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Take the Electronic Medical Records Survey

5 Responses

1. Houston Neal, on November 6, 2009 at 7:03 PM said:

   Hi Dr. Marcinko,

   I just want to thank you for participating in our survey. We had some good responses and I really appreciate your help. I posted the results this morning on our blog at:

   http://www.softwareadvice.com/articles/medical/obamas-emr-stimulus-of-2009-creating-buyers-or-tire-kickers-1102709/

   Feel free to use any of the charts if you want to blog about it.

   Thanks again,
   Houston Neal
   Software Advice
   http://www.SoftwareAdvice.com
   Office: (512) 364-0117
   Email: houston@softwareadvice.com

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2. D. Kellus Pruitt DDS, on April 22, 2012 at 11:07 AM said:

   End of the road for interoperability

   Yesterday, in my Health IT LinkedIn conversation with Genevieve Morris, Senior Associate at Audacious Inquiry, I predicted that within a year, the indefinite suspension of HITECH goals will mark the end of the road for interoperability. My opinion caught the attention of Phil Magistro, Director of Health Informatics in the Reading, Pennsylvania Area. Phil and I have met.

   http://www.linkedin.com/groups/Latest-healthcare-meaningful-use-rules-3993178.S.104202753?qid=635f09ef-99b6-4504-a204-4b3985f57f43&trk=group_most_popular-0-b-ttl&goback=%2Eamf_3993178_32932081%2Eamf_3993178_77324573%2Egmp_3993178

   Phil Magistro:

   Darrell, every year millions of credit card records are hacked, stolen or misplaced giving access to all that personal information. While I haven’t done any research I suspect that those breaches won’t spell the end of credit cards. I also belief you are in the minority with your views on the future of EHRs.

   My response:

   Do you know how stolen credit card numbers and stolen medical identities are alike? They are both easy to alter.

   Thanks, Phil. Haven’t we had this discussion before? Temporal financial identities defy comparison to medical identities that last a lifetime, including genetic information that can last generations. I have to say that I’ll certainly feel much better about the safety of my family when all HIT stakeholders understand the difference.

   I’ve always been seemingly alone in my views of the future of EHRs – especially in communities such as this. It happens much less often now, but I’ve been called a Luddite, white noise and old fart. Nevertheless, one shouldn’t assume that my apparent lack of popularity means I’m wrong. Consider this: Bi-partisan, subsidized, politically-correct EHR solutions to the nation’s unemployment problem depend on Meaningful Use of software that sports a 30% de-install rate. Truth has never been democratic. It’s not even polite.

   Since around the first of the year, I’ve noticed less and less resistance to my challenging comments both here and elsewhere. Perhaps you also sense a change in the atmosphere on the internet. For example, it’s been months since I’ve read that EHRs are urgently needed in dentistry because paper records are often lost in natural disasters.

   At least in part because of transparently lame selling points like natural disasters, I have reason to believe that the minority of consumers who share my concerns is quietly growing. For example, if my public criticism of the cost and danger of electronic dental records over the last six years was baseless or even exaggerated, don’t you think at least one of the thousands of HIPAA covered dentists in the nation would gleefully expose my faulty conclusions? I can’t even persuade EDR vendors and consultants to defend their products. Most block me from asking them direct questions on their Facebook accounts – some prophylactically. Imagine that.

   Thanks for your concern. But my ambitions are easily satisfied by subtle support from family and friends. I’m not running for office.

   The HIT mandate has taught me a lot about government efficiency. I learned that if provided enough federal money, parasite-infested good ideas resist de-worming – even as they increasingly cause more harm than good. Data breaches already cost healthcare $6.4 billion last year even as poor security is rapidly expanding to mobile apps. How can anyone be optimistic about that?

   It’s questions from angry customers that stakeholders should prepare to encounter. I’m only a nuisance who doesn’t mind giving HIT industry investors a heads-up. I’m just that kind of guy.

   D. Kellus Pruitt DDS

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3. D. Kellus Pruitt DDS, on April 22, 2012 at 9:57 PM said:

   EDRs

   Phil Magistro once again responded to my concerns about security of EHRs. I’m pretty sure the Director of Health Informatics doesn’t invest near as much thought into his message as I invest in mine. I imagine Phil wishes he could pull back this and a couple of other stinkers he hurriedly posted on the HIT LinkedIn site recently.

   http://www.linkedin.com/groupAnswers?viewQuestionAndAnswers=&discussionID=104202753&gid=3993178&commentID=77629775&goback=%2Egmp_3993178&trk=NUS_DISC_Q-subject#commentID_77629775

   Phil Magistro:

   Darrell, My opinion is that less resistance to your challenging comments means only that people are tired of beating their heads against the wall. You focus on one aspect of technology, the security piece, and condemn or try to invalidate the real and practical reasons that EHRs are beneficial and a necessary tool in health care. Your looking at this from a dentist’s point of view and not seeing the big picture across all providers – how an integrated electronic record is offers value to patients and providers in transforming how care is provided. It is not the only tool but it is a valuable one.

   I’m not going to get into more protracted disagreements with you but I may dip my toe in the water from time to time just so you don’t get the mistaken idea that folks are accepting your challenging comments.

   My reply:

   Since those who aren’t accepting the bad news are unable to express their opinions, that makes your job increasingly important. I hope you choose to return often. You’re doing all the good, Phil.

   Long before some in this LinkedIn group gave up trying to discount, ridicule and even hide my well-considered minority opinions, frustrated HIT stakeholders with Facebook accounts simply censored them without explanation or recourse. I call this progress. I’m happy here.

   “My opinion is that less resistance to your challenging comments means only that people are tired of beating their heads against the wall.” That’s hardly unexpected.

   If anyone could successfully cast doubt on very unpopular news I share concerning the true cost and danger of EDRs, instead of beating their heads against the wall, I think some would be using this opportunity to jump on the flaws in HIT experts’ conclusions who are much more knowledgeable than me. That could be interesting. Yet I get the idea that you blame this dentist’s inescapable focus on only one aspect of EHRs – security – for the absence of defense, which is basically the same thing. Without security, all other HIT benefits are nothing more than short-lived public relations gimmicks.

   Even the most politically-correct biased selling points for expensive and dangerous EHR products are powerless against wave upon wave of bad news – punctuated by frantic alerts within 60 days following really huge data breaches.

   Because transparency is encouraged on internet platforms such as LinkedIn, and since dissatisfied customers detest censorship, today’s patients are more likely to be properly informed of the inherent wastefulness of dangerous federally-subsidized EHRs along with the advertised benefits. Informed consent is the Hippocratic standard elsewhere in healthcare. Why not record-keeping?

   Did you know that in order to loosen up our grandchildren’s hold on $20 billion in stimulus money a few years ago, former presidential candidate Newt Gingrich along with other HIT lobbyists told lawmakers that EHRs will save $77 billion a year and over 100,000 lives? Even though nobody mentions it, interoperable EHRs fall far short of what our clueless grandchildren were sold. Gingrich used to proclaim, “Paper kills!”… not so much anymore.

   “You’re looking at this from a dentist’s point of view and not seeing the big picture across all providers.”

   Hell. I’m a dentist.

   As a dentist, I’m expected to purchase EHRs and to persuade my patients – perhaps with a free i-Pad raffle ticket! – to help me Meaningfully Use the technology you would protect from criticism if you could. So other than serving as folks’ acting spokesperson, what brings you here?

   D. Kellus Pruitt DDS

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4. D. Kellus Pruitt DDS, on April 23, 2012 at 6:37 PM said:

   LinkedIn EHR discussion continues

   http://www.linkedin.com/groups/Latest-healthcare-meaningful-use-rules-3993178.S.104202753?qid=0b018b63-77dc-40e9-9e4e-2755c048114f&trk=group_most_popular-0-b-ttl&goback=%2Egmp_3993178

   Phil Magistro:

   I will address only one sentence “…to help me Meaningfully Use the technology you would protect from criticism if you could.”

   This is an example of how you take specifics and create generalities. The last thing I have done and will do is try to silence critics. There are significant issues in any number of areas related to EHRs and their use that should be discussed. But your comments aren’t part of a constructive dialogue. They are a constant drum beat of negativity – of pointing out the obvious and trying to make it the only issue. And, although you are able to pull information from articles to reinforce your claims, you only present the negative side and completely overlook the big picture – how EHRs are only one tool, albeit an important tool, that can be effectively used with many other processes and systems to improve patient care at individual and population levels.

   There is a new book out that you should consider reading – Integration of Medical and Dental Care and Patient Data (Health Informatics).

   My reply:

   Thanks, Phil

   You said, “The last thing I have done and will do is try to silence critics.” I’ve looked back on your posts, and you are exactly right. Not once have you suggested that I should voice my opinions somewhere else, or that if I can’t say something constructive, I shouldn’t say anything at all. I appreciate that. But that wasn’t what I meant.

   Here’s the sentence in question:“As a dentist, I’m expected to purchase EHRs and to persuade my patients – perhaps with a free i-Pad raffle ticket! – to help me Meaningfully Use the technology you would protect from criticism if you could.” I should have said, “…. if you were capable.” Or put another way, “… if it were at all possible.”

   Genevieve Morris:

   First, I do agree with all of Phil’s comments. That being said, I want to follow-up on your comment about exchanging de-identified records. I took a look at WinID, and I’m not clear on how that helps. If I’m a new patient going to a dentist and I ask you to send my records including xrays electronically to the new dentist, how does he re-identify them without taking additional xrays, which is what I’m trying to avoid. I’m also not clear on how it helps you the dentist get a full patient history from me. How does WinID help you get my full medication list, which I have previously noted is very difficult for older patients to maintain? How does WinID help ensure that you know if a patient is just seeking pain medication?

   My reply:

   I’m sincerely glad you asked, Genevieve.

   Now that everyone appears ready to accept the fact that the epidemic level of data breaches and the inestimable expense of HIPAA compliance has already doomed current electronic dental records, I and others are also ready for constructive conversation.

   About 5 years ago, when I asked the CEO of a small hospital if de-identifying patients records were feasible for eliminating almost all risk of identity theft, he agreed that if digital PHI is not present, it simply cannot be hacked. But then, he quickly said the idea is a non-starter for a hospital for two reasons: 1. Sensitive information from breached medical records can often be cross-referenced with other accessible data, and then traced back to the patient, and 2. If the key (such as a flash drive or even a Rolodex) is lost, it would be impossible to reconcile millions of hospital patients with their records. That would be as big a disaster as a cyber-attack – which can do the same thing, and is increasingly likely.

   Just because de-identification is a non-starter even for physicians with small practices, that doesn’t mean it’s not worth investigating for use in dental practices.

   1. Even if it were possible to locate the owner of a dental record from only dental treatment information (without medical history), why would anyone bother?

   2. If for some reason, the key to dental patients identities is lost – or more likely, if insurers begin demanding reimbursement from dentists who mistakenly treat dental insurance thieves – WinID is an answer: With the unknown patient in the chair, all the dentist has to do is start entering the numbers of filled and missing teeth into the computer and within minutes that person is identified with certainty.

   Even though you say you agree with Phil, are you interested in meeting me half-way, Genevieve?

   In an earlier statement I didn’t intend to ignore, you said, “If you can tell me a way to keep paper records without creating siloes of information I’m happy to hear it… I would like to hear your thoughts about how you eliminate siloes of incomplete information if you don’t move to electronic records.”

   Imagine if fax machines were interoperable with computers? Just because something originates on a fax doesn’t mean it has to be printed, and vice-versa…. Wait just one minute! That service has been around for years!

   http://rightfax.com/

   “How does WinID help ensure that you know if a patient is just seeking pain medication?” I may be reading too much into your question, but it appears to be less about WinID and more about dentists needing to e-prescribe to prevent drug abuse. I may be wrong, but it seems you would have dentists purchase and Meaningfully Use (with patients’ cooperation) expensive and dangerous EHRs instead of applying cheap and efficient common sense. Coming from a medical background, you may still not appreciate how few patients dentists can treat in one day.

   Like the vast majority of dentists, I recognize the names of most of my patients, and dispense pain medications only 12 tablets at a time. Understandably, I don’t need a drop down box on a computer screen to alert me when patients return for more. I apologize if that wasn’t the direction you were headed, and welcome your explanation.

   D. Kellus Pruitt DDS

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5. D. Kellus Pruitt DDS, on April 24, 2012 at 10:30 AM said:

   Morris responds

   Genevieve Morris, Senior Associate at Audacious Inquiry, responded again on LinkedIn. This is probably be the longest-running discussion ever concerning EHRs in dentistry – surpassing my thread on PennWell in 2009.

   http://www.linkedin.com/groups/Latest-healthcare-meaningful-use-rules-3993178.S.104202753?qid=26ce8265-a407-4c8a-9942-366d3a9ad051&trk=group_most_popular-0-b-cmr&goback=%2Egmp_3993178

   ————————-

   Genevieve, if a new product is both more expensive and more dangerous than status quo, how should the vendor package the sales pitch? “It’s the law”?

   If you still don’t believe customers are always right in the land of the free – regardless of half-baked mandates – just give electronic dental records a few more months and providers a few more $100,000 HIPAA fines. Then we’ll evaluate how much more promising EDRs look as an investment. So far, 15% of dentists have paperless practices with little to no interoperability even with each other… (yet almost all dentists have fax machines).

   I’m not familiar with hospitals, and don’t know what a PCP is and why he or she needs discharge information. So I haven’t a clue why EHRs work 100% (?) of the time while faxes fail 73% of the time. You win. I won’t even attempt a challenge.

   As to your concern about lost paper dental records, in my 30 years of practice that’s never been a problem – yet electronic charts can be lost thousands at a time within minutes without a trace.

   Your concern about bad handwriting is a lame EDR selling point that even rookie vendors no longer trot out. If a staff member’s handwriting is so bad that others can’t read it, instead of reaching for a dangerous and expensive EDR system, one simply demands more careful handwriting. Besides, the need for legible notes isn’t going away. Dr. John Halamka, CIO, Beth Israel Deaconess Medical Center recently told NPR, “The paperless hospital is as likely as the paperless bathroom.”

   It’s much easier for a keystroke error to produce a 4 instead of a 1 than for someone to misdraw numerals using a simple, cheap ball-point pen. Criticizing paper cuts makes more sense.

   Your third concern about difficulty locating information in a paper record again applies more to hospitals than dentist offices. If only EHRs could be as user-friendly as paper dental charts! In dentistry, paper is not only the gold standard in security, but the freedom and convenience of paper dental records is still unmatched by digital.

   Obviously, you still don’t quite appreciate the simplicity of the business of dentistry. Most of our urgent communication is done over the phone. With phone calls, we don’t have to log on to a computer and there is no worry of a data breach or otherwise violating HIPAA. What’s more, I have heard that a huge problem with EHRs is the overwhelming amount of superfluous data which often obscures relevant information. Show me a dentist who wants to waste money on such avoidable, costly complications.

   As for reviewing medical and health problems, dentists using paper medical histories can concentrate their attention to patients’ reported changes since their last visit. Dated alterations are easy to follow. On the other hand, if an identity thief personalizes a stolen electronic health history, the changes are imperceptible even as organs start to fail. The way I see it, for digital to be as safe as paper, patients’ entire medical histories need to be reviewed at every visit. No money saved over paper there.

   “I’ve been to a number of dentists who don’t seem to remember me, and I’m sure I’m not the only one who has had that experience.” Just try to get 2 or more refills for Vicodin and see if your dentist doesn’t learn your name.

   Lastly, WinID is not an electronic dental record. It’s just a handy chairside identification tool for patients of record that is useless to all other providers.

   Thanks for recommending AHRQ. It’s been a few years since I tried them. Nobody responded. If I didn’t have a real job, I might waste even more time on bureaucratic dead ends… but probably not. I like it here.

   The way I see it, if the EHR industry doesn’t take security seriously, AHRQ will learn soon enough EDRs are doomed. After all, EDRs are both more expensive and more dangerous than paper dental records. Why ruin the surprise?

   D. Kellus Pruitt DDS

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