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How eMR Vendors May Mislead You

9 Responses

1. Brent, on June 21, 2010 at 5:57 PM said:

   On Beta eMRs
   [A word of warning]

   The purchase of a “pilot” or “beta” system usually leads to trouble. Although they are significantly less expensive, these systems are technically still under development and often have bugs and immature features.

   Remember the dictum “you can always add but you cannot always take away.” It is much better to start with a simpler system and add features later (“walking” before “running”) instead of obtaining a brand new system that has not been tried before and ending up having to dismantle it later.

   Once a system is extinguished, it is much harder to obtain buy-in to a replacement system by users who have lost confidence.

   Author: Brent A. Metfessel; MD, MS, CMP™ [Hon]
   Source: Healthcare Organizations [Journal of Financial Managment Strategies]
   http://www.HealthcareFinancials.com

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2. D. Kellus Pruitt DDS, on June 21, 2010 at 6:54 PM said:

   Don’t be shy. We need to talk, ADA

   Today, Shahid N. Shah MS posted an article [above] on this Medical Executive-Post titled, “How eMR Vendors May Mislead You.”

   How eMR Vendors May Mislead You

   Mr. Shah, a respected author on the business of medical practice and ME-P Thought Leader, writes: “The most important reason for the digitization of medical records is to make patient information available when the physician needs that information to either care for the patient or supply information to another caregiver.”

   So what about dentists? How often do we need obscure information to do our jobs in the lower 1/3 of a patient’s face? And how quickly do we need such information? If the US Mail is too slow, the fax and telephone are incredibly handy. Or, if one wanted the convenience of Internet communications without HIPAA liabilities, a dentist could quietly email a patient’s x-rays with only an initial and last name followed by a phone call, of course. (Even though it’s done all the time safely, don’t tell anyone you send patients’ unencrypted medical information or an unhappy employee could complain to HHS about the HIPAA violation and cause a investigation – plus potentially reap whistleblower monetary rewards. Seriously).

   Electronic medical records which almost make sense for physicians due to the complexity of the entire body, are still of questionable value. Mr. Shah lists the 6 major reasons vendors give physicians for the business case of investing $40,000 in their eMR systems (not in any particular order).

   It has yet to be documented that eMRs accomplish any of these benefits:

   • Increase in staff productivity

   • Increase of practice revenue and profit

   • Reduce costs outright or control cost increases

   • Improve clinical decision making

   • Enhance documentation

   • Improve patient care

   • Reduce medical errors

   If eMR vendors exaggerate the benefits to lure naive physicians to purchase their products that won’t sell without help from stimulus money – how realistic is it to expect electronic dental records to ever be adopted by more than 4 – 5% of dentists? It is doubtful that dentists can expect help from stimulus money either. That stuff will be gone before physicians are even linked up.

   So if vendors once again prove that they cannot be trusted to provide accurate information about their products, where should a dentist turn to find truth? Not so fast, ADA members.

   In the last two weeks, both the ADA and my own Texas Dental Association quietly addressed this issue after years of asking them the question, “Do eDRs save patients money in dental care as the ADA claims on its Advocacy page? The TDA told me in an unsigned PDF that to discuss the issue of eDR value to a dentist would involve “speculation,” which the TDA simply does not do. See: “Is the Texas Dental Association too Authoritarian?” It includes a link to the TDA’s response last week.

   Is the Texas Dental Association too Authoritarian?

   When I and a few buddies I enlisted from across the nation confronted the ADA about what the TDA calls “speculation” of the value of eDRs, the ADA simply took down the claim. See how well transparency works for ADA members? That was pulled off using Facebook. Is it any wonder why the TDA won’t let me back on the TDA Facebook? That’s a cute response from the TDA as well. (Question number 35). I’ll get to it soon enough.

   D. Kellus Pruitt DDS

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3. D. Kellus Pruitt DDS, on June 23, 2010 at 6:52 PM said:

   HIT vendors and HIPAA knowledge

   I’m still waiting for a response from Scott Leeper, Vice President of PracticeWorks – an HIT vendor which sells electronic billing systems to dentists. In his defense, it’s only been 24 hours since I sent him a message on his personal Facebook and invited him to come to the Dental Economics Facebook and explain what he meant when he stated “Another advantage of electronic claim submission is that it ensures compliance with privacy and security regulations, an important step in addressing HIPAA regulations.” His advertisement that looks a lot like an article is titled “Benefits of electronic billing” and is posted on the Dentistry iQ Website.

   http://www.dentistryiq.com/index/display/article-display/3992708854/articles/dentisryiq/hygiene-department/2010/06/patient_statement_efficiency.html

   Considering that the VP posted his confused statement on the Dentistry iQ Website rather than Facebook, do you think it is wrong for me to send a message to his private Facebook account concerning PracticeWorks’ questionable business ethics? As a dentist, my patients have access to me in my private life. Why shouldn’t dentists have access to Mr. Leeper on his Facebook? What possible excuse can the Vice President have for not taking personal ownership of PracticeWorks immediately upon reading my message yesterday? I would think most HIT vendors would leap at the chance to present their knowledge of HIPAA regulations. Maybe he doesn’t follow his Facebook account. In that case, I’d say that the surprise will grow even more special with time.

   So do you think Scott Leeper simply misstated what he intended to say on behalf of PracticeWorks, or do you think the Vice President of an HIT firm just might not understand as much about HIPAA as he perhaps should?

   D. Kellus Pruitt DDS

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4. Alex Rodriguez, on June 25, 2010 at 11:59 PM said:

   We assist Medical Groups and hospitals with bulk physical medical records scanning and conversions into EMR/EHR applications. We always recommend to our clients, that during the discovery/evaluation phases to call and interview multiple actual case studies.

   Carefully understand the value the EMR/EHR solution brought to the practice and group from their perspective. If time permits, take key members of your internal team onsite and see a few of these solutions in operation. This way you can plan objectives and goals collectively on going ‘paperless’.

   And, be sure all your internal folks are on board with the deployment and understand each conversion objective.

   Alex Rodriguez

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5. Dr. Marcinko, on June 26, 2010 at 9:58 PM said:

   The Public is not Fooled about eMRs

   Having just returned from a consulting engagement, and while preparing to speak at a medical convention and workshop next week, I just learned that the NPR / Kaiser / Harvard School of Public Health published a poll that shows that, for the most part, the public is on our side.

   They believe that “their doctor” is the best to take care of them, make decisions and decide what is the best treatment, and that insurance companies and government should stay out of the decision making process. The poll shows that the public believes that we are trying to keep cost down and that insurance should pay for all services asked for by their doctor.

   Click to access nprpoll_topline.pdf

   The poll also shows that the public, as many of us here at the ME-P, believes that just spending money on eMR’s is not going to improve their health or bring costs down; the most important part, it seems, is their relationship with their doctor … not their computer! What an epiphany?

   So; why are so many doctors scammed and bamboozled over eMRs?… enter the vendors!

   Dr. David Edward Marcinko MBA
   [www.BusinessofMedicalPractice.com

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6. Trent, on October 26, 2010 at 5:58 PM said:

   Does the White House Protect eMRs?

   When it comes to protecting the privacy of medical information, the Obama administration has slipped from its high mark in 2009, according to the annual “Privacy Report Card” from the Electronic Privacy Information Center.

   http://www.fiercehealthit.com/story/white-house-efforts-protect-medical-data-getting-worse/2010-10-25?utm_medium=nl&utm_source=internal

   Is ME-P contributor and dentist Darrell K. Pruitt more correct, than not, on this issue?

   Trent

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7. Darrell K. Pruitt DDS, on March 6, 2012 at 5:16 PM said:

   Study Finds EMRs May Increase Health Costs
   [Another I told you so]

   “Computerized patient records are unlikely to cut health care costs and may actually encourage doctors to order expensive tests more often, a study published on Monday concludes.”

   -Steve Lohr
   New York Times
   “Digital Records May Not Cut Health Costs, Study Cautions”

   Computerized patient records are unlikely to cut health care costs and may actually encourage doctors to order expensive tests more often. Industry experts have said that electronic health records could generate huge savings – as much as $80 billion a year.

   But, research just published Monday in the journal Health Affairs found that doctors using computers to track tests, like X-rays and MRIs , ordered far more tests than doctors relying on paper records.

   Darrell K. Pruitt DDS

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8. Singleton, on October 18, 2012 at 9:50 AM said:

   Hold eHR Vendors Accountable

   http://www.modernmedicine.com/modernmedicine/article/articleDetail.jsp?id=793082&sk=d6a586a278ae9da066e6f5575a9e0adf

   Singleton

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9. D. Kellus Pruitt DDS, on September 6, 2013 at 10:40 AM said:

   Dental office data breach blamed on faulty encryption – Worse things could happen

   More information about the recent orthodontists’ data breach was shared yesterday in Joseph Goedert’s HealthDataManagement.com article, “Orthodontist Breach Hits 10,000 and Includes SSNs.”

   http://www.healthdatamanagement.com/news/breach-notification-hipaa-privacy-security-46556-1.html

   The brief article reveals that the theft from Olson & White Orthodontics in Florissant, Missouri consisted of two desktop computers and an external hard drive. Interestingly, even though the practice had adopted encryption, its effectiveness was compromised because of unexplained problems. Otherwise, Olson & White would have never had to report the theft, and nobody would have learned of the breach of 10,000 encrypted identities until perhaps much later when multiple identity thefts might have been linked to Olson & White’s practice.

   Goedert writes: “Responding to an inquiry on security technologies that were employed on the computers, Daniel Nelson, an attorney with Armstrong Teasdale LLP and representing Olson & White, responded, ‘I can tell you that Olson & White utilized industry standard medical office products for processing and transmission of sensitive data. These products generally included encryption. In our post break-in investigation, however, we discovered potential vulnerabilities which led us to conclude that certain sequences of events could result in the storage of data in an unencrypted form.”

   When Nelson mentions that the practice uses “industry standard medical products” which generally include encryption, I’m reminded that Dentrix, the nation’s most popular EDR system, has received two Vulnerability Notes from the US Department of Homeland Security (DHS) in the last year because of their inadequate “encryption.” (See: “Vulnerability Note VU#948155 – Henry Schein Dentrix G5 uses hard-coded database credentials shared across multiple installations” and “Vulnerability Note VU#900031 Faircom c-treeACE database weak obfuscation algorithm vulnerability”).

   http://www.kb.cert.org/vuls/id/948155

   http://www.kb.cert.org/vuls/id/900031

   I know of someone who repeatedly hacks into Dentrix as a hobby. He is also the one DHS thanks in the Vulnerability Notes for pointing out Dentrix’s weaknesses. Who knows how many Americans Justin Shafer has protected from identity theft?

   Before there is hope of a better solution to data breaches from dental offices, we must face the truth: Encryption is false security. It protects careless providers more than clueless, vulnerable patients. Dentists who encrypt to avoid the risk of having to notify patients of identity breaches should inform their patients of their non-notification policy in the Notice of Privacy Practices (NoPP) that they ask patients to sign.

   Encryption makes no difference in the long run. Even though it is strongly recommended by HHS as well as the American Dental Association, encryption – including Dentrix’s – has a limited shelf life while the identities it protects last lifetimes. In my opinion, if dental patients’ identities are fumbled – encrypted or not – it is only ethical that they be informed. I would want to know. Wouldn’t you?

   I say we should strongly consider de-identification instead of encryption for dental practices. If patients’ identities are unavailable, they are impossible to steal, forever.

   D. Kellus Pruitt DDS

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