Practice by Numbers — Implementation Playbook (DSO)

Practice by Numbers Implementation Playbook

Analytics & Business Intelligence for Dental Service Organizations

---

1. Executive Summary

What Practice by Numbers Does

Practice by Numbers (PBN) is a comprehensive analytics and business intelligence platform that aggregates data from practice management systems, imaging software, and other dental technologies to deliver real-time operational insights, automated reporting, and predictive analytics. The platform transforms fragmented location-level data into unified, actionable intelligence across clinical performance, revenue cycle management, patient acquisition, and provider productivity.

Why DSOs Benefit from Analytics & Business Intelligence AI

At scale, DSOs operate with a fundamental disadvantage: data fragmentation. Each location generates thousands of data points daily across disparate systems, but without centralized analytics, identifying underperformance, replicating success, and making evidence-based decisions becomes nearly impossible. Practice by Numbers addresses this by:

• Eliminating manual reporting burden: Regional managers currently spend 8-12 hours weekly compiling spreadsheets from individual locations—PBN automates this entirely
• Enabling apples-to-apples comparison: Standardized KPIs allow true benchmarking across locations, providers, and time periods regardless of underlying PMS differences
• Accelerating pattern recognition: AI-driven anomaly detection surfaces revenue leakage, scheduling inefficiencies, and clinical outliers that would take months to identify manually
• Supporting M&A integration: New acquisitions can be onboarded into your analytics infrastructure within days, providing immediate visibility into acquired operations

Expected Timeline: Decision to Full Deployment

Phase	Duration	Locations Covered
Pre-Implementation & Pilot Prep	Weeks 1-2	Central team only
Wave 1 Pilot	Weeks 3-5	2-3 locations
Wave 2 Expansion	Weeks 6-9	5-8 locations
Wave 3 Scale	Weeks 10-14	Remaining locations
Optimization & Stabilization	Weeks 15-18	All locations

Total timeline for 15-50 location DSO: 14-18 weeks to full deployment

---

2. Pre-Implementation Checklist (Weeks 1-2)

Technical Requirements

Hardware

☐ Verify minimum workstation specifications at each location:

• Windows 10/11 or macOS 10.15+
• 8GB RAM minimum (16GB recommended for power users)
• Modern browser (Chrome, Edge, Safari—latest two versions)
• Dual monitors recommended for dashboard users (regional managers, office managers)

☐ Confirm network infrastructure:

• Minimum 25 Mbps upload/download per location
• Stable internet connection (99.5%+ uptime)
• Firewall rules allowing outbound HTTPS traffic to PBN endpoints

Software

☐ Document current PMS versions at all locations:

• Dentrix (G7.0 or higher recommended)
• Eaglesoft (21.0 or higher recommended)
• Open Dental (21.1 or higher recommended)
• Other PMS systems—confirm API availability with PBN

☐ Document imaging systems:

• Dexis, Patterson Imaging, Romexis, etc.
• Note version numbers and integration capabilities

☐ Identify existing BI tools being replaced or consolidated

Enterprise-Level Requirements

☐ 🟣 Determine hosting architecture:

• Cloud-hosted (standard) vs. hybrid deployment
• Data residency requirements (if multi-state with specific compliance needs)

☐ Configure SSO integration:

• SAML 2.0 compatibility with existing identity provider (Okta, Azure AD, Google Workspace)
• 🔵 Coordinate with PBN technical team for SSO configuration

☐ Establish centralized credentialing approach:

• Role-based access control (RBAC) hierarchy:
  • Executive view (all locations, all metrics)
  • Regional view (assigned locations, all metrics)
  • Location view (single location, operational metrics)
  • Provider view (individual production data)

☐ Document network standards across locations:

• VPN requirements (if applicable)
• Proxy configurations
• SSL certificate management

---

Vendor Onboarding Steps

Step	Action	Owner	Timeline
1	Execute master services agreement and BAA	Legal/Compliance	Day 1-3
2	🔵 Schedule kickoff call with PBN implementation team	VP Operations	Day 2
3	🔵 Receive dedicated Customer Success Manager contact	PBN	Day 3
4	🔵 Obtain access to PBN implementation portal	IT Lead	Day 3-4
5	🔵 Complete PBN enterprise questionnaire	VP Ops + IT	Day 4-5
6	🔵 Schedule technical integration planning session	IT Lead + PBN	Day 5-7
7	Establish escalation contacts and SLA expectations	VP Operations	Day 7

Key Vendor Contacts to Establish

☐ Implementation Project Manager (day-to-day coordination) ☐ Technical Integration Specialist (API/PMS questions) ☐ Customer Success Manager (strategic alignment, ongoing relationship) ☐ Support desk contact and ticket submission process ☐ Executive sponsor at PBN (for escalations)

---

Data/Access Prerequisites

Per-Location Requirements

☐ PMS administrative credentials or API keys ☐ Read access to PMS database (PBN operates read-only) ☐ Imaging system credentials (if integrating imaging data) ☐ Patient communication platform access (if applicable) ☐ Payroll/HR system credentials (if tracking labor costs)

Centralized Requirements

☐ Master location list with:

• Location ID/name
• Address and time zone
• PMS type and version
• Office manager contact
• Provider roster

☐ Organizational hierarchy definition:

• Regional groupings
• Reporting relationships
• Brand/sub-brand structure (if applicable)

☐ Historical data scope decision:

• ⚠️ Determine how much historical data to ingest (recommendation: 24 months minimum for meaningful trending)
• 🔵 Confirm PBN's data ingestion timeline based on volume

---

Internal Stakeholder Alignment

Stakeholder Alignment Map

Stakeholder Level	Role	Engagement Type	When	Owner
Board/Investors	Awareness	Quarterly update inclusion	Pre-decision	CEO
C-Suite	🟣 Approval	Initiative approval, budget sign-off	Week -2 to 0	CEO/CFO
CDO	🟣 Approval	Clinical metric selection, provider communication	Week 1	VP Operations
CFO	🟣 Approval	ROI targets, budget allocation	Week -1	VP Operations
VP Operations	Driver	Full ownership of implementation	Ongoing	—
Regional Managers	Co-pilots	Wave planning, location selection, daily coordination	Week 1+	VP Operations
IT Leadership	Enabler	Technical architecture, security review	Week 1-2	VP Operations
Compliance/Legal	Gate	HIPAA review, BAA execution	Week 1	IT Leadership
Office Managers	Informed → Involved	Location-level coordination, champion identification	Week 2+	Regional Managers
Providers	Informed	Communication about metrics visibility	Week 3+ (pre-Wave 1)	CDO
HR/Training	Enabler	Training logistics, competency tracking	Week 2+	VP Operations

Approval Milestones

☐ 🟣 Budget approval (software licensing + implementation support) ☐ 🟣 Timeline approval (including productivity dip expectations during rollout) ☐ 🟣 Data governance approval (what data is shared, who sees what) ☐ 🟣 Metric standardization approval (CDO sign-off on clinical KPIs) ☐ 🟣 Communication plan approval (what and when providers are told)

---

Baseline Metrics to Capture

⚠️ Critical: Without standardized baseline metrics, ROI measurement is impossible. Capture these BEFORE any location goes live.

Financial Metrics (per location, trailing 12 months)

Metric	Source	Standardization Notes
Collections per month	PMS	Gross vs. net collections—define once
Production per month	PMS	By provider, by procedure category
Accounts receivable aging	PMS	30/60/90/120+ buckets
Collection rate	Calculated	Collections ÷ Adjusted Production
Revenue per patient visit	PMS	Define "visit" consistently

Operational Metrics (per location, trailing 6 months)

Metric	Source	Standardization Notes
Patient visit volume	PMS	Unique patients vs. visits—define
New patient volume	PMS	Define "new" (never seen vs. lapsed)
Case acceptance rate	PMS	By treatment category, by provider
Hygiene reappointment rate	PMS	Before patient leaves chair
Chair time utilization	PMS/Schedule	Define "utilization" formula
Cancellation/no-show rate	PMS	Distinguish cancellation types

Clinical Metrics (per location, trailing 6 months)

Metric	Source	Standardization Notes
Average diagnosis time	PMS + Workflow	Time from imaging to treatment plan
Treatment completion rate	PMS	% of accepted treatment completed
Hygiene to doctor referral rate	PMS	Procedures referred during hygiene
Perio percentage	PMS	% of hygiene visits coded perio

Revenue Cycle Metrics (per location, trailing 6 months)

Metric	Source	Standardization Notes
Claim denial rate	PMS/Clearinghouse	By denial reason code
Days in A/R	PMS	Define calculation method
Write-off percentage	PMS	By write-off reason
Insurance verification rate	PMS	Pre-appointment verification %

Standardization Protocol for Cross-Location Comparison

☐ Create metric definition document with:

• Exact formula for each metric
• Data source specifications
• Inclusion/exclusion rules
• Time period definitions

☐ 🟣 CDO and CFO approval on metric definitions

☐ Assign one analyst to pull baseline data for ALL locations using identical methodology

☐ ⚠️ Do not allow locations to self-report—central data pull ensures consistency

☐ Store baseline in centralized repository with location-level breakouts

---

3. Location Readiness Assessment

Scoring Framework

Score each location on these five factors (1-5 scale). This produces a composite readiness score (5-25) used to sequence rollout waves.

Factor 1: IT Infrastructure Maturity (Weight: 1.2x)

Score	Network Speed	Hardware Age	PMS Version	Description
5	100+ Mbps	<2 years	Latest	Excellent infrastructure, no upgrades needed
4	50-99 Mbps	2-3 years	Current-1	Good infrastructure, minor updates only
3	25-49 Mbps	3-4 years	Current-2	Adequate, may need minor remediation
2	10-24 Mbps	4-5 years	Current-3	Requires pre-rollout upgrades
1	<10 Mbps	5+ years	Outdated	Significant infrastructure investment needed

Factor 2: Staff Tenure and Adaptability (Weight: 1.0x)

Score	Turnover Rate	Tech Comfort	Training History	Description
5	<15% annually	Highly tech-savvy	Completed 3+ recent tech trainings	Change-ready team
4	15-25%	Comfortable with tech	Completed 2 recent trainings	Adaptable team
3	25-35%	Average tech skills	Completed 1 recent training	Standard readiness
2	35-50%	Some tech resistance	No recent tech training	Will need extra support
1	>50%	Significant resistance	Training failures noted	High change risk

Factor 3: Patient Volume (Weight: 0.8x)

Score	Monthly Patients	Consideration
5	200-400	Ideal testing volume—meaningful data without chaos
4	401-600	Good volume, manageable complexity
3	100-199	Lower impact but also lower risk
2	601-800	High volume, higher risk during transition
1	800+ or <100	Very high-volume risk OR insufficient data

Factor 4: Tech Stack Compatibility (Weight: 1.1x)

Score	PMS Integration	Imaging Integration	Other Integrations
5	Native integration available	Native integration	All key systems integrate
4	Standard API available	API available	Most systems integrate
3	Requires custom work	Requires custom work	Some gaps
2	Limited integration	Limited	Significant manual work needed
1	No integration path	No integration	Would require workarounds

Factor 5: Local Champion Availability (Weight: 1.0x)

Score	Champion Description
5	Tech-forward provider AND engaged office manager both identified
4	Strong office manager champion with provider support
3	Office manager willing to champion, provider neutral
2	Office manager willing but stretched, no provider engagement
1	No clear champion, leadership gaps at location

---

Composite Score Calculation

Formula: (Factor 1 × 1.2) + (Factor 2 × 1.0) + (Factor 3 × 0.8) + (Factor 4 × 1.1) + (Factor 5 × 1.0) = Weighted Score

Max Possible: 25.5 points

Readiness Tiers

Tier	Score Range	Rollout Recommendation
A (High Readiness)	21.0 - 25.5	Wave 1 candidate
B (Good Readiness)	16.0 - 20.9	Wave 2 candidate
C (Moderate Readiness)	11.0 - 15.9	Wave 3 (with remediation)
D (Low Readiness)	5.0 - 10.9	Defer until remediation complete

---

Sample Location Scoring Matrix

Location	IT (×1.2)	Staff (×1.0)	Volume (×0.8)	Tech Stack (×1.1)	Champion (×1.0)	Raw Total	Weighted Score	Tier
Springfield	4 (4.8)	4 (4.0)	5 (4.0)	4 (4.4)	5 (5.0)	22	22.2	A
Riverside	5 (6.0)	3 (3.0)	4 (3.2)	5 (5.5)	4 (4.0)	21	21.7	A
Oak Park	3 (3.6)	4 (4.0)	3 (2.4)	4 (4.4)	4 (4.0)	18	18.4	B
Downtown	4 (4.8)	2 (2.0)	2 (1.6)	4 (4.4)	3 (3.0)	15	15.8	C
West End	2 (2.4)	2 (2.0)	3 (2.4)	2 (2.2)	2 (2.0)	11	11.0	D

---

Rollout Sequence Recommendations

Wave 1 Selection Criteria (2-3 locations):

• Tier A scores (21.0+)
• Geographic diversity (different regions if possible)
• Different PMS systems represented (to validate all integrations)
• At least one location with a newer acquisition (tests onboarding complexity)
• NOT your highest-revenue location (protect flagship during learning phase)

Wave 2 Selection Criteria (5-8 locations):

• Tier B scores (16.0-20.9) plus remaining Tier A
• Geographic clustering with Wave 1 locations (leverage nearby champions)
• Prioritize locations in same region as Wave 1 success stories

Wave 3 Selection Criteria (remaining locations):

• Tier C locations with completed remediation
• Pair each Tier C with a nearby Wave 1/2 champion for support
• Extend timeline if needed

Defer/Remediate (Tier D locations):

• Create remediation plan addressing lowest-scoring factors
• Re-score after 60 days
• Include in Wave 4 or subsequent wave

---

4. Rollout Strategy

Wave Structure Overview

Wave	Locations	Timeline	Primary Goal
Wave 1 (Pilot)	2-3	Weeks 3-5	Validate integration, refine training, establish baselines
Wave 2 (Expansion)	5-8	Weeks 6-9	Scale processes, identify regional patterns
Wave 3 (Completion)	Remaining	Weeks 10-14	Full deployment, address outliers
Stabilization	All	Weeks 15-18	Optimization, embed in operations

---

Wave 1: Pilot Phase (Weeks 3-5)

Selection Criteria for Wave 1 Pilot Locations

☐ High Readiness Score: Minimum Tier A (21.0+ weighted score)

☐ Manageable Risk Profile:

• Not your highest-revenue location
• Not undergoing other major changes (renovation, provider transition, etc.)
• Stable staffing (no planned departures of key personnel)

☐ Representative of Portfolio:

• Include at least 2 different PMS systems
• Include general dentistry AND at least one specialty (if applicable)
• Mix of geographic regions (tests remote support model)

☐ Champion Quality:

• Identified office manager willing to provide detailed feedback
• At least one provider actively interested in data/analytics

☐ Learning Potential:

• Location leadership willing to participate in weekly debrief calls
• Staff comfortable with being "guinea pigs"

Wave 1 Timeline

Week	Activities
Week 3, Day 1-2	🔵 Complete integrations, run test data pulls
Week 3, Day 3-4	Validate data accuracy against PMS source
Week 3, Day 5	Champion training (office managers)
Week 4, Day 1-2	Staff training (all roles)
Week 4, Day 3	Go-live Day 1
Week 4, Day 4-5	Daily check-ins, rapid issue resolution
Week 5	Stabilization, gather feedback, document learnings

Wave 1 Go/No-Go Criteria

To proceed to Wave 2, ALL of the following must be true:

☐ Data integration validated: PBN data matches PMS data within 1% variance

☐ Critical dashboards functional: All core reports generating correctly

☐ Zero unresolved critical issues: No blocking bugs, security concerns, or data integrity problems

☐ Staff adoption threshold met: >80% of users logged in and completed basic tasks

☐ Champion confidence: Office manager rates readiness to recommend 7/10 or higher

☐ Documented learnings: Training adjustments, FAQ document, troubleshooting guide updated

⚠️ If any go/no-go criterion is not met:

• Extend Wave 1 by 1 week
• Escalate to VP Operations for remediation plan
• Do not proceed to Wave 2 until resolved

---

Wave 2: Expansion Phase (Weeks 6-9)

Timeline per Location Cluster

Week	Cluster A (3-4 locations)	Cluster B (3-4 locations)
Week 6	🔵 Integration setup	—
Week 7	Training + Go-live	🔵 Integration setup
Week 8	Stabilization	Training + Go-live
Week 9	Buffer/remediation	Stabilization

Wave 2 Enhancements from Wave 1 Learnings

☐ Updated training materials incorporating Wave 1 feedback ☐ Known issues documented with workarounds ☐ Champions from Wave 1 paired with Wave 2 locations for peer support ☐ Refined go-live checklist based on Wave 1 experience

Wave 2 Go/No-Go Criteria

Same as Wave 1, evaluated across all Wave 2 locations in aggregate:

• Data accuracy validated at each location

• 80% staff adoption

• No unresolved critical issues
• Regional manager sign-off for their locations

---

Wave 3: Scale Phase (Weeks 10-14)

Timeline

Week	Locations	Notes
Week 10-11	Group 3A (larger batch)	Deploy 5-8 locations simultaneously
Week 12-13	Group 3B (remaining)	Include Tier C locations with completed remediation
Week 14	Buffer week	Address stragglers, remediation carry-overs

Wave 3 Efficiencies

• Deploy in larger batches (5-8 simultaneously)
• Leverage regional champions from Waves 1-2 for local support
• Reduce training time (optimized materials, video modules)
• Centralized support model (less on-site presence)

---

Rollback Plan

⚠️ If a wave fails (defined as: critical data integrity issues, security incidents, or staff rejection >30%):

Immediate Actions (Day of Failure Identification)

☐ VP Operations convenes emergency call with vendor, IT, and regional manager

☐ Determine scope: single location failure vs. systemic issue

☐ 🟣 Executive decision: pause vs. rollback

Rollback Protocol

☐ Disable PBN access at affected location(s)

☐ Verify PMS systems unaffected (PBN is read-only, so minimal risk)

☐ Communicate to staff: "We're pausing to resolve [specific issue]"

☐ Continue unaffected locations (if issue is location-specific)

☐ Conduct root cause analysis within 72 hours

☐ 🔵 Escalate to PBN executive contact if vendor-side issue

☐ Re-attempt rollout only after root cause addressed and verified

Isolation Measures

• Each location's integration is independent—one location's failure does not cascade
• Centralized dashboards can exclude specific locations from aggregate views
• Regional managers continue receiving manual reports during rollback period

---

5. Configuration & Integration (Weeks 2-3)

Step-by-Step PMS Integration

Dentrix Integration (Version G7.0+)

Step	Action	Owner	Duration	Notes
1	🔵 Request Dentrix API credentials from PBN	IT Lead	1 day	PBN is a certified Dentrix partner
2	Verify Dentrix eCentral connectivity at location	Location IT	2 hours	Required for cloud sync
3	🔵 Configure connection in PBN portal	IT Lead + PBN	2 hours	Per-location setup
4	Run initial data sync (may take 24-48 hours for historical data)	PBN	1-2 days	Automatic after configuration
5	Validate sync: Compare PBN dashboard figures vs. Dentrix reports	Office Manager	2 hours	Check 3-5 key metrics
6	⚠️ Troubleshoot discrepancies before go-live	IT Lead + PBN	Variable	Common: inactive providers, duplicate patients

Eaglesoft Integration (Version 21.0+)

Step	Action	Owner	Duration	Notes
1	🔵 Obtain Patterson eServices credentials	IT Lead	1-2 days	May require Patterson support
2	Configure Eaglesoft cloud services if not enabled	Location IT	Variable	Prerequisite for integration
3	🔵 Establish secure connection via PBN portal	IT Lead + PBN	2-3 hours	SSL required
4	🔵 Map Eaglesoft fields to PBN schema	PBN	4 hours	Customize for your procedure codes
5	Run initial sync	PBN	1-2 days	Historical data ingestion
6	Validate data accuracy	Office Manager + IT	2 hours	Production, collections, appointments

Open Dental Integration (Version 21.1+)

Step	Action	Owner	Duration	Notes
1	Enable Open Dental API in Program Links	Location IT	30 minutes	Requires administrator access
2	Generate API keys	Location IT	15 minutes	Store securely
3	🔵 Input API credentials into PBN portal	IT Lead	30 minutes	Per-location configuration
4	🔵 Run test queries	PBN	1 hour	Verify connectivity
5	Execute full historical sync	PBN	1-2 days	Depending on data volume
6	Validate against Open Dental reports	Office Manager	2 hours	Compare production, scheduling

---

Imaging System Integration

General Process (Dexis, Patterson Imaging, Romexis, etc.)

Step	Action	Owner	Duration
1	Document imaging system version and export capabilities	IT Lead	1 hour
2	🔵 Confirm integration pathway with PBN (API, file export, direct connection)	IT Lead + PBN	Call: 1 hour
3	Configure export settings or API connection per PBN specifications	Location IT	2-4 hours
4	🔵 Run test sync	PBN	2 hours
5	Validate imaging data appearing correctly in PBN	Office Manager	1 hour

⚠️ Note: Imaging integration is optional for PBN core functionality but enhances clinical analytics. Prioritize PMS integration; add imaging in Wave 2+.

---

Test Environment Setup

Centralized Test Environment (Recommended for DSO)

☐ 🔵 Request PBN sandbox environment with synthetic data

☐ Configure sandbox with:

• Simulated multi-location hierarchy matching your org structure
• Sample data mimicking your PMS mix
• Test user accounts for each role type

☐ Conduct integration testing in sandbox before any production connection

☐ Validate:

• Data flows correctly through hierarchy
• Aggregations calculate properly
• Role-based permissions restrict views appropriately
• SSO authentication works for all user types

☐ ⚠️ Do NOT use production patient data in test environment

Validation Checklist

Test	Pass Criteria	Owner
Single-location data pull	Data matches PMS within 1%	IT Lead
Multi-location aggregation	Sum of locations = enterprise total	IT Lead
Provider-level filtering	Each provider sees only their data	IT Lead
Regional rollup	Regional views show correct location subset	Regional Manager
Historical data accuracy	Trends match known historical performance	Office Manager
Real-time refresh	Data updates within stated latency (typically 24 hours)	IT Lead

---

Data Migration / Historical Data Ingestion

Step	Action	Owner	Duration
1	🟣 Determine historical data scope (recommend: 24+ months)	VP Operations	Decision: 1 hour
2	🔵 Confirm ingestion timeline with PBN based on volume	PBN	Call: 30 minutes
3	Run initial ingestion in off-hours to minimize bandwidth impact	PBN	1-3 days per location
4	Validate historical data against archived reports	Office Manager	2-4 hours
5	⚠️ Document any data gaps (missing periods, corrupted data)	IT Lead	Variable

---

Security and HIPAA Compliance Verification

Enterprise HIPAA Checklist

☐ Business Associate Agreement (BAA)

• 🔵 Execute BAA with PBN before any data transfer
• Store signed BAA in compliance repository
• Confirm PBN's subprocessor list and their BAAs

☐ Data Governance

• Document what PHI is transmitted to PBN
• Confirm data encryption in transit (TLS 1.2+) and at rest (AES-256)
• 🔵 Review PBN's SOC 2 Type II report
• Confirm data retention and deletion policies

☐ Access Controls

• Role-based access control (RBAC) configured and tested
• SSO enforced for all users (no local PBN passwords)
• Access logging enabled
• Quarterly access review process defined

☐ Audit Capabilities

• Confirm PBN provides access logs
• Define audit review frequency (recommend: quarterly)
• Establish breach notification protocol

☐ Location-Specific Considerations

• Verify each location's firewall rules allow only necessary traffic
• Confirm no PHI is stored on local workstations (browser-only access)
• Train staff on security protocols

---

Standardized vs. Location-Specific Configuration

Standardize Centrally (Apply Identically to All Locations)

Configuration Item	Rationale
User role definitions (Executive, Regional, Location, Provider)	Consistent access control
KPI definitions and formulas	Cross-location comparability
Dashboard layouts for each role	Reduces training complexity
Report scheduling (when reports generate/email)	Operational consistency
Alert thresholds (e.g., A/R aging triggers)	Standardized intervention points
Data refresh frequency	Predictable data availability

Allow Location-Specific Configuration

Configuration Item	Rationale
Provider names and credentials	Location-specific roster
Fee schedules	May vary by market
Operatory names/numbers	Location-specific physical layout
Local benchmark targets (after initial standardization period)	May adjust for market conditions
Individual provider dashboard preferences	Provider autonomy within guardrails
Specialty-specific metrics (ortho, perio, oral surgery)	Only applicable to specialty locations

---

6. Team Training Plan

Train-the-Trainer Model

For a 15-50 location DSO, direct training from central team or vendor for every staff member is impractical. Instead:

Champion Selection Criteria

Each location must identify one primary champion (ideally office manager) and **one