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Dr. Pruitt Invites Dr. Cohen to Discuss eDRs

11 Responses

1. Carmine, on November 24, 2009 at 12:22 PM said:

   Dr. Pruitt

   Did you know that the Military Health System and the armed services are considering halting the continued deployment of the official MHS dental electronic record and replacing it with an Army-developed tool?

   Check out this new report:
   http://www.govhealthit.com/newsitem.aspx?nid=72474

   Carmine

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2. Darrell, on November 25, 2009 at 12:04 AM said:

   Thanks, Carmine. Yes, I’m following the sad story.

   I only hope it is clear to Washington that the derailment of that expensive train was avoidable if the giddy cheerleaders had just once looked up from their LCD screens and noticed the bridge was out. So far, nobody has paid attention to the needs of the dentists who are ordered to use a records system that is worse than worthless. Now the military is back to where it was in 2007- patching make-do systems together as best they can. I don’t like to complain about our military, but I have to say that this is a shameful mess caused by boneheads.

   We can only hope our military HIT geniuses learned something this time.

   When will digital dental records start saving Americans money for dental care like ADA leaders promise?

   D. Kellus Pruitt; DDS

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3. Darrell, on February 4, 2010 at 12:11 AM said:

   Hackers phish using Adobe as bait

   Fresh on the heels of sharing news about hackers “spearphishing” using personalized emails to possibly steal patient IDs from unwary dental staff, I just read an alarming article in PC World titled “Adobe Warns of PDF Phishing Scam” written by Ellen Messmer that was posted Saturday.

   http://www.pcworld.com/article/188202/adobe_warns_of_pdf_phishing_scam.html

   “The phishing scam has a subject line ‘download and upgrade Adobe PDF Reader – Writer for Windows,’ includes a fake version of Adobe’s logo and provides links that would lead to malicious code or other trouble if a victim clicked on them. The e-mail appears to come from Adobe newsletter@pdf-adobe.org, which is part of the scam.”

   It’s only been a couple of months since ADA Delegates in Hawaii enthusiastically endorsed national adoption of electronic dental records, but let’s be honest. You heard these warnings about phishing from me today, February 3, 2010. Now, how long will it take for the ADA to say anything bad about eHRs… for the first time ever?

   Even though the ADA Advocacy Page continues to report that digital dental records will save money for dental patients, sometimes enthusiasm and ambition make otherwise well-intentioned committees giddy. If you haven’t computerized your office and still use pegboard and ledger cards, ignore the ADA Delegates. Don’t change a thing.

   What aggravates me is that the bankruptcy-level damage from data breaches in dental offices is avoidable, and the solution is simpler, cheaper and much more secure than even encryption (which consumers are waiting to reject anyway). It’s called de-identification and I promise it will work in dentistry even if it works nowhere else in healthcare.

   It is stupid to store bombs with their fuses attached. If patient identifiers are removed from digital dental records, nobody will pay for information about a person’s oral health. Let’s not get committee-silly. The ADA made a mistake. That’s all.

   D. Kellus Pruitt; DDS

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4. Darrell, on July 1, 2010 at 9:16 PM said:

   You’re misleading ADA members, Dr. Robert Faiella – We’ve got to talk

   I’ve read the article “Electronic health record – Will federal government require it by 2014? ADA responds” that was published in the June 21st ADA News.

   http://www.ada.org/news/4306.aspx

   Dr. Faiella’s ill-advised and transparently lame questions and answers are an embarrassment to all ADA members. Like most biased articles with no byline one finds in less professional publications than the ADA News, Dr. Faiella’s shameless promotion of eDRs is nothing more than a self-serving, meaningless press release for his favorite hobby. I might consider it frightening to think Dr. Faiella is working as hard as he can to help HHS and insurers to intrude in dentist-patient relationships – except Faiella not only has a history of awkward failure with his ADA/IDM fiasco, but the man is obviously as clueless about the eDR market as the dental marketing business. He’s going nowhere.

   Even Dentrix representatives recently admitted to me on their Facebook that there is no return on investment eDRs and that they threaten the welfare of dentists and dental patients more than paper records. (If I have misquoted the Dentrix representative named Eric, I invite rebuttal enthusiastically). So eDRs increase overhead and harm everyone. That’s a hard sell to smart people, and the mandate that Dr. Faiella warns us about is too absurd to ever get off the ground. Faiella is going nowhere with his ideas. Period.

   It’s a shame that the ADA Trustee is more concerned about HIT than the Hippocratic Oath. It would be wonderful to discover that the man has the guts to defend himself. He knows who I am, but has hid from me ever since I predicted the collapse of ADA/IDM six months beforehand. So even though he will read this invitation, I don’t expect him to respond.

   Theses 72 – 78, “The Cluetrain Manifesto.” (Levine, Locke, Searls and Weinberger)

   – We like this new marketplace much better. In fact, we are creating it.

   -You’re invited, but it’s our world. Take your shoes off at the door. If you want to barter with us, get down off that camel!

   – We are immune to advertising. Just forget it.

   – If you want us to talk to you, tell us something. Make it something interesting for a change.

   – We’ve got some ideas for you too: some new tools we need, some better service. Stuff we’d be willing to pay for. Got a minute?

   – You’re too busy “doing business” to answer our email? Oh gosh, sorry, gee, we’ll come back later. Maybe — You want us to pay? We want you to pay attention.

   I wonder if Bob would be my Facebook Friend. I have nothing to hide. Does he? I might just have some ideas about solving the privacy problems that confound his mysteriously quiet eHR team. If Bob will meet me half way and ask me to friend him, I’ll accept. Who knows where our free-wheeling discussion about interoperable dental records could lead from there – if those records contained no information thieves are interested in.

   Does Dr. Robert Faiella want to trot out talking points about fantasy that nobody believes, or is the newly reformed man interested in safe, marketable solutions? Otherwise, he’s going nowhere.

   D. Kellus Pruitt DDS

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5. Darrell, on August 16, 2010 at 11:36 PM said:

   If dentists are to believe what National Coordinator for Health IT Dr. David Blumenthal says, nobody in the entire ADA Department of Dental Informatics has a clue how to move forward with health IT in dentistry.

   This article written by Camille Tuutti was posted on Executivegov.com today: “Health IT a Team Effort between Government, Industry, Says Blumenthal”

   http://www.executivegov.com/2010/08/health-it-a-team-effort-between-government-industry-says-blumenthal/

   “The whole point is to increase communication and coordination among the different players in the healthcare system. You just can’t go it alone in this field.” – Dr. David Blumenthal.

   Did you hear that, ADA?

   You cannot get anywhere with HIT without communicating with the dentists who you would have pay for them. So where are you now, ADA Sr. Vice President Dr. John Luther, and what on Earth were you thinking when you took over control of the ADA Department of Dental Informatics seven years ago?

   I don’t think the ADA official who established the Department of Dental Informatics is still around. He may have been fired months ago for all ADA members know. That’s how well the proud, command and control ADA communicates with providers.

   Why do we put up with nonsense like this from the ADA?

   D. Kellus Pruitt DDS

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6. Proots, on August 22, 2010 at 1:12 PM said:

   Why even bother, Dr. Robert Faiella?

   Hey, @ADANews. Wake up! Nobody noticed Kelly Soderlund’s “ADA continues work on EHR development, implementation,” with Dr. Faiella’s photo.

   Link: http://www.ada.org/news/4603.aspx

   By the way, what happened to reporter Arlene Furlong who used to write the ADA’s fairy tales about eDRs and their necessity for dentistry? For that matter, what happened to Dr. Ahlstrom, the number 1 stakeholder in the ADA’s failed eDR push? And where is Dr. Luther? And Narcisi? Wasn’t Dr. Robert Faiella an important officer involved in the failed ADA/IDM partnership? Isn’t he also involved in the CareCredit/GE mess?

   Soderlund’s opening line: “The current model has been in place for more than a century.” Is that alone a reason for change? And to what? Neither Soderlund nor Dr. Faiella gave a single convincing argument for the need of eDRs. As a matter of fact, transfer of records has never been a big problem in dentistry with paper records until HIPAA came along.

   Why is the ADA so interested in promoting a tool that scares patients as well as dentists – who clearly aren’t wild about purchasing them? ($) Remember when Newt Gingrich visited ADA Headquarters six years ago? Bush didn’t send the former Speaker to Chicago with empty pockets.

   Where did you think the ADA Department of Dental Informatics came from? Dues? Ha! Soderlund writes: ”Following a request for proposal issued by HHS under the Bush administration, …” Do you see what’s coming? (Cha-ching!) “…the ADA worked to position itself as the expert resource and advocate for dentistry’s portion of the EHR.” Members didn’t pay for the push.

   If you are left with questions, don’t bother Dr. Faiella. He won’t respond. I’ve tried hundreds of times concerning several of his hobbies. However, ADA News reporter Kelly Soderlund generously offers the following link for any questions ADA members might have about eDRs:

   “For more information on EHRs, visit http://healthit.hhs.gov.” Good luck with that. What did you expect? An ADA Facebook? I’m going to go golf now.

   Proots

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7. Darrell K. Pruitt DDS, on August 24, 2010 at 12:08 AM said:

   eDRs

   Here is information the ADA should be providing members, but won’t. If an ADA member has questions about eHRs, Dr. Robert Faiella, the ADA’s eHR expert, passes off a link to HHS as helpful advice.

   In “Health IT Contracts Offer Little Protection For Buyers” by Nicole Lewis for InformationWeek, she provides honesty about eHRs that ADA leaders would prefer members not read.

   http://www.informationweek.com/news/healthcare/EMR/showArticle.jhtml?articleID=226900063&pgno=1&queryText=&isPrev=

   Darrell K. Pruitt DDS

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8. D. Kellus Pruitt DDS, on March 4, 2011 at 8:47 PM said:

   Dr. Margaret Scarlett invites rare discussion of EHRs in dentistry on Medscape

   Dr. Scarlett, a noted clinician, scientist and lecturer, posted “What’s Your Experience with EDRs?” on Medscape Blogs a few days ago.

   http://boards.medscape.com/forums?128@33.gLIyammYMOb@.2a077212!comment=1

   I haven’t had a chance like this since I welcomed Dentirix to Facebook about a year ago. Her bias makes it clear that Dr. Scarlett is passionate about technology. But perhaps her enthusiasm is clouding her common sense. I find it unnerving that the retired CDC official would attempt to sell baseless claims about advantages of electronic dental records that even rookie salespeople know better than to try these days. What happened to Evidence Based Dentistry in the CDC? I challenged her sales pitch in a comment following her article.

   Dear Dr. Margaret Scarlett:

   I applaud you for hosting a rare and urgently needed public discussion for the benefit of uninformed dentists in the audience who are considering EDR purchases and happened to come across Medscape Blogs. From your arguably biased introduction, I’m aware that this is not the direction you wanted this dentist-to-dentist discussion to take. Nevertheless, I think ultimately you will agree that right now is an ideal time to clear up potentially harmful misconceptions about the advantages of paperless over paper dental records. As you have probably noticed, other than you, nobody is promoting EDRs on the internet – not even huge EDR vendors like Dentrix.

   Silence in the community is never a sign of a healthy industry, and this alone should be a red flag to consumers. Silence from EDR salespeople on the internet can only mean that someone has already made them aware that they are incapable of defending the very products you promote. Even before HHS recently started fining providers millions of dollars for HIPAA violations, EDRs have never saved money in dentistry and are becoming more expensive and dangerous to dentists and their patients every day. About a year ago, following a couple of years of unresponsiveness, an ADA employee in charge of the Advocacy page of ADA.org was finally persuaded to drop your claim that digital records will save money in dental care. As I said, you’re pretty much on your own out here, Dr. Scarlett.

   You say “EDRs have the advantage of improving care,” but we both know you have no basis to make such a claim. You call EDRs “a retrievable resource for all patient information,” but you fail to mention that dentistry’s traditional means of communications – including the telephone, fax and US Mail – have adequately and safely served the profession for decades, and dentists don’t have to be HIPAA-compliant to use these communication tools.

   “They can reduce patient errors by having all records in one place.” Once again, where did you draw the data on which you based this claim? Did you take into account keystroke errors? You add that dentists can “note any drug or materials allergies.” Have dentists not done an admirable job of noting allergies for decades? What are you trying to say?

   Once again, there is no proof that EHRs save time and money for even busy physicians who maintain ten times the number of charts as dentists. So on what data do you base your claim that EDRs somehow save dental pracitces time and money? Where is the evidence?

   “Already, many dental schools and large practices have EDRs.”

   Other than the University of Florida dental school which in 2008 suffered a data breach which involved records of about 330,000 current or former dental patients, how many other dental schools and large paperless practices have had to report digital data breaches to HHS? How much did it cost them? Did I mention that recently HHS has started fining providers millions of dollars?

   D. Kellus Pruitt DDS

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9. D. Kellus Pruitt DDS, on February 28, 2013 at 12:12 PM said:

   EDRs then and now
   [The ADA’s anticipated benefits of electronic dental records fail the test of time]

   Recently, Juergen Fritsch, Chief Scientist at M*Modal, highlighted key points made in the latest RAND study which brutally discredits its earlier more optimistic 2005 study:

   http://blogs.computerworld.com/healthcare-it/21812/unfulfilled-promises-health-information-technology

   – EHR technology has been adopted too hastily, before it was ready for prime time. Many of the EHR systems deployed in hospitals today were originally developed many years ago and still have major usability issues that have been shown to adversely affect physician productivity.

   – Lack of interoperability. Existing EHR systems make it hard or sometimes even virtually impossible to share medical information across systems, despite the availability of mature standards governing the exchange of medical information. Proprietary data models and silos still dominate the field.

   – Lack of adoption. Despite the payout of $6.5 billion of Meaningful Use incentives, adoption of EHR systems is still lower than 40%. On top of that, most of the facilities that have adopted EHR systems are larger, urban and academic hospitals – leaving a significant gap around the smaller, rural and non-teaching hospitals.

   – Healthcare professionals are not embracing the technology. The government incentives are encouraging providers to ‘just buy what’s out there anyway’ instead of demanding more usable systems. They tend to get frustrated with healthcare IT in general rather than pushing towards a next generation of electronic record systems.

   – Patients are not embracing the technology either. Despite the availability of patient portals, few of them are signing up to access their records, and most of those never actually look at their data.

   ———————————–

   Dr. Robert Ahlstrom, a long-time promoter of electronic dental records and the rumor of a mandate, has served as chairman of the ADA Dental Practice Model 2020 Committee, a group of stakeholders who promote EDRs through federal regulation rather than customer demand. In July, 2007, Dr. Ahlstrom presented the ADA’s selling points for EDRs in testimony before the standards and security subcommittee of the NCVHS (Department of HHS).

   Click to access 070731p08.pdf

   – Dental office computer systems will be compatible with those of hospitals and health plans and referral inquiries handled easily.

   – Vendors will be able to supply low-cost software solutions to physicians and dentists who support standards-based electronic data interchange.

   – Administrative tasks can be accomplished electronically and dentists will have more time to devote to direct care.

   – Dentists will have a more complete data set of the patient in their care.

   – Patients seeking information on enrollment status and benefits will receive more accurate, complete and easier to read information.

   – Consumer documents will be more uniform and easier to read.

   – Provider and plan cost savings will translate to less costly health care.

   – Patient claims follow-up costs will be reduced.

   – Patients will be able to see the information in their medical and dental records and who has accessed those records.

   – Patient records will be adequately protected through organizational policies and technical security controls.

   – Patient visits to dentists and other providers will be shorter without the burden of paper forms and consumer claims correspondence with insurers reduced.

   ————————————

   Five years later and not one of the ADA’s rationalizations has proven credible. The nation was had.

   Though it is unsavory to consider the enormity of industry-wide deception, until dental leaders accept ownership of their bad advice, the welfare of clueless dentists and vulnerable patients will continue to be put at risk by the same unaccountable bureaucrats who wrongly inform dentists that EDRs are mandated.

   D. Kellus Pruitt DDS

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10. D. Kellus Pruitt DDS, on August 31, 2013 at 6:27 PM said:

    Orthodontists’ office reports data breach

    A data breach from a dental office was reported in the news hours ago for possibly the first time ever. If the EDRs had been de-identified, nobody would have cared.

    Yesterday, a Florissant, Missouri orthodontists’ practice started notifying 10,000 patients and their parents to be on the alert for identity theft (forever). Computers were stolen in a burglary that occurred 5 weeks ago. But then, who knows how many dentists’ stolen computers are never reported at all?

    Until Georgina Gustin’s article titled “Patients at Florissant orthodontist told of possible data breach after burglary” appeared in the St. Louis Post-Dispatch a few hours ago, not one news report covering data breaches from dental offices had ever made it to the internet – as far as I know.

    http://www.stltoday.com/news/local/patients-at-florissant-orthodontist-told-of-possible-data-breach/article_47bcd294-4234-5221-8cd6-d5e2b26ea8a6.html

    According to Gustin, the Olson & White Orthodontics’ computers contain patients’ personal information including names, addresses, X-rays, photos and health histories. The parents’ information include names, emails, Social Security numbers and credit scores.

    In addition to the increased risk of identity theft for families throughout the St. Louis area, the reputations of orthodontists Olson, White (and others) are forever damaged. That is a high price to pay for electronic dental records. The Ponemon Institute estimates that data breaches of patients ePHI cost healthcare organizations over $200 per record – $50 for notification and $150 in lost business. For Olson & White, that comes to over $2 million.

    In early 2006 I began warning dentists about the consequences of stolen computers. Those who hastily wrote me off as alarmist and worse, can expect to witness I-told-you-so redemption. Dare I say some HIPAA-covered dentists who read Gustin’s article may find it difficult to sleep tonight. Sorry.

    This time, instead of blaming me for bad news about dangerous but popular technology, how about speaking up for once to demand better solutions from the dental industry – especially EDR vendors who cannot be held accountable when their careless vulnerabilities cause dentists and patients to get hurt? I’ve been encouraging such transparency in the dental industry for 7 years as well, with similarly dismal results.

    I’m at a point where I am second-guessing my ability to motivate patients to brush their teeth. Hell, I can’t even get our dogs to stop barking.

    D. Kellus Pruitt DDS

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11. Darrell K. Pruitt DDS, on August 22, 2017 at 3:23 PM said:

    De-identification
    [My post, 4 years ago today]

    For those following the progress of de-identification of electronic dental records through tokenization, there is a discussion taking place on Data Masking and Data De-identification Linkedin Group.

    https://www.linkedin.com/groups/1839409/1839409-267008651#commentID_158249700

    GB • Tokenization does seem to fit as a solution to the problem, however, one thing to keep in mind is that with tokenization solutions the actual mapping of the original value to the “token” is usually stored somewhere. This means that there is an alternate location that would need to be secured – essentially just moving the point of vulnerability from your primary software’s repository to the tokenzation software’s repository. I would like to assume that vendors offering tokenization solution would automatically be encrypting their mapping tables/structures to secure them, but it is certainly a question to ask and confirm when evaluating your options.

    Darrell Pruitt • Since cloud-based electronic dental record systems currently store such information anyway – in encrypted format – it seems to me that tokenizaton would be relatively simple to plug in. – August 22, 2012.

    —————————————————–

    Four years later, and data breaches of patients’ medical identities have only gotten worse. De-identification of dentists’ primary dental records – utilizing cloud-based tokenization or even gravity-based metal filing cabinets – is still a promising idea that warrants investigation. If patients’ identifiers are unavailable to hackers, they simply cannot be stolen.

    De-identification of dental records is not what the government and insurers want. It would limit third-party control of healthcare.

    Darrell K. Pruitt DDS

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