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The Continuing eHR Saga
By Darrell K. Pruitt; DDS
If you were one of fifty governors who decide to jump off a cliff because flying looks so cool, would you proudly race to be the first to grab the air? Blissfully, Minnesota Governor Tim Pawlenty is way ahead of the pack. He’s so confident in healthcare information technology [IT] that he doesn’t even have to watch where he’s going – leaving him free to smile for the cameras. Now that’s cool.
Initial Ambitious Plans
Attention ME-P readers! Please gather around to watch a world-class belly-flop of a gutsy statewide eHR mandate. A few years ago, Governor Pawlenty had ambitious plans to lead the nation with an interoperable eHR system that was touted to include all providers – that means Minnesota dentists as well. Your landing could be vertical and abrupt, Pawlenty.
CCHIT Approved?
In fairness to a brick, back in 2005 Pawlenty could not have predicted the economic collapse that began three years later, nor could he have known about the subsequent $19 billion eHR money that would be made available to providers – but only if they purchase healthcare IT software that is approved by the Certification Commission for Healthcare Information Technology (CCHIT).
CCHIT Laggards
Even if the descending Pawlenty could have predicted the recent changes in the terrain, including the CCHIT qualification, he would have never guessed that to this day in March of 2009, the certifying commission would still be yet to certify even one single electronic dental record – thereby blocking Minnesota dentists from copious federal help in their efforts to become compliant in Pawlenty’s brave new state.
“The government is actually looking for places to spend the money where there is a strong likelihood of success stories”.
–Mike Ubl
Executive Director Minnesota Health Information Exchange
[Owned by Blue Cross Blue Shield of Minnesota, HealthPartners, Medica, Fairview Health Services, UCare and the Minnesota Department of Health].
Link: http://www.twincities.com/ci_11830085
“And that after this is accomplished, and the brave new world begins – When all men are paid for existing and no man must pay for his sins”.
-Rudyard Kipling
The CCHIT qualification was incredibly bad luck for Pawlenty’s nifty ideas of interoperability with all providers. When Minnesota dentists discover that they must pay $30 thousand for software they don’t want in order to practice in paradise, some may just swallow their pride, sell the portable ice-fishing house, and move to slow-moving Iowa.
Dentists, MDA and the ADA News
Why the surprisingly quick landing? If Pawlenty actually gave any consideration for dentistry at all, just like everyone else, he must have assumed that dentists’ concerns about digital records would be adequately attended to by the Minnesota Dental Association [MDA] and the American Dental Association. It was easy to make that mistake because of the enthusiasm for eDRs radiating from ADA Headquarters and expressed in confident terms in ADA News Online articles that have since stopped appearing. Most eDR enthusiasts naturally assumed that by now the majority of dentists in the nation would be saving money, lives and trees with paperless practices. However, the ADA has been nowhere to be found for a long time. As it turns out, the professional organization has still not yet even contacted the certifying commission. We know this, because when I personally contacted CCHIT a few weeks ago, it caught them off guard. I was told that I was one of the first to ever mention dentistry.
No Endorsements
To show how far the ADA has slipped, and as an example of its flagging influence on membership, I doubt that more than 5% of American dentists have made the ADA-endorsed leap from paper to digital. Why should they? It makes good business sense to wait, and most dentists are not techno-silly. Consider this; Even if a dentist is happy with a costly eDR system that demanded unanticipated time and effort to learn, in less than a year, CCHIT could determine that his or her favorite system is not worthy of certification because it does not integrate with physicians’ one-size-fits-all, CCHIT-certified eMRs. Tough luck, Minnesota dentists! Uncertified eDRs will be outlawed, while favored, large healthcare IT companies in Madison and Chicago will profit and pay more state taxes with Twin-Cities’ dollars. By then, all the stimulus money will be gone and lawmakers will no longer be giddy about eHRs due to the imminent explosion of data breaches everywhere caused by moving too fast. No return on investment [ROI] there.
Assessment
Still, Tim Pawlenty could have never known, yet away he sails with a stupid grin on his face.
Conclusion
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Filed under: Career Development, Health Insurance, Information Technology, Op-Editorials | Tagged: ADA, American Dental Association, Blue Cross, Blue Shield of Minnesota, CCHIT, Certification Commission for Healthcare Information Technology, Darrell Pruitt, david marcinko, DDS, DMS, eDRs, EHRs, EMRs, HealthPartners, HIPAA, HIT, IT, MDA, Medica, Mike Ubl, Minnesota Department of Health, ROI, Tim Pawlenty, UCare |
The Leading Business Education Network for Doctors, Financial Advisors and Health Industry Consultants 
Want some of this?
My name: Darrell K. Pruitt DDS
My goal: Seek immediate nomination as the first representative of practicing dentists before the US Department of HHS concerning eHRs – ever.
My motto: Nominate me. My slogan: Within 72 hours, one could do worse.
An article written by Paul McCloskey appeared on the GovernmentHealthIT website today titled “Deadline sets off scramble for health IT policy slots.”
http://govhealthit.com/Articles/2009/03/12/Deadline-sets-off-scramble-for-health-IT-policy-slots.aspx?Page=1
Not unlike a medieval reporter returning to the countryside with the freshest stale news from the latest royal court – sharing details of feudal favors that are being landed by the same lucky families who are always hanging around the drawbridge – McCloskey describes how the stimulus money and the delayed appointment of a HHS Secretary accelerates the rush to fill rare, powerful seats at the royal table. Nominations have to be in by Monday to be properly blessed.
I considered the call to chivalry for as much time as fate afforded me – considering the urgency of the crisis. I immediately submitted the following to be posted as a public announcement following Paul McCloskey’s article.
I know it’s a long shot, but I would consider a position on CCHIT if someone wants to nominate me.
D. K. Pruitt; DDS
—————————
That was several hours ago, and my comment has not yet been posted. I think there is a huge chance that McCloskey does not take me as seriously as he could.
Here is why dentists must act really fast if we want any federal representation at all for once. At stake is the pivotal influence in the very design of a certified interoperable eHR system which even dentists will be required to purchase by 2015. As of today, not a single eDR system has been certified, and this round of stimulus money is running out fast. How well do you think the expensive, hand-me-down mandate will fit dentists who prefer paper? Have you ever heard the description, “like (expensive) socks on a rooster”?
Government/private business ventures such as CCHIT and others are being assembled in a style consistent with Obama’s early traditional way of causing change – instantly. The seats available are in organizations which will report directly to the new HHS Secretary – if her taxes are in order and if she has neither employed illegal aliens nor unsuccessfully shoplifted.
Even though McCloskey did not mention the possibility that one or more dentists in the nation might be available to fill some of those influential posts, I like to think there is hope that it is not already too late for me to officially offer to represent my profession to the best of my ability. Otherwise, the nation’s dental patients will continue to have no representation at all and they will continue to be harmed by the same opportunists’ greed – only digitized and more cost-efficiently.
When one seriously considers it, the inexcusable neglect of the interests of 170,000 providers in the nation does not look good for healthcare reform plans. As an important part of healthcare, the number of dentists in the nation is second only to the number of physicians. What is more, as a general rule, patients are advised to visit their family dentists more often than their family physicians. Not to mention that Americans’ oral health is critical to one’s overall health.
One more thing: Almost all dental problems are preventable with careful maintenance and consistent, professional monitoring. I am describing a level of quality, one-on-one care that dental patients can only obtain from dental homes of their own choice – not from a list of preferred providers. Free-market dentistry is a savings-multiplier. Managed care dentistry causes fillings.
Discount dentistry brokers make the most money when their clients only see their assigned dentists when they simply have to in the worst way. How good is that?
I simply cannot hide that I am fervently jealous in my regard to the importance of dentistry (and I have a couple of kids in college if you know of anyone looking for a dentist), but nevertheless, I honestly think the nation needs at least five seasoned dentists to help undermine the selfish plans of any other board member as the situation demands.
Details for the Quick and the Interested
Paul McCloskey reports: “The Health and Human Services Department asked to receive by March 16 the nominations of technology and policy experts to sit on two key federal health information technology advisory committees created by the recently enacted American Recovery and Reinvestment Act (ARRA).”
The ARRA created a 20-member Health IT Policy Committee to make recommendations on establishing the reinvigorated Nationwide Health Information Network. There are three seats available here, but one must be an HHS employee and a second must be a public health expert. Here is the encouraging part: It was not clearly spelled out that the third could not be a dentist who makes no promises to get along with anyone.
Four of the remaining seventeen positions are reserved for the majority and minority leaders of the House and Senate – don’t expect solid thoughts to come from that direction. However, thirteen of the positions will be drawn from heath IT research, privacy and consumer groups, “among others.” I bet there is room for a practicing dentist or three there, but only if we act in the next three days.
A second panel, the Health IT Standards Committee, is empowered to oversee technical challenges related to standards, certification and interoperability. This means that new board members of CCHIT could also be needed. If readers are still not aware, there is not a single dentist in the CCHIT organization either. Maybe we can quickly slip in two really stubborn dentists to sit, and I do mean sit, on the meetings of this public-private entity as well.
CCHIT chairman Dr. Mark Leavitt, who was quoted in the article, said he has ambitious hopes for CCHIT under the new administration. He reaffirmed the plan to tie incentive payments to computer clicks rather than actual services that help people to get well: “It’s very important not only that you bought a certified EHR but there’s going to need to be proof of adoption and meaningful use,” Dr. Leavitt said.
I can just hear the directives in a modern, paperless, pay-for-performance dental office of 2013 that treats CHIPS patients in Texas – “I don’t care what they say, Beulah. Send everyone more images before some payer catches on to Ingenix’s glitch in their algorithm. Also, start pushing the ‘cracked tooth’ explanation. I hear they’re reimbursing better for that this week than ‘recurrent decay.’” “What?… Don’t look at me like that. It’s a slow month and I still have two kids in school.”
Even though it is a mystery whether eDRs are part of the current surge in new applications for certification, there is no doubt that CCHIT employees are earning their federal funding. Here is how Dr. Mark Leavitt, Chairman of CCHIT explains his commission’s success: “I think that’s driven by people’s confidence that CCHIT certification will basically be the qualification under the bill.”
No interference with the mission from free-market pressure is anywhere to be found.
With all the seriousness of a child at play, let me offer that if you want me to represent dental patients in front of the government, I think I can work it into my schedule.
Sincerely,
Darrell K. Pruitt; DDS
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