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Some Dental Consultants Say the Most Incredible Things

Are Dentists like … Rodney Dangerfield? 

By Darrell Kellus Pruitt; DDS

“Let’s face it — in our world dentists do not get the respect they deserve. They are not perceived to be ‘real’ doctors … Perhaps the lack of sex appeal in dentistry is part of why dental coverage for everyone is an afterthought in the national health care conversation.”

Gary Kadi DDS, DentistryiQ


Even if Dr. Kadi is correct, and the barrier between a 12 year old and his toothbrush is a world-wide lack of respect of dentistry, that hardly means that electronic dental records (eDR) are going to make the kid brush any better. Experience tells me that if mom’s nagging won’t motivate the stinker, the computer won’t either.

eDR Rationalization?

For those who read the article, did you notice how Dr. Kadi, a dental practice consultant, attempts to subtly insert a fat rationalization for adopting eDRs into the middle of a comment lamenting dentistry’s lack of respect? Tricks like Kadi’s make stakeholders look silly at times, and it bothers me that hardly anyone notices and appreciates the humor that these pros bring to marketplace conversation. That’s why I like to point out mistakes like Kadi’s when I come across them. It’s getting harder to find these kinds of articles about eDRs. My pleasure!

Working Both Sides of the Consulting Fence

As far as I can tell, all but a few dental consultants work both sides of the fence in order to please vendors who give them good deals, as well as dentists who pay for unbiased help. Sponsorship by vendors is the bottom level of a consultant career if one chooses to make a living at selling advice. In this way, the dental consultant business is a lot like the financial advice business. Some advisors push their favorite investments that serve them well no matter what happens to their clients’ money. If a client wants advice, but prefers not to pay full price, interested vendors can be counted on to quietly chip in on an advisor’s bill. And that is why the customer must always be cynical. What’s more, it is arguably one’s community obligation to publicly challenge such artists by luring them out into the open to explain further what they meant to say to naïve people. Dr. Kadi begins:

“The national health-care debate cannot be complete unless we include dental care as part of the discourse.”

He then presents oft-repeated, convincing findings which support the widely held conclusion that one’s overall health is dependent on one’s oral health. Even though this chunk of common sense has recently been supported with well-respected research, the news isn’t a revelation. Other stakeholders have proclaimed the findings as an example of ultra-modern “Evidence-Based Dentistry,” and proof of the need for thousands of their dental products. However, let’s not kid ourselves. A healthy mouth has less to do with computerization than the proper application of a low-tech toothbrush. 10,000 years ago, even buzzards recognized that bad breath from advanced gum disease smells like imminent death from a long way off if the wind is right. The results Dr. Kadi leans his reasons against only confirm traditional Evidence-Based Superstition.

eDR Lobbying 

By half-way through the article Dr. Kadi turned “The cavity in the health-care debate” into a PR piece for eDRs. He’s in so deep that he cannot recognize that his misplaced concerns about image have nothing to do with dental patients’ oral health. Image is only cosmetic.

“A validation [of bringing “sex appeal” to the profession] is the inclusion of dentistry in the recently mandated National Healthcare Information Infrastructure (NHII). The purpose of the NHII is to create an information network to facilitate the creation of an electric health record [eHR] for all aspects of health care. The primary impetus is to achieve interoperability of health information technologies used in the mainstream delivery of health care.”

Note: Dr. Kadi admits that the goal is HIT, and sharing health information is the tool – not the other way around. As anyone can see, that kind of nonsense will never work out well in the US. Why that would be as foolish as stuffing a certifying commission for eHRs with industry, government and academic leaders rather than providers – and then tossing billions of dollars that could otherwise be used for treating disease out in the street for the biggest and fastest stakeholders who grab the most. That would be simply ridiculous.

Dr. Kadi bravely continues: “This will enable an individual’s health care information to be shared by all the necessary health care parties in a secure manner, including dentistry. It will improve patient care and reduce the number of patients, currently 100,000 plus, who die each year due to a lack of accurate, complete, or timely information. The federal government estimates a cost savings of $85 billion to $100 billion per year with electronic health records [eHR].”

Is HIT – Or any IT – Really Secure? 

In a secure manner – really? There are so many other misleading statements in this paragraph as well. First of all, how can an eDR improve a dentist’s chance of successfully extracting a molar in one piece? It can’t. Secondly, how many of the alleged 100,000 victims died because of lack of electronic DENTAL records? Third, how many patients will die because of faulty information in interoperable records that would not have occurred if the records were paper? Fourth, to insinuate that patient information can only be shared over the Internet is plain silly. Telephone, fax and the US mail have been sufficient for dentistry for decades, and none involve HIPAA. Finally, the $85 to $100 billion in savings Dr. Kadi casually throws out is based on a five year old Rand study that’s been widely trashed for being biased in favor of the stakeholders who funded the research. That happens. It just amazes me that anyone in the healthcare industry who knows anything about HIT is foolish enough to still shop discarded garbage. And once again, regardless of the success of electronic medical records, how will eDRs save even $10 in dentistry? It’s impossible without re-defining “savings.”

Cost Savings

“Dentists and hygienists will play a vital role in this cost savings because people who go for regular cleanings will have their medical history updated in the shared system during each visit. In some cases, dental cleanings may be the only medical attention a person receives yearly.”

“Cost savings”? Where have I heard that term? And why didn’t Dr. Kadi simply say “savings”?

Now I remember. It was Dr. Robert Ahlstrom, the ADA’s eDR expert, who coined the handy buzzword in his testimony describing the benefits of paperless dental practices for the US Department of Health and Human Services in July of 2007. “Cost savings to providers and plans will translate in less costly health care for consumers. Premiums and charges will be lowered.” That would be the seventh of his 11 reasons that are each one so lame that other than Dr. Kadi, stakeholders never borrow them. Although it is undeniable that electronic records benefit insurers and the government more than the patient, if Ahlstrom hadn’t been coy, and had clearly stated that eDRs will save money in dentistry, his testimony would have been false. By calling it a “cost savings,” Ahlstrom technically concedes that using eDRs will indeed require an increase in cost of overhead – which dental patients will ultimately have to pay to obtain dental care. The saving part comes from “what could have been.” Whatever that could possibly mean, HHS Secretary Michael Leavitt bought it.

The PennWell Article

Because of a situation beyond my control, I am unable to provide a link, but to find more of my opinion of Ahlstrom’s testimony that is still used by lawmakers to establish national policy, simply google “Dr. Robert Ahlstrom.” My PennWell article from a year ago or so, “Dr. Robert H. Ahlstrom’s controversial HIPAA testimony,” is probably still his first hit. It could be on his first page the rest of his life.

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If necessary, I’ll make a few more examples of insensitive HIT stakeholders who know better than to offer such crap to the nation’s lawmakers as well as providers who are too busy to pay attention to the welfare of their profession. The ADA should reassure the nation that there are cheap, effective low-tech ways dental patients can stay healthy that don’t risk their identities and won’t bankrupt a dental practice because of a stolen computer. But; they won’t do it.


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37 Responses

  1. Gary Kadi is a practice management consultant, NOT a dentist!
    Pam Alexander


  2. That makes sense.


  3. Dentrix Hell – Update

    Dentrix is one of the largest electronic dental record vendors in the nation. You may know or recall that a couple of days ago, I posted a question on their new Facebook asking how much I could expect it to cost to recover from a data breach of 2000 patients’ digital records. Shane responded, “I agree. Fear should run our lives and hold us back. After all no one knows what’s really out there! That’s why I don’t fly anymore. ‘It’ could happen you know!”

    I asked Shane if he thought my question was foolish, but he still hasn’t replied to that question.

    In fact, nobody else in the incredibly giddy crowd that had gathered for the grand opening of Dentrix’s new Facebook volunteered information about data breaches either – sarcastic or otherwise. It’s as if the happy people have never considered the possibility that patients’ identities continue to be lost at an increasing rate from healthcare providers’ offices.

    It actually doesn’t scare me that an official from Dentrix has not yet come forward with a good-faith estimate of the liabilities of their product. What scares me is the fact that Dentrix has so damn many clueless, happy customers. Why hasn’t anyone in dentistry gotten the message about the danger of identity theft? I blame the ADA leadership for neglecting their responsibility to help protect dental patients in the nation from harm.

    When I re-visited Dentrix’s new Facebook this morning, I discovered that over night, even more happy customers had appeared – praising not only the wonderful convenience of the dental software product, but also a fun social gatherings that Dentrix sponsored including swell give-aways.

    Here is what I posted for some of whom may have had hangovers this morning: “I know this is a basic question, but are there any studies that show that Dentrix actually save money in dental care? Also, how much does it cost if a dentist’s computer is breached? It happens a lot.”

    It’s been seven hours now, and nobody has volunteered any help. What does that tell you about the costs of Dentrix’s product that Dentrix officials hide?

    As a matter of fact, all conversation on the new Dentrix Facebook suddenly stopped on my last post – leaving my questions about the return on investment as well as the safety of the Dentrix product as the first item visitors see. Sweet.

    Another happy conversation carefully arranged by expensive PR professionals, excellently performed by incredibly satisfied customers and quickly shut down by D. Kellus Pruitt for grins. I’m going to go golf. My job here is done … for now.

    D. Kellus Pruitt; DDS


  4. Spanking Michigan hard and Dentrix harder

    I consider it an unfortunate loss that we got off to a bad start, Michigan Dental Association Person. The information I provided MDA members a week ago, along with 7 other state and local ADA component Facebooks that only you and the Oklahoma Dental Association Person deleted, is indeed timely and important to ADA members in Michigan and Oklahoma as well as Texas and all the states in between. I appreciate the opportunity to offer a follow up. After this, I won’t interfere with your tight control of the content on a Facebook. And good luck with that. I’ve never seen it done successfully.

    I’m sure you agree it’s only fair that since we already have a history, I describe what has developed in the week since I enlisted help in challenging the unsupported claim on our ADA Advocacy Page that eDRs will save money in dentistry. In the last few days, the ADA finally took down the bad claim. I had tried on my own for 3 years to get someone to correct it. Evidently, at least one person in the 8 ADA organizations I contacted about the misstatement had enough pull in Chicago to have it deleted. I can only assume that it wasn’t someone in the MDA or the ODA.

    You cannot argue with the fact that the fervently unpopular goal of forcing the removal of bad information from an ADA publication, even if it ultimately causes embarrassment for anonymous people, is a worthy endeavor.

    I would also like to point out to my disappointed colleagues that it’s not just the ADA I challenged in the last few days concerning stubborn misconceptions about eDRs. Vendors don’t like me much either.

    Got a second?

    Dentrix is one of the most popular electronic dental record vendors in the nation. Thursday happened to be the grand opening of their new Facebook. Until all conversation on the site abruptly stopped at 6:47 pm yesterday, their Wall attracted 14 posts from the 108 new friends that Dentrix Facebook quickly attracted – including me. A dozen of the comments are glowing praise for Dentrix’s wonderful products, exciting social functions and swell give-aways. The other two are mine. Here’s the one I posted at 6:47 pm yesterday.

    “I know this is a basic question, but are there any studies that show that Dentrix actually save money in dental care? Also, how much does it cost if a dentist’s computer is breached? It happens a lot.”

    Between my first post at 5:20 pm on Thursday, three days ago, when I also asked about the cost of a data breach, and my final post yesterday which predictably shut down all conversation on the new Facebook, an anonymous Dentrix representative posted two comments – one congratulating the winner of “an awesome Ogio backpack!” and the other expressing that the Dentrix Person had a blast at the “Beer and Bowling during the 2010 Dentrix Business of Dentistry Conference!”

    Do you understand that Dentrix Person had to step over the only serious question on her bosses’ brand new Facebook to act silly for her friends? I don’t care where one practices, dentists who are considering going paperless should pay attention to the questions that eDR vendors won’t answer. I’m left wondering if Dentrix wants to sell software or party with friends.

    “Just show me the CarFax”

    The evasion of course reveals that Dentrix Person had no answer worthy of marketplace conversation in the land of the free. If she could have pointed out any respected studies showing proof of ROI, she would have done so immediately. There simply are none for natural reasons.

    The answer to the question she stepped over concerning the amount of breach liability Dentrix clients unknowingly accept when they go paperless, Person knows the answer, but fair business practice would hurt Dentrix sales.

    According to recent Ponemon Institute estimates, a breach of 2000 patient records would cost around $400,000. Proper notification of those affected would reportedly cost $50 per record and another $150 in lost income from the damage to one’s reputation. Remember. If a breach involves more than 500 individuals, the incident must be reported as a press release to local media services. That hurts forever even before the HIPAA and FTC (?) fines – as well as possible prosecution by state attorneys general.

    The Dentrix Facebook grand opening was huge, giddy fun while it lasted. But the party is over for Dentrix Person. As for me, it’s one more happy conversation carefully arranged by expensive PR professionals, credibly performed by incredibly satisfied customers and quickly shut down by an unshaven D. Kellus Pruitt sitting in his underwear eating potato chips.

    Here’s something you probably didn’t consider, MDA Person: Because nobody respects anonymous people… such as you, it’s not by accident that I’m visibly accountable every time I rudely intrude into dental care stakeholders’ comfortable, protected lives. Each time I’m forced to become blunt, it causes me to not only lose a just little more privacy – making me a potential target to just about any hothead I’ve pissed off – but it also leaves bad first impressions across the nation by the thousands. So what have you invested in the future of dentistry lately?

    D. Kellus Pruitt; DDS


  5. Dentrix Hell – You asked for it, sports fans

    For those who haven’t been following my party crash of Dentrix’s grand opening of their Facebook, in the last few days, while numerous satisfied customers praised Dentrix, I have asked serious questions. I requested studies showing a return on investment for Dentrix’s electronic dental record system as well as the cost of a data breach of 2000 patients’ Protected Health Information (PHI). Since I dropped by, the grand opening idea hasn’t turned out like Dentrix’s PR consultant promised, yet it is getting lots of attention on Facebook. Dentrix is probably not happy about that either as it turns out.

    When I stumbled across the grand opening last week, I noticed from the glowing compliments that were posted on the Wall that Dentrix has incredibly nice customers. It wasn’t difficult to tell that it was some sort of PR trick, but I couldn’t figure out where the devotion started, and how much it cost Dentrix. Then, when I won a “cool Dentrix water bottle” because of my love, it made sense (Random drawings managed by Facebook). This is rich.

    “Congratulations Darrell Pruitt, you’ve won a cool Dentrix water bottle. Thank you for entering our daily giveaway by sharing your love of Dentrix! Our next winner will be announced tomorrow so be sure to post your Dentrix testimonial on our wall today.”

    Darrell Pruitt

    – Seriously. I’m happy to have won a Dentrix water bottle, but I’d prefer to have my questions answered.

    Is ROI possible, and what are the liabilities of a stolen or hacked computer? If Dentrix has no answers for these two questions then I’m afraid your product is going to be difficult to sell me.

    Nevertheless, I’ll enter for another prize with a new question soon.


    – Darrell … by going completely digital with Dentrix, you do not need an internet connection. There are some features that integrate in with Dentrix(sending claims electronically, eBackup, eCentral, etc) that do require an internet connection but the core product of Dentrix does not need it. If you want to use those other features, you could configure your security settings in your software and hardware devices to only allow those programs to access the internet. You would need to run your backups manually or have some program do it automatically on a schedule but everything could be run locally in your practice.

    Also, if you choose not to use an internet connection, it wouldn’t be as easy to download the updates for Dentrix but on the other hand, you could have the updates mailed to your practice.

    [Blah, blah, blah … Christopher is lost in his own vocabulary. Brooke corrects his rookie mistake]


    – I’m pretty sure that ecentral needs internet connection because we just recently had an internet problem, and couldn’t get on ecentral.

    Darrell Pruitt

    – Let me suggest that there is no cyber security. Period. Even your ISP is vulnerable to hackers.

    So my question is, if I move to paperless, and my patients’ PHI is breached either by a hacker, stolen computer, dishonest employee or even a misplaced flash drive, how much would it cost to recover from a loss of 2000 files? The thing about the best hackers – like those employed by North Korea, China and Russia – is that health care providers never know that their patients’ personal information has been lifted until identity theft investigations lead to one’s practice. This is serious even before the HIPAA and FTC (?) fines.

    Secondly, are there any studies that show a return on investment for electronic dental records?

    I have to say that I expected to get answers to both questions about Dentrix much easier than this. Quite frankly, as an American citizen, this scares me because it shows that HIT vendors like Dentrix, even in the medical field, are obviously not taking privacy seriously.

    Sorry about being direct to the point, but I don’t care who you are. The hesitation should scare you as well.

    To appreciate the on-going (?) thread of my conversations with clueless but dedicated HIT enthusiasts, please visit the Dentrix Facebook. It’s become popular even before I promoted it.


    Even though their grand opening reached a lot of potential customers, didn’t work out like a PR consultant promised. My pleasure.

    D. Kellus Pruitt; DDS


  6. Michael, who I assume is a Dentrix representative, responded to my questions about value and safety of his company’s eDRs.


    – Darrell, I read from the bottom up, and so answered your questions about PHI/HIPAA breaches briefly below on your post from 06/10. Ultimately, Dentrix Dental Systems are not a legal firm, and are unable to give specifics about exact costs in that situation. A little more information in contained in my post below, but I would suggest talking to a legal expert experienced with HIPAA to answer your question directly about specific costs that you may encounter in a situation such as you describe. (Although I did try to list a few possible costs in my post below.)

    As far as electronic security and privacy itself is concerned, Dentrix is very concerned with privacy and with security, and all Dentrix and eServices products are designed to be able to utilize electronic security and encryption, and updates and changes to improve these features take place in just about every upgrade. In the end, it comes down to the use of these features by users of the Dentrix software, along with the protection of personal computers and security in the office. The unfortunate truth is that there is always a balance between usability and security, and there is no “one size fits all” option to computer security that can be used by every dental office. The Dentrix database and software can be designed to help prevent access to those without permission (such as by setting up passwords within Dentrix, tracking database access by user/password through the audit trail report, limiting access by user based on need and office duties, etc), but there are still individual computer and network security (and, yes, internet security) concerns which Dentrix cannot control from office to office. (Although, use of all eServices products over the internet does include heavy encryption and other security measures designed to prevent unauthorized access.)

    So, in a nut shell:

    1) We cannot give an exact cost of the loss of PHI for 2000 patients, as this is due to many factors, but you are right to be concerned about the possibility and to take precautions to limit and prevent this loss, and to know how to prepare if it ever does happen – this is the core of HIPAA.

    2) Dentrix Dental Systems is very focused on providing a product that will help you to protect your patients’ data, and is serious in it’s views on security and privacy.

    3) Additional security precautions must be taken on-site, working with a computer security consultant would be the best way to find and implement the best practices for your office.

    As for your question about studies on ROI for switching fully to electronic records, an internet search on “studies on ROI for electronic records” found a large number of studies and information for this topic in general, and I am told someone else who has these studies for Dentrix specifically will be addressing this question. Dentrix also offers a Profitability Coaching program to help increase your over-all ROI when utilizing Dentrix for your practice needs.


    My reply:

    – I want to thank you for your in-depth response to my questions, Michael, but I’m afraid that what you offered still falls short of the information this dentist needs to make an informed decision on going digital.

    Once again, I’ll be direct. If such proof of ROI exists for your product as we are promised, I don’t understand why at least one study highlighting value is not on the lips of every Dentrix employee. Businesspeople ask this question often. Nevertheless, I look forward to examining the forthcoming information.

    It also bothers me as a US citizen that you seem to be unaware of the liability of the product you sell, yet you say “As far as electronic security and privacy itself is concerned, Dentrix is very concerned with privacy and with security” – twice.

    From this consumer’s point of view, I shouldn’t have to go out on my own to find out about the liability of your product. But nevertheless, it is well known in the HIT circles that his fall, the Ponemon Institute released its latest estimates of the costs of data breaches to businesses, including dental offices. For breach involving 2000 records, the cost to the provider would come to about $400,000. That includes $50 per record for notification and $150 per record in lost production. Once the loss involves more than 500 individuals, HIPAA demands that details of the unfortunate incident be reported to the local media outlets as a press release, which will devastate a dentist’s reputation locally. But that’s not all. Soon the Office of Civil Rights will be posting the names of those providers on the Internet even without the providers’ permission. That will wipe out dentists’ reputations nationally.

    I’m afraid that by the time your colleague brings out the ROI study, it will be already be dated information. The costs of eHRs continue to rise. On top of the liabilities for data breaches, there is nothing holding down the cost of HIPAA compliance, and the inspections are supposed to start before the end of the year.

    Sorry. No sale yet. You’ve got to remove PHI and medical histories from your eDRs before they’ll be safe enough for my patients.

    Darrell K. Pruitt; DDS


  7. I asked Michael to be my friend on Facebook. So far, he has declined to accept the invitation.

    D. Kellus Pruitt; DDS


  8. Dentrix Hell III

    “As I try to envision how my patients can benefit from an electronic dental record system like Dentrix – which arguably they would pay for with higher dental fees – I must ask if they receive tangible reward for the increased cost of fillings.

    In the last 40 years or so, the amount of time a dentist needs to perform intricate handwork in unpredictable mouths has not decreased. In fact, before dentists were delayed by the numbing effects of local anesthetic agents and meaningless HIPAA forms, it took far less time to extract teeth. Yet from what I can tell, the only benefit interoperable eDRs have over low-tech devices such as fax, telephone and postman is slippery speed. How important is that? Dental offices aren’t emergency rooms.

    If the business office can’t keep up with a dentist, then perhaps either the dentist is trying to work too fast or someone in the business office isn’t. Profitable dental practices have been run with pegboard, ledger cards and carbon paper for decades.

    So what are my patients missing?”


    I’ve been here before. At this point, there is usually at least one slow-thinking hot head who will take it upon himself (it’s usually male) to aggressively accuse me of aggression. And occasionally, the person will say something like “electronic dental records are going to be mandated anyway – you have no choice – so quit attacking us.” Watch for me to be called a Luddite.

    This is not unlike trolling for action between checking my hygiene patients.

    D. Kellus Pruitt; DDS


  9. Dentrix responds

    A person named Eric responded on Dentrix. I am impressed with Eric because he didn’t let me get to him. He responded in a polite, professional manner, even if he is still just doesn’t get it.


    – The convenience of being able to request treatment history, perio probe charting, single or family ledgers in an organized, clean fashion, instantly.

    For an office the submits patients insurance, there in constant data input and calculations that must be made both accurately and efficiently. Dentrix provides the software to keep these business operations organized.

    Profitable author’s used to write books by hand, or use a printing press, why aren’t those still used today?… See More

    People used keep track of friends and contacts with a Rolodex, now we are on facebook.

    It’s technology and efficiency that is seen over every aspect in our lives, why not the dental office?


    After reading his reply, can you predict the faults in Eric’s reasoning that I will disassemble tomorrow?

    I replied: “Eric, i appreciate your thoughtful response. I’ll get back to you soon. May I ask if you are a dentist?”



  10. Dentrix Hell IV – my reply to Eric

    Thanks, Eric. I’m afraid you inflated the worth of eDRs.

    “The convenience of being able to request treatment history, perio probe charting, single or family ledgers in an organized, clean fashion, instantly.”

    For decades, paper treatment records have provided all the benefits you describe, except for “family ledgers.” I cannot think of an instance in my career when I needed account information in a treatment history. In fact, when attorneys find such information in paper treatment records, they tee off on the dentist with accusations of biased treatment decisions at chairside influenced by the plaintiff’s account information. In my office, the ledger cards are in a metal box at the front desk. While I’m treating patients, it’s not necessarily known by me who owes money. My patients and I like it that way.

    “Organized”? EDR pages might be organized according to what works for the vendor, but what if none of the available templates provide exactly what the dentist and hygienist desire? And you have to admit, it is much easier navigating through a couple of sheets of paper than to have to click even once with a mouse. Cumbersome navigation can make “organized” irrelevant. On the other hand, organization of a paper record system is typically an ongoing process that changes according to personal tastes of the dentist – “instantly.” Just to get to a window to make such changes require multiple clicks and perhaps a password for the best organized eDRs. That’s in addition to learning how to do such things. In my office, if I want a change in documentation, all I have to say is, “Janis we’re going to start charting decay like this from now on.” Done. See what I mean? Nothing is instant, even with digital records. But then, nothing has to be.

    “Clean”? Computers don’t prevent sloppy. Computers empower sloppy. It is much easier to click on a “5” by accident than to draw a “5” while meaning to draw a “4.” Keystroke errors just don’t happen with ballpoint pens. Here’s another advantage to paper records. When health histories are updated, a line is marked through the obsolete entry. Once changes are made on computers on the other hand, one must click on something at least once to view such a history. What’s more, if one’s health information is altered by an insurance thief, incorrectly listed allergies might not be detected until the autopsy.

    Here’s something else that may seem trivial about paper records which I’ve learned to appreciate. Because of normal wear of a manila file folder, without even realizing it, I have an accurate idea of how long the patient has been in my practice before knowing the name. I can name the owners of several of the thick files from across the room. As trivial as it seems, that’s instant information one doesn’t have to open a window to retrieve.

    “For an office the submits patients insurance, there in constant data input and calculations that must be made both accurately and efficiently. Dentrix provides the software to keep these business operations organized.”

    Here, you have a valid point. Insurance companies have sufficiently complicated reimbursement so that computers are needed just to figure out what 100% coverage really means. The insurance companies themselves are lost in their strategic, actuary-approved hoops. Just days ago, I read that even with computerization, healthcare insurance companies still screw up on 20% of the claims, yet they want to put their ideas of quality control on us using our NPI numbers.

    It’s a disincentive for insurers to pay claims on time and the Internet will only enable them to send rejection letters cheaper than the US Mail. When payouts are delayed for any reason, insurers’ keep the money longer. Do you think windfall profits will motivate insurers to delay fewer than 1 in 5 claims when interest rates climb? But then, who’s to say interest rates will climb?

    Dentists have been pushed by stakeholders into permitting insurers to move data entry for their product out of their business offices and into dentists’. National pharmacy chains wanting to save money on staffing are doing the same with e-prescribing. How would you like to have to log onto the computer in the middle of the night to get antibiotic to a patient instead of calling the all night pharmacy on the phone? Do you think we can get any sillier about hi-tech?

    “Profitable author’s used to write books by hand, or use a printing press, why aren’t those still used today?”

    That’s because modern printing methods are not only faster and cheaper, but one cannot tell one book from another of the same edition. What’s your point? Technology for the sake of technology is nothing but an expensive hobby. We don’t publish books.

    “People used keep track of friends and contacts with a Rolodex, now we are on facebook.”

    Other than this unprecedented candid conversation between a dentist and a vendor, Facebook has nothing to do with eDRs.

    “It’s technology and efficiency that is seen over every aspect in our lives, why not the dental office?”

    Even though computerization has increased the speed and profitability of almost all other businesses in the US, intricate handwork is the bottleneck in a dental practice – not the front desk… unless one must do the insurance companies’ work for free because of a contract obligation. That’s as good as it gets in dentistry until they can get 10 year olds to quit squirming so much.

    Believe it or not, I am actually a fan of eDRs, and I hope that I have the choice and not the obligation to purchase a system for my practice one day. But I will not participate in the national plan unless eDRs are both safe and make good business sense. Dentrix is one of the best, but it’s not there yet, and neither is software as a service. Even encryption doesn’t protect one’s practice and reputation from a dishonest employee with a flash drive and 10 minutes alone at the computer. For that matter, if a careless employee of a HIPAA Business Associate, or even an insurance company employee, loses a laptop containing 500 or more of a dentists’ patients’ files, the same HITECH-HIPAA Rule applies. The unfortunate dentist’s name will be announced in a press release by the local media concerning the data breach. When the patients are subsequently notified, a significant number will never return, and the blow to the dentist’s reputation will last for years. What’s more, if it’s a small community, a competitor with paper charts will add another operatory.

    Encryption in dentistry is a non-starter. Dentists will not accept the hassle and expense. In addition, patients will demand to be notified if their PHI is breached – even if it is encrypted. I would, and so would you. Encryption will only give providers and patients a false sense of security up until the moment when an identity theft investigator appears in the waiting room. There is no cyber security, but de-identification of dental records just might work.

    Sorry. Still no sale, Eric.


    – This just in: “Empowered OCR: Ensuring Better HIPAA Compliance From Covered Entity and Business Associate.” How much do you think HIPAA costs now?


    “(OPENPRESS) June 16, 2010 — The HHS office for Civil Rights also known as OCR, in its attempt to tighten HIPAA privacy regulations has detailed out six new ways to deal with reports related to the breaches in patient health information.

    OCR now has to its disposal, computer system which makes it easy for complainant to lodge online complains against breach in privacy of their health information. OCR is empowered to deal the breach in following ways.

    * Post information online and in Public media of any breaches involving at least 500 individuals

    * Directly report to Congress about the number and type of reported breaches, and the action taken.

    * Disclose data with purpose to provide technical assistance, training and guidance needed to ensure HIPAA compliance.

    * Share information with other federal agencies and contractors so that they can effectively respond and investigate the breaches.

    * Disclose information to third parties in order to assist them in their investigation of the reported breaches and conduct compliance reviews.

    * Publicly report the results of investigations and compliance reviews and thus provide complete transparency to process.

    The OCR is bound to disclose the minimum health data, which is necessary to investigate the breach and should protect the privacy of the individual or groups in the course of investigation.The office has authority, to impose heavy civil fines up to $1.5 million per violation. This should be an eye opener for the health service providers, especially Business Associates, who have not yet achieved HIPAA compliance.


    There’s got to be a better way. Let’s loosen up some and think laterally. We can get out of this mess.

    Darrell K. Pruitt; DDS


  11. Dr. Pruitt, TDA and the ADA, AMA, AOA, etc

    Rest assured, eHRs are still a work-in-progress. Here is the link to a blog post from a medical student named Josh Herigon, MPH who has limited HT experience.

    Nevertheless, given that “our tech savvy youth” is one of the omnipresent themes in IT discussions both health-related and non-health-related, his observations are worth noting.


    Moreover, when combined with the responses to his observations, they add up to a clear look at the challenges the healthcare sector still faces when it comes to implementing and effectively using HIT.

    Sorry medical association guys and dolls, some grown-ups have been saying same for years now; not so the eHR sales reps, commission generating societies, related shills and corporate product entities.

    Dr. Knows


  12. End of Dentrix Hell… or is it?

    Eric, the Dentrix representative, responded to my last comment (“Dentrix Hell IV”).


    – It all comes down to personal preference.

    If paper charts work for your practice, Darrell, who am I, or anyone, to suggest something better for you.

    I am only speaking from my personal experience with Dentrix. Like I said before, I understand your concern about the priceless information that is your patient’s information, but it is not Dentrix’ responsibility to provide the security of your digital information. Further, their FaceBook page seems like an inappropriate place for you to express your concern’s about digital information safety.

    Darrell Pruitt

    – Although I completely disagree with your statement that this is not the place to carry on a sincere and professional conversation about the security of your product, I’ll leave you alone.

    I may or may not return if I notice that naive dentists are being misled by unethical sales pitches that discount the importance of patient privacy. I do this not to be ornery. It’s just that I’m certain people I care about see dentists who use Dentrix software. I don’t want to see them get hurt by carelessness. And if I don’t keep you guys in check, who will?

    I’ve enjoyed this, Eric. Thanks for keeping our conversation frank and professional. I respect that. I think the community is a better place because we had this unprecedented meeting. I wish you and your company luck and encourage you to seriously take a look at removing PHI from your product. You wouldn’t store bombs with their fuses attached, would you?

    D. Kellus Pruitt; DDS


  13. Just between you and me, I do it to be ornery just a little bit.
    D. Kellus Pruitt DDS


  14. Nothing beats a Fort Worth mix of metaphors and mandates

    This month, my Fort Worth District Dental Society is sponsoring an all day continuing education seminar featuring Lorne Lavine, DMD – founder and president of Dental Technology Consultants.

    “The whole lecture is technical, and some of the items, such as how to get good clinical digital x-rays, would certainly qualify as clinical.

    We will discuss the 2014 deadline. Many dentists are unaware that the Federal Government is mandating that ALL patient records are supposed to be electronic by the end of the year 2014. While it’s the government and we know things can change, the last thing a dentist wants to do is stand on the sidelines and then realize in the middle of 2014 that they are behind the 8-ball; most offices need 12-18 months to get paperless. This course will give them a ‘treatment plan’ of what to get and in what order to move in that direction. It has everything from information for the neophyte, to advanced information for those who are already techn-savvy. Six steps to a chartless practice will be discussed.” – FWDDS “Twelfth Night” newsletter, September 2010. (No byline)

    My apologies to Dr. Lavine. One of the first things he’ll have to do when he gets in town is to clear up a local fantasy about federally mandated paperless practices.

    That’s sort of embarrassing, actually.

    Darrell Pruitt DDS


  15. Dr. Lorne Lavine is in town

    I was feeling ornery when I awoke this morning. So I decided I’d write a little something about Lorne Lavine, DMD. He’s in town today. Dr. Lavine is a successful dental consultant whose specialty is promoting electronic dental records. He has become so good at bad advice that he no longer actually has to practice dentistry to make a living. Not to mention that he has a mandate as well as an ADA President pushing sales for him.

    The huckleberry knows who I am, and is probably looking for me in the Fort Worth District Dental Society audience. That makes me grin.

    Lorne and I have bumped into each other on a couple of Internet venues over the last couple of years. He is one of only a few dental care stakeholders on Facebook who will not accept me as a friend. Others include Dr. Ron Tankersley, President of the ADA and Ms. Kim E. Volk, CEO of Delta Dental. Since, Dr. Lavine has 4111 friends, he simply can’t be very choosy about who he lets see his posts. As you can imagine, that makes me feel kind of special in the stakeholder’s life, and it doesn’t bother me to talk about it. He and I even share 27 mutual friends for crying out loud! If the stakeholder had just accepted me as a Facebook friend, it might have made it more convenient for him to read this. I suppose one of our 27 mutual friends will be kind enough to give him a heads up.

    In a January 5, 2010 ad that Lorne posted on Dentistry iQ, he provided his favorite reasons why dentists should become paperless – yet incredibly, he admits that he has no proof that dentists will ever receive a return on investment: “I absolutely feel there is a positive ROI, although there doesn’t seem to be any published articles that can really quantify that.”


    Let me point out that in order to sell his product, Dr. Lavine discounts the importance of a return on investment to customers who are not in dentistry as a hobby. To me, this sounds like a really odd sales pitch to hear in the land of the free. I find the deception that surrounds eDRs is frightening in a human rights sort of way.

    Months later, another eDR consultant named Dr. Larry Emmott posted numerous ads of his own claiming paper records cost dental practices $40,000 a year to maintain. I’m not kidding. After I failed to get clarification from Dr. Emmott, I discovered that to examine how he determined the estimate, I would have to buy his book for $100. When I asked Dr. Lavine about it (before he started evading me), he offered that $40,000 sounded a little high to him, but that he nevertheless has always respected Dr. Emmott’s expertise.

    In my efforts to resolve the arguably crucial business question of whether eDRs actually save money for dental care – thus increasing access for everyone – I became one of the first friends of Dentrix’s Facebook just in time for their June grand opening. Since Dentrix owns 30% of the US market, surely if anyone has information about ROI, it will be Dentrix. (See “Dentrix Hell”)


    The first thing I noticed about their Facebook grand opening were the glowing compliments on their Wall. Knowing Microsoft like I do, I would find such a swarm of nice customers incredible for any software company – incredible, as in hard to believe. It wasn’t difficult to tell that Dentrix had hired a PR trickster, but I couldn’t determine the origin of the customer devotion or what Dentrix invested in the Facebook ad campaign. The answers became clear when I unexpectedly won a “cool Dentrix water bottle” because of my participation in discussions about Dentrix. Considering that I was stepping on their toes while everyone else was kissing their cheeks, it is clear to me that their token of misplaced appreciation was a result of a random Facebook-moderated drawing: “Congratulations Darrell Pruitt, you’ve won a cool Dentrix water bottle. Thank you for entering our daily giveaway by sharing your love of Dentrix! Our next winner will be announced tomorrow so be sure to post your Dentrix testimonial on our wall today.” Is that not rich? I haven’t claimed my prize yet. In a couple of months I’ll return to the Dentrix Facebook and ask if it’s too late to receive my cool Dentrix water bottle – just for grins. Think they’ll remember me?

    It’s my opinion that Dr. Lavine’s potential customers here in Fort Worth should be made aware that if they spend $50,000 on an eDR system, the dentists’ patients can expect the cost of their care to go up. And for what? Electronic health records in dentistry significantly increase the risk of identity theft for patients without offering any significant improvement over conventional means of communication using the telephone, fax and US Mail. The only people who benefit from eDRs are dental care stakeholders such as Dr. Lavine and ADA politicians.

    Sales of eDRs are chronically depressed because of natural free market reasons and dentists with intelligence. So as a last resort to actually selling something that dentists are willing to pay for, Dr. Lavine resorts to tyranny to move his product: “Many practices are unaware that the government is mandating all patient records, both medical and dental, be electronic by the year 2014”

    Dr. John S. Findley as President of the ADA agrees with Dr. Lavine.

    In a September 2008 interview with ADA Reporter Judy Jakush a month before Dr. Findley took office, he also turned his back on American free market principles for dentistry: “The electronic health record may not be the result of changes of our choice. They are going to be mandated. No one is going to ask, ‘Do you want to do this?’ No, it’s going to be, ‘You have to do this.’ That’s why we absolutely need the profession to be represented in the discussions about EHR to make sure our ideas are enacted to the greatest extent possible.” (Within the last year, Dr. Findley’s capitulation has been edited from the ADA News Website).

    And if you are a rebellious type and are considering defiance of the mandate, Dr. Lavine threatens: “But woe to the practices that don’t do anything to become paperless, that wake up near the end of 2013 and realize they are nowhere near prepared.”

    When I warn a person that if they don’t visit a dentist of their choice regularly, their health will deteriorate, there is truth behind my sales pitch. It must be nice to sell goods by deceiving customers with 3rd party threats like Drs. Lavine and Findley. It’s my hope that someone from Fort Worth asks Dr. Lavine, “So what happens to those who aren’t prepared?”

    I don’t care if ADA President Dr. Findley and advice vendor Dr. Lorne Lavine call it a mandate or a law. If there is no punishment for noncompliance, it’s nothing more than a wish.

    Want to know something ornery? As I’m writing this, Dr. Lavine’s CE lecture for members of the Fort Worth District Dental Society is occurring within a few miles from where I’m sitting. It will be interesting to find out how it went. A few friends of mine are attending.

    I had better things to do.

    I’m actually waiting on primer to dry. I sanded down my golf tees and getting ready to repaint them.



  16. Poking Dentrix with a Sharpened Stick

    What follows is the comment that I posted following Dentrix’s Facebook advertisement of their new friendship with the Pride Institute – a dental consultant firm. Dentrix is inviting those attending the ADA meeting in Orlando in a few weeks to “join Dentrix at a Pride Institute VIP reception for hors d’oeuvres and drinks to toast Dentrix as a winner of Pride’s 2010 ‘Best in Class’ award for innovative [and dangerous] technology.”

    I wonder if Dentrix salesman Dr. Larry Emmott will be there. To offset the sticker shock of Dentrix eDRs, Dr. Emmott says paper records cost dentists $40,000 a year. That’s incredible.



    Wow. I didn’t know the Pride Institute was promoting electronic dental records. That’s progressive. However, I have some discouraging news to share if you were waiting on stimulus money to help with the purchase of an eDR system. Stimulus money looks doubtful, even if 30% of a dentist’s practice is Medicaid as required and the Democrats actually hold onto Congress.

    That hurts the plan for mandated interoperability by 2014 because even with taxpayer help, eDRs have not yet been shown to save dentists enough money to provide a return on investment – thus making eDRs a high-tech hobby that increases the cost of dental care for everyone.

    “Electronic health record rules pose problems for some dermatologists,“ by John Jesitus was posted yesterday afternoon on ModernMedicine.com.


    “The adoption of electronic health records (EHRs) among dermatologists is hitting a stumbling block — namely, the onerousness of final “meaningful use” rules recently released by the federal government.”

    Dentists only bill insurance companies for a limited number of procedures involving the lower 1/3 of the face. On the other hand, skin is the largest organ in the body. Sharing information in dermatology is much more complicated and urgent than communications in dentistry. Yet the government still can’t successfully bribe dermatologists to buy into CMS’s plans for interoperable tyranny.

    How can our grandchildren’s money possibly make it to high-tech dental offices before 2014? So far, the ADA Department of Dental Informatics hasn’t rolled out the ADA-approved plans for “meaningful use” of eHRs in dentistry because compared to picking up the telephone, they look really, really silly. And if a dentist fails to prove “meaningful use” of the computer for communications (instead of private phone calls and the US Mail), stimulus money will forever remain out of reach.

    According to John Jesitus’ article, Valerie B. Laing, MD, who recently selected an eHR system, says, ’EHRs haven’t been as efficient as our established routines. That’s been a big hangup with many of my colleagues.” She adds. “’Meaningful use’ may stall specialty’s adoption of EHRs.”

    If the truth about ROI without stimulus money isn’t mentioned in Orlando, the Pride Institute could be taking impressionable dentists on Disney rides.

    D. Kellus Pruitt DDS


  17. Advertising dollars bend Dentaltown

    I guess the bad economy challenges ethics even in dental journalism.


    Today, the dental magazine Dentaltown featured a press release for Dentrix that the editor failed to ethically disclose as a paid advertisement. Or perhaps Dentrix officials wryly took advantage of the Dentaltown editor’s relaxed standards before again misleading naïve dentists to assume that eDRs will provide a return on investment If Dentrix had anything more than empirical hope that their eDRs will decrease the cost of dentistry they would have produced the documents long ago.

    Let’s be truthful with customers for once, Dentrix. And Dentaltown, you lost a chunk of credibility in my opinion.

    Darrell K. Pruitt DDS


  18. Brighter Dentistry – 60% Off!

    I posted this on Stltoday.com following yet another suspicious article advertising Brighter.com’s claims of 60% discounts for dentistry. Doc, stay silent if you just have to for image sake, but if you and I don’t reveal the hiding places of dental care parasites, who will? The ADA?


    If it sounds too good to be true, it’s probably Brighter.com

    I think what Americans need right now is more transparency concerning discount dentistry brokers like Brighter.com. And I’m all over it. Right, Jake?

    In the last week, I’ve seen Claudia Buck’s “Drilling down to dental discounts” on at least 4 internet venues other than the latest here on Stltoday.com. For non-dentists, I imagine the McClatchy Newspapers’ press release is far too easily mistaken as journalism. That’s unfortunate because Americans are vulnerable in their concern for their families’ oral health.

    Brighter.com founder Jake Winebaum, who is quoted in Buck’s article, can never be held personally accountable for directing his clients to the least popular dentists in the community for a monthly fee. With nothing at risk, he has nothing to lose and naturally promises unrealistic discounts to increase sales. As a journalist, Ms. Buck should have asked the ambitious entrepreneur a couple of more questions about percentages before publishing the story. At best, she was duped.

    If knowledgeable dentists with 65% overhead expenses fail to stand up and challenge Brighter.com’s incredible sales pitch of 60% discounts, we are as guilty as ADA leadership for saying nothing while naïve consumers continue to be cheated by discount dentistry brokers advertising ever-higher discounts for “great dentists.”

    Since Brighter is a source of customers that is independent of patient satisfaction, participating dentists are hidden from the demands of free market competition. Let’s face the truth: At 60% discounts, Brighter is dentistry done by the very lowest bidders of dental services with no quality control. What’s more, according to satisfaction ratings on DR.Oogle, it shows. Such dishonesty with our patients is shameful, Doc. We must expose it wherever we find it.

    Following Claudia Buck’s article on another venue a week ago, I had a brief conversation with a still-anonymous Brighter representative I call Evelyn for convenience. She attracted my attention when she commented, “Thanks for the great article, Claudia! We get feedback from patients every day about how their Brighter membership helped them get the dental care they need at a price they can afford from a great dentist!”


    After doing some simple math proving that dentists simply cannot do safe dentistry with 60% discounts, I asked Evelyn, “You realize ethics aren’t free, don’t you?” Then I offered her a challenge: “If you will provide a link to a list of your participating dentists in any major city, I’ll find what names I can on DR.Oogle (doctoroogle.com), and we can compare the popularity of your dentists with all others. Got courage, Evelyn?” I added: “Let’s see how dental patients feel about Brighter dentists who cut corners.”

    A week later, and I’m still awaiting the list Why do you think Evelyn hesitates to reveal not only her name, but the names of Brighter’s “great dentists?”

    It’s simply against the Hippocratic Oath for dentists to allow preventable harm to happen to those we care for. Jake Winebaum doesn’t care for a single one of our patients as much as you and I do, Doc. And it shows.

    D. Kellus Pruitt DDS


  19. This week, I asked dental practice consultant Dr. Larry Emmott of “Emmott on Technology” about the danger of EHRs in dentistry. Yesterday. he replied to my question with a simple “no,” meaning “No, EDRs are not more dangerous for dental patients and dentists than paper records.”

    Today, I asked him, “Would you care to explain why your product is safer than paper dental records? I say you are wrong.”


    Other than in dentistry’s EHR market, are there any other medical device makers who are forgiven from disclosing the dangers of their products? Where’s the FDA?

    The disclosure I’ve been seeking for years from HIT stakeholders is unavoidable, and I think it is also imminent, sports fans.

    Soon, perhaps within months, EDR stakeholders inside and outside the ADA will meet on the internet for a public discussion about the safety and cost of electronic dental records versus paper. And you can trust that I will be right in the middle of it – keeping stakeholders like Dentrix and ADA Electronic Health Record Workgroup honest with vulnerable dentists and patients. That’s a promise.

    So what do you think of transparency now?

    D. Kellus Pruitt DDS


  20. At last … Someone challenges my opinion!

    SpawnyWhippet, an anonymous female who has “worked for 14 years as an IT vendor in hospitals in over 20 countries,” strongly disagrees with my opinion about the comparative danger and cost of EHRs in dentistry. She claims, “Paper records are unbelievably insecure.” In defense of the high cost of EDRs, she asks “What is the cost of storing, retrieving, searching, copying and duplicating and shipping paper records?” Like most anonymous vendors, SpawnyWhippet’s bias is defenseless.

    Every now and then I still come across ambitious HIT vendors who are so naive about the uniqueness of dentistry that they haven’t a clue until they wade in way too deep. I posted my rebuttal on ComputerWorld today:


    SpawnyWhippet, are you telling me I don’t know my business?

    You are simply wrong about the relative security of EHRs versus paper records, and I’ll prove it: How many electronic health records have been breached in the last year? Millions. So how many paper records have been breached in the last 2000 years?

    Even though you choose as a transparently weak selling point a description of “unattended trolleys full of records sitting in hallways or closets (?),” it’s silly to suggest that I as a dentist would carelessly leave my patients’ records open for passers-by to see. Besides. Who really cares about dental records anyway? Until you resurrected the incidental exposure argument, that lame rationalization for EHRs was abandoned by even rookie stakeholders 4 years ago – right after the argument of “fewer paper cuts.”

    For a thief to steal my patients’ identities from my practice, it would take a very quiet crew with dollies to quickly move 3, loud, sheet metal filing cabinets weighing a few hundred pounds each down a flight of metal and concrete stairs to a waiting truck without someone noticing. And then, before quietly returning the file cabinets up the metal and concrete steps to their original places – and in correct order – a pool of assistants would have to accurately convert thousands of handwritten patients’ PHI into digital format.

    On the other hand, a hacker can not only steal tens of thousands of patients’ digital, ready-to-use PHI in seconds, but nobody will know of the heist until fraud investigators show up in the doc’s waiting room. As a vendor, you really should have known that.

    SpawnyWhippet, you say, “Your statement about cost doesn’t stack up.” Your naivety about the dental business is excusable. Few HIT enthusiasts realize that most dental practices have less than 5000 active patients. The bottleneck in the industry isn’t the paperwork. It’s the dentists’ hands. So if my staff must file no more than 15 to 20 charts a day, you tell me: How much should that cost compared to HIPAA compliance?

    D. Kellus Pruitt DDS


  21. Attorney Jim Pyles responds:


    According to the Office of Civil Rights for HHS, the privacy of more than 11.5 million Americans has been breached in electronic health information breaches involving more than 500 individuals reported just since September of 2009.

    The difference between paper breaches and electronic breaches is that with electronic breaches (a) the privacy of millions of records can be breached simultaneously, (b) that privacy can be breached and health information stolen by individuals who need not have physical access to the records (and may not even be in this country and subject to its laws) and (c) most seriously, once an individual’s health privacy is breached electronically it can never be restored.

    One can recover a paper record but not an electronic impulse. One can get a new credit card number but not new health information. Also paper records typically exist in one place, while electronic records can (and do) exist in an infinite number of locations.

    Congress, the Government Accountability Office and the Department of Health and Human Services now all agree that electronic health records are NOT more secure than paper records. HHS has conceded that no electronic health information system can be made secure.

    Where did you locate someone who thought otherwise? Feel free to share.

    Jim Pyles

    James C. Pyles, Principal
    1501 M Street NW, Seventh Floor | Washington, DC 20005-17002


  22. How well do you think vendors can sell dental software without using the internet?

    This week, a couple of popular dental practice consultants abandoned their front where they briefly defended the safety of slippery EDRs against paper dental records’ long track record. That was days ago. Why do you suppose others haven’t stepped up to fill the gap?

    I say their colleagues in the advice business recognize how vulnerable their position is to truth. Otherwise, I would have been routed years ago by merciless stakeholders that are plenty pissed off at me. What’s more, spontaneous HIPAA inspections of dental offices haven’t yet begun. Regardless of the increasing amount of money Covered Entities will be expected to spend on compliance, can dentists put a dollar value on the anxiety of reporting one’s first data breach to the HHS? The fact is, as a healthcare provider it’s a virtual certainty that your practice will suffer a reportable breach within the next year – whether it is reported or not. (See “Ponemon Institute Survey Finds 90 Percent of Businesses Fell Victim to Cyber Security Breach at Least Once in the Past 12 Months,” Marketwire Press Release, June 22)


    Since the last of the digital record defenders have arguably capitulated, their self-exile from the community certainly won’t help sales of EDRs. One can already tell by the absence of articles in the ADA News touting the benefits of paperless that even the enthusiasts in the American Dental Association have given up the battle. This means that the same ADA leaders who persuaded members to unquestioningly volunteer for NPI numbers can do nothing more now than wait for news of surrender to reach Chicago’s ADA Headquarters. I bet it will be awkward.

    D. Kellus Pruitt DDS


  23. Shy salespeople even ignore customers

    If you still don’t recognize the mind-numbing, technology-friendly bias so prevalent in the dental industry, how do you explain EDR stakeholders’ universal shyness? Where else in American business do sellers hide from buyers’ questioned, yet the buyers don’t seem to mind? The insidious industry-wide deception that is widely tolerated by adults with post-graduate degrees fascinates this dentist.

    Every now and then an EDR stakeholder will confidently pop up on the internet, like Schein Dental consultant Cliff Marsh, his friend, HIPAA expert Don Cohen and QSIDental’s Vice President Kathleen Noll.

    Even though their credentials appear impressive, when I asked each of the stakeholders straightforward questions concerning the value their products, they pretended not to hear me.

    D. Kellus Pruitt DDS


  24. Fresh HIPAA consultant [A fresh HIPAA consultant happens along]

    Even though Henry Schein’s HIPAA consultant Cliff Marsh and HIPAA expert Don Cohen DMD appear to have stopped replying to my questions about the value of HIPAA without being of much help, I found another HIPAA consultant to replace them named Keith Decker. Keith works for Abner Weintraub, President of HIPAA Group Inc. As common sense has caused my other leads to play themselves out today, I’ve been exchanging emails with Keith. I think he’s just about had enough of me. Watch for him to either blow his composure with a customer in the front of the store before he quits responding, just like Marsh and Cohen.


    Dear HIPAA Group Co-Founder and President, Mr. Abner Weintraub,

    Some friends and I would like to know how much a dentist with 2000 active patients can expect to have to spend to become 100% HIPAA compliant. In addition, we would also like to know how much staff time one should set aside for compliancy the first year.

    I would imagine from your experience with HIPAA, it shouldn’t be difficult to come up with a range.

    D. Kellus Pruitt DDS


    Dr. Pruitt

    HIPAA compliance contains three parts, Training for all employees who have access to (PHI) Private health information at $25 per learner. Here is a link to that product:

    The HIPAA Policies and Procedures, just $325; http://www.hipaastore.com/hipaa-policies-for-covered-entities-p-10.html

    HIPAA Forms for $135: http://www.hipaastore.com/hipaa-forms-for-covered-entities-p-29.html

    Yes, you’ll need to spend some time preparing the documents and making sure your staff is HIPAA trained, but the investment can save you thousands if there is a complaint or breach from your office.

    I hope this helps, please share it with your friends.

    Keith Decker
    [HIPAA Group, Inc]


    Thank you, Mr. Decker. Your information is of great help.

    It appears that according to your estimate, for a small dental office with 4 employees, the cost to become 100% compliant would be less than $600. That’s much less than what a HIPAA consultant for Schein Dental Company quoted last week to me. Mr. Cliff Marsh said the bill could range from $2500 to $20,000. But quite frankly, I don’t think Schein’s HIT team knows as much as they should about HIPAA.

    As you know, the obligations of staff time is the most expensive part of becoming and maintaining 100% compliance year after year, and there’s a lot of training and documentation. Can you tell me how much time it takes? I can think of nobody better to ask.



    You do not need to spend a lot of money to be HIPAA compliant. There are a lots of people who hope you do, but it’s not necessary. If you’re willing to put your time and thought into the process.

    Let me point out that the HIPAA law does not require third party administration of HIPAA actually as a Covered Entity under HIPAA law, they ask you to become self-complaint by training your people on HIPAA and your HIPAA policies and procedures. The time it take is relative to what you plan to add to your policies.

    I suggest you purchase the forms, policies and training in one hit. Start your staff on the training, so they learn what is necessary to provide proper HIPAA care of your records. Pick a sharp Assistant and the two or you can knock out the polices and forms along with dealing with your practice in a few days.

    The products we provide are templates and all you need to do is fill in the blanks and make some decisions.

    I hope you’ll start getting your practice up to date quickly and I think you’ll appreciate the ease of use of all of our products.


    Keith Decker
    HIPAA Group, Inc


    Thanks for the information, Mr. Decker, but you still haven’t answered my question: How much time does HIPAA cost a dental practice, and is it worth the effort?

    In Chapter 1 of “The ADA Practical Guide to HIPAA Compliance,” authors Ed Jones and Carolyn P. Hartley describe dentists’ obligations:

    “Adopting Health IT presents challenges as well. For example, a dental practice must research and evaluate available systems, assess the current and foreseeable needs of the practice, negotiate the terms of the contract for the system and related services, including items such as the cost and availability of tech support, the number of licenses and authorized users that the contract will include, and the hardware and software features that enable HIPAA and HITECH compliance. Time and energy must be devoted to training staff to use the electronic health record system. A dental practice adopting an electronic health record should consult its attorney both with regard to the acquisition itself (including any contracts, licenses, and other legal documents) as well as with regard to the legal implications of using an electronic health record (for example, the dental practice should understand what will constitute the legal record and how the electronic health record would affect document retention requirements). A dental practice that intends to take advantage of the HITECH Act Medicare or Medicaid reimbursement incentives must understand and stay abreast of developments regarding the incentives, such as the qualifications of an ‘eligible provider,’ how to demonstrate compliance with the ‘meaningful use’ criteria, how reimbursement incentives will be structured, and certification criteria of dental information systems.”

    Is it really worth the trouble just to be able to file dental claims electronically? I don’t see how HIPAA pays for itself. Quite frankly, it looks to me like HIPAA only raises the cost of dentistry. Am I wrong?



    I can’t tell you how much time it will take you; I don’t know you or your staff. I can tell you about our products and I have. You are welcome to review what we have and if you wish you may purchase them.

    HIPAA is heating up with fines and penalties and compliancy is monitory for all covered entities who supply healthcare in the USA. It would be your decision on how to relate to that.

    I wish you well.

    Keith Decker [HIPAA Group, Inc]


    Please be patient with me and other interested dentists, Keith. It’s incredible how much misinformation is on the internet concerning HIPAA.

    As a HIPAA consultation business, you surely don’t mean to tell me that HIPAA Group Inc. cannot provide a reasonable estimate of how much time a dentist should expect to spend on becoming 100% HIPAA compliant. I’m not the first dentist to ask this question, am I? Of course not.

    I’m sure you are familiar with the list of obligations that Jones and Hartley describe. Knowing what you do about your business, would you say that in the first year it would likely take about 100 man hours (25 hours/per employee) for a small dental office to become compliant? Please try to help us here, Keith. After all, how can you say that HIPAA is worthwhile if you cannot say how much it costs?

    You say “HIPAA is heating up with fines and penalties and compliancy is monitory for all covered entities who supply healthcare in the USA.” So how many dentists have been fined and how much did it cost? Also, the way I understand you, if a dentist isn’t a covered entity, he or she cannot be fined. Is that a correct interpretation?


    I’m hoping to coax a few more answers from Keith. I want to see what he, Abner Weintraub and HIPAA Group Inc. are made of. Don’t you?

    D. Kellus Pruitt DDS


  25. QSIDental is unaccountable to dentists

    This morning, the executive assistant to Steve Plochocki, CEO of QSIDental emailed me to say:

    “I will personally go talk to Kathleen [Noll] when I get to the office. I do not know if she is traveling but you should hear from one of us later today. Thank you for your patience.”


    There is no honor in the HIT industry. QSIDental Vice President Kathleen Noll will never be held accountable for deceiving dentists.

    D. Kellus Pruitt DDS


  26. After receiving no response from Kathleen Noll concerning her promise of a return on investment for dentists if they invest in QSIDental’s electronic dental records, I finally went over the vice president’s head and sent a letter to CEO Steve Plochocki.

    What? Is that somehow unprofessional?

    D. Kellus Pruitt DDS


  27. Facebook Target

    Nine hours ago, Dental Economics posted a link on their Facebook to the latest issue of “Expert Tips.”


    I looked over the advice from numerous well-known dental experts including Dr. Gordon Christensen, Dr. Joe Blaes and Dr. Roger Levin, but nothing was said about digital records. So starting 8 hours ago, I’ve been trying to persuade still unresponsive Dental Economics officials to become more honest with their readers:


    I just noticed that in all of the Expert Tips there is not a single mention of Electronic Dental Records and HIPAA. As a matter of fact, there is rarely a mention of these topics anywhere on the Internet – not even press releases on DrBicuspid, and that crew will publish anything if the money is right. When one considers that the ADA says EDRs are to be mandated, does anyone else find it odd that nobody is discussing them? Speak up. Don’t be shy.


    How about it, Dental Economics? Is there anyone on your staff who can address questions about the cost and safety of EDRs? How about the cost of HIPAA compliance? Why do these feel like improper questions for dentists to ask a dental industry publication such as yours? How transparent are you, Dental Economics?

    Still nothing?

    If my question concerned the resolution of digital radiography, I imagine at least three readers would have responded by now. So why is nobody, not even vendors like Dentrix, Benco Dental CenterPoint, or QSI Dental, willing to discuss their digital dental records here on Dental Economics Facebook? I think we all know why.

    I don’t expect EDR vendors who chose to satisfy a federal mandate rather than their customers’ needs, to say a word to me in their defense. They have no defense. Each of them know that to make a sale, they casually deceived dentists about the cost and safety of their products compared to paper dental records. You’ll also notice that not one dentist dares to try to defend even the vendors they purchased EDRs from.

    It’s my opinion that Dental Economics officials should stop shielding EDR vendors and other unresponsive stakeholders from accountability to dentalcare principals: Dentists and patients. Today’s EDR vendors deserve to be eliminated from the dental industry simply because of their dishonesty. I recommend that you not adopt their standard of ethics, DE officials.

    Pitiful sales reflect the fact that today’s mandated EDRs will always be inferior to paper dental records in a free-market. Anyone wish to challenge that politically-incorrect statement or do we accept what I post here on Dental Economics as fact by default? I’m waiting.


    So what do you think? Do you agree with the status quo that for some counterintuitive reason, it is unprofessional for a principal in dentalcare to insist on transparency from mere stakeholders – including distant Dental Economics officials and traditionally-revered ADA leaders?

    I say every dental leader who secretly promoted HIPAA and EDRs for personal gain should be held personally accountable in the community for enabling insensitive HIT stakeholders to cheat dentists and endanger dental patients’ welfare.

    Or perhaps you are one who defies common sense and defensively hangs on to the lie that EDRs are safer and less costly than paper records. Please feel free to speak up so we can publicly correct your naive misunderstanding of dentistry.

    D. Kellus Pruitt DDS


  28. Good News About eDRs

    Good news from the front – Dental Economics (PennWell) responds on Facebook to my concern about the cost and safety of “mandated” electronic dental records. With luck, this could be an important milestone in transparency for the dental industry.


    PennWell editor Kevin Henry says he is as interested in bringing transparency to the EDR industry as I am. I know Kevin. I trust him. If we can get Health IT stakeholders to cooperate, our exchange on the Dental Economics Wall may prove to be the tipping point to open, natural, marketplace conversation concerning the current value of EDRs to dentists… and perhaps a solution or two. Pitiful sales and far too many de-installations reveal that EDRs need solutions much more than silence at this point.


    Hey Darrell, it’s Kevin. I won’t pretend to be an expert in EDRs but I would like to see your questions answered in a debate format (as we have discussed before). Let’s see what we can do to make it happen. I think readers would be interested. What say you?


    You know me, Kevin. I’m all for transparency. I hope you can make it happen. I wish you luck.

    Let’s work to make it happen. Nothing wrong with transparency and information being shared.

    You’re a good person, Kevin. I know of nobody more ethical in the dental publication industry than you. You should be running Dental Economics.

    D. Kellus Pruitt DDS


  29. More on Dental Economics

    As promised, Dental Economics posted the following invitation on their Facebook Wall today:


    “We’re throwing the door open for a debate on the safety and cost-effectiveness of EDRs. We know Dr. Darrell Pruitt has offered to take the “against” side. Who would like to join in the debate and represent the ‘for’ side?”

    Although I’ve never felt closer to transparency concerning EHRs in dentistry, I’m afraid it will take more than a polite invitation from even such a well-known publication as DE to persuade shy vendors to take ownership of their products. Since it is long-rumored that “EDRs are to be mandated whether dentists want them or not,” vendors have grown very comfortable selling a product that customers can’t refuse without breaking the law. That explains why they feel they can afford to hide from those who they would have purchase their dangerous and expensive EDRs.

    If I’m pleasantly surprised and someone with EDRs to sell is confident enough in their product to share selling points on the internet, I hope they know better than to lie about safety – especially since it’s a healthcare product. Just this week, the FTC spanked Reebok for deceiving consumers about unproven claims of health benefits. See “Reebok to pay $25M over toning shoe claims” by Sarah Skidmore that was posted on BusinessWeek.com yesterday.


    Skidmore writes: “The athletic shoe and clothing company will pay $25 million in customer refunds to settle charges by the Federal Trade Commission that it falsely advertised that its ‘toning’ shoes could measurably strengthen the muscles in the legs, thighs and buttocks. As part of the settlement, Reebok also is barred from making some of these claims without scientific evidence.”

    Dana Barragate, an FTC attorney involved in the case is quoted “We hope it sends a message to businesses that if they are going to make claims they must be justified.” Hear that, QSI CEO Steve Plochocki?

    Just last month, Kathleen Noll, Vice President for QSI Dental, claimed that her company’s EDRs are cheaper than paper dental records, but refused to share the scientific evidence with me. http://www.ada.org/news/6190.aspx

    I wonder if she’d share her mysterious “Return on Investment Worksheet” with the FTC.

    D. Kellus Pruitt DDS


  30. Paging … Dr. Feuerstein!

    Is Paul Feuerstein DMD part of our community? If so, do you think he’ll talk openly with us?

    I read about his presentation of the latest high-tech tools in dentistry at the Annual ADA Session, and have some questions concerning information he shared with his audience. That is, if Dr. Feuerstein can be reached through Facebook.

    On Monday, he presented “Be a Trailblazer: Embrace the Future of Digital Dentistry” to a packed crowd. Today, DrBicuspid.com Editor in Chief Kathy Kincade described his lecture in an article titled “Is it time to finally invest in digital dentistry?”


    According to Kincade, Dr. Feuerstein told the audience that all US dentists must adopt digital dental records within two years “under legislation enacted by former President George W. Bush.” Dr. Feuerstein isn’t the first to suggest that dentists who use paper dental records after 2014 will be breaking a mysterious law that nobody can seem to locate.

    In 2008, ADA President Dr. John Findley told ADA reporter Judy Jakush in an interview: “The electronic health record may not be the result of changes of our choice. They are going to be mandated, No one is going to ask, ‘Do you want to do this?’ No, it’s going to be, ‘You have to do this.’” After years of asking the ADA for an explanation of Dr. Findley’s surrender of the profession to tyranny, nobody responded. Does anyone else yet recognize the ADA’s strange behavior toward EDRs and HIPAA? Why won’t ADA officials be transparent with Americans?

    So if Dr. Feuerstein is indeed part of our community, perhaps he wouldn’t mind sharing with us what he knows about the law. Just like many of you who also don’t trust the security of EDRs, I would like to know how the federal (or state?) government intends to force dentists to purchase tools that are not only more expensive than paper dental records, but are also more dangerous for both dentists and patients.

    If the Hippocratic Oath doesn’t stop the harmful nonsense, surely the US Constitution will.

    D. Kellus Pruitt DDS


  31. The Return of HIPAA Consultants

    Do you know why the dental leaders who promoted HIPAA long ago never defend it? They don’t want to look silly twice.

    “OCR Starts HIPAA Privacy Audits” by Joseph Goedert was posted today on HealthDataManagement.com


    Goedert writes: “The HHS Office for Civil Rights during November will begin HIPAA audits to assess covered entities’ compliance with the privacy, security and breach notification rules.”

    Here’s what to expect if your practice is unfortunately selected for audit. The first clue could be 30-90 days advance notice of a site visit, probably by certified mail from the OCR. However, requested documents are expected to be surrendered within 10 days. Expect the process to include on-site interviews and investigations and could last 30 miserable, expensive days.

    To help outsiders understand what aggravates stoic dentists who sincerely want to do everything they can to safeguard their patients’ privacy, I offer an example of why Washington is nuts: HHS Secretary Kathleen Sebelius awarded the huge accounting firm KPMG a $9 million contract to perform HIPAA audits. Yet at the time, KPMG employees were already responsible for not one, but two major incidents listed on OCR’s public web site of breaches affecting 500 or more individuals. I wonder if KPMG is the only stimulus money recipient on Sebelius’ “Wall of Shame,” working for Sebelius.

    Though that’s certainly curiosity-provoking trivia, and might even make one’s ears turn bright red during an audit that’s turning out badly for the future of one’s practice, dentists should resist bringing it up in small talk with KPMG employees working on commission.

    Fear of audits loosens wallets.

    In a related note, Doc, brace yourself for the hatching of aggressive HIPAA compliance consultants – once again sporting self-righteous confidence so common with mandate stakeholders. “Hey, don’t blame me. It’s the law!” Here’s what makes the jobs-creation ruse especially detestable: If you are a covered-entity, you are at a marketplace disadvantage to HIPAA consultants who cannot be held accountable for selling useless advice and false sense of security. What’s more, because of dentists’ notoriously nasty attitude toward the Rule, HIPAA consultants already don’t like you.

    For years, dentists’ emotions have been abused by scary tales eliciting fear of $1.5 million dollar fines for HIPAA violations. However, since influential EDR stakeholders both inside and outside the ADA have always appeared unconcerned about HIPAA or even the growing number of data breaches, selling compliance training hasn’t proved nearly as lucrative as expected from the stakeholder-friendly mandate. But now that inspections are starting for real, those selling irrelevant advice are empowered like never before.

    As some guilt-prone dentists I know become preyed upon in the next few months by shocking ads warning of exaggerated, but real risks of a HIPAA audit, they can expect hints of panic to enter their consciousness early in the mornings – interrupting deep, delicious REM sleep just like the threat of OSHA inspections did two decades ago. Since a KPMG auditor can easily bankrupt a dental practice with a capricious finding of “willful neglect” of HIPAA requirements, even rumors of audits increase business for HIPAA consultants – as well as the cost of dentistry. That’s right. Dental patients, whose interests are never represented in power struggles over their care, always pay the most.

    If an ambitious KPMG employee determines that a dentist is guilty of HIPAA violations in connection to a data breach of 500 or more EDRs, the incident is more likely to mean bankruptcy for the dentist rather than a lucrative HHS contract and a badge. A dentist under investigation should probably keep that observation holstered as well. Think about it. Since KPMG already owns a couple of spots on Sebelius’ Wall of Shame, they probably don’t have much of a sense of humor.

    D. Kellus Pruitt DDS


  32. Ads for EDRs are easy targets

    I caught Williamette Dental Group CEO and President Dr. Eugene Skourtes once again misleading dental patients in Idaho Washington and Oregon about the safety of electronic dental records.

    Dr. Skourtes’ poor ethics and/or ignorance harms consumers as well as the entire dental profession in my opinion, and must be discouraged. As usual, it looks like I’m the only person in the nation willing to stand up against deceit in dentistry. My pleasure! I really don’t mind it at all.

    Dentists who advertise benefits of their EDRs on the internet are easy targets. So regardless how much you like high tech, HIPAA and your NPI number, Doc, don’t do it. I’ll pin you under your own words just like I did to Dr. Skourtes, and just for grins. Of course, one could always consider this a challenge. I’m always eager to publicly crush EDR selling points for sport if anyone’s interested.

    Reflexively, I posted my opinion following Dr. Skourtes’ press release this afternoon. (He never responded to my questions a few days ago following a similar ad for the dental group’s EDRs):

    Dear Dr. Eugene Skourtes:

    You claim that “EDRs are fundamental to improving care and making care delivery safer and more efficient.” That is untrue. There should be a law against being dishonest with vulnerable dental patients.

    Perhaps you didn’t realize that there is a reason dentists don’t advertise their electronic dental records like you do. You may not have heard the news. According to recent Ponemon Institute studies, 96% of healthcare organizations, including large group practices similar to the Williamette Dental Group, have suffered reportable breaches of patients’ Protected Health Information (PHI) in the last 2 years. What’s more, there has been a 32% increase in frequency of breaches in the last year.

    That means Williamette Dental Group patients are arguably at a higher risk of identity theft than patients whose dentists who never put protected health information on computers. Your patients in Oregon, Washington and Idaho deserve to be told of the danger of EDRs.

    Once properly informed, they may prefer to find a dentist who has paper dental records. Regardless, you have no right to deprive them of informed consent with deceitful ads.

    D. Kellus Pruitt DDS


  33. Pablo Sells …

    Pablo Lawrence sells Delta Dental plans as best he can.


    Dear Pablo Lawrence:

    Have you no ethics? You promise naïve and vulnerable clients that “Delta Dental providers are recognized throughout the country as one of the most dependable service providers in the market these days.”

    Then, you add, “Hence, [Delta Dental] functioned hard in delivering all of these coverage to aid people in acquiring good quality dental care at an affordable price.”

    “Most dependable providers”? “Good quality dental care”? Really? You wouldn’t tell lies to make a sale would you, Pablo Lawrence? You should be warning clients that Delta Dental is dentistry by the lowest bidders with no quality control.

    Want proof? Take a look at the list of the DeltaCare USA practices in Austin, Texas: 4 out of the top ten Delta practices that Delta Dental clients have to choose from are Castle Dental franchises. Castle dental has an F rating with the Austin Better Business Bureau … An F rating with the BBB, Pablo.

    Delta Dental is nothing more than a sleazy discount dentistry brokerage unaccountable to dentists or patients.

    And you are a sleazy insurance broker with poor writing skills, Pablo Lawrence.

    D. Kellus Pruitt DDS


  34. Dental consultant ethics

    Helping high-tech salespeople discover ethics – Only in the dental industry are unaccountable, unresponsive vendors allowed to sell products while ignoring their customers’ most basic questions about value. I posted a second letter to Dayna Johnson, “The Dentrix Office Manager,” today.



    Dear dental practice consultant Dayna Johnson,

    On January 18, following the publication of your Dentistry iQ article, “Going chartless,” I mentioned here on Dental Economics Facebook that at least a few dentists want to know how electronic dental records compare to paper records. When you failed to respond, I later added, “Who cannot notice that there is something seriously wrong with the electronic dental record industry when stakeholders like Dayna Johnson, Dr. Paul Feuerstein and Dr. Larry Emmott ignore direct questions concerning not only the cost of their products, but the safety?”

    It turns out that any embarrassment you might have felt last month for being incapable of answering basic consumer questions didn’t stop you from posting another Dentrix ad on Dentistry iQ today.


    The only reason for all three of you to ignore customers is that you intend to hide for as long as possible the true cost and danger of the products that earn you commissions – no matter how many dentists and dental patients are harmed.

    Unlike you, Feuerstein and Emmott, giving business advice isn’t something I do professionally, and it probably shows. Nevertheless, let me humbly suggest from a consumer’s point of view that even the most popular dental consultants cannot afford insult dentists like they once did. No more easy “mandated” sales for Dentrix reps.

    Don’t blame me. Blame internet transparency.

    D. Kellus Pruitt DDS


  35. The dental sector is on fire!


    Yep – it’s dental supply company stocks.

    The Dental Rep


  36. Discrepancy in the dental marketplace demands explanation

    DrBicuspid article number 1: “ADA: Dentists’ earnings not recovering from recession.” By Donna Domino, Features Editor, DrBicuspid.


    “December 16, 2014 — – Dentists’ earnings are not rebounding despite several years of economic recovery, according to new ADA research. Recent years have seen a stagnation of dental spending, an increased number of dentists and, as a result, stagnant dentist earnings, the study found.” (See study: “Dentist Earnings Not Recovering with Economic Growth.” Authors: Bradley Munson, B.A.; Marko Vujicic, Ph.D.).


    Domino adds, “The report used 2013 data from the ADA’s annual survey of 4,000 to 17,000 dentists in private practice, which includes 92.2% of active dentists in the U.S. The survey’s response rate was 18.4%. Net income was defined as income remaining after practice expenses and business taxes and included salary, commission, bonus and/or dividends, and payments to retirement plans.”

    DrBicuspid article number 2: “Stock guru Cramer: Dental stocks are hot now.” By DrBicuspid Staff.”

    “December 23, 2014 — Dental stocks are the hottest performing group in the market at the moment, according to CNBC ‘Mad Money’ host Jim Cramer.”


    Anonymous DrBicuspid author: “As long as the U.S. economy is doing well, dental stocks will do the same, according to a CNBC.com story. Cramer specifically highlighted Henry Schein, Patterson Dental, and Sirona Dental Systems in the story.” She adds: “According to Cramer, with an economy recovering from the Great Recession, consumers have more money to spend on dental procedures. Dental care is a $116 billion market that is growing 3% annually, the story noted.”

    Obvious question: If individual dentists are earning less than before the recession, as revealed by the ADA survey, who is purchasing the increased amount of dental equipment and supplies, as revealed by Jim Cramer? Here are three possible explanations which are not mutually exclusive:

    1 – Large, managed care and Medicaid clinics run by national corporations – which pay dentists, dental therapists and hygienists very little for fast, tedious work in sensitive mouths – are expanding rapidly and sending unprecedented amounts of money to Henry Schein, Patterson Dental and Sirona Dental Systems for supplies and equipment. Think “fast haircuts.”

    2 – Cramer is inviting hapless investors for a ride on a bubble whose collapse is imminent. Think “close haircuts.”

    3 – Henry Schein, Patterson Dental and Sirona Dental Systems are DrBicuspid clients who quietly funded the anonymous press release to increase their companies’ stock value and C-suite compensation packages. “Toupees”

    Unlike Donna Domino’s article based on peer-reviewed research, nobody at DrBicuspid is willing to take personal responsibility for the investment recommendation based on CNBC’s “Mad Money.” Note that the ONLY purpose for anonymity is unaccountability… It is because of comments like this that I was banned from DrBicuspid years ago.

    In my opinion, American consumers deserve transparency from secretive dentalcare publications. Don’t you agree? If so, please share this spamphlet. If we don’t speak up, nobody will.

    D. Kellus Pruitt DDS


  37. Dental EHRs and the pop of a balloon … Wait for it. Wait for it …

    In a few months, when leading dental institutions finally acknowledge that electronic dental records are both more expensive and more dangerous than paper, how difficult will it be to sell dental software once informed consumers start moving to paper-based dentists? Inevitably, patients will learn that if their identities are not linked to the internet, they simply cannot be hacked.

    (De-identification is the answer, Doc. It always has been… What? Still too soon?)

    Yesterday, a Schein official finally acknowledged that electronic dental records are more expensive than paper, but only after being publicly persuaded to embrace transparency by a disappointed dentist. My pleasure. She still doesn’t agree that paper dental records are safer, but as you can see, I will help change her mind by the end of the day.


    Dear Melissa Flygare, Sales Account Executive Team Lead, Henry Schein Practice Solutions,

    I am sorry to hear about your family emergency which kept you from responding sooner, and I sincerely hope it is nothing serious.

    Numerous dentists and patients appreciate Schein’s official response to consumer concerns about the cost and safety of Dentrix dental software. In the sincere interest of improving openness between dentists and dentalcare stakeholders – like Schein – as a principal, I will be frank as I share with you what is bothering me and other potential Dentrix customers. Long before Schein’s misrepresentation of G5 encryption resulted in an unknown number of unreported data breaches, as well as a recent FTC fine, Dentrix officials were notorious for hiding critical information from dentists… including yesterday’s admission that paper dental records are indeed cheaper than electronic dental records.

    Your response: “To answer your question – is software cheaper than paper? No – paper is rather cheap.”

    Finally! The first step towards transparency! It’s downhill from here.

    You might be happy to learn that I intend to share our conversation with the American Dental Association – one of Schein’s competitors in the dental EHR market with The Digital Dental Record – “The only EHR system endorsed by ADA Business Resources™.” A two year old ADA News press release featuring the favored EHR system continues to promise savings without revealing evidence supporting the counterintuitive claim. (There is no evidence). (See: “EHRs provide long-term savings, convenience.” No byline, ADA News, December 6, 2013).


    Similarly, Dr. Paul Child, the CEO of Dr. Gordon Christiansen’s Clinicians Report should be warned as well. In an undated Dental Economics article, Dr. Child says EHRs offer dentists a “high return on investment.” In the comments following his article, you will find my requests for evidence that were ignored but not censored. Schein’s Dentistry.co.uk website anonymously censors my comments. The Brits censored one yesterday. Transparency is accountability. Question everything. (See: “Digital dentistry: Is this the future of Dentistry?” by Paul L. Child Jr., DMD, CDT, CEO CR Foundation, for Dental Economics, undated).


    Your response: “Is it safer than paper? Absolutely!”

    Now you scare me.

    Your absurd, unsupported assertion that paper dental records are in great danger of being destroyed in natural disasters – while disregarding cyber-crime – is frightening for reasons which go beyond the dental field: “Henry Schein gets contract to modernize U.S. military health records.” Written by Ken Schachter for Newsday, August 20, 2015.


    Here is a recent article concerning the increasing danger (and expense) of EHRs. The discouraging article is only one of hundreds in the last few months: “Healthcare is the most targeted yet least prepared sector in the U.S. when it comes to cyberattacks, according to a report from the Institute for Critical Infrastructure Technology.” – FierceHealthIT, January 20, 2016


    Around the time the FierceHealthIT article came out, I was accused by an Schein employee of unfairly knowing the answers to my questions before I ask them. If he is correct, you were 1 for 2: Electronic dental records are BOTH more expensive and more dangerous than paper records.

    You deserve to know this: I began asking Dentrix and other vendors’ representatives the same two questions over 8 years ago, and continue to await what must be hundreds of their responses. On the other hand, in spite of personal difficulties, you responded in two days – making you the very first official in the dental HIT industry to embrace transparency with the dental community. Thank you for your courage, Melissa Flygare. May others follow your lead. Dentists would find transparency pleasing.

    D. Kellus Pruitt DDS


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