ORTHO BYTES

The use of computers, computer programs, and other computerized equipment to ass&t in the

orthodontic practice will be reported under this section of the AMERICAN JOURNAL OF ORTHODONTICS AND

DENTOFACIAL ORTHOPEDICS. Manuscripts, comments, and reprint requests, unless otherwise noted, may

be submitted to Dr. Martin N. Abelson, 14720 N. Shotgun Pl., Tuscon, AZ 85737.

Database or spreadshee t - What's the difference

One of the questions I am most frequently asked is, "What is the difference between a spreadsheet and a database program?" When do you use one or the other?

On the surface, both types of programs do the same thing. They store, calculate, and display data. It took me quite awhile to really appreciate the differences between the two types of programs. The simplest explanation is that a spreadsheet is rather like a racing form where all the data is arranged on one page, whereas a database is more like a filing cabinet where the data is stored by record set.

Let's discuss the spreadsheet in more detail. A spreadsheet is arranged essentially like boxes as seen on graph paper, but you can control the size of the boxes to fit the information. The boxes are arranged horizontally in ROWS, which are labeled numerically (l, 2, 3) and vertically in COLUMNS, which are labeled alphabetically (A, B, C) (Fig. 1). Each box is called a CELL and is assigned a corresponding letter and number according to its position on the grid. Thus cell B-6 would be found in column B, row 6. This is how the spreadsheet program locates information. You can usually have as many rows and columns as you desire. Any cell can contain a mathematical formula instead of being used to enter data. Therefore cell D3 could hold the formula D1 + D2 to produce the sum of those two cells. Formulas can be used vertically in the columns as well,

Picture a spreadsheet with 36 columns across and 8 rows down. Add in the ability to indicate what type of data (numeric, alphabetic, date) that may be entered in each cell. In the cells of each row going across we will enter the dimensions of each of a patient's 32 teeth (in cells A1 to El). (Note that the alphabet repeats itself using subscript numbers as you go across to the right side.) In the cell of the 33rd column (F1), we place a formula to add the total of the upper six anterior teeth and in the 34th column (G1) a formula to add the sum of the lower anterior teeth. In the cell in column 35

(H1), the sum of the upper teeth, and in column 36 (I1) a formula to total the lower tooth widths.

Next we enter the same information for six more patients in the same manner using the next six rows.

Finally, we go to row eight and insert formulas in columns F1 to I1 to average the figures found in rows one to six.

Now, every time we use our spreadsheet to enter patient data or when we change data in any one or more cells, the totals and the average cells will automatically reflect the net changes both horizontally and vertically. As you can imagine, handling the data in tiffs manner makes comparative analyses quick and easy for a practitioner. A classical example was provided by Halazonetis in his Bolton Index article. ~

If a spreadsheet is so nifty, why would anyone want to use a database program to store information? Obviously, once a spreadsheet becomes very large it becomes difficult to view and to handle, because many screens can be involved. Obviously visibility is a problem. A more accurate answer lies in the more advanced design of database programs that increase flexibility enormously.

In the first place, a database can be constructed in TABLE form. The table can look and function exactly like our spreadsheet (Fig. 2). However, databases provide a second format for data. A RECORD format would be one that is assigned to a specific entity (patient) (Fig. 3).

Each record, like paper records, would be divided into variably sized information boxes called FIELDS that would hold (patient) information or formulas. Some database programs allow the operator to create multiple pages for a record. Fields can be designated alphabetical, numerical, or alphanumeric and will only accept data in the indicated form. A field can be "hidden" to contain covert information. Fields can be designed to accept multiple lines of data or a single word or number. Instructions can be entered in a field to skip that field if another field has (or lacks) specific information or to perform complex calculations.

American Journal of Orthodontics and Dentofacial Orthopedics/March 1996 329

330 Ortho bytes American Journal of Orthodontics and Dentofacial Orthopedics March 1996

File Edit Search Format Functions Tools Graph Run Help A B C D E F G

1 2 3 4 5 6 7 8 9

10 11 12 13 14 15 16 17 18 19

Calc A1

Fig. 1

<Spreadsheet> H

Last Name First Name Case

Aracci Sara 1252 Herrios Carlos 1181 Boyd Lorraine 1219 Brancato John 1207 Breglia Marie 1238 Canneto Jeanine 1193 Carson Denise 698 Chitty Jean 752 DePena Toni Marie 1241 Detsky Adam J. 1208 Di Fiore Stephanie 1200 Dick Mohindre Dixon Philistine 767 Faustin Gary 741 Faustin Lynda 783 Federman Mars 1245 Federman Steven 1249 Gianunzio Keith 1214 Gibson Paulene Grant Tara Harris Joseph 774 Jewe!l Andrea 1260 Jewell Tracy 1257 Johnson Clifton 777 King Elizabeth 1242 King John 1253 Lanza Joseph 1237 Marks Portia 779 Martinez Hypatia 773 McLeod Nia 756 McLeod Rae 757 McMillan Tamika 765 Mignarri Karen 1218 Mignarri Michael 1247 Morganti Melissa 1205 Niciu Mary Lou 1216 Palmer Philip 733 Perri Catherine 1258 Perri John 1243 Placco Nicole 1248 Porcelli Roseann 1228 Prenske David 1259 Prenske Karen 1256 Ricci Nancy 1239 Richardson Calvin 771 Robertson Philip 776 Rochdale Vill Rose Boris 699 Toth Shirley 1224 Trusty Ruth Vergara Jessica 1261 Walker Sharon 1229

Home Phone

( 997-2612 ( 987 3835 ( 381 4O42 ( 698 8139 ( 835 1496 ( 835 1683 (201) 927 6789 718 978-4156 ( ) 664 2438 ( ) 967 7941 ( ) 698 4575

718 217 0658 718 949-2959 718 949-2959 ( ) 898 0861 ( ) 698 0861 ( ) 698 9112 718 949-0682 (203) 846 9785 718 978-3624 ( ) 381-6124 ( ) 698 8442 718 528-1141 ( ) 948 6166 ( ) 948 6168 ( ) 738 5219 318 848-8678 718 465-5942 718 527-6003 718 527-6003 718 978-1960 ( ) 381 2189

Work Phone

(212) 576-4364

Due Date

( ) 698 2537 (203) 661-1100 d 12 ( ) 834 3180 (212) 361 0765 * 212 412-8362 i0

20 (212) 288 5977 1 ( ) 381 2212

718 479-1010 7-3 1 212 820-5121 mom 212 820-5121 mom (212) 208 1584 d 10 (212) 208 1584 d ( ) 698 5231 mom 15 212 664-5237 nits (203} 847 4994 mom 212 270-9805

15 W. Count

212 330-5503 ( ) 328 9157 mom 5th ( ) 328 9153 mom ( ) 835 3300 I0 212 201-0138 mom 1 516 231-1990 ex 240 718 476-6208 1 718 476-6208 1

15 same

( ) 381 2189 same 15 ( ) 381 2508 ( ) 967 6100 ( ) 381 2869 ( ) 666 4100 e30 i0 718 528-0664 212 576-5235 mom 1 ( ) 835 1069 10 ( ) 835 1069 15 (516) 471 7374 (718) 899 1624 15 ( ) 698 3739 ( ) 834 2671 ( ) 921-0748 ( ) 963-2040 l0 ( ) 921 0748 ( ) 963 2040 i0 ( ) 698 7852 i0 718 978-8663 5 718 725-9293 718 973-7555 718 276-5700 718 576-5610 maint. (718) 529 1704 (212) 267 0440 dad 20 (203) 744 3797 (203) 845 7618 i0 718 465-5337 ( ) 235-1304 6 West. ( ) 835 5326 1

Fig. 2

American Journal of Orthodontics and Dentofacial Orthopedics Ortho bytes 331 Volume 109, No. 3

* P A T I E N T S * M A M A R O N E C K - A C T I V E

Title Mr. First Keith MI Last Gianunzio Nickname Birth Date 10/11/72 Age 18 Sex m Case No 1214

R.P.Mr. & Mrs. Archie Gianunzio Home Phone ( ) 698 9112 Street 219 Grant Terrace Work Phone ( ) 698 5231 room City Mamaroneck Home Phone 2 State NY Zip 10543 Work Phone 2

1st Visit 8 88 Status R Active Retained

Family Dentist Katz Referred by Katz

Due 15 Sibling Sibling 2

Memo

Tab Next Field; F2 Search; F7 Exit; F9 Create; Record 18

Fig. 3

ii I[

H II LI H li U H

II

Records can be automatically INDEXED (sorted) according to any specific field or field combination. For example, with this facility you could sort patients alphabetically, by start date, by referral source, or select out only Class I conditions that required second premolar extractions from a list of every patient you ever treated. You can combine a table format (spreadsheet) with the record format, using the table format to display selected data that helps you to locate a complete record.

If you think all this is neat, look what comes with a RELATIONAL DATABASE program. What makes them relational is that they permit you to LINK one or more databases, as long as they contain a common field, and then to display and or print out selected information in the form of REPORTS.

Let's see how that might function in our office environment. Suppose we have a database that contains our patient information, a second data base that contains treatment procedures and associated fees, another that contains insurance companies and their varied plans, and still another that contains all information on referring doctors.

In the patient database record we enter our treatment plan including the specific appliances and treatment time estimate. In the treatment procedures database, we have entered all procedures we use and fee schedules for regular fees, Medicaid, courtesy cases for each procedure. When we are entering our treatment plan for the patient, we do not have to type out the appliance descriptions. Instead, pop-up boxes will appear so all we have to do is mark our selections. As

we set up our treatment plan, we marked a box that indicates this is a regular fee case. When the treatment plan is completed, we are given an option as to whether we wish the program to compute the fee. If we say yes, the total fee appears magically, based on all of the information we supplied. When we go on to the payment plan section, payment combinations are displayed automatically and are integrated with the insurance policies of both parents and the payment schedule for each parent is automatically displayed. Let the parent argue with the fee computed by the computer.

All of these calculations and data transfers were accomplished by linking the patient database to the other applicable ones. The same process can be used to track referral sources and their effectiveness, collections, patient ages, or whatever you wish

CONCLUSIONS

If you have limited data you wish to compare and to calculate, the simple spreadsheet is your best approach. Once you have large volumes of data that require analysis and frequent updating, you will find that relational database programs will be best for the job. Spreadsheets are relatively simple to master. The advanced programming required to obtain reports and to interconnect databases may prove much more of a challenge.

REFERENCE

1. Halazonetis D. The Bolton ratio studied with the use of spread- sheets. AMJ ORTHOD DENTOFAC ORTHOP 1996;109:215-9.