More than dental software

The electronic signature

The terms digital and electronic are often confused by people. In its correct meaning, the broadest term is "electronic signature", which is based on the ESIGN Act adopted in the United States in 2000. This has also been adopted by the European Union, with a few modifications, and is referred to as eIDAS (the same acronym as the better known GDPR, for example). In practice, this type of signature is the most extensively known, i.e. when you sign on a touch screen with your finger or a special pen in the same way as you would on paper. It is no less authentic in itself, but no more official than a handwritten signature. There are qualified versions that can confirm the authenticity of the signature, just as witnesses or notaries do for a traditional hand-written signature, but, for electronic signatures, these are mostly some form of electronic certification.

The digital signature

In contrast to electronic signature, the term digital signature is a special type of electronic signature, but it is definitely the narrower category. It applies a PKI authentication, issued by a third-party service provider, so it is a qualified version of an electronic signature. In other words, in our everyday lives, at post offices, parcel delivery services and banks, we use electronic signatures almost every day - a form of our traditional handwritten signature that is applied through an electronic device rather than on paper. There is no difference in authenticity or probative value!

First, we need to consider what legal effect a traditional paper signature has, or is expected to have, in a dental practice. The legal effect of the electronic signature - including the biometric signature - used in Flexi-Dent is identical to that of a traditional paper signature. In purely legal terms, it is no stronger.

The electronic signature legislation is based on the ESIGN Act adopted in the United States in 2000. This has also been adopted by the European Union, with a few modifications, and is referred to as eIDAS (the same acronym as the better known GDPR, for example). In practice, this type of signature is the most extensively known, i.e. when you sign on a touch screen with your finger or a special pen in the same way as on paper. It is no less authentic in itself, but no more so than a handwritten signature. There are qualified versions that can confirm the authenticity of the signature, just as witnesses or notaries do for a traditional hand signature, but for electronic signatures these are mostly some form of electronic certification. Electronic signatures are regulated by specific legal rules in Hungary, just as in all other EU countries. In general, e-signatures are regulated in a similar manner in all western countries (USA, Australia).

To make your practice paperless and increase your own operational and legal security, you only need a few tablets to enable patients to read and sign documents in the waiting room and/or in the doctor's ward. Once the module is operational, the system is up and running after a few hours of cooperation. To increase overall efficiency, we advise to customize some points (e.g. the compilation of the medical history questionnaire and personalizing the answer types). We will provide assistance in this process and will explain the reasons for any eventual changes.

Time stamp simply means authentication. A time stamp is nothing more than the date and time stamped on the document at the moment of signature. It is a standard whereby the document examined at the time when the stamp is made is considered by computers to be the original. Subsequently, any modification or addition can be detected to determine whether the document has been tampered with or falsified to confirm that it is the original version. The time stamp can be issued by state-licensed companies and can be purchased from and used by service providers such as Flexi. We charge for each use at a rate equivalent to that of a text message.

According to the Eütv.,, healthcare providers must store all data pertaining to patients or generated during the medical care and the records in order to protect themselves. Until 2019, this storage obligation was 50 years, but, since then, practices have to store all patient-related documents for a slightly reduced period of 30 years. So, if a practice ceases to operate, it must continue to keep these records for 30 years. Moreover, this is in the interest of the practice, in addition to the legal obligation, since the practice is required to prove the facts related to a treatment in the event that any patient should bring a claim against your practice, as the burden of proof in the health system is always on the health care provide. If the documents are available, such proof is not a problem.

Most practices do not have dedicated staff to deal with legal documents. As such, it is very common that, without a responsible person, these processes are not strictly adhered to and the documents needed to protect a practice are not available. Although most practices have documents, they are often neglected or the wording may not comply with the requirements of the currently effective legal rules.. Therefore, Flexi has conceived and drafted consent forms most frequently used in dental practices. Furthermore, we have also prepared translations into several languages for dental tourism practices. The consent forms have been drafted and reviewed by legal and forensic experts and consultants, including a specialist in medical law, relying on knowledge and expertise at a cost that would be unreasonable for a single practice to manage on its own. In addition, if a law changes, we will automatically make any and all modifications necessitated by the legal changes. In addition, all these statements have been conceived, drafted and prepared in such a way that there is a logical link between them and, taken together, they can provide even more secure protection.

You can, of course. However, please note that you have to make sure that the entirety of the forms used will be logically connected in your practice in order to have a coherent document management system.

The price of the paperless surgery module consists of two parts, one is the module price, which is HUF 4990 HUF + VAT per chair per month, plus the cost of HUF 15 + VAT for time stamps. In order to ensure the long term (20 year) authentication required by the EIDAS (EU electronic signature law), each electronic signature requires the use of two time stamps. Therefore, for a two chair practice, we estimate the monthly cost to be approximately HUF 15-17 000, excluding VAT. Please consider that this amount is insignificant in the light of the saving achievable by the use of this module. Please continue reading to learn about it-

Let's go step by step through where and how this module can save money:

1. Less paper will be used in the office. Although it's only a few thousand forints a month, it will make a difference. A pack of 80 gram white A4 size paper costs HUF 2500.
2. Unfortunately, we know that we can’t prevent deforestation by using less paper, but we’re still doing something against it. We can save more by using less ink in the printer. The toner will also be discarded, which is hazardous waste and its production causes environmental pollution.
3. This paperless process will save you the hassle of constantly having to replace ink and paper, and you don’t have to pay the operator for replacing the toner cartridges.
4. You can save on buying more cabinets or having a new one fitted. Likewise, you will save on office space for storage. This cost is difficult to estimate, but it can be a one-time cost of hundreds of thousands every five to ten years, and it is something you’ll have to deal with.
5. There are two types of practice: the first one takes care of all administrative tasks required by law for their legal protection to the maximum extent possible in accordance with all the laws. In these practices, a receptionist spends an average of 90-120 minutes per shift to take care of the paperwork, while the possibility of human error is still high. In these practices, you can save two out of the eight hours of the receptionist’s working time, which 25% of their total time. This will give your colleagues more time to talk to patients and solve other problems.
6. In the other type of practices, the administration is managed on an ad-hoc basis, randomly or not at all. If the preparation work takes less than 90 minutes of the receptionist per day on average, we can conclude that that this function is not attended to correctly and the practice is operating at very high risk level. In these practices, any patient complaint opens the door to an out-of-court settlement almost immediately, as unfortunately the practice cannot defend itself against unfounded claims even with excellent patient services. The typical cost of such legal action ranges from HUF 250,000 to 3-4 million, depending on the type of the medical intervention and the subject of the claim.