DSOPro: Tell us about your career and how you got into IT and dental.

It’s a long way from where I thought I was going! I thought I would be going into full-time ministry. While I was in seminary, I decided I needed to get a job because I had a wife and a baby on the way. I discovered pharmacy technology and took the pharmacy tech certification test and passed it, which led to a job at CVS Health, or CareMark at the time, as a pharmacy technician. I had a technical acumen and CareMark didn’t have site support, so someone on site had to work with IT to figure it out. I really enjoyed that and was put in charge of a revenue-prediction computer. That sounds like a really important tool for a company that was running on just one laptop. No one knew that!

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That led to my first role in IT at CareMark. When they were acquired by CVS, I was promoted to Implement/Action Advisor. Until my current role at Riccobene, I always had clinicians reporting to me in addition to IT personnel. In my last position at CVS Aetna, 200 nurses and pharmacists reported in through me, in addition to a smaller IT team. I did a lot of the telecom and virtual desktop (VDI) work. I was let go from CVS Aetna through one of their layoffs. When I applied to Riccobene Associates Family Dentistry, my current boss said, “Well, healthcare IT is probably not that much different from dental.” Oh man, that was a lie!

Dental IT is way different than healthcare IT. Some of it’s the same, things like cybersecurity and identity access. But as far as investment in tech, dental is where healthcare was about 6 years ago, so some of the tools don’t work exactly like you’d expect them to work.

DSOPro: Describe your responsibilities and what’s involved when onboarding new offices.

I’m the head of IT, so anything IT related comes through me, from dental imaging to Microsoft Excel not working. The entire gamut of IT reports to me. I think the most important thing is service delivery. So that’s what our emphasis is. Making sure the tools that we use are working and when they’re not, that they’re fixed quickly. IT is a broad subject, so I try to surround myself with people who know what they’re doing and think I’ve been relatively successful in finding those people.

DSOPro: How is the IT staff structured?

We have a mix of in-house personnel and managed service providers (MSPs). Riccobene Associates Family Dentistry was historically located in Central North Carolina. All the offices were within an hour and a half of Raleigh. We’ve about doubled or more in size in the time I’ve been here. Now we have a bunch of offices in Virginia and on the coasts of both North and South Carolina.

It doesn’t make sense to have our IT people drive 3 hours to the newer locations. If there is an emergency, whoever is closest goes, but people on the team have different specializations. If there is a server issue, there’s a guy I go to every time. If there’s a panoramic x-ray issue, there’s someone I look up first. Other members on the team often can handle it, but when you’ve got someone who knows those things like the back of their hand, you go to them first. So, our department is not so much territory-driven as it is problem-driven.

We also use third-party service providers in Virginia and in parts of North and South Carolina. There will be a point where it might make sense to hire internally, but we’re not at those thresholds in those areas yet.

DSOPro: Describe some of the challenges you face managing IT operations in the dental setting.

I think lack of investment in dental technology is probably the biggest challenge. I’m sure none of the companies we use want to hear that, but things like application interfaces, so two programs can talk to each other, are difficult, so it’s hard to get your data. The dental software is not built for multi-users, so you have to do some interesting installs on your computers.

Dental technology is just behind healthcare. Everything I was used to on the healthcare side, all the investment and engineering, is slowly coming into dental, but it’s just not quite there yet. I get it that dental is a fraction of the healthcare spend in this country. If you’re launching a new software, you’ll probably be going where you will have the most potential customers.

One example of the difference is that in dental, tech support for most major vendors ends at 8 p.m. In the healthcare world, I expect to be able to get tech support at 2 a.m. There are very few companies that offer around-the-clock IT support in the dental world.

When we buy an office, I’m often disappointed to see the IT hardware being used. It’s mostly old. I don’t think this is the case at Riccobene, but often when we buy practices, I see that IT is viewed as an expense not an investment. It’s a challenge when you buy a new office where everything’s aged and you’re trying to convince them that IT is an investment. Some of it, like security, is an expense. But the mindset in dental is that IT is just an expense, not the path forward.

DSOPro: How do you ensure compliance with healthcare regulations and data protection laws?

That’s a challenge everywhere. It impresses me that Riccobene is dedicated to that. We have a chief compliance officer, so someone at the head of our company is driving compliance of all sorts. A lot of that is just keeping up with the regulations, doing the HIPAA self-assessments, reaching out to third parties for external assessments as well, and making sure our data is secure. You have to buy the programs that make it secure. I think the National Institute of Standards and Technology (NIST) does a good job of taking a really complex subject like cybersecurity and breaking it down for all sizes of businesses. It enables me to engage non-IT leaders and say, “Here are the things that we need to do to make sure our data is secure.” That concern is every day. There’s no, “Hey, let me not think about data privacy today.”

DSOPro: What role does IT play in improving patient experience and outcomes?

Just think about your experience at a dental office 10 years ago. It was all paper based. Think about it today, where you can book an appointment online. I think that every company at some level is a tech company. You have a generation of patients now who don’t want to call the office. So, to reach them or have them engage and come to your office, you must have technology in place to book appointments online, and the ability to text back and forth, accept electronic payments, etc. You must have secure payment methods where they can pay from their phone, pay online, or tap their card and go. Technology is at the core, but you also must have competent, friendly people. I still think the people are number one. But you need to have the technologies in place that enable your people to provide service in various ways. Enable the technology so staff can meet people where they are, whether they want to talk to someone or rather have a faceless interface. Make sure that your people can provide that experience.

I’m excited to see where dental is going and that there is a lot of new technology coming out.

DSOPro: What emerging technologies are you excited about?

I’ll say AI. I do think AI is a little overblown right now, but radiographic AI is able to help clinicians identify problems, and probably more importantly, gives the patient visual understanding of what’s going on. It’s easier for patients to see that a slight shadow is actually a cavity when the AI is highlighting it in color. That’s a pretty significant technology and I think it’s going to be table stakes for every dental practice. If you aren’t using it, why not? And 3D pans and x-rays continue to get more accurate, faster, and easy to manipulate. Procedures that may be difficult today just because you can’t get a good view are going to be much easier in the future.

If you’ve ever been to a walk-in clinic, it’s all self-check in. Some people love that, some people hate it. I don’t know any dental office that’s offering that, but I think that technology is coming. Riccobene is really good at consistently keeping appointment times on track. It would be great to text patients and tell them we’re running 10 minutes late or we are ready for them early. That technology will improve patient wait time and the patient experience. Some people don’t like waiting rooms or have anxiety about seeing the dentist and would like to wait in their car, hit a self-check-in button, and then receive a text that says, “Come in, it’s your turn.” That technology is being used in other parts of the world. I think we’ll see that adoption in dental.

DSOPro: What types of challenges do offices face with AI?

The only AI that I think is good so far is the radiograph reading software. We’re hearing a lot about ChatGPT and generative AI right now, but it’s just not very good. It makes errors. That will rapidly improve. I think the big challenge users will have is not wanting to adopt. Every big change in human history has disrupted jobs, but it hasn’t gotten rid of jobs. The jobs just change.

What I would tell front desk staff about AI is, “Do you want to spend your day telling patients when you’re open or do you want to be engaging patients to make sure the schedule’s full?” Use AI to relay things like, “Our office is open from 9 to 2,” or “We don’t take Medicaid.” That’s what AI is really good at. Giving those transactional interactions to AI frees your staff to engage and talk with patients about why they need dental care and focus on the aspects that are non-transactional, where humans excel.

DSOPro: How is your company leveraging data analytics and AI in your operations?

Virtually all our offices have the radiograph AI or will soon. That is the significant next-level thing, setting us up for the future types of AI. We’re using that to success across our company. We are also running pilots to see the effectiveness of a chatbot for booking appointments. Some patients, like me, would rather book an appointment with a robot than have to call and talk to someone.

We’ve looked at things like AI transcribing notes into charts but in my opinion, that’s just not ready for the clinical space. It’s probably 6 months out before we try it, but we have our eye on the technology that types your notes as you talk.

DSOPro: What do you use to manage electronic health records?

I recommend dental practices get that stuff on the cloud. Having an on-premises server post in your practice management data or EHR is antiquated. It’s not the best way to run your company and it will never be completely secure. Whereas if you put it in the cloud, which has its own privileges, then you’re leveraging the power of the group. On the cloud you’ve got one company or a handful of companies protecting a thousand servers. They have better tools in place to keep that secure.

DSOPro: How do things work within your company between the IT department and other teams like clinical staff and administration? What do you do to foster collaboration?

I think it’s helpful that I report to our chief operating officer because my boss is in operations. That alone helps with collaboration, knowing that the people in ops are reporting to the same person I do. That was a strategic change we made when I came on board, and it’s been helpful. In a previous position, I was very much involved in the project management office, and it has been wildly successful here, where all projects IT and otherwise go through a resource committee, which I’m on. Leaders from all the different functional departments are as well. No one starts a project on their own. We get together, review the ROI, etc. We started that over a year ago and it’s been transformative to how we cooperate with each other. All major projects and sometimes minor ones are reviewed so we know what’s coming and commit resources to it.

DSOPro: Do you and your staff have to do the technology training?

Yes. When we implement new technology, we tend to learn it. Some people on my team have been here so long they know how to take x-rays. It seems funny that an IT person could teach a new dental assistant how to do that. When we have technology that our teams are being trained on, the admin needs to know how to run it because my goal is that our end users don’t have to think about whether it’s working or not. To get there, my team needs to know how to fix things, which means they need to understand the software or hardware.

DSOPro: What are your priorities for the IT department over the next few years?

Service delivery is number one. I think IT at its core enables users to do their best work. I break our technology roadmap down into four things. Service delivery is number one, technology is number two. And are we providing new technologies, researching new technologies? And then not so sexy, I would put security behind that infrastructure. Is everything safe, secure, set for the future? Are we replacing things? And maybe parallel to that is compliance. Are we obeying all the laws?

DSOPro: Do you have any advice for companies looking to improve their IT infrastructure in the dental industry?

Yes. First, be honest about your own knowledge. Use third parties to engage and to help point out your weaknesses because everyone has blind spots. Third-party assessments are required for really large companies, like the payment card industry. Third-party assessments aren’t very expensive and provide a roadmap. I think at a minimum you’ll find you won’t worry about things you thought you had to. If you know that a hardware is good, you just need to check on it and then can focus on other things.

And usually, a third party that sells every brand of everything is the best. They will conduct an honest assessment of what they see. I like resellers like Opkalla and Blue Equinox, which is very focused on security, because they sell every vendor. They’re not saying you need to get Dell servers, or CrowdStrike versus SentinelOne. They will talk with you about what you have for this or that and then build a roadmap for you so you can decide what you want to prioritize and where you’re willing to accept risk. Then you can discuss the risks with the C-level and the finance teams and decide how much of this risk you will accept and how much you want to mitigate. Those decisions can’t just happen in IT. It’s my job to fix the infrastructure and identify problems, but it’s the executive’s job to decide which of these are important and need to be addressed. IT is involved in that, but other leaders must be involved, too.

DSOPro: Anything you’d like to add?

Find peers you can chat with. Dental IT professionals are a relatively small group in the United States. Find other leaders you can bounce ideas off and ask questions. It can be lonely for those who don’t understand the challenges of dental, and there are plenty of groups out there you can get involved in.

Many DSO organizations have an IT branch, and in my opinion, the most helpful thing about them is that peer connectivity. Check LinkedIn to find heads of IT in dental spaces and tell them you’d love to connect.

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About Brian Mullenix

Brian Mullenix serves as the Vice President of Information Technology Systems at Riccobene Associates Family Dentistry. A career Healthcare IT leader, he spent 15 years at CVS-Aetna, where he specialized in the implementation of new technologies and user access management. At Riccobene Associates, he has spearheaded numerous security initiatives to enhance the organization’s security. Brian holds a Master of Science in Information Technology from the University of North Carolina at Greensboro and possesses multiple certifications in IT and project management.

Riccobene Associates Family Dentistry

Riccobene Associates Family Dentistry is a leading DSO platform facilitating high-quality general and multi-specialty dental services across North Carolina, Virginia and South Carolina. Through its state of the art facilities in the Southeast, best-in-class clinical teams, and patient-centric approach to care, Riccobene provides comprehensive and individualized care across its 62 clinics.