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Looking to Convert to a Paperless Dental [Medical] Practice?

Why Does the ADA Promote eDRs?

By Darrell K. Pruitt DDS

Not so Fast!

Before a dentist trustingly accepts the recommendation of the American Dental Association and unwittingly converts his or her practice to paperless, one should read the story I copied below which was posted on VillageSoup.com yesterday.

Unlucky dentist loses everything …


Worst Way to Start Off the Year

I have been on my own for last 7 yrs. We have a small business server (windows 2003) 6 work stations, completely paperless using Dentrix 11 and Vixwin platinum. One morning, when we returned to work, we could not access the server. Went into panic mode! Not able to get anything! Not knowing the schedule. Who is coming what they are coming for, etc. It was decided that my server crashed. It was set up w/2 hard drives to mirror each other and also had an external drive back up (Seagate). We ended up rushing the drives to a data recovery company in (data doctors). They sounded very promising claim 90% success). I agreed to pay additional $4100 to rush case! We were led to believe all is well once they diagnosed case. A few hrs later every thing changed. We got the bad news that both drives are not recoverable since they found a minute scratch on one of the plates. Also we are not able to recover anything from the external drive.

At this point I have lost all patient records including x rays going back 7 yrs. I have no access to schedule, ledgers, notes, insurance, X-rays, anything. This is leading both me and my wife into depression. We are very stressed, at a loss. This is a catastrophic loss. Not sure how to move forward?

I am worried about the liability on top of everything else. How do I tell my patients? How do I know who paid for what balances on work that needs to be done, etc. I keep waking up at night thinking of all the possible problems.

This is the lowest point in my career. I don’t even want to go into the office from stress. If any one can offer any advice I would really appreciate it. I know in the past you guys lifted me up. I love forum name.

Thank you.


On top of the anguish this person already suffers, the HIPAA violation must be reported to the Department of Health and Human Services. Thanks to HITECH, an expensive inspection is likely to follow. The dentist’s letter reminds me of a desperate private note from a dentist a few months ago describing his HIPAA violation. He lost a laptop computer he was using as a daily backup device. Since there were thousands of his patients’ unencrypted PHI on the computer, he was similarly paralyzed by the same cold and lonely panic a professional feels when optimistic career plans suddenly crumble into a dark void that includes abject business failure. People sometimes hurt themselves and others when even choosing to do the right thing leads to ruin. A person with any compassion can tell from reading the dentist’s plea for help that the newer harsher penalties from HHS and state Attorneys General for data breaches will only further destroy the lives of innocent dentists and their families. HITECH is cruel nonsense in dentistry and ADA leaders are stone-cold heartless.

Although encryption is strongly advised in the “ADA Practical Guide to HIPAA Compliance,” If ADA officials dared to keep track of their failure in promoting safe digital dental records, I bet their own data would show that less than 3% of US dental patients’ PHI is encrypted. Yet proud leaders in my profession remain stoically unresponsive to members’ and patients’ concerns about risks of data breaches. They call their aloofness “professionalism.” It infuriates me that shy ADA officials hide from personal accountability for the careless harm they cause dentists and dental patients.

“Image is everything” ADA/IDM slogan

The nation’s ambulatory healthcare providers – including dentists, podiatrists, chiropractic doctors and physicians – cannot continue to blindly trust our professional organizations to protect our practices from the dangers of the electronic health records they promote for their personal benefit. We’ve been sold out.


As far as I can tell, selfish ADA leaders with careers invested in dental informatics just can’t tolerate truth. When I consider the pain they cause at no risk to themselves, I say the parasites should be encouraged to move on down the road and look for their power in a field where they won’t endanger others.


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10 Responses

  1. Interoperable eHRs in dentistry by 2015
    [A mandate that failed]

    Judy, a friend of mine, asked “Are the dentists here organizing any efforts or even understand this whole issue – that all patient records have to be uploaded to a Health Information Exchange by 2015?”

    I replied:

    That’s a timely and relevant point, Judy. Other than vendors’ ads, there is no organized effort to help dentists to understand eDRs, and my profession’s handful of ambitious leaders who mindlessly bought into eDRs long ago now aggressively avoid the embarrassment of accountability using evasion, censorship and even suspension of dentists’ membership on secret complaints if necessary to “uphold the honor and dignity of the profession.” I’m certain that whoever said one can never ask a stupid question wasn’t one of the half-dozen Texas dentists who serve on the TDA Council on Ethics and Judicial Affairs.

    By February, I will have reported for 5 years that ADA leaders are still unwilling to discuss eDRs with ADA members. Think about how easy it would be for the ADA to prove me wrong. All they have to do is open the ADA Facebook and let the information flow both ways.

    In spite of the fact that a few years ago an ADA President from Texas declared that adoption of digital health records “will not be our choice,” interoperable eHRs will not make it to dentistry by 2015 or even by 2020 because they: 1. Do not offer a return on investment, 2. they do not improve dental care, and 3. as long as patients’ PHI is available to everyone, they are thousands of times more dangerous to dentists and their patients than paper dental records.

    In 5 years, vendors have never successfully challenged these insurmountable arguments against the unquestioned adoption of eHRs in dentistry, and it’s been over a year since anyone has even tried. That is why if any dental patients’ records are ever to be uploaded to a Health Information Exchange it will have to make business sense to do so. ADA Presidents are no longer powerful enough to simply declare it so even if they are from Texas.

    In contrast to the former Soviet Union, mandates are nothing more than political promises in the land of the free. In the best of democracies, common sense in business trumps stakeholders’ self-serving fantasies every time.

    D. Kellus Pruitt DDS


  2. Will Dental Patients Demand Paper Records by 2014?

    Unfortunately for EHR vendors trying to sell dangerous mandated products that increase the cost of dental care, politically-incorrect or not, customers are still always right. With each new data breach, George Bush’s mandate for universal electronic health records by January 2014 is looking less likely to arrive on time than Obama’s mandate to close GITMO by January of 2010.

    “While Americans trust their physicians to keep their healthcare information private, they don’t extend that same trust to computerized records systems”, according to a new survey from CDW.


    “Thirty-five percent of 1,000 survey respondents indicated they are worried that their health information will end up widely available on the Internet. And, half of the respondents believe that electronic health records (EHRs) will have a negative impact on the privacy of their health data.”
    – Lucas Mearian

    “U.S. patients trust docs, but not e-health records”, survey shows.

    Mearian adds that the full results of the survey will be released next month.



    What happens if long before 2014, finicky consumers on the east side of Fort Worth who hear about ever increasing incidences of identity thefts from stolen and hacked computers out of dental offices learn to seek dentists who still keep cheaper paper dental records rather than digital?

    I also offer convenient hours and free parking.

    D. Kellus Pruitt DDS


  3. Yesterday, a patient who discovered my discouraging comments about electronic dental records confided that his first impression of my attitude towards “progress” wasn’t flattering.

    But, after reading about the dangers of medical identity theft, he said he now understands my point and is grateful for paper dental records. Now and then things work out and life is good.

    D. Kellus Pruitt DDS


  4. Normally, I’ve posted my daily opinion by now. But today was not only a day spent placing an unusually large number of labor-intensive fillings, but I’ve also been increasingly busy in a continuing discussion of the dangers of data breaches with various EDR stakeholders on several Facebook venues. Pressure for more honesty in dentistry is building against rigid but futile resistance from biased advocates of EDRs and HIPAA.

    One of the threads started August 5 on Proud to be Dentist Facebook, and has collected lots of responses. Appropriately, it began with a Record Linc advertisement for their EDR.


    In the last few days, I’ve asked the anonymous Record Linc rep and a couple of other EDR stakeholders about digital records’ safety and value. Some have hung around for a few rounds to provide irrelevant and misguided information, but eventually they all left. And I’m afraid I was unable to convince a single one of them of EDRs’ danger to dentists and patients. I find it surprising how emotional some get over their favorite high-tech tools.

    Today, I asked the same question on Dental Learning Facebook. In response, Jason Dps started an Facebook survey titled, “Is it true that electronic​ dental records are more dangerous for both dentists and patients?”


    So far, this is the opinion which is winning with 7 votes: “EDR will soon be the norm. We must focus our energy on safety of information.” Coming in second with 3 votes is the opinion “I don’t know; but I do know that fluoride is dangerous for dentists and patients.” (?)

    I also got into a spirited conversation with the very popular dental practice consultant Linda Miles:


    No I don’t agree…Paper charts are about as dated as polyester uniforms of the 70’s. As I said nothing is 100% ….not even paper charts…and the benefits of EDR far outweigh the risks you are conjuring in the minds of the readers. Let’s face it….there are risks involved in everything!

    So you are saying I shouldn’t warn of the risks, Linda?

    My mama taught me to “never get into a tinkling contest with a skunk”. I feel this is a huge tirade that will only build if anyone in dentistry responds with any opinion other than yours…I also think the sky is falling so perhaps you should get on that one for now.

    Please settle down, Ms. Miles. It is a simple question about the safety of a communications tool for dentists – nothing more important than that. Try not to take it so personally. The fact is, since September 2009 until a month ago, 11.5 million EHRs have been breached. I doubt that more than a couple of thousand paper dental records have been compromised in the last two thousand years. So don’t you now agree that paper records are indeed safer for both dental patients and dentists than the EDRs promoted by the ADA?


    I failed to accomplish my goal today. I think Linda Miles left, still unconvinced of the dangers of EDRs. What’s more, I think she is through responding, and I doubt she will ever say anything to me again. Why is it so difficult to communicate with dental care stakeholders?

    In spite of the popular belief that “EDRs will soon be the norm,” it’s my opinion that between here and there, a painful rendering of the EDR industry will be encountered. I also think the shakeup will be big, bold, and coming soon. I look forward to the action. Some days aren’t so busy, and it helps to have a hobby to pass the time.

    D. Kellus Pruitt DDS


  5. Lorne Lavine to the Rescue

    Dr. Lorne Lavine is a dental consultant who like Linda Miles, makes his living selling advice to dentists. I discovered this morning that he came to Linda’s defense in the EDR discussion following yesterday’s survey about the safety of EDRs titled: “Is it true that electronic dental records are more dangerous for both dentists and patients?”


    Linda, who later in our conversation called me a skunk (?), started the thread when she replied, “Explain what you mean by DANGEROUS.” I think Dr. Lavine, who has for years evaded my questions about the EDRs he sells, stumbled into a mess when the vendor should have just sat on his hands. Dr. Lavine replies:

    Without putting words in Linda’s mouth, I think what she’s saying is that your reputation precedes you, Darrell. As far as your concerns go, while it’s true that EHRs are at risk, all it takes is some very simple encryption protocols in place on the server and backup to be safe; people like me have been lecturing on this topic for years. Windows Server has built-in encryption called EFS, all new computers can be encrypted with Bitlocker, you can set up a separate partition with TrueCrypt, etc. Just because someone chooses to not follow proper procedures doesn’t make it unsafe. Riding a roller coaster without a safety harness would probably kill you, but hardly anyone ever gets killed on a roller coaster because they force you to wear that harness…same deal here. As a matter of fact, if you have encryption in place, you are exempt from the HIPAA/HITECH breach notification rules.

    I answered:

    One’s reputation is important. Thanks for the compliment, Dr. Lavine. So what percentage of dental records are encrypted? In your practice, are your patients’ PHI encrypted? Once again, since September 2009 until a month ago, 11.5 million EHRs have been breached – not paper records. So what’s your point?

    By the way, Linda Miles and Lorne Lavine, in what other industry in the nation do customers tolerate being treated so rudely by those who would sell them (dangerous and expensive) stuff?


    D. Kellus Pruitt DDS


  6. Epilogue:

    A few hours following my last post, Linda Miles removed her comment which headed the thread – thus eliminating the entire conversation.

    No explanation was given.

    Darrell DK


  7. My encounter with Miles and Lavine

    My encounter with Miles and Lavine – I might have mentioned that this week I became part of an extremely rare public discussion about EDR safety with Linda Miles and Dr. Lorne Lavine. It followed a survey sponsored by Dental Learning Facebook. Here is my summation of the unprecedented encounter that I shared today with Dental Learning:


    I think it’s safe to say this week’s survey here on Dental Learning Facebook concerning the safety of electronic dental records is pretty much complete. Following the question, “Is it true that electronic dental records are more dangerous for dentists and patients?” almost half of the respondents (6) believe “EDR will soon be the norm,” and that “We must focus our energy on safety of information.” Before assigning much significance to the results, one should consider that coming in second with 3 votes is the opinion: “I don’t know; but I do know that fluoride is dangerous for dentists and patients.”

    Does absence of interest in EDRs indicate a strong or weak market?

    It’s unfortunate that our discussion was so brief following dental practice consultant Linda Miles’ response “Explain what you mean by DANGEROUS.” The subsequent lively conversation eventually attracted Dr. Lorne Lavine – another well-known dental practice consultant. Dr. Lavine contributed to the discussion his expertise in modern technological advancements in dentistry.

    On Thursday, Miles obviously had second thoughts before unexpectedly and without explanation deleting her remark at the top of the thread – which deleted the entire conversation. Nevertheless, my synopsis of our constructive debate had already been picked up by the Medical Executive-Post in real time.


    Linda, Lorne and I only had time to come to an agreement that the danger of data breaches from EDRs is millions of times greater than for paper dental records. Of course, that danger alone is a deal-stopper. If dental patients don’t trust the security of EDRs they will simply find dentists with paper records… who coincidentally will also be able to offer dentistry at a lower price than dentists who are HIPAA-covered entities with NPI numbers.

    It’s a coincidence that around the time Ms. Miles asked for clarification of the adjective “dangerous,” Neil Versel, writing for InformationWeek, posted “E-Prescribing May Increase Medication Errors – Redundant medication orders occurred more often with computerized physician order entry and clinical decision support systems than without.”


    Doc, tell me. How many prescriptions do you sign a day? And how many variations of drugs do you routinely prescribe? So do you really need a HIPAA-compliant, interoperable digital system for your prescribing needs? Really? How about if the expensive new hackable software offers no improvement over cheap, safe paper prescription pads that have no USB ports?

    I also didn’t have time to provide a link to another InformationWeek article from July 26 by Ken Terry titled “How Health IT-Related Errors Hurt Patient Safety – New analysis explains how the occasional glitches with EHRs and related systems can get out of hand.”


    And as for the noble, oft-repeated, politically-correct goal, “We must focus our energy on safety of information” – the first thing to do is open your eyes. Going paperless is a bad decision right now, and HIPAA compliance will never be cheaper. Dentistry simply cannot get there from here.

    D. Kellus Pruitt DDS


  8. Proof of ROI on EDRs?

    QSIDental EDRs pay for themselves, says VP Kathleen Noll

    Some may recall that I repeatedly asked if anyone who attended the National Dental Benefits Conference in ADA Headquarters last month would like to share with at least one interested dentist what was said about electronic dental records. Nobody responded publicly, privately nor anonymously.

    Perhaps I’m indeed the only dentist in the nation needlessly questioning the cost and safety of EHRs in dentistry, and therefore should quit embarrassing myself, my profession and Schein Dental consultants by doubting technology as well as salespeople. What do you think? Should I find a less violent hobby and leave everyone alone – comfortable in their thoughts? Please respond. I’m naturally interested in your opinions.

    Yesterday, an article about the Conference was posted on the ADA News titled National Dental Benefits Conference eyes trends.” Unfortunately, Kelly Soderlund’s article offered very little information about what was said concerning EDRs.


    Nevertheless, she did provide the name of the speaker. That’s certainly a lead worth pursuing.

    Soderlund writes: “Kathleen Noll, vice president of Technical Marketing and Implementations for QSIDental, presented Embracing the Electronic Dental Record. She discussed the selection, implementation and cost savings associated with implementing an electronic dental record, including descriptions of the components of an electronic dental record and current digital radiography products, a return on investment worksheet of proposed savings realized from utilizing both electronic dental records and digital radiography, and strategies for a successful implementation.”

    A few minutes ago, I sent QSI Vice President Kathleen Noll the following letter through the QSI website.



    Dear Kathleen Noll – Vice President of QSIDental

    I understand from yesterday’s ADA News article that at this year’s National Dental Benefits Conference, you informed the audience that electronic dental records cost less than paper dental records.

    In support of your claim of a positive return on investment for dentists, you provided a worksheet which reveals the savings that dentists can expect from going paperless. Could you please share that information with me and some friends?


    D. Kellus Pruitt DDS


  9. Tokenize eDRs?

    “Tokenization” – remember that word. Next time you hear it, think “Electronic dental records.”

    As you read about security by tokenization in the following press release, please imagine with me its application to dentistry. Though the possible solution to epidemic-level data breaches might not be feasible elsewhere in healthcare, the uniqueness of dentistry makes de-identification a walk-over. What’s more, the tried and proven business-to-business “token” technology featured in the ad has been used safely in millions of businesses for more than a decade.


    How Tokenization Keeps Your Data Secure (no byline), July 11, 2013

    If you have information that you need to keep secure, you only have a few options as far as technologies are concerned. One of the most popular choices is encrypting the data so nobody can read it. But encryption can be cracked with enough time and effort, and can’t be trusted to keep your data safe by itself. Fortunately, there’s another option – you can remove the data from your system entirely.

    Tokenization is a process that does just that. Using our service, sensitive information such as credit card data, medical information, bank account numbers, and more is secured by keeping it out of your system entirely, so there is never any opportunity to steal or hack it.

    The process works like this: A customer on your website wants to buy a product. They input their information – including credit card numbers and other personal data – into your order form. Traditionally, that information would be passed to you, and it would be your responsibility to keep it secure. But using tokenization, the information is instead passed into an offsite, secure server. There, the sensitive data is replaced with a “token.”

    These tokens look and act just like real customer data, but they aren’t real. They have no value except as a placeholder that refers back to the original data – which, you’ll remember, is stored in a secure environment. A token is not encrypted data; rather, it’s randomized information that cannot be traced back to your customers. In other words, it’s totally secure.

    These tokens are then passed on to you, the merchant, for the purposes of completing your order. You can store the tokenized data into your system the same way that real customer data would be stored, but your risk and compliance burden is significantly reduced because the tokenized data cannot be used for any other purpose.

    And when it comes time to process the payment, your data is kept just as secure. The tokens are passed back through the secured server, matched with their real counterparts, and passed along to the payment processor. You never encounter the data itself, reducing risk and cost for you and improving your customer security.

    That’s tokenization – a way of keeping data secure by completely removing it from your system. If you’re worried about security or having trouble keeping your system PCI-compliant, tokenization could be a perfect solution.

    TokenEx is a leading provider of tokenization security services. Our systems are Level 1 PCI-certified, and we will help you reduce your PCI compliance and improve your customer data security.


    There seems to be one huge obstacle in the way of de-identification of dentists’ primary records: Since software without medical histories cannot be used to demonstrate Meaningful Use, it cannot be CCHIT-certified. That’s sort of unpatriotic.

    While dentists were asleep, the ARRA stimulus money became so powerful elsewhere in healthcare that dentistry’s leaders became distracted by the excitement. EDR vendors also remain uninterested in discussing alternative solutions with customers.

    I’ll just wait for them at the end of the block. Eventually, they will pass by here.

    D. Kellus Pruitt DDS


  10. Thinking about going paperless, Doc?
    That would be a very, very foolish decision right now. See for yourself.

    “Calm before the storm? Ransomware, botnet attacks predicted to surge – The volume of ransomware attacks may have slowed during the first quarter of 2017, but WannaCry and the resurgence of Locky signal what’s on the horizon.
    By Jessica Davis for HealthcareIT News
    June 07, 2017.


    It gets worse.

    “Ponzi Scheme Meets Ransomware for a Doubly Malicious Attack”
    By Sheera Frenkel for the New York Times
    June 6, 2017.

    “SAN FRANCISCO – The first message to pop up on the computer screen let the victims know they had been hacked. The second message gave them a way out.

    The victim had a choice: Pay the hackers a ransom of one bitcoin, a digital currency worth roughly $2,365, in exchange for regaining access to the computer, or try to infect two new people on behalf of the attackers. If someone the victim knew fell for the bait and became infected, the attackers would consider the ransom paid and cede control of the infected computer.”

    Doc, do you have any acquaintances who might take advantage of your trust to phish you with an infected email attachment just to get out of having to notify their patients and HHS of a ransomware attack… which can cause bankruptcy? (Do you have anyone in mind should you get attacked?)

    Need more evidence that going paperless is a lousy idea?

    “Firms stockpiling Bitcoins ready to pay off ransomware crooks”
    By Lisa Vaas for Naked Security
    June 7, 2017.


    Then again, you could get lucky. The American Dental Association says “EHRs provide long-term savings and convenience.” (No byline, ADA News, December 6, 2013).


    Surely ADA leaders wouldn’t lie to you for selfish reasons, would they?

    D. Kellus Pruitt DDS


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