The New Dentist Blog

Guest post by Dawn Christodoulou, President/Owner of XLDent

Every day, news reports show us the devastation that can be brought to any doorstep by Mother Nature or other unplanned situation. Our best defense against this is to ask ourselves, what is our plan if such a thing were to happen to our dental practice?disaster plan checklist (002)

Your answer should be a disaster plan. This is something that should be in writing, reviewed at least annually, naming a specific person (such as your Office Manager or another person) entrusted with following the practice owner’s wishes, bringing some semblance of order to the chaos to come.

There are many examples of disaster that can throw your practice into a tailspin.

Fire, flood, or other natural disaster:

  1. Make sure dental staff members are accounted for and safe. Have a designated staff member (and a back-up person) activate your prepared, written Emergency Action Plan with appropriate contact information for the office team and patients.
  2. If you are aiding in the cleanup process, be sure to wear appropriate personal protective equipment (PPE) to protect against water-borne illnesses and aspiration of materials.
  3. If possible, make arrangements to pay staff right away to help them cover basic needs for food, shelter, and any medical treatment they may need.

Theft or embezzlement:

  1. Review protocols surrounding passwords and security. Every staff member should have their own login credential assigned and known only to them. For example, XLDent practice management software recommends security groups which clearly identify staff members and access permissions.
  2. Review security logs. This is where you will find record of every transaction performed for each staff member’s login. It’s good practice to periodically review these for inconsistencies.

Unexpected illness or death:

  1. Make sure Standard Operating Procedures are written and up-to-date. They may be needed in the event a staff member’s duties are to be completed by another member or even by a temporary replacement hired from an outside agency. Be familiar with local dental staffing agencies that may be a resource for temporary administrative and clinical employees.
  2. Know who is designated to handle the estate of the doctor and if there is a document (such as a will) to provide a path for transfer of ownership.

One area not yet discussed is your practice data. Your disaster plan should include a data recovery section. Data recovery is critical to keep your business going after a disaster event has occurred. In many of the examples, office computers and equipment may be damaged or lost. Knowing your data is safe and secure is peace of mind you don’t want to risk. A reliable managed data backup option is XLDent’s XLBackup.

In all cases, remember your best bet is to be prepared. With a proper disaster plan, an unplanned sequence of events can quickly be turned into a planned response for you and your team.

To connect with XLDent, call 800-328-2925 or email xldentinfo@xldent.comDawn

Dawn Christodoulou is the President/Owner of XLDent. She has more than 25 years of experience computerizing dental offices and helping both new and established practices streamline electronic workflows for increased efficiency, improve patient engagement, and achieve maximum profitability. Dawn is also a member of ADA SCDI Working Groups 11.1 Standard Clinical Architecture and 11.9 Core Reference Data Set.

Guest post by Stevan J. Orser, DDS, AAACD

Years ago, at a dinner meeting with my two partners, I proclaimed the need to advance our cosmetic dentistry skills. Cosmetic dentistry was the hot topic in our profession, and the cosmetic programs at seminars were packed—many top lectures had standing room only. This was true of the courses at the American Academy of Cosmetic Dentistry’s (AACD) annual scientific session, but we knew if we wanted to be the best, we needed to learn from the best.

I made sure to register early and secure my spot at the next AACD meeting. At that meeting, I heard a lecturer say: “During one’s career, it is really helpful to have a mentor.” He defined a mentor as “someone who is already where you want to be. They’ve done what you’d like to do.” I considered my options, and with much anxiety, I contacted the chairman of AACD’s Accreditation process. The truth is, I didn’t know him. I had only heard him lecture and saw his amazing cosmetic dentistry slides in that lecture. But I knew he was the best person to reach out to.

I was shaking in my boots when I met him for early morning coffee. I did the only thing any of us can do to initiate change, I just showed up. The meeting went great, and he was generous with his time and ideas. Later that day, I signed up for the AACD Accreditation Written Exam and began the Accreditation process.

Generosity from the helpful people who have gone ahead of me has been a constant experience I’ve had with the AACD. It’s an organization with so many people willing to help and share. You may feel they’re more advanced, yet they will help you and they believe in you. We do things beyond our comfort zone because others know we can. It was the belief in me and the comradery that’s made my experience in AACD like no other organization. Twenty years later, my AACD colleagues remain a major positive force in my career.

The AACD and its members are here to serve and support you, getting you where you want to go. New members and first-time conference attendees are shepherded into the community at the annual scientific session with special events and opportunities to connect with veteran members. AACD affiliates offer local opportunities to connect, and involvement in AACD committees offers a unique opportunity to enjoy comradery with like-minded professionals while supporting the organization and its members. The AACD Accreditation process is the single most rewarding program in which I have participated. Years later, I now mentor others and have the honor of guiding several people to their peak of becoming Accredited Members.

At the American Academy of Cosmetic Dentistry, we’re all in this together. But to be a part of it, you just have to show up.

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In addition to creating life-changing smiles at his Arlington Heights practice, Dr. Orser teaches other dentists at the prestigious Eubank Teaching Institute in Plano, Texas and is a visiting faculty member at UCLA. He also currently serves as an accredited examiner for the American Academy of Cosmetic Dentistry.

Guest post by Aaron M. Layton DDS

Three years ago I purchased my practice. A nice, modern practice with a solid patient base and long-term employees – everything I dreamed of. But it wasn’t more than a few months before I knew managing a team was going to be my most difficult task to date. (You think Boards were tough…ha-ha-ha.)

I dove into every HR book in the Barnes and Noble business section and any Webinar associated with keeping a team happy. One thing stuck out: You are more likely to be sued by an employee than a patient. This bothered me, so I armed myself with the best possible thing I could imagine, KINDNESS.

I’m a nice guy. I made accommodations for employee medical appointments and vacations. I increased benefits and salaries. I was the nicest guy around. Who would ever sue the nice guy?  But I was wrong – very wrong in fact.

On my birthday of 2016 I was sent a letter from my State Legal Board saying a former employee was claiming she was terminated because of her mental health which made her disabled. I had wrongly let someone go who was disabled? After the shock and a few pieces of birthday cake, I located an attorney and began the process of disputing the claim.

As of today, I spent $6000 dollars, one appeal, and countless hours worrying about what could happen.  In the end, the claim was dropped with no marks on my record and all I lost was sleep and money.

From this recent experience I learned two important lessons.

1) Nice guys do get sued, and actually more often. When you’re the nice guy you often provide everything your employees want.  You make sacrifices and adjustments – in fact, you’re better than Santa Claus. If things don’t work out, these employees just want to keep getting at any cost. Keep an employee manual and stick to it. If someone breaks an agreement, hold them accountable. It doesn’t hurt to be a nice guy, just be a nice guy who follows all the rules. It’s good to be nice, but more important to be fair.

2) Everyone needs an Employment Attorney. I thought an attorney was only needed when problems arise, but just like in dentistry, a good Employment Attorney can provide preventative care to keep you out of trouble. A wise old dentist once told me, “When things don’t work out, just call it education.” This past year, with my education budget I got a live course in employment, handbooks, and dealing with disgruntled employees.

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Aaron Layton, DDS, is a 2010 graduate of Indiana University. He completed three years working at a large group practice in Vermont before buying his own practice in Fort Collins, Colorado, where he currently works and resides with his wife and their four children.  

Guest post by Nelson Kanning, DDS

Why would anyone boast about being a loser, especially if losing involved money? Who in their right mind would consider losing money a gift? Most dental practice owners and even associates would throw a fit at the idea of setting a goal to lose money. But, I’m proposing being a loser can make sense, particularly if you’re a new dentist.

Until recently it was hard to admit that being a loser is one of my greatest gifts. The majority of my experience with teams has been as a loser. High school football; we lost. I played for a Division I football team that was bowl champ the year prior to me joining. Then, we lost. Losing used to be tough. However, now I’m finding being a loser is a joy.

I’d say this revelation happened about six years ago. I was sitting in the audience at the American Academy of Cosmetic Dentistry’s (AACD) annual scientific session in Seattle. During one of the opening sessions, I became curious about the awards being given to offices who participated in their Whitening Challenge. Offices who participate in the AACD Charitable Foundation’s Whitening Challenge agree to donate a portion of profits from their whitening to the Give Back a Smile program, which restores the smiles of survivors of domestic violence. And one office received the award for donating the most profit from whitening to the AACD. That office’s benevolence inspired me. Their team was excited about the program. The doctors felt good about the service to their patients and to a much greater cause. That day, I realized that program had to be part of my practice.

It seems fit, here, to reveal that dentistry is my second career. Through my twenties, I made a living as a professional fundraiser asking people to donate money to leadership programs, support scholarships, and buildings for a private liberal arts college. During that time, I was always fascinated by the joy the donor received knowing their money was making an impact for someone deserving. The Whitening Challenge has given me that same feeling of joy. It is a whole lot more fun to give money away freely than it ever was to ask for money.

Does donating increase my bottom line? Who knows. But ultimately, who cares. You’re not a dentist solely for the profit. Remember, you said it yourself in your interview: “I really want to help people and make a difference.” Boom, here is your chance. Finding a cause for your practice, like the Whitening Challenge, can make instant connections with skeptical patients as well as entice new patients into our chairs. It has given my team a cause they are proud to stand behind and excited to share with our community. However, it mostly reminds me that when you do the right thing, despite your overhead, your monster loans, and your financial ambition, being a loser just feels good.

AACD.Blog.4.7.18.Kanning (002)Nelson earned a BS at William Jewell College, with an emphasis in Leadership and Biology. After graduating, he served two years as a leadership trainer and capital campaign consultant for Sigma Nu fraternity. Although he enjoyed his mission-driven work in the non-profit sector, Nelson decided to pursue his original desire for a career as a dentist.

Dr. Kanning served on the AACD Charitable Foundation Board of Trustees from 2015 to 2017 and served as the chair from 2016-2017. His office has participated in the Whitening Challenge since 2013 and won the Bright White award in 2014 for donating the most whitening proceeds of all participating practices in that year. Since his office has started participating in the Whitening Challenge, they have donated nearly $25,000 in whitening proceeds.

 

Guest post by Dawn Christodoulou, President/Owner of XLDent

Practice collections have started the trend towards a steady drop in what dentists are collecting for their work. Without a thorough understanding of insurance benefits and collection policies, paired with a good communication strategy, the ripple-effect on staff morale and productivity can exacerbate this decline.

Insurance Collections

Submitted claims is a first step to insurance collections. If weeks pass before anyone confirms that claims were received and being processed, that time has been lost. Insurance carriers do not make a habit of contacting dental practices to let them know if additional critical information or documentation is needed. Electronic claim services embedded in a practice management software are your first line of defense. For example, in XLDent, with one-click, claim status tracks claims instantly; easily avoiding costly delays.

Fee Schedules XLDent.TND.Blog.Electronic.Claims.Status.3.21.18.jgep (002)are a critical part of making sure your office is making accurate contractual adjustments. EOBs are not always the easiest to decipher, especially for staff with little or no experience with insurance billing. Ensure your team is prepared with payer contract details and fee schedule information so they can post accurate adjustments. Patients will appreciate attention to this detail too, so that your treatment plan estimates are as close to accurate as they can be.

Patient Collections

Every practice should have a written financial policy that lays out the terms involved with insurance processing – what is filed, by whom, and where the responsibilities lie. Payer structures and guidelines can change, so review this policy annually, and adjust it as needed. Any changes should require an updated review and signature from your patients.

It’s no surprise that Standard Operating Procedures (SOPs) guide your practice through critical business processes, and collections are no exception. Establish a collection’s timeline, which includes number and frequency of communications, and consequences for non-payment. Practice administrators should adhere to them, but not without exception. Administrator’s should bring any individual patient concerns or circumstances that need review to the practice owner for further discussion.

Think about how patients want to interact with your practice nowadays, including making payments. XLPortal is a comprehensive solution allowing patients to not only make payments online, but also verify and update medical forms before an appointment, view upcoming treatment plans, and more. Convenience can often be a compelling factor in getting that payment sooner rather than later.

The best way to tackle collections head on is to start with the basics. There is always an opportunity to turn declining collections around, and practices just starting out should strive to establish successful procedures from the start.

To connect with XLDent, call 800-328-2925 or email xldentinfo@xldent.comDawn

Dawn Christodoulou is the President/Owner of XLDent. She has more than 25 years of experience computerizing dental offices and helping both new and established practices streamline electronic workflows for increased efficiency, improve patient engagement, and achieve maximum profitability. Dawn is also a member of ADA SCDI Working Groups 11.1 Standard Clinical Architecture and 11.9 Core Reference Data Set.

Guest post by Brian Baliwas, DDS

Four years ago, I took a risk as a new grad and joined a group practice in San Francisco to try and build a patient base of my own. A few trusted mentors supported the idea and gave me the confidence that building something for myself straight out of school was a good idea.

I saw a staggering FIVE patients in my first week. My days were full of hygiene and down time, but I kept a positive outlook throughout it all. I knew that if I did good work and treated people like family, this slow start and double-digit patient count would be temporary.

Like any dental startup, the priority was getting patients in the door. When I wasn’t with patients, I brainstormed different ways to market my practice with a limited marketing budget. Today, my patient count is in the quadruple digits, and I believe social media has played a significant role in that growth.

Social media gives dentists an opportunity to show potential patients something no other type of marketing can: a glimpse of who they are behind the mask. Dentists who treat social media like traditional advertising and post about whitening specials and Invisalign discounts miss out on the opportunity to really convey their personality and practice philosophy.

In addition to growing my practice, social media has allowed me to connect with people I may have never met. Aside from patients, I’ve met other dentists, specialists, dental students, laboratory techs, and dental product reps. I use it to stay connected with people I meet at conferences. I even met the person mentoring me towards AACD accreditation, Dr. Adamo Notarantonio (@adamoelvis), through Instagram!

The question you must ask yourself when starting a dental social media account is: what do you want to share and who are you targeting?

If growing a practice is your goal, don’t get caught up focusing on irrelevant numbers. Patients don’t (directly) care about your follower count, follower to following ratios, how many likes you received, or other meaningless social media statistics. Focus on content and providing information they would find valuable. Nothing else matters.

If you have a great personality and provide honest dental care, your future patients deserve to know! Take pictures of your office, staff, patients and dental work (with permission), volunteering, CE courses, hobbies, humor, family, and individuality. Share who you are… and then share some more.

AACD.BLOG.3.7.18.BrianBaliwas.photo (002)Brian Baliwas (@sfdentalnerd) received his DDS degree from the University of the Pacific Arthur A. Dugoni School of Dentistry, where he graduated with high honors and was elected to join both Omicron Kappa Upsilon and Tau Kappa Omega dental honor societies. He is an active member of the American Academy of Cosmetic Dentistry and the Academy of General Dentistry, and maintains a fee-for-service private practice in San Francisco, California, with two locations near Union Square and the Marina district.

His practice philosophy is centered on conservative, highly esthetic, comprehensive dentistry that utilizes modern technology and techniques. Dr. Baliwas also teaches part-time at UOP in the Department of Integrated Reconstructive Dental Sciences.

 

 

Guest post by Dawn Christodoulou, President/Owner of XLDent

I have to imagine that most every practice has a 2018 goal of growth. Now it’s time to start implementing your plans so changes can take hold and start producing results. Goals are a means to keep everyone motivated and pushing for excellence. Investing in new technology can certainly provide advantages that make you stand out from the crowd, and get new patients coming in your door. Current patients will take notice too, and feel confident that they made the right choice entrusting you with their family’s dental care.

Let’s first talk about recall. Maybe it’s not your strong suit, but it needs to be! Seventy-five percent of your revenue comes in through your hygienists, and getting people scheduled is the first major hurdle to making that happen. There are many ways to improve what you are already doing to reach patients, but perhaps you would rather this particular problem would solve itself? Automated patient communications are the answer to the time-consuming and challenging task of reactivating dormant patients and reminding scheduled ones to come in. Using a customizable combination of phone calls, emails, and texts, front desk staff can better utilize their time interacting with patients and focus on patient experience.

Many offices gain or lose staff after the holidays. Either way, the start of a fresh year is a chance to review standard operating procedures, especially if they haven’t been updated in a while. SOPs provide guidance to each member of your team, so they always know what part of the workflow is whose responsibility. Better to lay out practice expectations at the beginning, so that your new, or re-assigned, team member fits into your practice like a puzzle piece from the start.

Faster and mXLDent.Blog.1.21.18 (002)ore accurate payment processing, clearer insurance benefit coverage, and electronic insurance payments (EFT) are a few focus areas for those looking to streamline payer and insurance services. To maximize these options, integration of the service is a must. XLDent’s integrated ERA solution not only auto-populates the payment amount during the posting process, but also the contractual adjustments from Electronic Remittance Advice.

One of the best things to do when there is a slow-down and the winter doldrums set in is to retrain or “tune up” your team. Webinars are a great way to kick this off, but on-site and live web training are important options to consider as well. They give you a more hands-on training that isn’t quite the same as watching a video. Whether it’s appointment reminder automation or staff education, this year, set out with your best foot forward for growth!

To connect with XLDent, call 800-328-2925 or email xldentinfo@xldent.comDawn

Dawn Christodoulou is the President/Owner of XLDent. She has more than 25 years of experience computerizing dental offices and helping both new and established practices streamline electronic workflows for increased efficiency, improve patient engagement, and achieve maximum profitability. Dawn is also a member of ADA SCDI Working Groups 11.1 Standard Clinical Architecture and 11.9 Core Reference Data Set.

Guest post by Dawn Christodoulou, President/Owner of XLDent

The modern dental office is becoming fully integrated into the digital age, with the ability to capture and analyze much of the data it generates on a weekly basis. Close monitoring can guide the Practice Owner to reflect on which marketing methods are generating the most leads, how successful collection efforts are, and production trends.

In a matter of seconds, a KPI (Key Performance Indicator) should tell you whether your practice is growing, maintaining, or starting to decline. XLDent offers a brand new KPI Dashboard feature to help you gather this data quickly, and formXLDent.TND.Blog.Dec.2017.Dashboard2 (002)at it into easy-to-read graphs, giving you a window to the health of your dental practice. This Dashboard is mobile-friendly and accessible from anywhere, anytime.

An analysis of your Clinical team can tell you several things:

-Production is the most basic building block of your business, so these daily, weekly, and monthly totals are a great place to start looking for trends, peaks and valleys. They can be useful to determine whether you should think about adding more staff to manage your patient care without delays or protracted schedules.

-Is the hygiene team making sure to schedule the next recall appointment with the patients before they leave the treatment room? Recall metrics need to be clearly visible, concise, and up to date.

-Are your recommended treatment plans being accepted, scheduled, and followed through or are patients not feeling confident in your team? Perhaps you will need to add education for patients who are unsure if planned treatment is truly needed.

-Are overhead costs crippling your ability to run a successful business? The materials and equipment you choose (and the method they are deployed) should be reviewed periodically, so that modifications can be made, where appropriate.

An analysis of your Administrative Team will point out the following areas:

-The number of new patients coming into the practice each month. Are they referred from satisfied patients, calling you because of a successful marketing campaign, and is your office creating the best experience once they come in?

-Are your Collections being handled in a timely manner? Not everyone is comfortable asking patients to pay their balances, so it’s a good idea to seek out the right staff person to tackle this roll.

With all this information at your fingertips, performance goals can be set and achieved. Practice growth decisions should include clear expectations of what your team is capable of, and what systems and positions may need to be modified going forward. Keeping track of your practice’s growth, and potential, doesn’t need to be a major time commitment. The new XLDent KPI Dashboard can provide a window into where you’re headed in just minutes.

To connect with XLDent, call 800-328-2925 or email xldentinfo@xldent.comDawn

Dawn Christodoulou is the President/Owner of XLDent. She has more than 25 years of experience computerizing dental offices and helping both new and established practices streamline electronic workflows for increased efficiency, improve patient engagement, and achieve maximum profitability. Dawn is also a member of ADA SCDI Working Groups 11.1 Standard Clinical Architecture and 11.9 Core Reference Data Set.

Guest post by Dawn Christodoulou, President/Owner of XLDent

Dental practice ownership has indeed been in a state of change over the last 10-15 years. The landscape of corporate practices and multi-owner practices is something of a norm. But it hasn’t always been this way. Single-owner private practices are evolving.

Why the shift?

Traditionally, a dental office consisted of one office with a single practitioner owner. Recent years have seen a trend towards alternate models, which include DSOs (Dental Service Organizations) and corporate clinics. To maintain a dentist-owned status while having the flexibility to expand your business, some are opting for a multi-location practice.

Corporate and large-scale DSOs often provide expanded services, extended hours, and other patient conveniences. Competing with these practices means you must be focused on providing premium patient care. This may mean creating a practice of specialty colleagues to provide all services “under one roof”. If you aren’t ready to own a multi-specialty practice, consider connecting with colleagues nearby to build a streamlined referral network. Patient experience is a priority and creating a practice of personal, patient-focused care will help you stand out from the competition.

What changes will you be making?

Owning multiple dental practices can be rewarding, exciting, and profitable if properly executed. Multiple locations can help to position yourself in a way that allows you to be more competitive which could mean double income potential, but also, double stress and increased overhead. To be successful and competitive you need to have done the proper planning to take on a second, third, or more facilities.

Infrastructure and operations are the backbone of any successful business, and your dental practice is no exception. As you look at your management software and elements needed to run multiple locations, you might first think cloud. The good news… you don’t need a cloud-based system to make this happen. The key is a robust practice management system that already has everything you need to run your multi-location business efficiently and effectively.

The XLDent replication solution helps multiple locations run seamlessly while utilizing one single database. Or, your preKPI-Dashboard2 (002)ference may be to keep independent data for each, while accessing XLDent at all locations throughout the day. Whichever you choose, your team will be able to run a cohesive, streamlined operation at various locations around town. Plus, practice owners can stay informed about the practice(s) with the XLDent KPI Dashboard. This bird’s-eye view lets you see current practice stats anywhere, anytime.

Whether you’re a sole practice or are considering branching out with a team of associates and specialists on board, your management software solution is one important factor in making it a success.

To connect with someone from XLDent, call 800-328-2925 or email xldentinfo@xldent.comDawn

Dawn Christodoulou is the President/Owner of XLDent. She has more than 25 years of experience computerizing dental offices and helping both new and established practices streamline electronic workflows for increased efficiency, improve patient engagement, and achieve maximum profitability. Dawn is also a member of ADA SCDI Working Groups 11.1 Standard Clinical Architecture and 11.9 Core Reference Data Set.

Guest post by Dawn Christodoulou, President/Owner of XLDent

As the owner of a practice starting out or a stagnant one trying to grow, you are faced with figuring out what impacts practice growth the most. When properly planned, three areas can help to maximize growth from day one.

  1. Systems

You’re likely not thinking about efficiency or productivity during your first days or weeks in business. With a handful of patients each day, you’re not faced with bottlenecks, communication gaps, or duplication of processes. Alas, you soon will be. Systems minimize gaps or overlaps in your daily processes. They are needed for productive workflows and profitability.

Create standard operating procedures (SOPs) early on. Doing so sets the stage for staff expectations, accountability measures, and helps you measure areas of success or needs for improvement. Early on, you are likely running your practice without a full team. You have an assistant also taking on the front desk role, because you’re simply not busy enough yet to hire a full-time admin team member. As you bring on new staff, a written set of SOPs will ensure each team member is prepared and knows their responsibilities. Systems should be created knowing they will evolve as your practice grows and staff roles change. XLDent provides each practice, whether just starting out or transitioning from another PMS, a core set of SOPs to start with. They are a fantastic starting point for those new to establishing systems, and are customized by each practice as needed.

  1. XLDent blog photo Mockup-12-19-16Reviews and Referrals

I doubt there’s a practice starting out today that doesn’t have an online presence from day one. From the day you open your doors, focus on creating a process for reviews and referrals. Nothing attracts new patients more than a healthy online rating and patients who aren’t afraid to tell others about their great experience. After a visit, ask your patient if they were happy with their experience and funnel them right over to do that 5-star review. Lighthouse 360 helps you automate this. Emails. are automatically sent post-visit, and good reviews are posted right to your website and social media pages.

  1.  Patient Experience

It’s no surprise that convenience and consumer experience are priorities when a new patient chooses a dentist. They are especially significant in gaining one who is loyal. Don’t discount the importance of electronic reminders, online access, and paperless forms, to a patient. A busy mom doesn’t want to be faced with a stack of forms to complete that you’re going to scan and shred anyway. Consider a system that embraces all aspects of a streamlined paperless system, so you’re not left with the task of finding disconnected solutions that leave you with clumsy systems.

To connect with someone from XLDent, call 800-328-2925 or email xldentinfo@xldent.com

DawnDawn Christodoulou is the President/Owner of XLDent. She has more than 25 years of experience computerizing dental offices and helping both new and established practices streamline electronic workflows for increased efficiency, improve patient engagement, and achieve maximum profitability. Dawn is also a member of ADA SCDI Working Groups 11.1 Standard Clinical Architecture and 11.9 Core Reference Data Set.