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Just Hand Me the [Dental] Pliers

By Darrell K. Pruitt; DDS

An article written by Arlene Furlong for the ADA News titled “HHS launches online health history tool,” was posted yesterday on ADA News Online. http://www.ada.org/prof/resources/pubs/adanews/adanewsarticle.asp?articleid=3388

The article announces the updated online (or paper) family health history that is a free download from HHS.  (See “Surgeon General’s Family History Initiative”)

http://hhs.gov/familyhistory

Just Imagine 

Imagine this: If this catches on, dentists will no longer have to wait until patients are finished filling out their health histories before being seated for treatment. There’s more. Dentists will no longer have to mail health history forms to patients prior to their appointments – an arguably unreliable method of avoiding the non-productive time spent waiting. There are occasions when the patients appear for their appointment just in time, with our health history form in their hands – sometimes in the envelope we sent a few days before. After introducing themselves to Janis, my office manager, they ask for a pen and clipboard.

The Options as I See Them

Option 1: If a dentist has a paperless practice, soon the uniformly-accepted document will be available for automatic download into the patient’s digital file, any time of the day, without anyone in the office lifting a finger.  However, for the modern convenience, there are modern liabilities.  The dentist must be a HIPAA-covered entity and assume significant risk of a breach that can adversely affect the welfare, and trust of the dentist’s patients. 

Option 2:  If a dentist has an office computer, but the patients’ treatment records are paper, the digital information can be printed for insertion into the patient’s folder, and then deleted.  HIPAA is not involved unless the information is stored digitally – as in, “We are sorry to inform you, Mrs. Aschbacker, but (insert name) neglected to delete your digital health history from one of our computers, and regretfully, we were hacked.” 

Option 3:  If a dentist does not have a computer, then a simple fax link will work swell.  HIPAA can be completely avoided.  But most importantly, patients’ privacy is not risked in a modern way.

Consider this Instead

I consider this to be either the first chance for healthcare providers to take control of the establishment of interoperability for the benefit of the principles in healthcare (providers and patients), or it is the last chance for it to happen if left to the stakeholders (everyone else).

HHS History 

The HHS health history includes not only the patient’s health information, but also questions the health of his or her relatives.  If one’s relative has cancer, emotional problems or even an addiction, how likely is it that the participant will be honest if he or she fears data breaches?  Breaches must be stopped for e-miracles to appear in healthcare. That is a fact. Now, dream with me a second!

Imagine the research capabilities if citizens are allowed to opt-in to an Internet platform and readily confide even their most personal health secrets.  It is simple to understand that the tightly held real or imagined symptoms are sometimes the most important.  These are also the secrets that some will not discuss with anyone but the doctor. It is my opinion that until we reliably de-identify eHRs, install a double-key security to access the records controlled by the owners of the information, and put the control of the development of miracles in the hands of the principles, eHRs will be dangerous, forever.  Trust only happens once in a lifetime.  We must not betray the interests of our patients for short-term, wasted bailout money, ADA.

Seeking Uniformity in CCHIT Requirement  

A uniform government-supported hybrid solution to interoperable health records is a beautiful idea in so many ways – especially expense.  It simply makes common sense to include fax connections in the CCHIT requirements [www.HealthDictionarySeries.com]. Consider what might happen in a hospital emergency room if the Internet goes down for some reason – it happens.  My advice is, don’t destroy those fax machines just yet.  They might come in handy – especially in a disaster.  That is why aircraft are built with redundant controls. Please consider it. 

Information is the product and digitalization the tool.  Not the other way around.

American Dental Association

I told the ADA about the hybrid fax idea a few weeks ago. Yet fax machines were not yet mentioned in Furlong’s article.  Why not?  Since the idea did not originate in the traditional chain of slow and measured thought that does not always begin with a principle, I assume its sudden presentation was too “out of nowhere” for the good ol’ boys to handle.  It is my opinion that the leadership model of the ADA is not flexible enough to think laterally very quickly.  That easily restricts timely movement that transparency demands, making the dinosaur very slow to react and defenseless in silence.

Assessment

Come on, boys, get with it. Do something relevant; or not!

Conclusion

And so, your thoughts and comments on this Medical Executive-Post are appreciated.

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

Filed under: Information Technology, Op-Editorials | 3 Comments »