using, Google's AI assistant or any of a number of other, you are using them in very important elements of your own personal life. But sometimes we hesitate to use them because we don't fully understand them when we're practicing dentistry.

So the cloud really just refers to services and software that you access online through a browser where the software and the data is not in your office, not under your physical control. You're connecting to it through the Internet.

Artificial intelligence, on the other hand, is a broad classification of tools used to organize and filter and prioritize information so you have the right bits of information where you need it, when you need it.

It also changes it into a form that you can use.

We'll look at some AI, imaging features in radiology.

The same radiograph marked up through an AI program is much more usable much more quickly, even though the information is essentially the same.

Basically, artificial intelligence allows computer systems to simulate problem solving that that people do. Okay? It's a very broad classification of software, and it is beginning to make its way into medicine now, in a much, much larger way.

Because a human being can never fully analyze an image or a paragraph of text, you know, in the way that a machine can because machines don't get tired. They don't get lazy. They don't get distracted. They don't have fights with their, with with their spouse that distract them. Computers always do it the same way every single time.

A properly trained algorithm can do that in a way that a human can't do it.

Subsets of AI that are useful for us, one of the most one of them is natural language processing, which is basically, if you use Siri or Google's assistant or anything that recognizes your voice, it's been trained on an algorithm with many, many human conversations, and it's gonna approximate what you would what you would want if a human were sort of fully interpreting that information. And, it's become extremely accurate. It's easy to train. And is it perfect?

No. Pardon me. Definitely not perfect.

So you can't take everything it says without checking it, but it's a tremendous workload reducer. I like reducing the workload, and there's a lot of work in dentistry.

Generative AI is another step beyond natural language processing where it's using these practice these practice sessions and all of this massive amount of data that's trained on to generate new content. And in dentistry, I use that primarily to turn a whole bunch of patient interaction, material into a cohesive note, into a treatment note.

Extremely accurate time saver for me. And when I look at these notes afterwards, they always contain things that I probably would have missed if I was just scribbling them down on a piece of paper the way I used to or even if I was typing while I was talking to the patient.

And I don't like typing while I'm talking to a patient because I like looking at people when I'm talking to them. And the more time I can spend looking at the person and less at the screen, the happier I am, and I think the better my patient feels like they're being cared for.

The computer vision, now we're getting into what's really helpful with radiology.

It's again, it's not new to dentistry. You use face AI face ID to unlock your phone, and that is basically an an AI interpreter that's been trained on a picture of your face and can pick it out of a crowd of other faces, even ones that look very similar to yours. It's amazing, really.

Radiology, I wanna emphasize that when people look at these, radiographic interpreters like Pearl and they're AI of put off in this, well, I could do that. I mean, I I could see the disease there. I I could do that. It's not doing anything I can't do.

I would agree because the way these are trained is by showing them hundreds of thousands of images and showing them how they're interpreted by humans, and they learn from our experience.

So you could do that, but the computer's faster, and it's more accurate. Between caries, anatomical segmentation of different parts of the teeth, calculus detection, we're gonna go through a few other things.

It saves me time. Yeah. I have to check it. I can't just see a mark on the screen and say, oh, yeah. That that's what it is, but it's a tremendous lowering of my workload.

For example, here. So here's a an X-ray on the left, and I look at that quickly and I say, oh, AI, look at this tons of calculus. This person has perio. Oh AI god. Number thirty.

That's a real disaster. You get focused on that, Many of us and you might not think you will, but I'll go out on a limb and I'll say I I would, will miss the caries on the mesial of number three because there's too much information noise in this picture, and the information gets lost in that way. Okay?

Basic things that I'm doing with this now, to save time and to make treatment more effective.

The first, of course, is caries detection.

Caries is just different shades of gray in a different pattern on the radiograph.

Machines are great at picking that up. They pick up things all the time that are significant and very minor, even things that don't need to be treated. Very early decalcifications that I would never notice can be noted there and stored there. That image, I can look at it later and see if something has progressed. It's really amazing.

Measuring bone levels for perio, the absolute measurement, obviously, is all subject to variability because of the angulation of the X-ray, but you look at the same image over AI.

And with Pearl, we can do this. We look at the same image or the same view over time, and you can see progression of disease or lack of progression of disease.

Calculus is notoriously difficult to see on X rays. It's big calculus is easy. Little ones often get missed, and they're very helpful to see, particularly when my hygienist is doing a quadrant or root planing.

This view up on the screen, very helpful for her. Is it gonna make a night and day different? No. But it's gonna make sure that she's not losing track of an area that she should really be paying attention to. Periapical area is also tailor made for AI because they really are just varying shades of gray in certain patterns that can be trained very easily trained.

I talk about workload reduction. I look at this picture and I say, wow. This is look at that giant perio lesion on the mesial number two and this big caries lesion on four. Wow.

And I'm I'm going to treatment planning already, and a lot of times I would miss this AI caries lesion on the mesial two. I didn't notice in this picture. You go back and look at it now and you see it. Distracted like you were before, you might not.

So I keep using the term workload reduction because I feel like I worked I worked too hard. You probably do also. I wanna work at things that I need to be engaged in, okay, and not waste my energy scrutinizing something that could easily be interpreted for me by a computer. Okay? When I have a hygiene check if you're a general dentist and you have a hygiene check, you go in there, and you have three to five minutes with that patient, maybe. I wanna spend as much of that time looking at the person as and as little time as possible looking at the screen.

This lets me do that. Even if I wanna find the same stuff, the fact that it was screened quickly with one click of the mouse reduces the amount of time I have to focus. Now as far as security, even if you're not gonna gonna store your, radiographs and other images in the cloud yet, one day you will. It's inevitable.

You start with a service like one of the AI interpreters, certainly AI Pearl, which is what I use.

That all happens in the cloud. Okay? Because the processing power to do this AI stuff, you don't have that kind of power on the machines in your office. So it all goes through the cloud, which means they keep an entire backup database for all of your images.

So if your backup fails, you lose your images, and you're using a service like Pearl, up in the cloud is where all of your stuff is still safe. That's like, you know, an extra seat belt on you. And I've even at the very beginning they don't publicize this. I I think, frankly, I think the Pearl people should talk about this a little bit more because it's a pretty good feature.

But as soon as I saw this, I said, wow. And I was already paying, like, a couple hundred bucks a month for a different service to back up all my images, and then I didn't have to anymore. It was included. It's kinda cool.

So about this cloud thing, it mystifies a lot of people even though we use it all the time.

Instead of software running on our computer, it's running on somebody else's computer, and we're connecting to it through the Internet.

Whether you still have any DVDs in your house or whether you watch everything on Netflix, same principle. You know? Instead of having a player and a DVD in your house, you stream the service. It's very much like streaming practice management, services, imaging services over the Internet. And it's got some advantages and disadvantages. Everything does.

The advantage is the much simpler hardware requirements. Any machine that can connect to the Internet can take advantage of this. You don't have to worry about whether your machine is powerful enough. If it can connect to the Internet and can stream an image and your Internet connection is fast enough, then you could do anything on that that you could do if it was in your office.

Updates, you don't have to worry about updating your software.

Risk partnering, we're gonna talk about risk a little bit later. You have basically somebody else responsible for protecting that information and document that is being responsible, for protecting that information.

Even better is dentists are very, you know, frugal, I'll say. I'm one of them.

Most of these things are lower in cost than a comparable service or program that you're maintaining on your own computer in your office.

Disadvantages, there can be some. If you're in an area where the Internet service is spotty or not that fast, these things can be a little bit, a little bit flaky.

That's really happening much less now that high speed Internet is available everywhere.

Vendor issues, smaller companies will come and go, but established stable companies, I only work with established and stable companies, really don't have that same kind of vendor risk that, other things do.

So I'll define it as just the on demand delivery of IT resources and data, basically, from someplace else. And we maybe it's because it's called the cloud that we want. The cloud. What is it?

It's like a wispy kind of thing, but it's not. I'm gonna solve the mystery for you, really. That cloud, all it is is somebody else's computer someplace else. Usually, a better computer managed by people who are better at protecting computers than you or I.

It doesn't mean you can't do it yourself, but I have found that the risks are much less when a good and well organized and well documented, set of software tools, is managed, via the cloud over the Internet.

I mean, in your own personal life now, if you need to find an email from five years ago, you can go to Gmail and it's there. That's in the cloud. You know? You're checking your investments. You wanna see if that trade was done on time or anything like that. All of that information is stored from your pit standpoint in the cloud. So that's important stuff.

So there is no reason that we can't use this in dentistry as well even though we tend to feel, you know, weird about it, about not having that stuff on a server in our office.

But the problem in our closets, and I'm gonna include a picture of mine, is that that is much more vulnerable than you think it is nowadays. The risk of hackers, ransomware, malware, those things are much harder to control than they used to be. It it's very difficult to secure your system completely even if you have a good backup.

We have feelings about these things, a feeling about what's safe and what's not. Like, you walk down the street and one alley is very dark and one is well lit. You're gonna go down the well lit one because it just seems safer, and it is. But there are things that seem safe in IT that that aren't really.

And AI the nearest example with the server I can give is that during the depression, when people lost all of their money because the banks failed, right, shortly after that, there were a number of people after the depression who kept large amounts of money in their houses, under the floorboards, in the freezer because it felt safer.

Right?

Was it safer?

No. It wasn't safer because under the floorboards in your freezer, obviously, your house could be robbed, your house can burn down. A lot of things can happen to that, and in a bank, it's much safer. We have the same perception a lot of the time with cloud based stuff, and, I I encourage you to think about it that way. You know, if you're because I get I wanna talk to groups of dentists, and I ask who would be, you know, leery about having their practice and patient data stored in a cloud, based provider off-site. And, usually, most of the hands go up, and so I get it. I do.

When you think about what's connected to your server, IT company, patient contact manager if you're sending out texts, if you're using a voice over IP phone system like I am, if you have any remote staff or if any of you log in to your server from off-site, it's a major conduit, for malware and bad things to get into your computer. Well documented. It happens all the time.

Your accountant, your marketing people, they can get in there. It's a lot of connections to that. Okay?

And backing up, I'm not gonna do a whole thing on backing up, but I will tell you that during hurricane Sandy here in New York, we at the New York State Dental Association were trying to help a number of dentists restore their drowned offices. There were a number of people who had backups that didn't work or that didn't work completely because they hadn't been checked. If you have a backup of your own stuff and your IT person says, yep. No problem.

You have to have them restore that backup onto another computer and be certain that it works. If you haven't done that, call them up and get them to do it because that's the only way. You can't look at a list of files and say, oh, yeah. Definitely.

It's it's fine. You have to restore it for a backup. It's not something I worry about now because because my stuff is cloud based, but it's very important. Otherwise, you might not have a backup.

You might just think you do. So this arrangement that we see, all the things connected to your server when you move to the cloud kinda moves into a different sort of, realm. So I still have a server because I share information throughout the office.

It's connected, though, to the cloud through a secure connection.

And up there are things like Pearl and Curve, which are the main imaging and practice management facilities I use.

Doctor First is a company that I do electronic prescribing.

Mango is my phone system because all my phones go through the Internet. And when people say to me also, well, what if the Internet goes out? That's another objection, to cloud based computing and cloud based which I understand.

Things like Pearl, Curve, Mango, everything's what if you have an Internet? What if the Internet fails and you don't have it?

My answer to that is if the Internet goes out, you're gonna have a lot more problems than just your practice management software.

When you have no Internet, you can't process credit cards. You can't send in insurance claims.

You can't do a you can't send text messages and, reminders to pay there's ton of stuff that you can't do. Okay? So the notion that if you have everything in house but the Internet fails, you're still gonna be fine is a little suspect. It's just something to think about. Okay?

So we wanna be logical about this stuff. The goal for me is something I like to call zero information loss. It's kind of a fantasy I have about everything that I need to know. Like, a patient calls up the front desk, has a conversation. Somewhere in that conversation is something about that they don't like mint or that, you know, we wanna make sure we don't use mint. And I want that piece of information in a note to be accessible everywhere so so everybody knows it's my hygienist knows it, my assistant knows it, I know it.

Multiply that times the number of different pieces of information that we need.

That's what we're approaching. Okay? And it's not only that we can do this through cloud based practice management, but it's a major helpful tool.

In my practice now so this is just some of the things that I do.

My patients give me all their information either on a kiosk or an iPad in my office, or they do it online through a secure portal. That information goes right into their database entry. In other words, when I look at a patient's medical history, it's not from a crumpled piece of paper that got stored somewhere, and then my front desk person had to just retype it, and, hopefully, they got it right. It's the actual information from the patient going into there.

Okay? And on the patient's entry, you will see that I have this person that has an allergy to some animals. They have an autoimmune issue, bronchitis, type one diabetes. They're taking Lipitor.

They're taking insulin.

That's directly from them, and that's gonna stay there unless they change it. Okay?

Free form information, even things that are not picked off a list elsewhere, all of that information is there as well.

So what it is really is a way of thinking about this stuff as not being, you know, my job to kind of shepherd that information around.

Okay?

So an example of zero information loss, you know, is how I think about these things. And, by the way, things like things like, artificial intelligence interpretation of images is not it's very shortly will not be only limited to radiographs.

Things like, microscopic slides, pathology slides, oral pathology images of lesions in the mouth, that is all it's it's it's getting close. Okay? We're not there yet, but in the practice lifetime of most of the people watching this now, that will absolutely be a thing that will be available. Okay?

And, again, the accessibility I bring this up again because this is look at the the over here, I AI, somebody with a tongue lesion, that needs to be biopsied.

They see there's a saying, you know, when you're in driver's ed, you know, speed kills, but speed doesn't kill in pathology in things that are serious like this. Delay does. And we have patients who will avoid getting done what they need to get done unless we make it so smooth and easy for them that they can just flow right into treatment. This is an this is a very functional thing to be able to do this. This is the way that we should be able to communicate with our patients. It's the patient's interest not to lose that information.

So today, I'm with a patient, and we see a lesion. Could be on a something in in the mouth. It could I mean, obviously, it's the mouth. It could be something on the tongue.

It could be something that needs treatment. They maybe need endo. They need periosurgery, whatever it is. But AI identify a suspicious lesion, say, on the we'll take a photograph, a radiograph of it, and it'll be analyzed immediately, And I'll be able to see, is that something we need to do something about, or is it something that I'm not quite as worried about?

Okay?

Photos, I can share with the specialist now. I do this in my office right now. I have at least two of the five specialists that I work with on a regular basis have a direct access into, one one to their practice management system, one directly to them, where I can send an image and say, hey. Can we chat about this? And, usually, within five or ten minutes, I can have communication with them about what they think about it. Very helpful.

Right then and there, I can schedule a patient for treatment. If I'm gonna do something about this, I can schedule it right there and there. If the specialist is going to, we can do that in the treatment room.

Clinical note, very important.

I use an artificial intelligence interpreter for almost everything I do. I have a little microphone. I explain it to the patients. We don't record your conversations.

It's directly interpreted by a computer that helps me not miss information when I write my note, and I have no need for the patient to think I'm infallible. I have not found that people are thinking, well, you can't just keep you need a computer to help you do that. No. What I find generally is that people are really happy that I'm trying to be so thorough as not to miss anything.

Because in medicine now, in dentistry, certainly, everybody's in a hurry. You know? We're we're under a lot of pressure.

We're we're under a lot of efficiency pressure. You know? If you're practicing in network, you gotta deal with insurance stuff. You know?

You have to not waste time because time is money, and it is also patient care and patient wellness. So when you hand a patient a referral slip and say, okay. Call this person. How often do they go?

Not often as often as you think they do. When it gets managed right there in the treatment room, it does. Okay?

Right. And the last thing I have to do, I still have to see my next patient. Okay? So all the stuff that has to happen to get this person the care that they need, it can't screw up my schedule. I have I still have other people I gotta take care of, and that's what I'm gonna do. Now with all this stuff, this is usually when I get started questions getting questions about the elephant in the room.

And my joke about it, there's not really an elephant. It's a hippo.

That's hippo the hippo.

No by the way, I can do this on a webinar or live because I never hear anybody laugh at that joke, but I still like it, so I'm gonna keep telling it.

There are a lot of things we have to comply with that are beyond the scope of this course. I'm just gonna talk about a couple of them.

Hypophobia is a a term I coined for a mental illness that we have in our profession, which is, this fear of doing anything with people's information even if it helps them because of some HIPAA problem. You have to be very specific, and you have to understand what HIPAA is and what it's not. It's not really meant to inhibit treatment. It's meant to get patients the things that they need, safely.

Okay? So we shouldn't have an irrational fear of communicating with a patient. Any of these things that you're gonna use need to be in your risk assessment very quickly. We're wrapping this up.

We're coming to the end of some of this stuff, but this is my image for a risk assessment. And you probably have one written down on a a dusty book in your office someplace. But if the, office of civil rights from health HHS is what we call the HIPAA police ever comes and comes knocking on your door, the first thing they're gonna ask for is a risk assessment. It's like when a police officer says to you, license and registration.

And if you say to them, gee. I forgot where I keep that, then you got a problem because they're all of a sudden really keyed into AI does this person not have a license and registration? So your risk assessment, if you haven't looked at it in a while, anything that you have that's cloud based, AI based, these things should be included in it as, as things that are places where patients' information can be, can be stored and shared.

Business associate agreements you have to have. Okay? So here are there's a ton of companies. Curve and Pearl are the ones we're thinking about today. Here are some of the others companies that I work with that have online access to my information. I have a business associate agreement, which is a piece of paper saying they've agreed to comply with HIPAA, protect the information, and to notify me if anything goes wrong.

That covers me against an awful lot of problems. So if you're involving yourself with a cloud based company or a company that does AI stuff and they don't offer you a business associate agreement or if you ask for one and they say, oh, you don't really need that, I'd be pretty dubious. Okay? Because when these people come knocking on your door, the HIPAA police I think of them as agent Smith, you know, in the matrix, and, even though they're not really.

I I've met these people. They're they're they're just doing their job. They wanna make sure that people are kept safe, that information is secured, and not only, protected, but also given out where and when it needs. The most common HIPAA violation, by the way, I'm gonna leave you with this thought, the most common HIPAA violation in twenty twenty three through current is failure to failure to share patients' information properly when they request it.

They ask for a copy of their records. They ask for something to be sent to another doctor, and we don't do it or we don't do it in a timely fashion. That's actually the most common thing that people complain about.

Okay? So this aspect of artificial intelligence and cloud based computing as things that provide smoother access to information getting where it should be is actually not as much a security risk as a security benefit if you're careful in using it properly.

There's a lot more to this subject. I've tried to touch on the basic points, but we're almost done here. I do wanna I do wanna leave some time to take, take some questions because, usually, there are a number of questions. Some of them always with these, there are some questions that are very similar from one group to the next and some that I've never heard before, which is great because that always helps me improve this course and make it better in the future.

I really do want to once again pass my thanks on to Pearl and to Curve for sponsoring this because I I think it's important to do it. There's a ton of wonderful stuff coming at us in dentistry. We just have to be able to evaluate it properly.

If anybody has anything they wanna ask me beyond this, email me. That's my email address, mitchell studio fifty seven dental dot com. I get a lot of emails from a lot of people, and I am happy to answer them because I also learn from people who ask me questions.

So that being said, I am gonna let, Sheela and the Pearl and the Curve people take back control of this webinar and start getting some questions, organized, so we can answer them.

Thank you so much, doctor Rubinstein. I will share my screen here in just a moment. We are getting so many wonderful comments.

Sounds like everybody's very appreciative of what you're sharing with us today. Something we really need to be mindful of, and ways that you've shown us to find resources to be able to take those steps in the right direction. Because at the end of the day, we wanna make sure that this is not a headache we have to tackle at any time. So thank you for all of that.

Those of you moving into thoughts about cloud dentistry, as well as AI in general, we would love to answer those questions for you. I do want to share my screen, and then also, Haley's gonna jump on here in just a moment.

And let me just, get this started. We would encourage you to put your questions in the chat. I'm seeing some come in, and we're going to be able to address those. A lot of people have questions about, these HIPAA things you were talking about.

And just as a quick reminder, you know, inside of having all of these things HIPAA compliant, it's also mindful to be thinking of how can we start using different products in the market AI AI. Right? Having the ability to show the image that doctor Rubinstein was talking about is really fascinating for a clinician to be able to have that second set of AI, you know, similar to spell check. Right?

We all know how to write. We all know how to diagnose.

But to have a little red line or a red dot remind you, can you take a closer look here, like number three, especially when that patient comes in for number thirty, right, and we're talking about focusing on possibly a crown or something. But an extra set of eyes that doesn't get tired, doesn't have diagnosis fatigue is nice. And the important part here, I think, as a clinician myself, is to be able to turn that to our patient, there are two very significant things that happen. Number one, they are starting to understand those areas that are no longer shades of gray.

Right? And they can accept dentistry more often. And then the second one is this was an interesting silver lining when I was using Pearl, which is AI used to stand there and stare at my radiograph, and we know that sixty four percent of patients have no idea what, they're actually looking at, but I still did that. But when I used AI, I was able to then present the dentistry a little bit quicker.

Like, this area is light pink. It's not moved into the enamel. This area is dark peak. It's moved past the enamel.

We wanna take care of that. That bought back so much time for me as a presenter to be able to open up the the remaining time for my patient. They were asking more questions because they were more informed.

Now second opinion is one of our features. We have two additional features that help with practice management and insurance verification.

But what I do want to, let your team know today that you guys that are here is there's a couple things.

We love second opinion, and I love even more that you can have it inside of Curve because it's a seamless integration.

So there's no workflow change, and that's really what makes this a hundred percent utilization.

You're able to take your imaging just like you do, use your sensors just like you do, review, and show patients X rays, but you have this nice little button right in the middle where you click the button and you're able to bring this directly into your imaging system and have the AI overlay within seconds. So that's really exciting when we were able to integrate with our partners and move into that seamless integration. Right? Pro second opinion is available for multiple imaging system and, again, works in seconds, but also having it inside of your imaging system is a huge win.

So I will invite you to have a demo for your team. You know, sit down, invite your team, have your clinical team and your front desk team thinking about how do we use these images, can we use them for case presentation, can we use them for claim submission? And, also, thinking about the environment of moving to cloud. Right?

So I encourage you to scan one of these or both of these, hopefully.

Have that time with your practices. And I know Haley wanted to jump in as well and give us some more information about curve, but feel free to again, we'll be back in just a second for some questions.

We wanna make sure that we AI, I'm seeing these questions pop up quite a bit here, and we wanna make sure we get to doctor Rubinstein. So, Haley, go ahead. Take it away for us.

Of course.

Alright. So I'm gonna share my screen, and thank you, doctor Rubinstein. You brought up a lot of great points that, curl in. We also, as our partnership, does resolve for a lot of practices we talk to. So each and every day practices come, I talk to them about how we can incorporate their their clinics, opportunities, and one of them is the cybersecurity.

And because we're cloud, we can be logged in anywhere, essentially. But what you're seeing right now is the user interface for what we have here at, Herb. And, really, AI know that doctor doctor Rubinstein did speak about the AI.

But to the right hand side, it gives you information quickly without having to memorize any icons. So it's user friendly too for adaptability in your practice.

Now not only do we have, you know, your basic practice management system, we also have patient engagement included where you have two way texting. You have that free ability to go back and forth with your patients. They can even send you images and directly send it straight to their files and letters. You can have campaign messages that go automatically out to a patient to remind them. And even when the patient confirms through that message, it will actually go back to the schedule instantly.

Not only are we doing patient engagement, but alongside that is the patient of today wanting to schedule and book online or at least request. But as practices do know, we want control. So having control systems is really giving parameters around patients and what they schedule and how. So then your team is met with exactly, like, this appointment, an outlined appointment to know that this needs to be verified and giving that patient experience a long time with your AI and safety around that.

Now on top of the patient engagement, we also have easy charting. So the charting and AI imaging is all included here where AI know that Sheela showed you we have the images where once they're ready, we can actually load it for that second opinion, and then you can present it to a patient to exactly what they might be looking at and explaining it to what they know and understand it to be. A more visual learners. I think we all have been visual learners our whole life. Right?

From seeing an apple and saying this is an apple and then memorizing that that is an apple. So same thing with the patient. You're sitting there showing them exactly what you're speaking to instead of it being something that you're just speaking at them with.

Now on top of the imaging, we can, of course, have that charting where you have treatment plans, forms. Doctor Rubinstein, did explain to you about how the patient fills it out in a cloud system. We'll luckily incur when a patient fills out a form, all that medical alert information populates.

So AI he mentioned too, if they made any adjustments to it, you are understood and it's accurate.

We want it to be accurate.

And then, of course, we have built out insight dashboards too for your practice. So then you can really see and deep dive into what's going on in a more roundabout way and high level. So then you can accurately, you know, market better or even know exactly the type of treatment you might have outstanding.

So, really, we just have this all in one system. We have it to where really anyone can come in and control your day and really customize how you want your operations to be in a very secure way.

Thank you, Haley. Mhmm. How much has changed, doctor Rubinstein, since we started doing dentistry.

Great. Yeah. I I I say this AI said it yeah. It's kind of funny. I tell people, you know, everything's changed since you graduated, and and it doesn't matter whether you graduated two years ago or yeah.

It's just constantly. It more now than ever. And we we get nervous about it, but it's also, like, wonderful. I mean, there's just so much that we have available to us.

We just didn't have before. We just you know, it's it's amazing, really.

Excellent. Yep. And Curve's done such a great job. So thankful for their partnership.

I am going to invite our director of partner growth, Kimberly Quishan, back on the call. She is, behind the scenes making this all work as well as monitoring the chat and making sure that the questions are, delegated accordingly. So, Kimberly, go ahead and take it away. Let's see what the the teams here would like to know more about.

No. Perfect. And I wanna say, thank you, doctor Dzinc. I've noticed you've jumped in and answered some of them, but there were some questions specifically around the generative speech programs.

Yeah.

I think it's great to have it AI. In understanding of, like, the technical side of can you dig in a little bit to how you're making that happen?

Sure.

The first thing I point out is that I do wear a little microphone on my lapel. And if a patient is experiencing it the first time, I always tell them that I'm recording the conversation, but we're not keeping a recording of it. It's just to and if they don't want me to do it, I I haven't had anybody object to it. Usually, they're, happy that I'm trying to be thorough.

There are actually a number of things that can do this for you. What you cannot do is use something like chat GPT or some other you know? Because without that business associate agreement, without that agreement with a health care qualify a company that does this in a HIPAA compliant way, I I don't even wanna go. You you can't do that. So there are fortunately a number of companies that have things that do this.

I've worked with a number of them. They all work pretty well.

One that I worked with that was specifically dental was called Bola AI.

There are ones that are specifically for medical use.

One of them is, Heidi, h e I d I.

They they all work fairly similarly. They're all trainable.

You do have to go and do a bunch of notes with them and then correct them afterwards, and it gets to understand your own style. But the the utility is incredible because, literally, I'm not even narrating.

It will be record it it'll be just hearing everything that's happening if I'm having an interaction with a new patient or somebody with an emergency. And I I should have shown an example of it, but it you know, I AI have one. After you're done with the interaction, you sit down behind your desk, you pull it up, and you tell it what kind of you want a SOAP note? You want a referral letter?

It takes the information that was salient in that interaction and puts it in that form. And I will tell you it is not perfect, but it is way better than me doing the note from memory fifteen minutes after the encounter with the patient. I routinely read the notes and see things in them that I would have missed or I would you still have to read every word of it because AI can have weird things that it just does occasionally, but the number of corrections is is getting smaller as I've been using it. So I hope that answered the question reasonably well.

It's very little risk. Try it. You know? In some and if you don't like it, don't use it.

But it's I tried it thinking I wasn't gonna like it, and now I can't live without it.

It's so funny. When you mentioned that, it always makes me remember, whenever I'm trying to type in my my autocorrect, I'm trying to say good, and it keeps correcting to food. I'm like, good grief.

This is just too much. But the reality being, I would never want to remove it from my, from my iMessaging for sure. That's cool.

But speaking of it's funny you use the analogy, and and I just did also of spell check. There was a chat. Sheila, this one's probably gonna be for you, but the cost of adding Pearl, and, the doctor messaged it as spell checking the X rays, which I thought was cute.

I like that. Yeah. Yeah. Sheila, you can take that one.

Sure. Yeah. So, right now, with second opinion, we're starting roughly on our standalone product around three forty nine. So encourage you again to book those demos. There's always specials, and, I'll also let Hailey chime in as well.

Yeah. Please do book the demos. You'd be able to see the integration for sure, and then we would actually give you a full quote breakdown specific for your needs at your clinic too during that time.

Perfect. Thank you. Okay. There was, a question in the chat that I think is gets into detail, but doctor Rubinstein, I'd be curious about your thoughts. It the question refers to using a backup locally and in the cloud. What are your versions and, like, what what are some watch outs that anyone would need to be, aware of if they're using this sort of hybrid approach to backing up? What do you recommend, or what insights can you provide there?

Yeah.

Basically, what I recommend is that whatever it is, you need to test it and make sure that it works because anything can fail. And it was it was interesting when we had this issue with hurricane Sandy that we went to it wasn't just people who didn't have an appropriate backup, but it was some people's backup wasn't formatted properly. The IT people hadn't accounted for every and and they didn't work.

What I do is I now have all of the main, sources of of information are basically in, Pearl and in Curve and one or two other databases. They're all based in the cloud now. I don't have a local backup of any of it, okay, which is a little scary at first. For maybe the first six months, I maintained a local backup on my own disk, on my server in the in the in the office.

All of the stuff is downloadable, Curve, for example. I mean, at any point you want a copy of everything, you can download it, and you can save it somewhere in a closet if that makes you happy and it makes you feel better.

Some people do.

So that's that's possible. But I I no longer have I had a hybrid system for a while where I had my own backup, and then I had a cloud based backup service.

That service AI got rid of because this the, the companies I'm working with now all have it built into their functionality.

But I I have no problem if anybody wants to keep, in addition, their own local backup. Just make sure that it's encrypted and protected because when you have it, you have to protect it. Okay? Because if somebody walks off with your computer and it wasn't encrypted, guess what?

All of your information is now in the public domain. It's a it's a it's a breach. You have to report it. That can't happen if you don't have it in your office, which is why I don't have it in my office anymore.

I'm trusting it to people who I believe are way better at taking care of it than me. I'm good at fixing teeth. I'm good at taking care of people. I mean, I'm very confident in those things.

Shepherding information around the Internet is it's not my core competence, and it's never going to be. So that's why I've stopped doing it.

Sorry. It took me a second to get my, thank you very, very much. Took me a second to get my my, mute off.

There were a couple of people who raised their hands, but it's really best. If you do have a quick question, can you just plop it into the chat or the chat box? I've seen them come up.

Otherwise, Sheila, I know we're right at time, so I will I'll hand this back over to you unless the a couple come in right now. I'll keep my eye on it.

Excellent. Well, I just wanted to really thank everyone for joining us. We have ongoing webinars at Pearl each week, and we hope you'll join us again. Doctor Rubinstein, thank you so much for your knowledge and spending time with us.

My pleasure.

Be impressed.

Really AI pleasure. It was a lot of fun. I really enjoyed doing it.

Thank you for being here. And our partners, really thankful to have you. Haley, thanks for joining me.

Of course.

And and we do look forward to having all of you back on our webinars. Feel free to check out our website.

Kimberly, I will thank you again for helping us. And if there are no other questions, we will see you soon.

Goodbye, everyone. Have a great day and a great weekend.

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