Sesame Communications — Implementation Playbook (DSO)

Sesame Communications Implementation Playbook

Patient Communication AI for Dental Service Organizations

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1. Executive Summary

What Sesame Communications Does

Sesame Communications is an AI-powered patient communication and engagement platform that automates appointment reminders, recall campaigns, online scheduling, reputation management, and two-way patient messaging across multiple locations from a single centralized dashboard. The platform integrates with major practice management systems to synchronize patient data and deliver personalized, timely communications via text, email, and voice.

Why DSOs Benefit from AI-Powered Patient Communication at Scale

Patient communication represents one of the highest-leverage AI applications for multi-location dental organizations. At scale, DSOs gain three distinct advantages:

1. Operational Standardization: Consistent patient messaging, branding, and communication protocols across all locations eliminate the variability that erodes brand equity and patient experience
2. Labor Arbitrage: Centralizing communication workflows reduces the need for location-level front desk staff to manually confirm appointments, send recalls, or respond to routine inquiries—multiplied across 15–50 locations, this represents significant FTE savings
3. Data Aggregation for Decision-Making: Unified reporting reveals system-wide patterns in no-show rates, recall effectiveness, and patient engagement that individual locations cannot see in isolation

Expected Timeline: Decision to Full Deployment

Phase	Timeline	Milestone
Pre-Implementation	Weeks 1–2	Infrastructure audit complete, baselines captured
Pilot Wave (2–3 locations)	Weeks 3–5	Go-live and stabilization
Wave 2 (5–8 locations)	Weeks 6–9	Expanded rollout with refined playbook
Wave 3+ (remaining locations)	Weeks 10–16	Full deployment
Optimization	Weeks 17–20	ROI validation and workflow refinement

Total timeline: 16–20 weeks for a 30-location DSO, with variability based on IT infrastructure heterogeneity and staff readiness.

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

Technical Requirements

Hardware

☐ Verify all locations have workstations with minimum specs: Windows 10/11 or macOS 10.15+, 8GB RAM, modern browser (Chrome, Edge, or Firefox current version) ☐ Confirm stable internet connectivity: minimum 25 Mbps download/10 Mbps upload per location ☐ Identify locations with outdated hardware requiring upgrade before deployment (flag for Wave 2 or 3)

Software

☐ Document PMS version at each location (Dentrix, Eaglesoft, Open Dental, or other) ☐ Verify PMS versions meet Sesame integration requirements (⚠️ older PMS versions may require upgrade) ☐ Confirm browser versions are current across all workstations

Network

☐ Ensure firewall rules allow outbound HTTPS traffic to Sesame servers ☐ Whitelist Sesame IP ranges and domains per vendor specifications ☐ 🔵 Request network requirements document from Sesame onboarding team

Vendor Onboarding Steps

Step	Owner	Timeline	Notes
Execute Master Services Agreement	Legal/Procurement	Day 1–3	🟣 Requires C-suite signature
Execute Business Associate Agreement	Legal/Compliance	Day 1–3	🟣 HIPAA requirement
Assign dedicated Sesame account manager	Vendor	Day 3	🔵 Vendor initiates
Schedule technical kickoff call	IT Lead + Vendor	Day 5	🔵
Receive API credentials and documentation	Vendor	Day 5–7	🔵
Assign internal project manager	Operations	Day 1	Single point of contact

Key Vendor Contacts to Establish

☐ Account Manager (strategic relationship, escalation path) ☐ Technical Implementation Specialist (integration support) ☐ Customer Success Manager (post-launch optimization) ☐ Support Hotline and Ticket System (day-to-day issues)

Data/Access Prerequisites

☐ Compile list of all PMS login credentials or API access tokens per location ☐ Document patient data schemas across locations (⚠️ field mapping inconsistencies are common) ☐ Export sample patient datasets from 2–3 representative locations for integration testing ☐ Verify patient consent language in existing intake forms covers automated communications ☐ Identify data hygiene issues (duplicate records, outdated contact info) requiring cleanup

Internal Stakeholder Alignment

Decision-Makers Requiring Approval 🟣

Stakeholder	Approval Required For
CEO/COO	Budget authorization, strategic priority ranking
CFO	Capital expenditure, ROI expectations
Chief Dental Officer	Clinical workflow changes, provider adoption
VP of Operations	Rollout timeline, resource allocation
General Counsel	BAA, data governance, compliance sign-off
Board/Investors	Strategic AI investment (if material spend)

Stakeholders Requiring Notification

Stakeholder	Communication Needed
Regional Managers	Rollout schedule, location selection rationale
Office Managers	Timeline, training expectations, champion selection
Providers	Workflow impact summary, patient communication changes
IT Staff	Technical requirements, support expectations

Stakeholder Alignment Map

                    ┌─────────────────────┐
                    │   Board/Investors   │ ← Quarterly updates on AI initiative
                    └──────────┬──────────┘
                               │
                    ┌──────────▼──────────┐
                    │      C-Suite        │ ← Monthly rollout status, budget tracking
                    │ (CEO, COO, CFO, CDO)│
                    └──────────┬──────────┘
                               │
              ┌────────────────┼────────────────┐
              │                │                │
    ┌─────────▼────────┐  ┌────▼─────┐  ┌──────▼───────┐
    │ VP of Operations │  │ IT Lead  │  │ Compliance   │
    └─────────┬────────┘  └────┬─────┘  └──────────────┘
              │                │
    ┌─────────▼────────────────▼─────────┐
    │         Regional Managers          │ ← Weekly updates during active wave
    └─────────────────┬──────────────────┘
                      │
    ┌─────────────────▼──────────────────┐
    │   Office Managers (Champions)      │ ← Daily check-ins during go-live
    └─────────────────┬──────────────────┘
                      │
    ┌─────────────────▼──────────────────┐
    │   Front Desk, Providers, Staff     │ ← Training, support
    └────────────────────────────────────┘

Baseline Metrics to Capture

⚠️ Critical: These metrics must be captured BEFORE go-live to enable ROI measurement. Inconsistent baseline measurement is the #1 reason DSOs cannot prove AI value to boards.

Standardized Metrics Across All Locations

Metric	Definition	Collection Method	Target Measurement Period
No-Show Rate	Appointments missed without 24hr notice / Total scheduled appointments	PMS report	Trailing 90 days
Same-Day Cancellation Rate	Cancellations within 24hrs / Total scheduled appointments	PMS report	Trailing 90 days
Recall Conversion Rate	Patients completing recall visit / Patients due for recall	PMS report	Trailing 6 months
Time from Recall Due to Scheduled	Average days between recall due date and appointment scheduled	PMS report	Trailing 6 months
Front Desk FTE Hours on Communication	Hours spent on appointment confirmation, recall calls, patient inquiries	Time study (1 week sample)	Current week
Online Review Volume	Google/Facebook reviews submitted per month	Manual count	Trailing 90 days
Average Star Rating	Mean rating across review platforms	Manual calculation	Current snapshot
Patient Response Rate	Patients responding to outreach / Outreach attempts	Current system (if tracked)	Trailing 90 days

Baseline Data Collection Protocol

☐ Create standardized reporting template for all locations ☐ Assign regional managers to validate data accuracy at each location ☐ Establish data collection deadline (minimum 1 week before pilot go-live) ☐ Aggregate data into central dashboard for cross-location comparison ☐ Flag locations with incomplete or unreliable baseline data (deprioritize for Wave 1)

Estimated Time: 8–12 hours across all locations

Enterprise-Level Requirements

Network Standards

☐ 🟣 Decide: Centralized hosting (single instance, multi-tenant) vs. location-level deployment

• Recommendation: Centralized for DSOs—enables unified reporting and reduces administrative overhead ☐ Document VPN or SD-WAN requirements if locations use private network connectivity ☐ Verify DNS standards across locations for consistent access

Identity and Access Management

☐ Confirm SSO compatibility (SAML 2.0, OAuth 2.0, or Azure AD) ☐ 🔵 Request SSO integration specifications from Sesame ☐ Define role-based access control (RBAC) structure:

• System Admin (central IT)
• Regional Admin (regional managers)
• Location Admin (office managers)
• Standard User (front desk, staff)
• Read-Only (providers who view but don't manage)

Centralized Credentialing

☐ Establish master user provisioning workflow (new hires, terminations, role changes) ☐ Integrate with existing HR/identity systems if available ☐ Define credential audit frequency (recommend: quarterly)

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3. Location Readiness Assessment

Scoring Framework

Score each location on the following factors using a 1–5 scale, then calculate a composite readiness score.

Factor 1: IT Infrastructure Maturity (Weight: 25%)

Score	Criteria
5	Fiber internet (100+ Mbps), all workstations <3 years old, current PMS version, IT-managed network
4	50+ Mbps internet, most workstations current, PMS within one version of current
3	25–50 Mbps internet, mixed hardware ages, PMS 2+ versions behind
2	Inconsistent connectivity, majority of hardware outdated, PMS significantly behind
1	Unreliable internet, legacy hardware, PMS no longer supported

Factor 2: Staff Tenure and Adaptability (Weight: 20%)

Score	Criteria
5	<15% annual turnover, documented history of successful tech adoption, formal training programs
4	15–25% turnover, recent tech adoption with minimal issues, informal training
3	25–35% turnover, mixed tech adoption history, resistance to past changes
2	35–50% turnover, significant resistance to recent tech changes
1	>50% turnover, active resistance to technology, no training infrastructure

Factor 3: Patient Volume (Weight: 20%)

Score	Criteria	Risk/Reward Notes
5	Top 20% of locations by monthly patient visits	Highest ROI potential, but also highest risk
4	60th–80th percentile	Strong ROI, moderate risk
3	40th–60th percentile	Balanced
2	20th–40th percentile	Lower impact, lower risk—good for pilot
1	Bottom 20%	Minimal impact, may not justify effort

Factor 4: Tech Stack Compatibility (Weight: 20%)

Score	Criteria
5	Same PMS/imaging as majority of DSO, all integrations pre-validated
4	Compatible PMS, minor configuration differences
3	Different PMS but supported by Sesame, some integration work required
2	Legacy PMS with limited API support, significant integration effort
1	Unsupported PMS or imaging system, manual workflows required

Factor 5: Local Champion Availability (Weight: 15%)

Score	Criteria
5	Tech-forward office manager + engaged provider, both committed to champion role
4	Strong office manager willing to lead, provider supportive
3	Office manager willing but not tech-savvy, or provider willing but office manager resistant
2	No clear champion, but no active resistance
1	Active resistance from office manager or providers, no champion candidate

Composite Score Calculation

Composite Score = (IT × 0.25) + (Staff × 0.20) + (Volume × 0.20) + (Tech Stack × 0.20) + (Champion × 0.15)

Location Readiness Matrix Template

Location	IT (1-5)	Staff (1-5)	Volume (1-5)	Tech Stack (1-5)	Champion (1-5)	Composite	Recommended Wave
Example: Downtown	4	4	3	5	5	4.15	Wave 1
Example: Suburban A	3	3	4	4	3	3.40	Wave 2
Example: Rural B	2	2	2	2	2	2.00	Wave 3

Recommended Rollout Sequence

Composite Score Range	Recommended Wave	Rationale
4.0–5.0	Wave 1 (Pilot)	High readiness, representative, manageable risk
3.0–3.9	Wave 2	Good readiness, apply lessons from pilot
2.0–2.9	Wave 3	Requires more preparation, benefit from refined playbook
<2.0	Defer/Remediate	Address infrastructure or staffing issues before deployment

Wave 1 Selection Criteria (Beyond Score)

☐ Include at least one high-volume location to stress-test system ☐ Include at least one location with your most common PMS/imaging configuration ☐ Avoid locations with upcoming major changes (renovation, provider departure, etc.) ☐ Select locations in different regions to test regional manager engagement ☐ 🟣 Final Wave 1 selection requires VP of Operations approval

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4. Rollout Strategy

Wave Structure Recommendation

Wave	Locations	Timeline	Purpose
Wave 1 (Pilot)	2–3 locations	Weeks 3–5	Validate integration, refine training, identify issues
Wave 2	5–8 locations	Weeks 6–9	Scale with confidence, train more champions
Wave 3	8–12 locations	Weeks 10–13	Accelerated deployment using proven playbook
Wave 4 (if needed)	Remaining locations	Weeks 14–16	Complete rollout

Buffer between waves: 1 week minimum for lessons learned documentation and playbook updates

Wave 1 Pilot Location Selection Criteria

Required Criteria (Must Meet All)

☐ Composite readiness score ≥ 4.0 ☐ Confirmed local champion (office manager or provider) ☐ No major operational changes planned during pilot period ☐ Regional manager engaged and available for support

Preferred Criteria (Meet 2+ of 4)

☐ Uses most common PMS configuration in your DSO ☐ Patient volume in 40th–70th percentile (enough volume for meaningful data, not so high that issues are catastrophic) ☐ Geographic proximity to central team or vendor support ☐ History of successful technology adoption

Wave 1 Risk Mitigation

• Select locations where a temporary rollback would not significantly disrupt operations
• Ensure at least one pilot location is low-to-moderate volume
• Avoid selecting all pilots in same region (reduces risk of regional-specific issues)

Timeline Per Wave

Wave 1 (Pilot) Detailed Timeline

Week	Day	Activity
Week 3	Mon	Integration testing complete, final configuration review
	Tue	Champion training at pilot locations (4 hours)
	Wed	Staff training sessions (2 hours per role group)
	Thu	Go-live Day 1: Morning launch, afternoon stabilization
	Fri	Go-live Day 2: Issue remediation, workflow adjustments
Week 4	Daily	Champion check-ins with central team (15 min)
	End of week	Week 1 retrospective, metrics review
Week 5	Daily	Reduced check-ins (every other day)
	End of week	Pilot evaluation, go/no-go decision for Wave 2

Wave 2+ Compressed Timeline (Per Wave)

Week	Activity
Week 1	Champion training, staff training
Week 2	Go-live, stabilization, daily check-ins
Week 3	Reduced check-ins, metrics review, lessons captured

Go/No-Go Criteria

Criteria to Advance from Wave 1 to Wave 2 🟣

Criterion	Threshold	Measurement
System uptime	≥99% during pilot period	Sesame dashboard
PMS sync success rate	≥98% of appointments syncing correctly	Integration logs
Staff adoption	100% of trained staff using system	Champion attestation
Patient-facing message delivery	≥95% delivery rate	Sesame reports
Critical issues	0 unresolved critical issues	Issue tracker
Champion confidence	All champions rate readiness ≥4/5	Champion survey

Decision Authority: VP of Operations, with input from Chief Dental Officer and IT Lead

Criteria to Advance from Wave 2 to Wave 3

Criterion	Threshold
All Wave 1 criteria met for Wave 2 locations	Yes
No systemic issues identified	No recurring issues across multiple locations
Training model validated	Champions successfully trained their teams
Rollback not required	No Wave 2 location required rollback

Rollback Plan

Rollback Triggers

• 5% of appointments not syncing for >24 hours

• Patient communications sent incorrectly (wrong patient, wrong time, wrong content)
• System downtime >4 hours during business hours
• Provider or office manager requests rollback due to clinical/operational impact

Rollback Procedure

Immediate (within 2 hours):

1. Champion contacts regional manager and central IT
2. Central IT disables Sesame automated communications for affected location(s)
3. Location reverts to manual communication workflows
4. Vendor notified via escalation path

Short-term (within 24 hours):

1. Root cause analysis initiated with vendor
2. Patient communications manually verified and corrected if needed
3. Staff notified of temporary reversion

Resolution Path:

1. Vendor provides fix or workaround
2. Central IT validates fix in test environment
3. Gradual re-enablement with enhanced monitoring
4. ⚠️ Do not re-enable until root cause confirmed resolved

Isolation Protocol

• Rollback at one location does not affect other locations
• Other waves continue unless issue is systemic (affects >25% of deployed locations)
• Systemic issues trigger pause of all waves pending resolution 🟣

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5. Configuration & Integration (Weeks 2–3)

Practice Management System Integration

Dentrix Integration

Prerequisites: ☐ Dentrix version G7.3 or higher (⚠️ earlier versions may have limited API functionality) ☐ Dentrix server accessible from Sesame integration service ☐ Administrative credentials for Dentrix

Step-by-Step Integration:

Step	Action	Time Est.	Owner
1	🔵 Request Dentrix integration package from Sesame	—	Vendor
2	Install Sesame connector on Dentrix server	30 min	IT + Vendor
3	Configure API credentials in Sesame dashboard	15 min	IT
4	Map data fields (patient name, phone, email, appointment type, provider)	45 min	IT + Vendor
5	⚠️ Validate two-way sync: create test appointment in Dentrix, confirm appears in Sesame	30 min	IT
6	⚠️ Validate patient data sync: verify 50 random patient records match across systems	1 hr	IT
7	Enable real-time sync and monitor for 24 hours	24 hrs	IT
8	Sign off on integration checklist	15 min	IT + Office Manager

Eaglesoft Integration

Prerequisites: ☐ Eaglesoft version 21 or higher ☐ SQL Server access for Eaglesoft database ☐ Eaglesoft API license (verify with Patterson)

Step-by-Step Integration:

Step	Action	Time Est.	Owner
1	🔵 Confirm Eaglesoft API license active with Patterson	—	IT
2	🔵 Request Eaglesoft integration credentials from Sesame	—	Vendor
3	Configure ODBC connection from Sesame to Eaglesoft database	45 min	IT
4	⚠️ Test connection and verify read/write permissions	30 min	IT
5	Map data fields in Sesame configuration	45 min	IT + Vendor
6	Run test sync batch (100 patients)	30 min	IT
7	Validate appointment sync accuracy	1 hr	IT
8	Enable production sync	15 min	IT

Open Dental Integration

Prerequisites: ☐ Open Dental version 22.1 or higher ☐ Open Dental API key generated ☐ MySQL database accessible (if using direct database integration)

Step-by-Step Integration:

Step	Action	Time Est.	Owner
1	Generate API key in Open Dental (Setup → Misc Setup → API)	15 min	IT
2	Enter API key in Sesame dashboard	10 min	IT
3	🔵 Sesame validates connection	—	Vendor
4	Configure data mapping (Open Dental field names to Sesame)	30 min	IT + Vendor
5	Test appointment sync (create, modify, cancel)	45 min	IT
6	Test patient data sync	30 min	IT
7	Enable automated sync	15 min	IT

Test Environment Setup

Centralized Test Environment (Recommended for DSOs)

☐ 🔵 Request dedicated test/staging instance from Sesame ☐ Clone data from 1 representative production location into test environment ☐ Configure test environment with anonymized patient data (HIPAA compliance) ☐ Establish naming convention to prevent test/production confusion (e.g., "TEST - Location Name")

Validation Checklist

Test Case	Expected Result	Pass/Fail
New appointment created in PMS	Appears in Sesame within 5 minutes	☐
Appointment modified in PMS	Updates in Sesame within 5 minutes	☐
Appointment cancelled in PMS	Reflects in Sesame, cancellation message suppressed	☐
Patient phone number updated in PMS	Updates in Sesame within 5 minutes	☐
Patient opts out of texts in Sesame	Future text messages blocked	☐
Appointment reminder sent	Patient receives SMS and/or email as configured	☐
Patient confirms via text	Confirmation status updates in PMS	☐
Patient requests callback	Notification delivered to front desk	☐
Two-way text conversation	Messages logged and accessible in Sesame	☐

Data Migration

Historical Data Ingestion (If Applicable)

☐ Determine historical data scope (recommendation: 2 years of patient records, 1 year of appointments) ☐ 🔵 Request data import template from Sesame ☐ Export data from PMS in required format ☐ ⚠️ Validate data quality before import (duplicates, formatting issues, missing fields) ☐ Import in test environment first ☐ Validate imported data accuracy ☐ Schedule production import during low-activity period (weekend or evening)

Estimated Time: 4–8 hours per location for data preparation and validation

Security and HIPAA Compliance

Enterprise-Level HIPAA Checklist

Requirement	Action	Owner	Status
BAA executed	Signed by vendor and DSO legal	Legal	☐
Data encryption in transit	Confirm TLS 1.2+ for all connections	IT	☐
Data encryption at rest	Confirm Sesame encrypts stored PHI	IT + Vendor	☐
Access controls	RBAC configured per defined structure	IT	☐
Audit logging	Confirm all PHI access logged	IT + Vendor	☐
Breach notification	Confirm vendor breach notification SLA (<24 hrs)	Legal	☐
Data retention	Confirm retention policies align with DSO policy	Compliance	☐
Minimum necessary	Confirm only required PHI shared with Sesame	Compliance	☐
Patient opt-out	Mechanism to honor opt-out requests	IT	☐
Data governance	Define who owns patient data, deletion procedures	Legal + IT	☐

Standardized vs. Location-Specific Configuration

Standardize Centrally

Setting	Rationale
Brand voice and messaging templates	Consistent patient experience
Appointment reminder timing (e.g., 48hr, 24hr, 2hr)	Best practice standardization
Review request workflow	Unified reputation management
Opt-out handling	Legal/compliance consistency
Escalation procedures	Clear support paths
Reporting metrics and dashboards	Cross-location comparability
HIPAA-related settings	Compliance consistency

Allow Local Discretion

Setting	Rationale
Office hours and scheduling availability	Location-specific operations
Provider-specific preferences	Clinical autonomy
Specialty-specific messaging (ortho vs. general)	Relevant patient communication
Local phone number for two-way texting	Patient familiarity
Location-specific signature/branding (within guidelines)	Community identity
Recall interval preferences	Provider clinical judgment

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6. Team Training Plan

Train-the-Trainer Model

Champion Selection Criteria

Criterion	Weight	Evaluation Method
Technical comfort	25%	Manager assessment
Peer influence/respect	25%	Manager assessment
Availability for training and support	20%	Manager confirmation
Communication skills	15%	Manager assessment
Tenure at location (>6 months preferred)	15%	HR data

Recommended: Office Manager as primary champion, with a backup (often lead front desk staff)

Champion Responsibilities

• Complete train-the-trainer certification (2 hours, 🔵 vendor-led)
• Deliver role-specific training to location staff
• Serve as first point of contact for staff questions during rollout
• Conduct daily check-ins with central team during go-live week
• Submit weekly adoption feedback reports
• Train new hires within 1 week of start date

Champion Certification Process

Step	Activity	Duration
1	Self-paced e-learning modules	1 hr
2	🔵 Live virtual training with vendor	1 hr
3	Hands-on practice in test environment	30 min
4	Certification quiz (>80% to pass)	15 min
5	Access to champion resource kit	—

Role-Specific Training Outlines

Front Desk Staff Training (Champion-Delivered)

Duration: 90 minutes

Module	Duration	Content
Overview	15 min	Why we're implementing Sesame, what it does, benefits for staff
Dashboard Navigation	20 min	Logging in, main interface, key features
Appointment Management	25 min	Viewing sync status, handling confirmation responses, managing patient replies
Two-Way Messaging	15 min	Initiating conversations, response protocols, escalation
Troubleshooting	10 min	Common issues, when to contact champion vs. escalate
Q&A	5 min	—

Common Resistance Points:

• "This is going to take my job" → Emphasize: tool handles routine tasks so you can focus on complex patient needs
• "I prefer calling patients" → Acknowledge preference, show how system handles patients who prefer calls
• "What if the system makes mistakes?" → Show audit/override capabilities, human review points

Day 1 Cheat Sheet: Front Desk

┌─────────────────────────────────────────────────────────────┐
│                    SESAME QUICK REFERENCE                   │
│                      Front Desk Staff                       │
├─────────────────────────────────────────────────────────────┤
│ LOGIN: [URL] | Username: [email] | Password: [reset link]  │
├─────────────────────────────────────────────────────────────┤
│ DAILY TASKS:                                                │
│ ☐ Check dashboard for unread patient messages (8am, 12pm)  │
│ ☐ Review confirmation responses for today's appointments   │
│ ☐ Respond to patient inquiries within 2 hours              │
├─────────────────────────────────────────────────────────────┤
│ PATIENT SAYS THEY DIDN'T GET A REMINDER:                   │
│ 1. Check Sesame for delivery status                        │
│ 2. Verify phone/email in PMS                               │
│ 3. If still missing, manually resend from Sesame           │
├─────────────────────────────────────────────────────────────┤
│ HELP:                                                       │
│ → First: Ask [Champion Name]                                │
│ → If urgent: Call IT at [number]                           │
└─────────────────────────────────────────────────────────────┘

Provider Training (Champion-Delivered or CDO-Led)

Duration: 45 minutes

Module	Duration	Content
Overview	10 min	Strategic rationale, what changes for you
Patient Communication Flow	15 min	What messages patients receive, how it affects appointments
Dashboard Access	10 min	How to view your schedule, patient engagement metrics
Feedback and Adjustments	10 min	How to request changes to your preferences

Key Messages for Providers:

• This does not change how you deliver care
• Your patients receive consistent, professional communication
• No-shows and