Preparing for Implementation

Teledentistry can be employed and is proven beneficial for oral health promotion, education, diagnosis, and the monitoring of oral health conditions (Sharma et al., 2021). Given the unique aims of teledentistry implementation, there is not one workflow structure that fits every program. Once a team establishes an initial workflow, the improvement opportunities do not end. A future state process map helps manage the changing environment and is part of ensuring continuous quality improvement.

Assessing Readiness

Catalyst staff developed a School-Based Teledentistry Readiness Assessment (SBTRA) to Through the process of creating an infrastructure for a new initiative, it is essential to understand the knowledge and readiness of each person to implement teledentistry.

The readiness assessment establishes baseline and outcome measures and builds out project teams. Based on the readiness assessment results, you can inform future educational opportunities and areas needing attention. The Catalyst team created the SBTRA tool based on staff and external clinical expertise. The tool’s results assist the Catalyst staff in providing education and resources regarding teledentistry implementation and sustainability.

Catalyst staff developed education and training modules based on identified gaps from the SBTRA and the implementation of best practices. The readiness assessment also identifies possible implementation challenges with new procedures or processes for each team.

The SBTRA focused on:

  • People’s capacity includes staff’s knowledge, skills, and motivation to adapt to change.
  • Organizational capacity includes structures for system change, internal communication, and establishing clear roles and responsibilities.

Be specific. Include patient populations and measurable outcomes. Design a workflow and process map as a team. 

What specific tasks does each staff member get assigned? Think from start to finish – scheduling the appointment through follow-up:

  1. Who will collect patient/caregiver consent?
  2. How will the appointment be scheduled?
  3. Who needs to be present for the appointment?
  4. Who will record the notes and track the next steps?
  5. If asynchronous, when will patient photos be reviewed?
  6. How will you train dental and medical staff in the new technology?
  7. Who needs to receive training?
  8. How will you provide technology-related education and assistance to patients?
  9. How will you follow up with patients? (Via the patient portal, over the phone, via text message, etc.)
  10. How will you inform patients of the available new teledentistry services? (Social media, mailings, radio ads, billboards, etc.)

The purpose of a memorandum of understanding between a healthcare entity and a school is to formalize the terms and conditions under which parties shall work together to support the provision of specific healthcare services in the school setting. The document is typically not a legal document, although all organizations may seek legal counsel to develop and sign the document. The MOU usually clarifies a cooperative/collaborative arrangement involving two or more organizations, indicating how they will work together, representing the goodwill of each organization, and helping define their expectations, roles, and responsibilities. The MOU addresses such things as the following (not exhaustive but illustrative)

  1. Foundational written agreement to establish policies and procedures
  2. Purpose of the collaboration
  3. Responsibilities of all parties
  4. Billing and compensation
  5. Confidentiality
  6. Termination provisions
  7. Scope of agreement
  8. Liability

Consent Forms

Consent forms for the school-based teledentistry program should align with protocols and procedures used in your brick-and-mortar clinic. Consent forms should be concise with health literacy in mind, including simple language vetted by the school staff and families and translated based on the patient population. Consider adding a Q.R. code and a workflow with the school nurse that includes having multiple ways to share the consent form with the parent/guardian if the child does not have one on file. Additionally, consider sharing information about the program and consent in the following:

  • Caregiver newsletters
  • Open houses
  • School website
  • Inserts in student folders
  • Communications from school staff

Defining Services

  • Oral health education and referrals: a professional educates, guides, and refers patients to local dental providers.
  • Emergency triage: providers can understand the severity of a case to determine the next steps, including scheduling an in-person visit or prescribing appropriate medications.
  • Consultations or patient monitoring: save patients a trip to the office and keep the dental chair available for hands-on procedures by conducting pre- and post-surgery consultations through teledentistry.
  • Limited oral exam or preventive services: dentists can make initial diagnoses, establish treatment plans, or authorize remote services.
  • Community-based comprehensive care (virtual dental home): members of the care team deliver comprehensive oral health services remotely (at school, different clinic locations, long-term care facilities, designated community centers, etc.) through authorization and guidance of providers using teledentistry.

Financial Planning

Understanding the allowable uses of teledentistry in your state and which codes/procedures have reimbursement is essential. The development of sustainable income streams requires a good understanding of the capacity and capability of staff to provide services to patients. The clinic billing department facilitates all sources of revenue. Clinics should work to diversify their funding streams to ensure sustainability and the flow of under and uninsured students. Example funding streams are listed below:

  1. Medicaid
  2. Private Insurance
  3. Sliding fee scales
  4. Grants and fundraising

In some states, Medicaid School-based services allow school districts to receive partial reimbursement from Medicaid for qualifying health and related services provided to Medicaid-eligible students.