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Inviting Debate with eDR Stakeholders

12 Responses

1. D. Kellus Pruitt DDS, on November 20, 2010 at 9:25 PM said:

   How’s that eDR mandate going?

   “John” (no last name provided) from the EMR and HIPAA blog responded to my invitation to discussion yesterday. His correction of my misunderstanding leads off today’s conversation about the progress in the bi-partisan mandate to include electronic dental records in healthcare reform.

   John:

   Carl Bergman (from EHR Selector) sent me the following email with some good info:

   At EHRSelector.com, we list seven EMRs that support dentistry. Comparing those to the ONC list, I found three that are certified as complete, that is, they meet all certification criteria. They are:

   AblelMed, Curemed and NextGen.

   D. Kellus Pruitt DDS

   Thanks, John. Could have fooled me, and I’m a dentist!

   Now that you mention it, it seems like about a year ago, I heard a rumor that NexGen was seeking CCHIT “certification” for dental software – even before “meaningful use” in dentistry was defined (?). Yeah. Right. What’s the point? As far as I know, nothing else was said about the unheralded accomplishment. NexGen certainly didn’t purchase many press releases bragging about it. And why should they? NexGen is more involved in hospital systems than dentistry. Dentrix is the major vendor of dental software, and if Dentrix is somehow certified like NexGen, it’s hardly a selling point.

   Also, I tried to post another comment yesterday on this thread, but it didn’t take. I’ll try again. Thanks for your response.

   D. Kellus Pruitt DDS:

   (I unsuccessfully submitted this comment yesterday following Don B’s comment: “So dentists only qualify for Medicare reimbursement under very restrictive conditions … and are a Medicaid EP if in private practice they ‘Have a minimum 30% Medicaid patient volume.’”)

   You now know the long-hidden secret: Digital interoperability with dentists’ offices has always been a non-starter. Today seems to be an excellent day for making that point. I sense something happening in the industry.

   Did you catch the news this afternoon “Electronic Health Records: Why We’re Not Going to See Them by 2014,” by Ken Terry for bnet.com?

   http://www.bnet.com/blog/healthcare-business/electronic-health-records-why-we-8217re-not-going-to-see-them-by-2014/2103

   Less than 10% of hospitals will qualify for ARRA incentive money that becomes available Jan. 1, 2011. Hospitals have several years head start on dental offices plus entire departments for handling HIT and the intricate security issues digitalization brings to healthcare. On the other hand, dental offices typically have less than 5 employees. I bet less than 10% of dentists’ offices are even HIPAA compliant. What do you think?

   Here’s some more news that popped up just a few hours ago, Andis Robeznieks posted “CCHIT seeks comments on specialized EHRs” on ModernHealthcare.com.

   http://www.modernhealthcare.com/article/20101119/NEWS/311199996/#

   Robeznieks writes: “The Certification Commission for Health Information Technology has opened a public comment period for its proposed oncology and women’s-health electronic health-record certification criteria and test scripts. The comment period will end Dec. 10 at 5 p.m. CT.”

   Is it possible that following the establishment of “meaningful use” guidelines for these specialists, dentistry could be next in line? Robeznieks describes the difficulties shoehorning oncologists into the one-size-fits-all healthcare mandate:

   “KLAS, an Orem, Utah-based health IT market research firm, released a report on oncology EHRs in September that noted the challenges faced by both those seeking to market and use the products. ‘The oncology market has been ignored by enterprise software vendors for the most part,’ report author Monique Rasband said in a news release. ‘Oncology seems to be on the roadmap for most vendors, but few have made much progress, and their functionality doesn’t seem to be meant for use as a full oncology platform.’”

   See what I mean? Dentistry simply will not fit into the current plans for interoperability – even with the stimulus money available to oncologists. Dentistry is a forgotten, unglamorous healthcare niche. The special thing about dentistry is that the bottleneck in a typical practice isn’t the front desk where computerization is overkill. It’s the dentist. And no amount of computerization can speed up an extraction for an anxious patient.

   D. Kellus Pruitt DDS

   By the way, this thread has been picked up by the Medical Executive-Post. See “Inviting Debate with eDR Stakeholders.”

   Inviting Debate with eDR Stakeholders

   Everyone is invited.

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2. D. Kellus Pruitt DDS, on November 22, 2010 at 10:09 PM said:

   The eDR discussion continues … There is no debate

   Every year or so, I enter into increasingly significant conversations with others in Health Information Technology. I’m glad I made contact with John (no last name given) from the EMR and HIPAA blog. Our discussion about electronic dental records continues.

   http://www.emrandhipaa.com/emr-and-hipaa/2010/11/18/emr-stimulus-q-and-a-emr-stimulus-money-and-dentists/comment-page-1/

   Our discussion is also being followed on the Medical Executive-Post.

   Inviting Debate with eDR Stakeholders

   John commented on November 21st, 2010:

   This happens about every week or two. I get behind on a post and then there are so many comments I have to wait until I have down time to catch up. Anyway, Dr. Pruitt, the reason your comments didn’t show was that if you have more than 2 links they get automatically moderated. I think I approved all of them now, so they should be there now. If not, let me know and I’ll search for others that might have enjoyed the wrath of the spam filter.

   It seems like there is a bit of confusion in this post (and in the medical community in general) between the Medicare and Medicaid parts of the EHR stimulus money. I must play ignorance when it comes to much of the dental electronic records world. I’ve considered really branching out to learn about it, but there’s been too much other EHR stuff that this post is really my first entry about dental IT.

   I have no doubt that dental will have a hard time getting any stimulus money from the HITECH act. This is true for many other medical specialties as well. Meaningful use was designed for general medicine. So, take that for what it’s worth.

   As far as certification of dental EHR software, you’re right that it’s useless unless you are trying to get the government stimulus money. It serves no other purpose (at least not one beneficial to the doctor).

   As I said in my disclaimer above about not knowing details of dental EHR software, I can’t help but wonder how many of this list of possible EMR benefits could be applied to dental. That would be the starting point to establishing an ROI. I imagine there are many similarities. [See “Benefits of Using an EMR or EHR Over Paper Charts”]

   http://www.emrandhipaa.com/benefits-of-emr-or-ehr-over-paper-charts/

   All of this said, I hope that this thread starts some good conversation for dentists looking at going electronic and helps get more information out there about electronic dental health records.

   —————-

   Thanks, John, for the explanation. I figured the lost post was a glitch or something. I wasn’t sure if I had posted it correctly.

   I’ve followed EMR and HIPAA off and on for a year or so. You and your team have done a great job at posting relevant and unbiased information about healthcare information technology. That’s rare to find on the Internet these days — especially for dental issues. Dentists have to rely on vendors for information because nobody is taking a leadership role in the issue, and the ADA isn’t saying a thing.

   I’ve taken your long list, and surprisingly only found one benefit that might be an advantage of eHRs in dentistry – “Improved patient communications.” If dentists could perform this service without having to become HIPAA compliant, it would be wonderful, but it still wouldn’t lower the cost of dental care.

   Here are my responses to other possible advantages of electronic dental records over paper:

   Legibility of Notes – No more dealing with various handwriting styles since notes are typed.

   – Is this really what computerization is for? No. If legibility of notes is a problem, the more logical solution would be to ask the person to write better. Typical dental practices only consist of 5 or so people. Computers empower sloppiness. It is much easier to mistakenly record 5 mm instead of 3 mm on a keyboard than a paper chart.

   Accessibility of Charts – Indexed and easily searchable by multiple identifiers. No more searching the entire clinic for a lost paper chart.

   – Physicians deal with tens of thousands of charts, and hospitals have millions. A typical dentist has two to five thousand. There are not many places for charts to hide in a dental office. Also, dentists usually know a significant number of their patients’ names on sight.

   Transcription Costs Savings – Many users have been able to save on transcription costs by implementing an EMR.

   – Transcription? What’s that? Dental treatment involves the lower third of the face. Not the whole body.

   Space Savings – Many people are able to save space where they’d normally be storing shelves and shelves of paper charts.

   – Dentists offices only store two to five thousand THIN charts, not tens of thousands.

   Eliminate Staff – This almost never happens immediately. Usually this happens through natural turnover of employees and usually occurs with your front desk or medical records staff.

   – Exact opposite: Mandating eDRs would cause dentists to have to hire HIT staff. The front desk has never been the bottleneck in dentistry.

   Eligibility for Pay-for-performance – It could take two years or more for you to implement an EHR and implement a meaningful quality improvement mechanism that would lead to your receiving payments from these programs.

   – That’s hardly a selling point to dentists – know what I mean?

   New Physician Recruitment – Many new physicians are looking for practices that use an EHR and will only work for an organization that uses an EHR.

   – Whether there is even a computer in the office or not has very little effect on a dentist’s work.

   Multiple Users Use a Chart Simultaneously – Most EMR programs support multiple users accessing a chart at the same time. Many even allow multiple people to chart notes at the same time also.

   – That has never been a significant issue in dental offices.

   Lab Results Returned Automatically – This depends on a lab interface, but is more reliable and integrated with the care given.

   – Not an issue.

   X-Ray Results Returned Automatically – This also depends on a X-ray interface, but has the same possible benefits of a lab interface.

   – Not an issue.

   Save a Tree and the Environment – You won’t eliminate your use of paper, but you can significantly reduce the amount of paper/charts you use in your practice.

   – Are talking about healthcare or rationalizations? I guess you could also say digital completely eliminates paper cuts.

   Electronic Prescriptions – Scripts sent electronically or printed out avoid problems of legibility by the pharmacy receiving the script.

   – Dentists write so few prescriptions that filing electronically would raise the cost of dental care without benefitting the patient. That’s against the Hippocratic Oath.

   Spell check – Many EMR software includes a spell check and often even include a medical dictionary.

   – Really?

   Disaster Recovery – Depending on your EMR backup schedule, you can store a copy of your data in multiple locations for better disaster recovery. Plus, in an emergency you could carry a backup of your data with you. Think about how you’d carry a room full of charts with you in an emergency.

   – Disaster Recovery: Which can one read easier by flashlight? Paper of digital. I cannot think of any reason I would want to remove my patients’ protected health information from my office. I cannot imagine why a dentist would be interested in taking such risks with data breaches… yet I know dentists who transport hard drives to and from home every day as back up.

   Drug to Drug Interaction Checking – Most EMR provide a database of Drug to Drug interactions when writing a prescription.

   – That would be nice, but this doesn’t negate a dentist’s obligation to stay on top of these things. We don’t prescribe very many medications, and perhaps only 8 to 10 variations. If harm is occurring because of drug interactions involving dentists’ prescriptions, those instances need to be documented starting today. Perhaps this is a concern. I just don’t know.

   Drug to Allergy Interaction Checking – Most EMR provide a database of Drug to Allergy Interaction checking when writing a prescription.

   – Even if one’s practice is paperless, patients must be asked if they are allergic to any medications before prescribing – that’s the rule in my office.

   Patient Safety? – Better information access, reduced gaps in communication between providers and reduction in duplicate testing.

   – If an emergency dental patient with digital dental records were on vacation, and the attending dentist were able to download tons of information about the patients dental history from 10 years back – to diagnose the problem almost always requires a new x-ray. Often all it takes is one x-ray and a look at the tooth to determine the problem. Many times the patient gives a reliable diagnosis even without the dentist’s help.

   Integration with Physician Dispensing Software – Could make more money using a physician dispensing (yes, I know they can’t really “dispense”) software

   – Not applicable

   Quality of Care?

   – EDRs have not been shown to improve quality of care. They don’t even save money on care.

   Increased Efficiency?

   – Only for the largest practices.

   Better Patient Services?

   – You mean waiting for the HIPAA releases patients sign without reading?

   Improved Workflow?

   – You mean waiting for the HIPAA releases patients sign without reading?

   Improved Patient Communications

   – Possibly. After all that is what computers are good at.

   Improved Accuracy for Coding Evaluation and Management

   – That helps pharmacy chains and insurance companies, but it has nothing to do with patient care.

   Improved Drug Refill Capabilities

   – No. Nothing beats speed-dial.

   Improved Charge Capture

   – Doubtful. Negotiating actuary department-approved hoops to capture what insurance companies owe providers long after the work left the building has nothing to do with patient care and everything to do with slow-paying, clever insurance companies.

   Improved Claim Submission Process

   – Helps Delta Dental, BCBSTX and United Health, but does not help the patient.

   Reduced Medical Records Transportation Costs

   – Not an issue

   ———–

   As you can probably see, John, this is the frontier. Until our conversation, hardly anything has been said anywhere by anyone other than me and a few now-silent vendors. This is special. Thanks.

   D. Kellus Pruitt DDS

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3. Dr. Pruitt, on November 23, 2010 at 11:42 AM said:

   Why does the ADA hide the bad news about eDRs as policy?

   On Monday, http://www.Chiroeco.com a business magazine for chiropractic offices, posted the following article warning providers about the devastating consequences of a data breach.

   If a computer is stolen from a dental office, it could bankrupt the practice even if self-reported according to the law. The liabilities a dentist assumes by storing patients’ personal information on computers has been largely downplayed if not completely ignored by our dental leaders whom we trust to help protect our practices and our patients’ interests. Why? Who got to them?

   http://www.chiroeco.com/chiropractic/news/10502/865/hhs-to-identify-by-name-all-private-practices-experiencing-a-breach-affecting-500-or-more/

   HHS to identify by name all private practices experiencing a breach affecting 500 or more (no byline)

   As you know, HIPAA-covered entities experiencing a security breach are obligated to notify affected individuals, the U.S. Department of Health and Human Services (HHS), and, in some cases, the media. When a breach affects 500 or more individuals, the covered entity must report the incident to HHS within 60 days of discovery.

   HHS, in turn, provides a brief summary of the event on its website .To date, HHS has listed private practices anonymously, identifying them only as “Private Practice.”

   HHS took the position that private practices could not be specifically named on the website because they are identifiable as “individuals” within the meaning of the Privacy Act, which would potentially require the practice’s consent prior to listing it by name. Pursuant to the Privacy Act, HHS may designate its publication of breaches, including naming private practices, as a “routine use” of the information such that prior consent is not required for the publication.

   Accordingly, on April 13, HHS published a Federal Register notice stating its intention to start identifying private practices by name on its breach website, designating such publication as a “routine use” of the information under the Privacy Act. Although it has yet to do so, HHS has been entitled to name private practices (both prospectively and retroactively) since May 23rd, 40 days from publishing its Federal Register notice.

   Darrell K. Pruitt DDS

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4. D. Kellus Pruitt DDS, on November 23, 2010 at 9:01 PM said:

   Come on out with your hands up – TDA

   The EDR discussion continues, plus an invitation to the TDA

   John responds:

   Someone who wanted to remain anonymous sent me the following message:

   I am currently working for a dental PMS/EMR company and can tell you that while we are planning to meet as many of the MU regulations as possible, many of them do not even apply to any of the dentistry specialties. Without a clear path to certification and clear requirements, I’m not really sure how they are going to deal with specialties, let alone the dental one.

   ———-

   Thanks, John. I know a software developer or two who say the same thing. CCHIT certification looks like an expensive and futile bureaucratic exercise to a growing number of people who should know – even before eHRs are extended to the 160,000 or so individual dental offices in the nation – urban, rural and very rural.

   Nevertheless, the leaders of the Texas Dental Association don’t agree with our anonymous software developers. About the time you spoke with your friend, this was posted on the TDA Today online to help Texas dentists better prepare for receiving incentive payments to help pay for their paperless practices:

   ———–

   Texas Medicaid Electronic Health Record (EHR) Incentive Program

   This is the first in a series of articles to keep you informed of the Texas Medicaid Electronic Health Record (EHR) Incentive Program and continuing efforts to implement health information exchange initiatives across Texas. Future articles will focus on helpful reference web sites, health information exchange, meaningful use for dentists, certified EHR technology for dental practices, and other relevant topics of interest to dentists and health information technology (IT).

   Under the American Recovery and Reinvestment Act of 2009, eligible dentists can qualify for Medicaid EHR incentive payments when they adopt and use certified EHR technologies. Dentists may receive up to $63,750 over a 6-year period with the Medicaid EHR Incentive Program as long as they meet eligibility criteria. Texas Medicaid is planning to begin registration for the EHR Incentive Program in January 2011, with payments expected to begin around April 2011. First year incentive payments are available between 2011 and 2016, with the last year of incentive payments anywhere from 2015 to 2021, depending on what year the dentist started receiving payments. For Medicaid providers, eligible professionals do not need to report on meaningful use or clinical quality measures until 2012.

   Visit the Texas Medicaid Health IT webpage for more information, upcoming webinars, events, and answers to questions. To contact the Health and Human Services Commission with additional questions, go to HealthIT@tmhp.com or call (800) 925-9126. [I had no luck with the link, and I don’t do telephone].

   —————

   Note: There is a very good chance that the Texas Medicaid dental plan will become capitation – the cruelest but cheapest type of dental benefits plan made. Because of the unfair business model of Dental Health Maintenance Organizations, more money is made when clients stay away from contracted dentists. That is why DHMOs are shunned by dentists and patients alike. I don’t know any dentists who can tolerate 30% capitation in their practices.

   But then again, ARRA stimulus money might not make it even that far. Governor Perry has threatened to pull Texas out of Medicaid altogether. He also threatened to pull Texas out of the nation last year, so it’s hard to tell what he will do.

   In summary, the HIT industry says meaningful certification of eDRs is as unlikely as finding Medicare providers in Texas. Nevertheless, TDA officials say it’s a done deal, and promise more information about digitalization in a series of upcoming articles. I look forward to hearing more about the TDA’s plans. It looks like a dead end to me.

   I’ll contact the TDA to give them the opportunity to take part in this important and unprecedented discussion. Don’t get your hopes up. In five years of asking my professional organization questions about HIPAA and eDRs, all I’ve gotten are committee-approved talking points, if not silence. Surprisingly, TDA officials don’t talk with members about these things on the Internet, yet they encourage TDA members to buy into turning their practices paperless. The TDA is truly a fascinating study of a command-and-control institution wilting in the harsh light of transparency.

   D. Kellus Pruitt DDS

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5. Darrell K. Pruitt DDS, on March 9, 2011 at 10:00 PM said:

   A rare discussion about electronic dental records. Where is the ADA anyway?

   Finally! Another increasingly rare public discussion about electronic health records in dentistry and I’m right in the middle of it. It’s been a long time since I trumped lame selling points with honesty on a public venue.

   On March 3, I entered into a discussion about EDRs on the Medscape Blog following Dr. Margaret Scarlett’s arguably biased article, “What’s Your Experience with EDRs?” To her surprise I’m sure, rather than attract hi-tech dentists who are experiencing digital bliss with their paperless practices instead of being scared to death of data breaches and HIPAA inspections, she only attracted me and a few clueless EDR enthusiasts – who I don’t think are even dentists.

   http://boards.medscape.com/forums?128@112.2FrQa9DuOk0@.2a077212!comment=1

   All the enthusiasts brought to the discussion were the usual unsupported selling points that EDRs save time and money and eliminate stupid human errors. Nothing new and easily squashed. Mysteriously, Dr. Scarlett herself has yet to respond.

   For the last few hours now, the last words in the string are mine. I ask: “Where are the EDR vendors in this debate? Where is Dentrix? Where is EagleSoft? What does it mean when even those who sell EDRs cannot defend their products? Most importantly, where is the American Dental Association?”

   D. Kellus Pruitt DDS

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6. D. Kellus Pruitt DDS, on March 24, 2011 at 5:30 PM said:

   De-identify dental records now

   Most assume because I point out undeniable fatal flaws of politically-correct EDRs (and so enjoy doing so), that I don’t appreciate the good things that interoperability could bring – such as precious discoveries in dental care data-mined from thousands of dentists’ pooled treatment information.

   Just like everyone else, I’d like my grandchildren to benefit from Evidence Based Dentistry on an internet platform. But, those miracles are simply not going to happen unless EDRs are trusted by both dentists and patients regardless how many billions of healthcare reform dollars are thrown at it.

   I recently read that half of Americans already fear identity theft from their EHRs, and digital isn’t getting any safer.

   Face the truth: EHRs are becoming increasingly more dangerous to everyone.

   Forget encryption, forget HIPAA and all the dental care stakeholders who want a piece of the stimulus action at my patients’ expense. Dentists who actually care for patients must simply break out on their own and de-identify their patients’ records.

   If Protected Health Information is not included in dental charts, NOBODY seriously cares if someone outside the dental office sees their dental record. Why would one store bombs with fuses attached?

   If it’s not there, it cannot be stolen.

   D. Kellus Pruitt DDS

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7. D. Kellus Pruitt DDS, on March 24, 2011 at 8:32 PM said:

   Today was rewarding for me. Months often pass before anyone engages me in myth-busting discussions concerning electronic dental records, stakeholders and HIPAA.

   But today I enjoyed two open conversations occurring simultaneously about the taboo topics in dentistry – one on Dental Facebook and the other on my own Facebook Wall. Maybe the mountain is finally moving.

   D. Kellus Pruitt DDS

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8. D. Kellus Pruitt DDS, on July 16, 2011 at 3:41 PM said:

   The continued influence effect of EDR misinformation

   Whether it’s unprofessional or not, I’ve developed an intense fondness for the sport of confronting and dispelling lame misinformation that favors electronic dental records over paper. It’s erg exciting. But I have to say, I’ve found it surprisingly difficult for common sense to compete with the simple, catchy phrase (and CHT book title) “Paper kills.” The lie’s beauty and phenomenal ad power is in the way its simplicity disengages thought.

   “Paper kills” sounds just too cool to be false. It reminds me of the sports drink ad in Mike Judge’s movie Idiocracy. ”Brawndo – The thirst mutilator.”

   That’s why I found Monday’s Australian Broadcasting Corporation article, “Setting the record straight almost impossible,” particularly interesting.

   http://www.abc.net.au/science/articles/2011/07/11/3265013.htm

   Though American dentistry isn’t mentioned in the University of Western Australian behavioral study described by science reporter Dr. Branwen Morgan, the conclusion certainly explains EDR stakeholders’ emotion-laden, stoic mindset that persists years after they should have surrendered their untenable position – denying paper’s proven track record of safety and value for dental patients.

   The results were published in February titled “Correcting false information in memory: Manipulating the strength of misinformation encoding and its retraction” (Ullrich K. H. Ecker, Stephan Lewandowsky, Briony Swire and Darren Chang).

   http://www.springerlink.com/content/dlp3455520r4lqk2/

   From the Abstract: “Information that is presumed to be true at encoding but later on turns out to be false (i.e., misinformation) often continues to influence memory and reasoning.” Assistant Professor Ullrich Ecker tells ABC that the “continued influence effect of misinformation,” occurs even if the retraction is understood, believed, and remembered.

   Even though my adversaries’ position in our internet strategy game is indefensible – as proven by the dentalcare stakeholders’ silence – I now better understand why the struggle has been much more difficult and has taken much more time than I imagined it would years ago. Billions of taxpayers’ dollars and bi-partisan popularity provided irresistible momentum to a fat, hungry monster that’s too big to fall. But fall it will.

   It’s only a matter of time before one or more embarrassed stakeholders will have no choice but to publicly admit they were misled. Then we’ll celebrate. And later, stakeholders will forget the embarrassment and have to be reminded again. No problem. They are in it for power and quick mandate money. I’m in it for long-term transparency and a high score. How can I possibly lose?

   D. Kellus Pruitt DDS

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9. D. Kellus Pruitt DDS, on November 14, 2011 at 9:26 PM said:

   An open letter to Dr. Gordon Christensen’s CR Foundation concerning censorship

   I think those who sincerely want to sell customers their products should treat us with common respect, no matter who they are. What do you think?

   https://www.facebook.com/pages/CR-Foundation/160588080492

   Dear CR Foundation Facebook moderator,

   Last week, I posted three sincere, cogent and important comments here on your Facebook that were deleted hours ago without even a warning – much less a response to my questions. Please read them again, carefully this time, and share with us your reasons for censoring the comments:

   Tuesday – “Dear CR Foundation: Has anyone yet published a study showing that electronic dental records offer dentists a return on investment?”

   Wednesday – “HIPAA inspections begin this month.

   http://www.healthdatamanagement.com/news/hipaa-privacy-security-compliance-audits-43589-1.html “

   Thursday – “Are electronic dental records safer for dentists and patients than paper dental records? Shouldn’t CR Foundation be investigating this?”

   What was your boss thinking? Does he understand that when he evades questions about EDRs and HIPAA – for whatever lame reason – it only attracts more attention to the critical dental issues he least wants to address?

   He should have just left them alone rather than hiding the questions from others who might have been able to provide answers. It’s the CR Foundation for crying out loud! Answering dentists’ questions is the essence of your business!

   I think you realize by now that your customer, a practicing dentist, is owed an explanation for rudeness by an anonymous CR Foundation employee. In the most successful businesses in the land of the free, staff are always held accountable when they show disrespect to customers, otherwise such bad habits will only worsen and could even destroy customers’ trust in the company when the word gets around – and it gets around fast these days. That is why I demand to speak to your boss. I should mention that even Wal-Mart employees, who wear name badges for accountability, are ordered to allow unhappy customers an audience with supervisors. Please don’t disappoint this customer again, Anonymous.

   Sincerely,

   D. Kellus Pruitt DDS

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10. D. Kellus Pruitt DDS, on November 19, 2011 at 8:36 PM said:

    Presidential candidate Newt Gingrich says “Paper kills.”

    Three weeks ago, Dr. Paul Child, CEO of CR Foundation was held accountable for publicly stating: “Dentists who have not yet adopted [electronic dental records] should do so now! Daily advances and improved software adapted from other industries allow this technology to be affordable, attain the fastest adoption rate, and offer a high return on investment.”

    http://www.dentaleconomics.com/index/display/article-display/2974000845/articles/dental-economics/volume-101/issue-10/features/digital-dentistry-is-this-the-future-of-dentistry.html

    Six years ago, an equally optimistic Newt Gingrich, representing his for-profit Center of Health Transformation, got away with telling a similar fib on NPR’s Talk of the Nation, “I think having electronic health records will be less expensive by a big margin than paper records. It is a simple fact that paper kills.”

    http://www.npr.org/blogs/health/2011/11/18/142518903/gingrichs-history-on-health-care-gets-an-exam

    Dr. Child, representing a widely-respected dental materials research firm, lost his job for volunteering a single statement unsupported by fact. On the other hand, Gingrich is a politician. That profession’s ethics fit much looser than ethics in the healthcare industry, as well as most other businesses in the nation. As one might expect, Gingrich continues to profit from misleading physicians as well as dentists about the true costs of HIT.

    Around 2004, Gingrich personally visited ADA Headquarters to persuade gullible ADA officials to unquestioningly promote HIPAA, the NPI number and paperless practices to membership. ADA officials obediently took orders from HHS until the patriotism started looking silly around 2008 – about the time Newt Gingrich’s 2008 book “Real Change” was published.

    Gingrich writes that our 20th century health care system is “weighed down by the chains of over-regulation.” Yet in the 21 pages devoted to health care, “quality” is mentioned a dozen times without mentioning how EHRs will be used to regulate the quality of doctors’ work.

    In the whole 300 pages of the book, dentistry is mentioned twice – as examples of Medicaid fraud in Florida and New York. So what can dentists who don’t commit fraud expect to gain from interoperability with President Gingrich’s online auditors?

    Go, Ron Paul!

    D. Kellus Pruitt DDS

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11. D. Kellus Pruitt DDS, on July 17, 2012 at 10:41 PM said:

    eDRs

    I’ve been beaten up on the internet enough to be aware that few dentists – especially those who have invested in electronic dental records – are ready to consider that HIT in dentistry was poorly planned. I contend the naivety is not the fault of colleagues who actually treat disease. It’s the fault of well-meaning leaders who hastily grabbed stake in the popular EDR “mandate” – basing reckless decisions on the future of dentistry on political correctness and CDT royalties rather than common sense and the Hippocratic Oath.

    Long ago, Ponemon Institute studies began revealing the growing number of data breaches from providers’ offices. Perhaps because of leaders’ pride and/or investment of careers into HIT, they resist transparency about the products they promote. In the absence of a trustworthy source of information, pervasive vendor-friendly bias makes my opinion very unpopular on a (decreasing) number of dental industry venues. It’s also why your assumptions concerning EDR security are wrong, Keith.

    “The only thing a thief could want from a dental chart would be the financial information. If you have a password protected system and all the other safeguards in place this should be almost impossible for someone to steal.”

    Impossible to steal? Ponemon estimates that 96% of healthcare organizations have experienced reportable data breaches in the last two years. Between 2010 and 2011, the number of breaches doubled, and may double again by the end of 2012. Medical identities go for $50 each on the black market while financial identities only bring $5. This means thieves are targeting health insurance coverage. And when a medical history is altered to suit an imposter, it can easily put the victim’s life in danger.

    “With paper records someone simply has to break into the office and copy that info down from records.” Identity thieves of course prefer digital over paper. For one thing, nobody has to decipher bad handwriting before entering it on a computer. Secondly, filing cabinets make far more noise than hackers. What’s more, if a burglar steals a computer from a dentist’s office, passwords are no better protection than the Maginot Line.

    “The biggest problem in our area has been vandalism of the office after the thief did not find money or drugs(what most of them are after) Imagine coming in to the office and having a couple thousand charts tossed around the office.” That’s the first time I’ve heard that one. Don’t forget the danger of paper cuts.

    “With the electronic record if they did steal this information there is a good chance of knowing which records were accessed and when, you can not look at a paper chart and tell this.” When a computer is stolen, usually ALL the dentist’s patients are instantly involved. Once again, nobody steals paper dental records.

    James Pyles, a widely-respected attorney who has fought for patient privacy rights for years was quoted in a FormTek.com article yesterday. He describes the difference between paper and digital: “We now have electronic disclosures of patient privacy that are entirely different from disclosures of paper records. You can get a paper record back; you cannot get an electronic record back. You can disclose millions of electronic records simultaneously; you cannot do that with paper records.”

    http://www.formtek.com/blog/?p=3099

    Want a solution? De-identification of EDRs is far better than even encryption. If dental patients’ identities are not present in a stolen computer, nobody has to be notified, and a computer is all it costs – not lawsuits, HIPAA fines and one’s reputation in the community.

    Once we take ownership of our blunders, corrections can be made and we can move toward safer, real advancements in dentistry. Remember: Patients’ unnamed dental histories have no black market value.

    D. Kellus Pruitt DDS

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12. D. Kellus Pruitt DDS, on December 7, 2012 at 2:16 AM said:

    Ponemon Study and EDRs

    In April, I predicted that common sense would drag de-identified EDRs to the negotiating table by the end of the year. It’s right on schedule.

    It seems only days ago indignant EDR salespeople and sympathetic Linkedin moderators were still using censorship to hide the increasing liabilities of dental software from dentists. Nevertheless, in spite of all their efforts to delay the bad news as long as possible, recent Ponemon findings suggest that EHRs have already become too dangerous for dentistry; as there are two safer alternatives – pegboard, ledger cards and lots of carbon paper, or de-identification of EDRs.

    The “Third Annual Benchmark Study on Patient Privacy & Data Security,” sponsored by ID Experts and independently conducted by Ponemon Institute, has been published.

    Click to access Third_Annual_Study_on_Patient_Privacy_FINAL.pdf

    The following are some of the top findings of the study:

    • Ninety-four percent of organizations in the study have had at least one data breach in the past two years. The average number for each participating organization is 4 data breach incidents in the past two years.

    • The average economic impact of a data breach over the past two years for the healthcare organizations represented in this study is $2.4 million. This is an increase of almost $400,000 since the study was first conducted in 2010.

    • The average number of lost or stolen records per breach is 2,769. The types of patient data lost or stolen most often are medical (and dental) files and billing and insurance records.

    • The top three causes for a data breach are: lost or stolen computing devices, employee mistakes and third-party snafus.

    • Fifty-two percent discovered the data breach as a result of an audit or assessment followed by employees detecting the breach (47 percent).

    • More than half (54 percent) of organizations have little or no confidence that their organization has the ability to detect all patient data loss or theft.

    Each time a stakeholder hides the cost and danger of EDRs, or even worse, censors an American’s concerns about privacy, the dentalcare parasite willfully endangers the health and wellbeing of dentists and their patients for selfish gain. If we don’t publicly discourage deception that is winked at by the US Dept. of HHS as well as the American Dental Association, dentists might be forced to return to 1950s practice management technology to retain breach-wary dental patients. Understand this: Dental patients really, really hate being informed that their dentists have fumbled their identities… the first time. No more bullshit. Let’s talk de-ID.

    D. Kellus Pruitt DDS

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