Dentists – Don’t Crush that Fax

Just Hand Me the [Dental] Pliers

By Darrell K. Pruitt; DDSpruitt4


An article written by Arlene Furlong for the ADA News titled “HHS launches online health history tool,” was posted yesterday on ADA News Online.

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”)

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 []. 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.


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


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

3 Responses

  1. About Heartland Payment Systems,

    Did you know that the Associated Press just reported that payments processor Heartland Payment Systems Inc, said its system used to process Visa, MasterCard, American Express and Discover Card transactions was breached last year, but asserted that merchant and customer data were not affected.

    And so; what about that healthcare eHR privacy and IT security? Fact or fiction? Think about it!



  2. DrBicuspid, the ADA and Split Allegiances

    On February 10, I was told that my membership on and the privileges that come with membership are suspended “until further notice.” I was shocked, sort of.

    From: Brian Casey from DrBicuspid Forums []
    Sent: Tuesday, February 10, 2009 12:41 PM
    Subject: Your membership on

    Dr. Pruitt,

    We have determined that your behavior on the Forums is a violation of the Terms of Service for the site. We have suspended your ability to post in the Forums until further notice. You can direct any further inquiries to me regarding this matter.

    Brian Casey
    Editorial Director
    IMV Publishing

    So, what was the real reason I was unexpectedly kicked off of the DrBicuspid forum, the hard-core inquisitive might ask Brian Casey.

    I suspect my blunt criticism of Dr. Marty Jablow’s deception on the forum, concerning the safety of electronic dental records, probably made Brian Casey uncomfortable from the very start. I know I made Marty Jablow uncomfortable. (See “Making a splash on”)


    You see, Dr. Jablow is in the IT business, and is a long-term, consistent advertiser on He recklessly promotes electronic dental records to naïve dentists in a market that I contend he doesn’t understand.

    Mixing advertisers with Web 2.0 transparency is a modern twist in an ancient journalistic struggle for those who run Internet platforms. It is increasingly difficult to straddle the divide between accommodating paying advertisers, while at the same time, honoring free speech from consumers who vocally dislike the products the advertiser sells. It is difficult to be unbiased when one’s paycheck is in the balance. That is when in the best organizations, professional ethics take over. I’m afraid DrBicuspid is hardly exemplary, and neither is the ADA.

    Wouldn’t you know it? The ADA also happens to be suspiciously involved in this deception in a way that demands, but will not receive, a public explanation from the organization’s leadership.

    The lame attempt at content control by DrBicuspid reminds me of the lame payola scandal in the late 1950s, for which Alan Freed was eventually convicted of accepting bribes from record companies to play specific records on his radio program.

    Do you think I am being too harsh? See for yourself: I have grown increasingly critical of my professional organization on several Internet venues, including, for their creeping, silent abandonment of the ADA’s mission, which is simply protecting dental patients from harm. A perfect example of mission creep is my non-profit organization’s partnership with for-profit Intelligent Dental Marketing in Utah – which shares the profits made from proprietary lists of ADA members. The fat, ADA dinosaur is being devoured from within by a renegade bureaucracy – an aggressive, self-perpetuating cancer with an independent blood supply.

    For three years, my concerns have been universally ignored by the ADA – from the last three national presidents down to my local representative in the state organization, including three charismatic Texas Dental Association presidents. Everyone I have contacted about taboo subjects like ADA/IDM has refused to respond. I am left with the conclusion that the leaders of the ADA simply will not allow themselves to be held accountable to membership. I have made no secret that it is my opinion that because of unaccountability, the American Dental Association is failing the profession it is dedicated to serve at the profession’s most critical time in history. Now that I have experienced the games played by the leaders of the forum, I suspect someone in Chicago directed someone else to become more aggressive at protecting some phony-baloney jobs. Since it is quickly coming to a point in dental history when everyone but the leadership of the command-and-control ADA knows that the ADA has lost control, I suspect that panic happened this week, and someone in the PR department of the organization was charged with silencing dissent when possible. Look at this.

    Within hours after I was booted from DrBicuspid, a friend was sent an ad from the ADA featuring in its “Vendor Showcase.” Coincidence? The ad says:

    “ is your source for unbiased daily dental news. Join today for free and get a complimentary T-shirt.” At the bottom of the ad is the explanation: “You are receiving this special offer as a member of the ADA.”

    Other than the timing and the T-shirt, here is something else I found odd about the ad that was spammed to other dentists by the ADA on behalf of DrBicuspid, for advertising revenue. Not only did the ad not appear on my computer, but my friend was blocked from forwarding it to me. He had to send it to my office manager’s computer for it to be accepted in my practice location.

    Can there be an innocent explanation for this? Or does this mean that if the money is right, and if a vendor agrees not to provide a haven for malcontents, the ADA will side with them rather than dues-paying troublemakers? That’s a tough call. Don’t expect anyone to defend it. I’ll be back, God willing. You got my six.

    D. Kellus Pruitt; DDS


  3. Advertising Dollars and Ethics

    I received an advertisement for Kerr Herculite Ultra Composite this morning on my computer. It was sponsored by Even though I was banned from offering my opinions to the DrBicuspid forum (until further notice), they still sell my email address to their favorite vendors.

    Is there anything ethically wrong with that?
    Someone should ask for their opinion. I would post the question myself, but am no longer permitted to do so, until further notice.

    D. Kellus Pruitt; DDS


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