The Great eHR Debate

Another IT Challenge for Dentists

By Darrell K. Pruitt; DDS

I posted this on my surrogate blog (Baltimore Sun). I’m hoping to gather a crowd of town-folks to witness me send a collection of door-to-door scoundrels on down the road. 

http://www.topix.net/forum/source/baltimore-sun/T0GLLJEPSJAJJDBCJ/p5#lastPost

“EHR Debate of the Century – Pruitt vs. All Comers”

Allow me to invite you to the “EHR Debate of the Century – Pruitt vs. All Comers”

Kevin Henry, editor for Dental Economics, has invited healthcare IT experts other than me to a debate concerning electronic health records in dentistry.  I posted my acceptance of the challenge here.

http://community.pennwelldentalgroup.com/forum/topic/show?id=2013420%3ATopic%3A14917

Dental Economics

http://community.pennwelldentalgroup.com/forum/topic/show?id=2013420%3ATopic%3A14859

When I read that he was entertaining questions for a panel of experts, I hammered out twenty or so questions in less than five minutes and posted them below his comment.  Every one of my questions is a subterranean stinker except for the last two.  Those two are as sweet as honey. 

This Could be Fun

I have to assume that the other unnamed and unarmed experts are healthcare IT stakeholders, not principals like me.  Since I’m defending my patients’ turf instead of the price of a company’s stock, I cannot and will not lose.  This could get exciting.  Wake the kids.  I’ll also do my best to spread the word about the train wreck in my own way.

I must take this opportunity to acknowledge the courage of PennWell and specifically Mr. Henry for stepping out in front of the vast silent, lost crowd to offer consumers transparency at last, and perhaps just in time.  I will never forget your help in my efforts to salvage evidence-based miracles that my future grandchildren might still be able to enjoy, if we’re lucky.

“The events going on right now are the seeds of a unification of faith and honor of all thirteen colonies on our continent.  The smallest fracture between us now will be like a tiny carving into a small oak sapling, which will grow large over time, and future generations will be able to read our failure in giant letters.” 

Thomas Paine, Chapter III, “Common Sense.”  1776

OSEBD

If we are to reap miracles from Open Source Evidence-Based Dentistry [OSEBD], we cannot afford to disappoint our patients the first time out with a loser EHR that ADA President Dr. John Findley says dentists will have to accept – regardless of the Hippocratic Oath.  The interoperability that Findley does not understand but nevertheless promises the nation will never be realized if leadership continues with this reckless, parasite-infested course in healthcare IT adoption.

Open-Source EBD using trustworthy data will only get one chance at trust.  Contrary to what Findley says, EHRs are not inevitable.  It is abysmally foolish for a bureaucrat to suggest that the nation’s dentists, 85% of whom are sole-proprietor small business owners, will abandon their own Constitutional Rights for the common good.  That is being far too generous with others’ rights, Dr. Findley.

Bribing the Doctors

Until both dentists and patients trust EDRs, interoperability simply will not happen anywhere.  Consider this:  EMR adoption by physicians is going so badly that HHS Secretary Michael Leavitt had to bribe 1,200 physicians just to try EMRs.  Do you know the difference between EMRs and EDRs?  EMRs make tremendous sense. 

Bribing the Dentists?

How many dentists will the next Secretary have to bribe?  Taxpayers should be warned that investing in EHRs in dentistry is a waste of healthcare dollars until Personal Identification Information (PII) is removed from them.  What, I ask you, could be simpler than that?  “And, what about the interoperability with physicians’ records?” a deeply-rooted healthcare IT stakeholder might timidly ask.  Forget the MDs.  Forget Newt Gingrich.  Forget ONCHIT.  And especially, with extreme prejudice, forget the National Association of Dental Plans (NADP).  Let’s set up our own system, with or without the ADA, collectively fine tune it to our own needs which only practicing dentists truly understand, and make the opportunists come to us for once, damn it.  Just because physicians’ practices are so terribly infested with parasites that they cannot move into the future should not stop dentists from leading the way using precedent-setting innovation in a free market.

Assessment 

Even before Secretary Leavitt addressed the ADA House of Delegates in 2006, which Kevin Henry mentioned in the invitation to the coming debate, I wrote that maintaining EDRs with personal information is like storing bombs with fuses.  It is still earthly stupid.  So are we, the nation’s dentists, going to sit back in our lawn chairs and watch for the muddy explosion?    Not me.  I’m going to defuse the sucker.  You just sit back and watch. 

Conclusion

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Understanding and Investing in Collectibles

Sans Cash Flow Entitlements

[By Staff Writers]

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Many medical professionals have a broad range of investments that are typically not securities and rarely provide entitlement to specific cash flows.  One example is collectibles, which are durable real property expected to store value for the owner. 

Definition

According to Jeff Coons PhD, CFP™, the term collectible may represent such items as artwork, jewelry, sports memorabilia, stamps, and wine. While a detailed discussion of the wide variety of collectibles markets is outside the scope of this post, there are common characteristics of collectibles as an investment. 

Common Collectible Characteristics

First, the value of a collectible generally rests entirely in the eye of the beholder.  Since there is typically no cash flows associated with a collectible, unless the collector charges at the door for a look at their collection, the value of the collectible is only what another collector is willing to pay for that particular item. 

Second, while there are some collectibles that may be considered standardized across individual pieces in terms of quality and other defining characteristics, collectible investments are generally unique.  As a result, there is typically not an active market with prices established on a regular basis for most collectibles in a manner similar to the stock and bond markets.

Assessment

In total, the lack of ongoing cash payments from a collectible and the general non-comparability of items result in the collectibles market being more of a knowledge-based market than most of the investments discussed on the E-P.  Since the value of a collectible is limited to the amount that another collector-investor is willing to pay for the item, a knowledgeable investor may be able to benefit from the lack of information of another investor. 

By the same token, if a physician-investor does not have superior information regarding the value of a collectible, then the basic lack of economic fundamentals behind a return assumption for such investments makes collectibles generally less attractive as compared to investments providing ongoing cash payments.

Conclusion

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