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By Darrell Kellus Pruitt; DDS

If someone says computerization in dentistry is inevitable, remind them that the metric system is inevitable as well.  Sometimes inevitable takes a long time though – even when it makes sense.  Interoperable dental records don’t.

Contrary to what healthcare IT stakeholders promise to win financing from a newbie Obama administration, interoperable eDRs will increase my cost of providing care, increase my liability as a businessman and endanger my patients’ health and welfare. Those are just three of many reasons why I intend to firmly stand in the way of their adoption until security problems are resolved to my satisfaction. I dare not grow discouraged, for there are far too many depending on me. 

If my grandchildren are to benefit from the miracles of trusted Open Source Evidence Based Dentistry, we must not allow today’s temporary collection of reckless stakeholders to burn consumers’ trust in eDRs even once. 

It is for these reasons that I watch very closely for the mention of eHRs on the Internet.  I am particularly alerted to danger when someone tells lawmakers that they have their own special plans for my patients’ dental records – without first discussing them with me.  I’m funny that way about my Hippocratic obligations and I don’t care what anyone thinks.

The Professor and IT Advocate

Valerie Powell, PhD., a professor of informatics at Robert Morris University, began commenting about dentistry and eHRs on ModernHealthcare.com in April.  She has posted five comments.  Her most recent appeared on November 25, and it was in response to my counterpoint titled “Dentistry EHRs not necessarily inevitable.”

http://modernhealthcare.com/article/20081124/REG/311249951

I continued my point-by-point critique of her uninformed ideas right here on the Medical Executive-Post in an article titled “Dental eHR Controversy Continues.”

https://healthcarefinancials.wordpress.com/2008/11/28/much-more-on-dentistry-and-the-ehr-controversy/

Valerie Powell never returned a response.

www.HealthDictionarySeries.com

Today, Powell’s name popped up on my google-alert.  She was interviewed for an article posted on the Pittsburgh Tribune-Review, written by Allison M. Heinrichs and titled “Experts lobby to add key dental data to medical records.”

http://www.pittsburghlive.com/x/pittsburghtrib/s_603452.html

She and her lobby went over my head.  That was wrong, as well as foolish.

I must say this in defense of her courage, however. In the last two years, Valerie Powell PhD., is the only person in the US who is publicly pushing for interoperable health records in dentistry.  She continues to hopefully plod along even though there are no longer any dentists promoting them – from what I can tell.  The ADA long ago gave up on unwittingly pushing dentists to go paperless. In fact, because of the palpable resentment among membership over being misled about the NPI number, the ADA Department of Dental Informatics [ADA-DDI] no longer even suggests that members sign up for them.  Just ask the department for yourself at NPI@ada.org

Tell them I sent you. They know who I am.

Even the eHR debate that limped along on PennWell was seemingly unnoticed by not only representatives from the ADA Department of Dental Informatics [ADA-DDI] but also by software vendors whose very market awaited their responses.  There still must be a dozen or so unanswered questions about eHRs in dentistry featured on this thread.  Does it not seem strange to anyone else that dental software firms are not tripping all over each other to get the names of their products in front of thousands of dentists for virtually no cost?  Transparency on the Internet certainly beats traditional advertisement if a business can tolerate the matching accountability.

Other than Dr. Powell, why do you think healthcare IT stakeholders are so shy?  And when they do speak up, why do they continue to over-stretch worn out rationalizations rather than offer tangible reasons for eHR adoption in dentistry? 

For example, the lame Hurricane Katrina excuse for digitalization of dental records was stupid even before it was approved by some committee as a talking point.  For anyone here in west Texas, it sounds really, really silly.  Here is another almost extinct slow-moving talking-point I like to lampoon, “Someone can steal paper charts just as easily as they can steal digital records.”  Is there anyone in the nation who can argue that point successfully?  Please step forward; Your audience awaits. 

Recently, I heard a fresh, incredible reason why dentists should computerize – malpractice protection.  Someone who really should have known better told me with a straight face that there are not only more negligence lawsuits filed in dentistry than digital privacy breaches, but that if a dentist has a paperless practice, almost all malpractice lawsuits could be prevented.  I find it hard to believe that a dentist could be so naïve.  Or worse, that a dentist would assume a colleague is so naïve.

Regardless of bald lies mixed in with irrelevant talking points, some rationalizations for connectivity are better than others.  But that still does not mean dentists must computerize their practices to accomplish worthy goals.  For example, one thing Dr. Powell understands on a professional level is the importance of dental health in overall health.

“The research shows that there is a close relationship between diabetes and periodontal disease, also with stroke, respiratory disease, and kidney disease. Some research shows that certain oral diseases are associated with conditions that lead to low birth weight.  And yet dentists and physicians aren’t communicating. I really don’t believe we’re going to get an optimal improvement in clinical care until we take care of this problem.”

Valerie Powell, PhD [Piittsburgh Tribune-Review]

Dr. Powell’s goal is sound, and I cannot argue with her about the urgent need for better communications between all healthcare providers.  In fact, with the sudden downturn in the economy, it so important that we quickly gain control of the expensive and preventable chronic illnesses she mentions, that the nation cannot afford to wait until dentists are paperless.  That could be decades.  The $25 billion bailout that the healthcare IT industry is requesting will be squandered in part for political favors by members of Dr. Powell’s lobby.  I call that churning profits.  That was the old, inefficient way of doing things in dentistry.

We need something now and we need something that will cost virtually nothing.  We need a system for better communications that can be erected in less than six months and will allow taxpayers to keep their $25 billion.  Above all, in order to make this work, we must avoid HIPAA as much as possible.

I’ve put some thought to the serious problem that Dr. Powell describes.  I think I have found a hybrid solution that will not require dentists to become HIPAA-covered entities to communicate more effectively with physicians’ computers.  In fact, physicians also don’t have to be covered entities.  And no, it is not a person-to-person phone call – an increasingly underrated form of communication in my opinion that also does not require HIPAA’s involvement. 

Do you know what the solution is yet? 

Keep reading. There’s more. A solution?

My solution would allow e-prescribing to occur in dentistry, without the dentist having to “volunteer” for a dangerous NPI number.  This would help Glen Tullman, the shy CEO of Allscripts – a monster stakeholder in e-prescriptions.  Otherwise, poor Glen is fresh out of ideas.

http://community.pennwelldentalgroup.com/forum/topics/glen-tullman-ceo-of-allscripts?page=1&commentId=2013420%3AComment%3A22103&x=1#2013420Comment22103

Committees just do not creative thinkers make.

That’s not all! The hardware necessary already exists in most dental offices, and can be obtained for less than $200 at any electronics store.  And just wait until my solution is combined with state-of-the-art voice-recognition capabilities.  All communications with physicians and pharmacies could be done chair-side in the presence of the dental patient without having to store their identifying information digitally anywhere.  All that is needed is a universally acceptable paper format and an acknowledgement that paper is going nowhere soon – thank goodness. 

So what is the revolutionary idea?  It is so simple it will knock you down.

(Drum roll)…  Make eDRs and eMRs compatible with common fax machines as a requirement for ONCHIT accreditation.

Wow!  Now how difficult was that?

Assessment

I invite Dr. Valerie Powell, Dr. Franklin Din, or anyone else interested in finding a solution rather than funding, to discuss with me problems with my idea.  I happen to think it is a cheap, common sense solution that will give us all the benefits Powell promises without excessively endangering anyone other than dental software vendors looking for bailout money. Another difference is my plan has a chance in hell of working www.HealthcareFinancials.com

Conclusion

And so, your thoughts and comments on this Medical Executive-Post are appreciated. What do you think? What is your plan? Let the conversation begin.

Note: Dr. Pruitt blogs at PenWell and others sites, where this post first appeared.

Speaker: If you need a moderator or speaker for an upcoming event, Dr. David E. Marcinko; MBA – Publisher-in-Chief of the Executive-Post – is available for seminar or speaking engagements. Contact: MarcinkoAdvisors@msn.com  or Bio: www.stpub.com/pubs/authors/MARCINKO.htm

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Filed under: Information Technology, Op-Editorials | Tagged: eDRs, EHRs, EMRs, HIT, IT, medical records | 8 Comments »