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Kelly Mclendon RHIA censors D. Kellus Pruitt DDS

12 Responses

1. Darrell, on August 16, 2009 at 2:32 PM said:

   Dear Kelly Mclendon, RHIA:

   I told you to expect yesterday’s article describing your rude behavior to appear on your first page on Monday. I misjudged your Internet power. My article floated to the top quickly to reach your first hit only hours after it was posted on the Medical Executive-Post. It turns out that you are weaker than I thought. I was fooled by the quality of your Website design. Please extend my compliments to your webmaster.

   Here is your first hit on Google this morning, including the meta:

   “Kelly Mclendon RHIA censors D. Kellus Pruitt DDS – How’s this for the title of a comment that should make it to your fist page by Monday ‘Kelly Mclendon RHIA censors D. Kellus Pruitt DDS’?”

   Please let me know by a response to this thread when you have posted the three comments you invited and censored… or not. Is your brand worth defending?

   D. Kellus Pruitt; DDS

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2. Dr. Pruitt, on August 19, 2009 at 6:53 PM said:

   I sent this to Kelly McLendon, the Registered Health Information Administrator. I intend to make him face reality.

   __________________________________________
   From: pruittdarrell [mailto:pruittdarrell@sbcglobal.net]
   Sent: Wednesday, August 19, 2009 1:52 PM
   To: ‘spacecoastmedicine@gmail.com’
   Subject: You’re not through with me 8.19.09

   Dear Kelly McLendon, RHIA (Registered Health Information Administrator)

   Because you still refuse to post my comments on your Website, it is rather clear to those following this thread that you and I are at an impasse in our relationship – me, a pushy healthcare principle who demands to discuss the dangers of HIT, and you, a shy healthcare stakeholder who would rather hide. As you will see, you are not a lot different than other shy HIT stakeholders I have trapped.

   Since my participation in healthcare is arguably more vital to the welfare of patients than yours, I consider it unethical that you would choose to conceal truth from me and others for your selfish interest, yet you call yourself a professional. It is unaccountable stakeholders like you who cause the price of healthcare to soar and cause patients harm in other ways as well. I don’t like you, Kelly McLendon.

   But let’s move on. We have a lot of rocky ground to cover, and I’m dragging you along.

   I have a project going. I am collecting HIPAA consultants. Earlier today, I trapped Olivia Wann RDH. (See “Olivia Wann RDH questioned by D. Kellus Pruitt DDS”)
   http://community.pennwelldentalgroup.com/forum/topics/olivia-wann-rdh-questioned-by

   A few weeks ago, HIPAA consultants Sharalyn Fichtl and Travis Criswell from Dental Compliance Specialists LLC published a confusing article in my local dental journal about HIPAA compliance that appears to contradict the information from the ADA by 90 degrees. I have already been told by Ms. Fichtl that a retraction is not forthcoming – end of story. How good is that? (See “HIPAA consultants – Who can one trust?”)
   http://community.pennwelldentalgroup.com/forum/topics/hipaa-consultants-who-can-one

   And of course, Medical Executive-Post is hosting the piece your name headlines (See “Kelly Mclendon RHIA – censors – D. Kellus Pruitt DDS”).
   https://healthcarefinancials.wordpress.com/2009/08/16/kelly-mclendon-rhia-censors-d-kellus-pruitt-dds/

   If you would like to make use of your knowledge, can you answer a couple of questions I asked Olivia Wann? She has yet to get back with me.

   1. How will eDRs (electronic dental records) improve care of dental patients?

   2. How will eDRs increase patient safety?

   3. What does Olivia Wann mean when she says that having a national system for computerized health records will simplify compliance in the US?

   4. How will eDRs save costs in dentistry?

   5. How will eDRs minimize errors in dentistry?

   6. How will eDRs maximize efficiency?

   Perhaps you should just stay silent. I’ll grow bored with picking on you eventually, Kelly McLendon RHIA.

   D. Kellus Pruitt; DDS

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3. Kelly Mclendon, on August 27, 2009 at 3:05 AM said:

   Kelly Mclendon Responds

   Paranoid to the point of needing meds huh? Debating closed minded twits like you are not my forte, too easy and you look too foolish. Get a life and understand that it’s not my website you are attacking, get a grip. Mised that one by a mile, I hope you practice better. Not my website.

   Amazing how far out you are from reality. So have you taken the time from your tea parties and town hall rants to misrepresent the truth here? Nice job on the title of your latest rant…you make yourself look like a superstar that’s for sure…do more…I love the attention…

   Since you insist here are the easy answers, try them out, maybe you’d find out they are accurate. But since you’ll not try how would you know?

   I will say that dental is not as important as physician EHR’s but the points still hold true…to some degree…

   1. More accurate and secure records that can actually be read. More ability to share data with other EHR’s, including histories and allergies. Electronic records are more secure and has much more auditability if managed correctly with security. But we’ve answered that over the years, where were you when we were discussing that?

   2. Rules, alerts, reminders, oh maybe not since you know it all already…

   3. No idea. National system for medical records far out from this point. Very hard to achieve and we are not even close.

   4. Probably won’t unless they are used to improve care and reduce duplicative services. After all you charge whatever you please for cash. Of course that’ll be a dwindling market as more and more can’t afford your services…so go ahead and keep on thinking of yourself first.

   5. Hello…alerts and reminders..in meds mgmt and CPOE. Even though you don’t do too many meds, what about those allergies you forgot to address? Oh I forgot you know all already and read so much into that memory that you again…know it all.

   6. Much easier to tie all aspects of clinical and practice management through to billing together, at least maybe if the vendors are there for you (I’m no expert in dentistry EHR). I’m not a fan of many vendors either.

   So here are my questions to you…now, now no more rants with predictable, boring answers, how about some original thought, is that too much to ask?

   1. If not now for electronic records when?

   2. Why not take advantage of $$ that are out there to help you afford it?

   3. How do you stop the double digit rise in medical care costs per year (at least to my health plan, lame as it is)? of course it doesn’t even have dental benefits, can’t afford them…we pay, oops cash again. And we have no control so charge what you want to…

   4. How many need to be unable to afford insurance to do something about the totally wacky system we have and what would that something be? Don’t we already pay for everyone who does not have insurance in medicine, maybe not dentistry, since no one is refused the ED or admission for emergent cases? Whey do I wna to pay for all of that ina completely closed non-transparent system? How much does it add to my insurance rates? How much does insurance overhead add to my rates?

   5. Do you really think there’ll be standalone paper records for physicians in 20 years? Dentists, who knows, less needs for sure to be electronic, but since my dentists all have them and like them, it seems you are already behind. Well that’s a surprise.
   I’ve seen arrogance before, but it’s so misplaced here. Especially from a clinician that knows nothing of computer systems development, standards or implementation protocols, security or the law (I love the invariably bankrupt’ comment from a lost computer. of course if it had HIPAA Security encryption that did not require breach notification if lost and was tough, nearly impossible to hack and you can’t show one case that supports you position……

   Again do you want CCHIT info so you can really learn what they are all about? Just curious since you missed answering that one…

   Oops another mistake, paper has long been denied the ability to trump electronic records in safeguards against spoliation if electronic records well designed. And some are, but would you know the difference? Nah you wouldn’t, you don’t even try.

   Kelly Mclendon

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4. Darrell Pruitt DDS, on August 27, 2009 at 12:48 PM said:

   Ann,

   Thanks for posting Mr. McLendon’s comment. Sometimes democracy is ugly at first.

   I’ll be back with my measured response to Mr. McLendon’s comment. I want readers to know that it is my intent to harvest good out of this unprecedented breakthrough in marketplace conversation about dentistry. I think dental history will show that we are at the beginning of something wonderful because Kelly McLendon has enough pride to fight back, and fears no one.

   Everyone knows that it would serve nobody’s purpose for Kelly McLendon and I to wrestle in the dirt when rational conversation might just sweep away misconceptions about electronic dental records.

   I celebrate the passion and dedication Kelly McLendon brings to this discussion. I think that there is a good chance that together, Kelly and I can shape this dialogue into a constructive, cutting-edge conversation which just might open doors to true solutions to security problems in dentistry instead of silence. As Kelly McLendon says, if not now, when?

   Thank you, Publisher-in-Chief Dr. David Marcinko, for your devotion to transparency in health care.

   D. Kellus Pruitt; DDS

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5. Darrell Pruitt DDS, on August 30, 2009 at 5:49 PM said:

   Welcome, Kelly Mclendon RHIA

   Mr. Mclendon, I sincerely thank you for your response. It has long been my goal to establish an unprecedented and urgently needed public dialogue about electronic dental records. Readers are fortunate to have an HIT representative with your education and experience. Perhaps our dialogue about eDRs will attract others with similar professional interests and expertise. All HIPAA consultants are certainly invited to share professional knowledge.

   Maybe our discussion will even attract a representative of the ADA Department of Dental Informatics so that other misconceptions about dentistry can be eliminated once and for all. We both agree that it is time for progress, and for the moment, it looks like progress of eDRs in the nation is up to you and me, friend. We are it. Nobody else is discussing interoperable digital health records in dentistry. This is an exciting opportunity for those with your courage.

   It is my hope that after we discuss the six questions that HIPAA consultant Olivia Wann RDH left unanswered, and your additional five questions for me, you will stick around to entertain some ideas for a solution to the problems facing interoperability with dentists. I find this adventure into the frontier of dentistry immensely exciting. I’ve been waiting for you for years, Mr. Mclendon. Together, with our combined passion and determination, we can make a difference. If not you and me, who?

   You are correct when you accuse me of being naïve about your field of study. I do, however, know a lot about dentistry, and I am declaring that contemporary wisdom about interoperable digital health records does not apply to dentistry. And therein lies our nation’s problem. If dentistry is not part of the health network, my grandchildren will never benefit from the miracles revealed by open source evidence based dentistry.

   Though your response was understandably heated, it was wonderful to read. Now that I’ve rudely attracted your interest, I have no intention to carry taunts and petty animosity forward in this discussion. You and I have an opportunity and an obligation. Let’s get to work.

   Olivia Wann’s unanswered questions:

   1. How will eDRs (electronic dental records) improve care of dental patients?

   Mclendon – “More accurate and secure records that can actually be read. More ability to share data with other EHR’s, including histories and allergies. Electronic records are more secure and has much more auditability if managed correctly with security. But we’ve answered that over the years, where were you when we were discussing that?”

   – Are eDRs indeed more accurate? I say accuracy has nothing to do with computerization. Accuracy is solely dependent on the information entered. Whether it is written in longhand or on a keyboard, it makes no difference. Many are overly optimistic about the capabilities of computers in dentistry, including a handful of leaders in the American Dental Association.

   – Are eDRs more secure than paper records? Absolutely not. This is a widespread misconception that is so simple to dispel: How many paper records have been breached in the last 2000 years? Perhaps a few thousand? How many digital health records have been breached in the last five years? Millions. Case closed.

   – Auditability of digital records is another widespread misconception. It is simply impossible to audit any of the millions of records that have been breached, paper or digital.

   – Are eDRs any more legible than handwriting? I concede that point in favor of digital records, but that is a petty rationalization rather than a reason for investing $40 thousand into an eDR system. It is much cheaper to improve one’s penmanship.

   I’ve often heard the lame “handwriting” selling point repeated again and again by enthusiastic HIT fans, yet every one of them conveniently forget the danger of simple key-stoke errors that arrived with digitalization. This common mistake can become critical when wrong numerals are entered on patient health records. On the other hand, if one intends to draw the number “3” in a paper chart, one is not likely to end up with a “4.”

   Here’s something to consider: If there is a massive power failure, which is easier to read by flashlight? Paper of digital?

   – Do eHRs provide the ability to share more data about patients? Yes. Is that a good? Yes and No. Portability is a definite advantage of eHRs in dentistry if one is in the military or otherwise moves frequently. But for the vast majority of US citizens, the consistency of dental homes is far more important for proper care than portability. Malignant portability is in fact the reason eHRs are unacceptably dangerous in dentists’ offices.

   Internet communication is overrated in dentistry because enthusiasts, including the ADA’s own eDR proponent Dr. Robert Ahlstrom, are almost universally blinded by misguided faith in the capabilities of technology. (See “Dr. Robert H. Ahlstrom’s controversial HIPAA testimony,” Dec. 21, 2008.)
   http://community.pennwelldentalgroup.com/forum/topics/dr-robert-h-ahlstroms

   Anything that can be shared on the Internet can be shared without encryption over a $200 fax machine without the security risk of an email and without the administrative work and liability that comes with being a HPAA-covered entity. What dentist wants to invite PriceWaterhouseCoopers employees, working on commission as inspectors under contract with the HHS, to snoop around one’s patients’ files? Is this in the best interest of our patients? Is this really what American citizens are demanding?

   Is there a need for dentists to instantaneously share information that cannot also be handled with a phone call? No. Dentists’ offices are not emergency rooms. Let’s not get silly.

   – “Electronic records are more secure and has much more audit ability if managed correctly with security. But we’ve answered that over the years, where were you when we were discussing that?” I clearly proved already that this whole statement is completely false.

   2. How will eDRs increase patient safety?

   Mclendon: “Rules, alerts, reminders, oh maybe not since you know it all already…”

   – Rules, alerts and reminders have clearly been ineffective in controlling the exploding ID theft problem.

   3. What does Olivia Wann mean when she says that having a national system for computerized health records will simplify compliance in the US?

   Mclendon: “No idea. National system for medical records far out from this point. Very hard to achieve and we are not even close.”

   – HIPAA consultant Olivia Wann’s statement continues to be a mystery, even to fellow HIPAA consultants.

   4. How will eDRs save costs in dentistry?

   Mclendon: “Probably won’t unless they are used to improve care and reduce duplicative services. After all you charge whatever you please for cash. Of course that’ll be a dwindling market as more and more can’t afford your services…so go ahead and keep on thinking of yourself first.

   – Will eDRs improve care? I think that is a huge question. I have seen nothing to support that argument.

   – Will eDRs reduce duplicative services? Perhaps, if a dentist doesn’t plan ahead. Since dentistry is not a life and death emergency, the US mail is great for sending radiographs, paper images or even CDs. Why make it complicated, expensive and dangerous?

   – Compared to my HIPAA-covered colleagues, will my cost of services rise if I am not computerized? Of course not. As a matter of fact, dentists like me with paper-based practices will inevitably enjoy significant market advantage for both security and cost of providing services.

   We are entering exciting times in dentistry. Within the next few months, dentists in the nation will wake up to the fact that HIPAA is expensive. Who pays for the expense? Dental patients. This means that I can look forward to windfall prosperity because when breaches begin to be reported by the local media, don’t expect patients to seek dentists with digital records. They will seek dentists with paper records. Like Darrell Pruitt DDS, 6737 Brentwood Stair Road, Suite 220, Fort Worth, Texas – call for an appointment today – (817) 451-2323. I’ve got a couple of kids in college. I could use the business.

   – As for your last comment from question 4, I always put the interests of my patients first. You simply don’t know me, and all you’ve seen is my tactless alter-ego. Without me, my patients have no representation at all. I take my obligation seriously.

   5. How will eDRs minimize errors in dentistry?

   Mclendon: “Hello…alerts and reminders..in meds mgmt and CPOE. Even though you don’t do too many meds, what about those allergies you forgot to address? Oh I forgot you know all already and read so much into that memory that you again…know it all.”

   – Meds management is a real problem in today’s dental care, and it needs to be addressed. Unfortunately, interoperability is not the answer yet. As a matter of fact, the dangers from inaccurate medical histories are magnified because of the portability of eHRs. As I mentioned earlier, identities are often used to fraudulently obtain medical insurance. When this occurs, allergies and other important pieces of information are changed. Let’s face it. In the nation’s dentists’ offices, the incredibly safe track record of paper is unmatched.

   6. How will eDRs maximize efficiency?

   Mclendon: “Much easier to tie all aspects of clinical and practice management through to billing together, at least maybe if the vendors are there for you (I’m no expert in dentistry EHR). I’m not a fan of many vendors either.”

   – Since you are unfamiliar with dentistry, it is understandable that you would be unaware that efficiency is a secondary issue on the business end. Like so many other consultants whose clients are nothing less than complex medical practices with multiple physicians- including huge hospitals, you overestimate dentistry’s complexity. First of all, digital records offer minimal help with efficiency in the operatory. Secondly, consider that dentists only bill for procedures performed on the lower 1/3 of the face. That means compared to physicians, dentists bill fewer variations of treatment. Ultimately, the simplicity produces far fewer items for action that come across my office manager’s desk during the day compared to an office manager for a solo physician.

   In addition, dentists see fewer patients a day because dentistry is a profession that requires providers with finite time in the day to perform intricate handwork in unpredictable mouths. Unlike Medicare primary care providers, our work cannot be successfully rushed to save patients money.

   The bottleneck in my practice is not the front desk, it’s me. I’m certain this is the same for almost all dentists in private practice since over 85% of us are solo practitioners (ADA News Online).

   Now we come to your questions for me:

   Kelly Mclendon: “So here are my questions to you…now, now no more rants with predictable, boring answers, how about some original thought, is that too much to ask?”

   1. If not now for electronic records when?

   Indeed. I’m with you. But show me something I desire to purchase. I spit on mandates. The sharing of information is the goal, and health information technology is the tool. Not the other way around.

   2. Why not take advantage of $$ that are out there to help you afford it?

   If you’re talking about the billions of stimulus dollars being offered for “meaningful use” of CCHIT-certified software for dentists, there is no such thing. In addition, the money that Washington set aside for eHRs in dentistry was invested instead into purchasing hundreds of thousands of used cars at above-market prices for their scrap value. Go figure.

   I once worked for a boss who, just before Christmas, staggered into the shop with his shirt torn open. He gasped, “I was just mugged … And your bonus money was in my pocket!”

   3. How do you stop the double digit rise in medical care costs per year (at least to my health plan, lame as it is)? of course it doesn’t even have dental benefits, can’t afford them…we pay, oops cash again. And we have no control so charge what you want to?

   How indeed do we stop the rise in the cost of medical care? For one thing, we can tell Washington to stop mandating unwanted, expensive information technology products that bring HIPAA into our dental practices. Lots of systemic health problems are made worse by poor oral health care. If dentists could avoid being trapped into HIPAA compliancy it would help to keep dental care affordable for Americans to get their teeth cleaned a couple of times a year. That is called “prevention.” It’s a bargain, for now.

   “And we have no control so charge what you want to…” I will charge what the market will bear, and I will fight viciously for that right. Nobody should attempt to take that freedom from another American, not Delta Dental, BCBSTX or United Concordia. And certainly not you, Kelly Mclendon.

   4. How many need to be unable to afford insurance to do something about the totally wacky system we have and what would that something be? Don’t we already pay for everyone who does not have insurance in medicine, maybe not dentistry, since no one is refused the ED or admission for emergent cases? Why do I want to pay for all of that in a completely closed non-transparent system? How much does it add to my insurance rates? How much does insurance overhead add to my rates?

   I understand your pain. I’m afraid these problems will not be solved with interoperable health records alone. If it were only that easy.

   5. Do you really think there’ll be standalone paper records for physicians in 20 years? Dentists, who knows, less needs for sure to be electronic, but since my dentists all have them and like them, it seems you are already behind. Well that’s a surprise.
   I’ve seen arrogance before, but it’s so misplaced here. Especially from a clinician that knows nothing of computer systems development, standards or implementation protocols, security or the law (I love the invariably bankrupt’ comment from a lost computer. of course if it had HIPAA Security encryption that did not require breach notification if lost and was tough, nearly impossible to hack and you can’t show one case that supports you position…

   Yes, I’m already behind. And it looks like it will surprise you to learn that I am behind just like almost all other dentists. You are obviously unaware that eDRs are not selling in dentistry for one simple reason: There are tens of thousands of quiet dentists in the nation who feel exactly like I do about the misconceptions such as those you brought with you. I can see why it is indeed frustrating for those whose businesses are propped up by government mandates, not consumer demand.

   You got me, Mr. Mclendon. I know nothing about computer systems development, standards or implementation protocols. But do I need to know all of that in order to be a good dentist? Contrary to your opinion, I would say that I do know more than the average layperson about security and the law. But most importantly, I know dentistry.

   The “bankruptcy” line amused you. I assure you that dentists find it frightening because they know it is true.

   Is encryption the answer to security in dentistry? Not likely. Let me ask you this. If your dentist fumbled your identity, yet it was encrypted, would you rather not be told? I explored this question several months ago in a small HIPAA compliance survey I performed. (See “HIPAA Rules and Dentistry – A Survey of Dentists [Pilot Study]”)

   Click to access hipaa-survey-dentists4.pdf

   On page 4, under the topic “Password security,” I posted the results from the responses of 17 dentists to the question: “Do you think encryption is an effective safeguard if a computer is stolen?” 71% of the dentists responded Yes, 29% said No. I would bet that if one polled consumers, it would be around 70 – 30 against encryption. What do you think?

   Very few dentists encrypt their patients’ data, and I know dentists. They’ll simply drag their feet the more they are pushed until a buddy down the street goes bankrupt. Then they will either encrypt or drop out of computerization altogether. And I am sure you know that encryption is no protection from a dishonest employee who could get away with thousands of identities in minutes.

   Can electronic dental records become truly more secure than paper records? I say yes.

   I’ll leave you this, Mr. Mclendon: Does a dental assistant need to know a patient’s social security number to do his or her job? Is it critical to know a patient’s birthdate while extracting a tooth?

   What if dental records were de-identified and only two of the 18 patient identifiers were available to staff members who need to know a patient’s name and sex? Wouldn’t that work far better than even encryption? If we are going to store bombs, do we have to leave the fuses attached?

   Kelly Mclendon, I am sincere when I invite you and all HIPAA consultants to explore this topic. Now that we have put a few of the common, lame misconceptions to rest, after we mourn the loss of fantasy for a few minutes, let’s make some real progress. We can do this.

   D. Kellus Pruitt; DDS

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6. Darrell, on August 30, 2009 at 8:12 PM said:

   Word gets around fast these days

   Here is what John Hamm, who may or may not be a blood relative, said about me on Dr.Bicuspid today following an article titled “HIPAA now requires breach notification” (no byline):
   http://www.drbicuspid.com/index.aspx?sec=sup&sub=pmt&pag=dis&ItemID=302619

   “Wow. I just read D. Kellus Pruitt’s response today to a HIPAA consultant in a discussion on healthcarefinancials.com. It’s title: “Kelly Mclendon RHIA – censors – D. Kellus Pruitt DDS” https://healthcarefinancials.wordpress.com/2009/08/16/kelly-mclendon-rhia-censors-d-kellus-pruitt-dds/

   “Mclendon made a fool of himself when he tried to censor a comment. Pruitt knows his stuff, but it just takes him far too many words, and he goes off in all sorts of pointless ego-trips.

   “Nevertheless, maybe you should interview him about EDRs, Kathy Kincaide.”

   I wonder if the narrow-minded John Hamm knows that Kathy Kincade kicked me off of DrBicuspid for overuse long ago.

   D. Kellus Pruitt; DDS

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7. Dr. Pruitt, on August 31, 2009 at 4:56 PM said:

   I probe in all directions for answers on behalf of my patients.

   “Securing health records in small doctor’s offices and clinics is not easy: small offices can’t afford Fort-Knox style data protection measures, like hiring security experts to make sure hackers aren’t getting into their systems. Even if electronic health records software includes encryption and other security features doesn’t mean those features will be turned on and used.”

   That is the opening paragraph of an Aug 4 article “Security and Hacking, Real Fears.” It was posted on the Patient Privacy Rights Blog. PPR is a well-known, successful non-profit organization dedicated to helping Americans preserve their privacy in health care – an honorable, important goal. I contribute to the organization, and encourage others to do so as well.

   I think the answer to dentistry’s security problem is not a return to pegboards and ledger cards, but to simply limit the portability of PHI. I think the PPR article clearly points out that the human factors out the rigid reasoning of computers every time.

   I responded:

   Dear Patientprivacyrights:

   As a dentist, I read with interest your comment: “Security and Hacking, Real Fears “
   http://dpeelmd.blogspot.com/2009/08/security-and-hacking-real-fears.html

   “Securing health records in small doctor’s offices and clinics is not easy: small offices can’t afford Fort-Knox style data protection measures, like hiring security experts to make sure hackers aren’t getting into their systems. Even if electronic health records software includes encryption and other security features doesn’t mean those features will be turned on and used.”

   I have reason to believe that in about a week, the liabilities of maintaining identifiers on computers is going to price computerization out of most dental offices within a year. The first major HITECH regulation is due from HHS on August 18.

   My question is this: If identifiers could be somehow removed from dental records, and stored on a separate memory device that is strictly controlled by only a few people, would thousands of dental patients require being notified of a breach if the key was not involved?

   I appreciate your response.

   D. Kellus Pruitt; DDS

   August 10, 2009 12:51 PM

   So far, Patient Privacy Rights has not responded. It may actually be a legal question for which the organization hasn’t an answer. I thought it was worth a try.

   D. Kellus Pruitt; DDS

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8. Olivia Wann RDA, BS, on September 1, 2009 at 12:04 PM said:

   Hello Dr. Pruitt,

   Thank you for your invitation to discuss further eDRs. Your discussion does not indicate that I responded to your questions through eRDH Village.

   First, I wanted to clarify that I am not a RDH. I am a RDA with a BS in Health Care Administration. My area of focus as a consultant and professional trainer is how to comply with regulations to avoid violations. I also seriously try to prepare practices for upcoming changes. My goal is to avoid practice interruptions caused by compliance issues … compliance issues including HIPAA, OSHA and labor disputes. I work for the dentists. Between law school and my work, I am committed 7 days a week.

   Thus, the electronic health record is certainly not my sole focus. If you would like to consult with a few HIPAA attorneys particularly those who have strong presence in the area of the electronic health records, please let me know. I’m glad you find the topic engaging. The complexity of our industry has certainly changed over the years. We share concern for the privacy and security of protected health information. The opinions and perspectives are quite interesting. I hope I can be a resource for you especially in the future.

   Thanks
   Olivia

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9. Darrell, on September 1, 2009 at 4:46 PM said:

   Dear Ms. Wann,

   Thank you for responding on this venue. I indeed understand that you answered my six questions on the eRDH Village. I have been waiting for weeks for Kristine A. Hodsdon, Director, RDH e-Village to forward those answers, because as she knows, I cannot go to the site without it freezing my computer.

   I look forward to reading your answers, Ms. Wann. Ms. Hodsdon said ” … her answers are more detailed than I have ever seen in a reply.”

   Sincerely,
   D. Kellus Pruitt; DDS

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10. Dr. Pruitt, on September 1, 2009 at 8:51 PM said:

    HIPAA consultant Olivia Wann RDA responds – defends OSHA as well

    I have recently received the answers that HIPAA consultant Olivia Wann RDA provided on eRDH Village a couple of weeks ago. As a reminder, my six questions come from one paragraph in Wann’s article “What’s new with HIPAA” that was published weeks ago.

    “Having a national system for computerized health records will improve patient care, increase patient safety, and simplify compliance in the United States. Additionally, these records will save costs, minimize errors and maximize efficiency.”

    Here are my six questions, Olivia Wann’s responses and my replies to her responses. This is ugly progress.

    1. How will eDRs improve care of dental patients?

    “According to the experts, electronic health records (EHRs) will improve care for patients through the ease of access to previous radiographs, medications prescribed, prior medical services provided, etc. The dental record would be similar, providing access to previous dental history. The EHR will promote continuity of care and help dentists and doctors work closely with other providers and health care professionals.”

    – Ease of access to previous radiographs. I have been in practice for 27 years and until HIPAA came along, I never had as much trouble obtaining new patients’ prior radiographs. They are only x-rays of teeth, for crying out loud. There is no street market value for dental radiographs. HIPAA is worse than worthless.

    It gets worse. Now that dentists have digital radiographs, they send them in emails to my office, and they are very poor quality, and I cannot even tell right from left. It is misleading to tell dentists that eDRs are going to ease access to radiographs. Please do not continue to use that claim.

    – Updating medications. I already discussed the dangers of depending on digital health histories with HIPAA consultant Kelly Mclendon earlier in this thread, so I will not repeat that information. What is wrong with looking a patient in the eyes and asking, “Are you taking any new medications I need to know about?” “Updating medications” is another rationalization. Not a reason. As for “prior medical services” and “etc,” patients are not comatose when they go to the dentist. Please show some common sense.

    – Portability. Once again, I’ve already covered this small advantage / big problem.

    “The EHR will promote continuity of care and help dentists and doctors work closely with other providers and health care professionals.”

    -Ms. Wann, can you give me an example? What’s wrong with telephone conversations or even the US Mail?

    2. How will eDRs increase patient safety?

    “Accurate lists of medications with flags for contraindications, known drug allergies, and access to previous medical treatment and other relevant care (medical and dental) undoubtedly increases patient safety. I can remember years ago, a patient failed to tell us during his medical history update that he had had a heart attack since his last visit.”

    – Medications and warnings. Myth already busted.

    – Does access to previous care increase patient safety? Probably. Can such information be transmitted over a fax machine? Of course. Why isn’t it? Nobody thought it was important enough until stakeholders needed a reason for healthcare IT.

    – Unrevealed information can sometimes be critical. However, the extremely safe, long track record of paper-based dental care cannot be matched with computerization. Not yet.

    3. What do you mean when you say that having a national system for computerized health records will simplify compliance in the United States?

    “One of the issues is an Accounting of Disclosures of protected health information. Layers of security that require log-ins will detail who is accessing the record and for what purpose. For example, hospital settings have more sophisticated software to require providers to log on to the network and indicate why they are accessing a patient’s record.”

    – I see.

    4. How will eDRs save costs in dentistry?

    “This may not appear to be a cost-saver for the private practice. However, one of the objectives of HIPAA was to prevent health care fraud and abuse. Medicare and Medicaid fraud costs millions of dollars which ultimately affects the taxpayers. Personally, I had no idea the amount of Medicare/Medicaid fraud taking place until I researched the material for a training program on the topic of dental insurance.”

    – I’m sorry, but that is hardly an answer to the question.

    “I like to compare a compliance issue such as HIPAA to OSHA. OSHA protects employees in the workplace. HIPAA protects patients’ health information. Compliance with OSHA may result in added expenses in having to provide training and documentation as does compliance with HIPAA. Promoting job safety lowers work-related injuries and illnesses which saves worker’s compensation costs. Promoting privacy and security of patient’s protected health information demonstrates compliance and minimizes the risk of violations.”

    – Sometimes in this confusing world, there is a natural tendency for us to categorize and cubby-hole items in order to grasp their significance. Mistakes occur when lawmakers assume dentistry is no different than hospital medicine as well as when one compares unfunded government mandates. HIPAA simply cannot be compared to OSHA. OSHA actually makes a little bit of sense. It is far less dangerous than HIPAA.

    And, since you brought up OSHA as the exemplary model of unfunded mandates that also help keep consultants busy, let’s talk about OSHA. How many work-related injuries occur in dentists’ offices? How many healthcare dollars are wasted on preventing a handful of injuries? Let’s not get silly with money that could keep children from going to bed with toothaches.

    “My concern in writing the article (July 31, 2009 RDH eVillage) is to be sure covered entities fulfill their training and policy requirements. Comparable to OSHA where the employer is responsible for the employee’s violations, the covered entity is responsible for its organization’s violations. Thus, having the necessary policies and procedures in place is a must particularly in light of the upcoming EHR. Furthermore, the employee has personal liability if a “knowing” violation takes place.”

    – Electronic dental records sound like they are not only scary, but the administrative work must be a nightmare.

    “We can look at the EHR as a government issue as mandated by the HITECH Act. Regulatory issues are not optional and thus we can save costs through compliance and avoidance of violations. As a business owner, I would much rather manage my compliance programs successfully myself rather than having to be burdened with additional regulations due to a lack of compliance. It is quite challenging to meet the demands of compliance, and I am sure it will be equally challenging to transition into the EHR.

    – Electronic dental records sound like they are not only scary, but the administrative work must be a nightmare.

    “Obviously with the EHRs, privacy and security of data is a real concern. Granted, we are all consumers of health care. The question has been raised: How do we prevent the dentist or hygienist from accessing records of the OB/GYN? These are valid concerns for privacy. Obviously, special features and layers of control should be incorporated into the software.”

    – Now you’re talking.

    “It may have been a difficult jump for some dental offices to go from paper records to electronic and yet now we can hardly imagine using the old peg board system which was labor-intensive. Technology is costly, perhaps painful and yet it promotes progress.”

    – Not in electronic dental records it doesn’t.

    5. How will eDRs minimize errors in dentistry?

    Comparable to the medical profession, drug alerts and access to an accurate medical history will minimize errors.

    – This myth has already been busted. You’re repeating yourself.

    6. How will eDRs maximize efficiency?

    A national electronic medical record promotes ease of access rather than having to wait for hard copies once a Records Transfer request has been made. A patient could reside on the East Coast and easily continue healthcare on the West Coast.

    – You are again repeating yourself. This has already be revealed to be a misleading statement as well.

    “Olivia Wann, RDA, BS, joined the dental profession in 1985. She attended Tennessee Technology Center as a RDA and graduated from St. Joseph’s College with a BS in Health Care Administration. Currently, Olivia is a second year law student at the Nashville School of Law. Olivia founded Modern Practice Solutions in the year 2000 providing in-office training, consulting and national seminars on compliance topics. Please visit http://www.modernpracticesol.com or contact Olivia at (615) 308-6695.”

    Thank you for your response, Ms. Wann.

    I’ll be back for a wrap-up, unless there are any other HIPAA, or OSHA consultants in the nation who would like to defend their profession on this public platform.

    D. Kellus Pruitt; DDS

    Where is the American Dental Association?

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11. D. Kellus Pruitt DDS, on November 29, 2011 at 7:25 PM said:

    Censored by David Jordan

    It really, really aggravates me to be censored by ambitious but misinformed dentalcare stakeholders like Mr. David Jordan, the Dental Access Project Director at Community Catalyst.

    http://blog.communitycatalyst.org/index.php/2011/11/22/pbs-newhour-explores-the-growing-need-for-better-access-to-dental-care-and-dental-therapist-solution/

    Like W. K. Kellogg Foundation leaders who also assume they can’t be held personally accountable for shopping bad dental ideas, Mr. Jordan recklessly promotes 2nd tier dentistry for the inconvenient poor in the US (but not for his own family, of course). How noble!

    When someone like Mr. Jordan casually censors any dentist’s common sense concerns about enabling inadequately-trained high school graduates to extract large portions of teeth, it tells me that this man’s ambitions have become far more important to him than the people he serves. Alaskans deserve to be treated better than pawns.

    What happened to you, David Jordan? Less than a week ago, you ran an ad on your blog promoting cheap, 2nd tier dentistry for the poor. Yet this week you seem incapable of defending the true value of dental therapists.

    D. Kellus Pruitt DDS

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12. D. Kellus Pruitt DDS, on September 11, 2014 at 2:46 PM said:

    Critical healthcare news is censored by Fort Worth’s local dental leaders without explanation

    As many of you know, the Fort Worth District Dental Society has kindly permitted me to post links (without my commentary) to important current news articles on their Facebook for several months. In fact, many of you have “liked” the FWDDS Facebook per my invitation a while back, raising the number of fans for their Facebook from 20 to 60 in days.

    https://www.facebook.com/pages/Fort-Worth-District-Dental-Society/520983141287312

    Following yesterday’s posting of a local news report describing a breach caused by a stolen computer from a dental office in Arlington, local dental leaders chose to hide this kind of information from membership by censoring it, without explanation.

    As a citizen, do you think hiding the danger of data breaches from local, dues-paying dentists stands a chance of improving the safety of dental care in Fort Worth?

    Since I am no longer able to post on the FWDDS Facebook, I suppose (unresponsive) local leaders are already working on ways to keep local dentists informed about HIPAA, electronic dental records and data breaches. What do you think?

    D. Kellus Pruitt DDS

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