[Do] eHRs Fail to Improve Healthcare Quality?

I told you so … wow! That felt really, really good!

By D. Kellus Pruitt DDS 

If you haven’t been following the bad news for electronic health records that has broken in the popular media in the last few days, you may be unaware of recent studies that are about as welcome in Washington DC as Wikileaks revelations of diplomatic farts – but much more serious. Healthcare reform itself is in the balance, and President Obama’s credibility with mandates is already shot.

Records will show that a few politically-incorrect troublemakers knew all along that EHRs will fail to save money or improve the quality of healthcare – ever – unless doctors and patients are involved in their development. This troublemaker warned dentists 5 years ago about how HIT stakeholder and former Speaker of the House Newt Gingrich deceived naïve ADA Delegates about benefits of eHRs to dental patients. In turn, 3 years later, the ADA’s HIT stakeholder, Dr. Robert Ahlstrom, deceived Bush’s HHS Secretary Michael Leavitt with biased, self-serving testimony he gave to the NCVHS. (See “Dr. Robert H. Ahlstrom’s controversial HIPAA testimony” that I posted in 2008.)

http://community.pennwelldentalgroup.com/forum/topics/dr-robert-h-ahlstroms

Do you still not agree that long ago, I told you so?

At a time when President Obama’s healthcare reform is teetering between the Houses, just wait until lawmakers catch the news I’m bringing to you hours, days or even weeks ahead of Fox News: Transparency just caused a huge chunk of anticipated funding for reform to evaporate like American’s property values. After billions of stimulus dollars have been gleefully spent benefiting influential healthcare stakeholders rather than principals, the bi-partisan feel-good digital fantasy is bankrupt. Pop goes the bubble.

Although there have been minor news reports of growing disappointment in eHRs for years, the results of two recent studies by Public Library of Sciences (PLoS) and Stanford clearly expose the lack of value of eHRs for Americans. We’ve been had.

The WSJ 

On January 21, the Wall Street Journal posted an article titled, “Study Looks For, Can’t Find Much Evidence of E-Health’s Benefits,” by Katherine Hobson.

http://blogs.wsj.com/health/2011/01/21/study-looks-for-cant-find-much-evidence-of-e-healths-benefits/

Hobson writes: “With the U.S. and the U.K. heading full steam towards electronic medical records and other health IT applications, how much evidence is there that they improve care?

Not a whole lot, according to a review of existing research on the topic published this week by PLoS Medicine. While governments and other proponents are claiming that digitizing health records can save lives and increase efficiency, the review’s ‘key conclusion is that these claims need to be scrutinized before people invest quite large sums of money in these technologies,’ Aziz Sheikh, lead author of the study and a professor of primary care research and development at the Center for Population Health Sciences at the University of Edinburgh, tells the Health Blog.’”

US News & World Report

And; only hours ago, US News & World Report posted a story titled “Electronic Record-Keeping Alone May Not Boost Health Care.” (no byline).

http://health.usnews.com/health-news/managing-your-healthcare/policy/articles/2011/01/25/electronic-record-keeping-alone-may-not-boost-health-care

“Electronic health records have so far done little to improve the quality of health care in the United States, a new study states.

Researchers from the Stanford University School of Medicine analyzed data on use of electronic records from 2005 through 2007. The data came from a nationwide physician survey that encompassed nearly 250,000 outpatient visits.”

The ADA 

So how does the truth about eHRs affect ADA leadership’s stubborn push for paperless practices in dentistry? Well, if as a trusting ADA member, you haven’t already swallowed the propaganda, now wouldn’t be a good time to convert to paperless.

eDRs

Though my unpopular but accurate statements about eDRs eventually got me in secret trouble with vetted, anonymous Texas Dental Association officials, I predicted this week’s bad news years ago on the TDA online forum. Unfortunately, my warnings to other TDA members about the ADA’s biggest blunder in history were censored by the TDA Executive Director without warning or explanation. Why? She isn’t accountable to anyone and “Image is everything.” (ADA/IDM slogan).

Just how difficult can it be to recognize that eHRs are inefficient in dental practices for simple, common sense reasons? First of all, dental records which involve prevention and treatment of disease in the lower third of the face rarely include laboratory test results like medical records which concern the whole body. In addition, dentists maintain tenfold fewer thin patient charts than physicians’ thick ones. So if the value of eHRs are questionable for hospital care involving millions of charts, I think dentists are safe to ignore Presidential eHR mandates. The bottleneck in dental offices isn’t the front desk, it’s the dentist … or at least it should be. As for thumbing your nose at a Presidential mandate, I wouldn’t get too concerned. Obama also mandated that the prison at Guantanamo Bay was to be closed over a year ago. It didn’t happen, and nobody went to jail.

Unfunded Mandates 

Unfunded mandates just don’t carry the respect they once did when they were less common and actually made sense. Considering the absurdity of eHRs in dentistry, worse things could happen for trusting, clueless Americans.

Those who represent our concerns in government probably don’t yet realize that in the last four days, the price of healthcare reform skyrocketed even further out of reach, and we simply cannot borrow any more money from our grandchildren just to throw it away on expensive hi-tech crap. As for myself, I’m sending this ME-P to my national and state representatives: Cornyn, Hutchison, Barton, Burgess, Harris, Davis, Patrick and Veasey, I hope you will contact your representatives as well. The Internet makes it so easy these days to educate those who would otherwise determine our future based on deception from healthcare stakeholders.

Assessment 

I publicly challenge Dr. Robert Ahlstrom, who is currently a member of the ADA Council on Dental Practice and chair of the Members Advisory Group to an Internet discussion concerning electronic health records in dentistry. It’s the same unanswered challenge I issued to the influential dentist over 3 years ago: I still say electronic dental records are an expensive hobby paid for by dental patients in higher fees, and they do nothing to improve patient care. What do you have to say about that, Dr. Robert Ahlstrom? You know you’re going to have to face me again and again, so please don’t disappoint ADA members by continuing to hide. It makes the whole ADA look cowardly.

Conclusion

Always remember: I told you so, Dr. Robert Ahlstrom. And so, your thoughts and comments on this ME-P are appreciated. How do you select an eMR consultant? Feel free to review our top-left column, and top-right sidebar materials, links, URLs and related websites, too. Then, subscribe to the ME-P. It is fast, free and secure.

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9 Responses

  1. On Clinical Health Information Technology [HIT] Management

    Darrell, excellent post and good thoughts.

    However, another method of improving medical performance, beyond mere electronic medical records (EMRs), is through better use of information technology in some clinical areas.

    Health management technology is being designed to improve patient safety in several ways. For example, information technology facilitates the collection and analysis of medical and health data so that therapies that cannot be demonstrated to be effective can be eliminated.

    Information technology also allows facilities to use bar coding or radio frequency identification devices (RFIDs) to ensure that inventory and supplies are accurately identified and inventories are maintained at the appropriate levels. By maintaining the lowest level of inventory consistent with good service, a facility can lower the amount of funds required to finance the inventory. Furthermore, information technology allows facilities to use drug data bases and electronic prescribing with computerized physician order entry (CPOE) systems. These approaches prevent losses that may occur due to medication errors.

    Lastly, information technology is vital for decision support systems that reduce the incidence of human error in decision making.

    So, enterpise-wide HIT is more than just patient eHRs.

    Hope Hetico RN MHA
    http://www.HealthcareFinancials.com
    [Managing Editor]

    Like

  2. Excellent points and well taken, Hope

    Please give me a heads up when eHRs aproach the break even point.

    Darrell

    Like

  3. Sharecare responds again concerning EDRs. After 5 years of directly asking ADA leaders questions with no noticeable effect, I could get used to the attention of a well-meaning, but naive internet laison like Sharecare.com.

    This is just too easy, sports fans.

    ——–

    Thank you Darrell for your comment. We are looking forward to getting our American Dental Association content up very soon. In the mean time take a look at this Q&A on ada.org that may offer some insight into your question.

    http://www.ada.org/news/4306.aspx

    I replied: I sincerely appreciate your valuable time, Sharecare. I can only imagine that you are very busy. Unfortunately, the ada.org link is a dead end as well. The only mention of patient safety in the ADA News article is a one-sentence, non-specific goal stated by Dr. Robert Faiella, chair of the Board of Trustees’ Electronic Health Record Workgroup: “First and foremost, the privacy and security of health information is essential for any interoperable system.” – June 21, 2010.

    I too look forward to the day when ADA’s experts like Dr. Faiella join the Sharecare team to answer dental questions. I have others. For example, I would also like to ask Dr. Faiella how much money EDRs save for dental patients over paper records.

    It goes without saying that the unprecedented transparency Sharecare promotes is a wonderful service to consumers like me who deserve unbiased answers to basic, patient-centered concerns about healthcare cost and safety.

    Nevertheless, while we wait on the ADA to join the community, can you tell me if electronic medical records are safer than paper records for physicians’ patients? That could give me a clue about the safety of unencrypted social security numbers, birthdates and addresses that are stored on computers in 150,000 or so dental offices across the nation as well.

    Thanks, Sharecare. I’ll be looking forward to your next link.

    Darrell

    Like

  4. More on Sharecare

    Can consumers trust Sharecare for unbiased answers? Yesterday afternoon, I posted the following question on Sharecare Facebook:

    “As a dentist, I think it’s wonderful that experts from the American Dental Association are joining the Sharecare team to answer questions concerning oral care. Can you tell us when can we expect them to arrive?”

    This morning, I discovered that Sharecare not only deleted the arguably complimentary question, but the leaders also decided to de-like me as retaliation. Sharecare officials seem clueless that big business is no longer in control of the media. They also don’t realize that childish, command-and-control tools like censorship have been obsolete for years.

    So why do you think Sharecare officials are suddenly protective of the ADA? And how can it possibly help Sharecare to piss off a vocal customer in the front of the store? As everyone knows, the customer is always right.

    There is no doubt that my questions to Sharecare website, Twitter and Facebook over the last few days concerning the comparative safety of EDRs challenged the leadership of Dr. Oz’s company. Since the ADA has not yet started contributing content according to their contract with Sharecare, Sharecare simply had no answer for me beyond a couple of ADA.org links that even Dr. Oz would recognize as canned irrelevancy concerning the topic of my question.

    I assume Sharecare was hoping to just quietly get rid of me. But when their non-answers brought even more attention to their evasion, I can only imagine words were exchanged between Sharecare.com and the ADA Council on Communications. I suspect Dr. Oz and co-founder Jeff Arnold are justifiably upset with the ADA for not keeping up their end of the bargain – providing a healthcare information technology expert like Dr. Robert Faiella for questions such as mine.

    A few weeks before I started visiting Sharecare, even Dr. Oz’s uninformed answers to dental questions were better than what the ADA has to offer, and those were bad enough. I also think Dr. Oz himself knows that digital health records in dentistry as well as physicians’ offices are thousands of times more dangerous to patients than paper records. Yet he is not about to admit it because the truth is so politically unpopular. I dare claim that my simple question is causing awkwardness around both Sharecare.com and the ADA this afternoon.

    What does Sharecare’s evasion tell consumers about the relationship between Sharecare and the American Dental Association? It clearly shows that consumers’ interests are hardly as important to Dr. Oz and Mr. Arnold as the interests of their business partners – like the ADA.

    D. Kellus Pruitt DDS

    Like

  5. Sharecare Update

    A couple of hours ago, Sharecare Facebook posted a link to answers to the following dental question: “Should I use a particular type of dental floss?”

    http://www.sharecare.com/question/particular-type-dental-floss

    Two well-written, accurate, no-risk answers were provided by Sharecare dental experts Dr. De Vizio DMD of Colgate Dental Products (a Sharecare sponsor) and Dr. Jonathan Levine, author of “Smile!: The Ultimate Guide to Achieving Smile Beauty,” (A link to purchase his book is provided).

    I provided my opinion of flossing on the Sharecare Facebook – taking the advertiser-friendly topic on an ornery, unexpected ride more consistent with bumpy reality:

    ———-

    Let’s put aside canned talking points about the benefits of flossing and be honest with consumers. It makes no difference if it is made from nylon or PTFE by Colgate or Glide, or whether it is flavored or cheap. If it doesn’t make it to the mouth, it’s string.

    Don’t lazy people have a right to healthy mouths also?

    As a dentist with years of experience patiently teaching fallible people to keep their teeth and gums clean and healthy, I have determined that for the majority of my patients, the human tendency towards laziness trumps all scientific evidence of the effectiveness of floss.

    For our patients who conscientiously floss like we recommend – and there are many – we support and encourage their dedication to good oral health. On the other hand, all dentists and hygienists know several patients by name who casually trash respected scientific study by failing to cooperate like test subjects. I must confess that I also find flossing too cumbersome, messy and time consuming to pick up as a routine.

    So how do we help those like me who will never be flossers? If after a few visits, we notice that a patient is still failing to prevent plaque and tartar buildup between their teeth, we recommend concentrating more aggressive use of the bristles of a mechanical toothbrush between the teeth, and/or using a toothpick-type device to work around each tooth at their convenience – such as during the commute to work or while watching the news.

    For many mouths, these simple alternatives are actually more effective than floss because often concave shapes of the roots between the teeth are physically impossible to clean with straight section of stretched floss. However, plaque and debris in the bottom of the depressions are easily disturbed by rapidly vibrating toothbrush bristles or even a simple toothpick. We recommend the Arm & Hammer Spinbrush. It’s inexpensive, uses two AA batteries and has torque like hedge-trimmers.

    (This is not a paid endorsement of the Spinbrush. It’s just the truth).

    Darrell Pruitt DDS

    Like

  6. Driving wedges deep into faults

    Today, I did some research on Sharecare and discovered that UnitedHealthcare is a paying sponsor of Sharecare.com. That gives me ornery ideas. Watch this. I’ll probably dice it up and post it on Twitter as well:

    ——-

    (Posted as question on Sharecare.com)

    Dear Anonymous employee of UnitedHealthcare:

    As a dentist, it pleases me to learn that UnitedHealthcare signed on as a contributing sponsor to Dr. Oz’s Sharecare. On behalf of clueless clients and naive dentists in our shared community who are searching for unbiased answers about dental insurance, we welcome your unprecedented openness, UHC. (I’m posting this on Sharecare Facebook as well).

    I have numerous questions about your dental insurance. Your answers will greatly aid readers in selecting the types of policies that are right for their families, as well as better inform dentists fresh out of school – many with growing families and in debt to the point of vulnerability. Here is my first question, UnitedHealthcare. Others will come later:

    I went to the UnitedHealthcare PPO list of dentists located in Dallas, and compared their rankings on Dr. Oogle (doctoroogle.com) with other Dallas dentists. Excuse me for saying this, but it appears that the providers you prefer are not preferred by your clients by a long shot.

    One could argue that since your clients have no meaningful choice of dentists, quality control is left to competition for your dentists’ jobs, and there are tangible signs in the marketplace that you clearly aren’t paying them enough. Considering that most people can think of any excuse to put off seeing even a dentist they like, can your clients expect you to begin paying your dentists a competitive wage any time soon?

    I’ll give you a day or so to respond.

    D. Kellus Pruitt DDS

    Like

  7. Sharecare, UnitedHealthcare and Dr. John Luther

    Sharecare.com responds on behalf of UHC, a source of ad revenue for Dr. Oz’s company. And in a related story, former ADA Sr. VP Dr. John Luther is finally located and cornered about the NPI number he pushed as an ADA official years ago.

    Shelly, from Sharecare.com’s technical team, replied today to my question for UnitedHealthcare concerning the popularity of their managed care dentists on Dr.Oogle:

    “You have reached the Sharecare technical program support team. We provide support for the Move It and Lose It program and the Sharecare Website. As your question is in regards UnitedHealthcare Dental, I have provided a link to their Group page on Sharecare, where you can find related links.”

    http://www.sharecare.com/group/unitedhealthcare-dentalhttp://www.sharecare.com/group/unitedhealthcare-dental

    As one might expect, not one of UHC’s canned responses were relevant to my question about the quality of their product. Nevertheless, while I was there I submitted my application for Group membership. I’m hoping that once I’m approved to join the UHC Sharecare community, I’ll be able to converse more easily with others on the UHC page, including Dr. John Luther – who I discovered is one of UHC’s Sharecare experts on dental insurance. So we meet again, John. Sweet.

    Dr. Luther and I got to know each other in the summer of 2007 when he was the Senior VP in charge of the ADA Department of Dental Informatics. I had asked him how the NPI number benefits dental patients. After providing me links to irrelevant canned responses from CMS instead of the truth, the last thing the ADA official said to me was “If you don’t like my answer, write a letter to the editor.”

    Then a few years later, I heard an rumor that the ADA quietly let him go. I wondered where he’d end up, and it turns out he landed at UHC. Considering the informal executive exchange program that exists between the revolving doors of the ADA and insurers, I wonder if Dr. Luther was somehow involved in a trade for UHC and Delta Dental veteran Dr. Kathleen O’Loughlin – the ADA’s new Executive Director. The timing was right.

    While UnitedHealthcare employees must appeal to consumers who pay their premiums, the Dr. John Luther I remember was a hard-nosed, command-and-control leader in an ADA good ol’ boy environment where officials aren’t accountable to anyone. So if UHC officials don’t permit Luther to hide behind the power he enjoyed at the ADA, I wonder if after 3 ½ years he’s ready to explain how the NPI number improves dental care. I intend to find out.

    It’s only fair. Dr. Luther was the ADA official primarily responsible for tricking uninformed ADA members into volunteering for their permanent 10 digit NPI numbers.

    D. Kellus Pruitt DDS

    Like

  8. On Titus Schleyer DMD’s “Electronic Dental Records”

    Dr. Schleyer’s article describing electronic dental records that was recently selected by MetLife for their continuing education curriculum, is years out of date – causing MetLife’s “Quality Resource Guide” to be irrelevant and arguably dangerous to both dentists and dental patients – most of whom are still unaware of the danger of medical ID thefts from even dental offices.

    In the last 24 hours, MetLife, which saves money when HIPAA-covered dentists file claims electronically instead of using the much safer US Mail, posted 8 identical press releases announcing “MetLife adds six new quality resource guides” (no byline) – including an ad in Dental Economics.

    http://www.dentistryiq.com/index/display/article-display/1553764758/articles/dentisryiq/industry/2012/1/metlife-guides.html

    If MetLife intends to sell dentists online ADA CERP-approved CE courses covering electronic dental records, the information they share in their “quality” guides should be more current than Dr. Schleyer’s 2008 (?) article – apparently published back when the Director of the University of Pittsburgh’s Center for Dental Informatics was still openly encouraging dentists to purchase EDRs.

    As I read Dr. Schleyer’s unenthusiastic recommendation to dentists near the end of the article, I found it surprising that even after listing numerous ways that EDRs are inferior to paper dental records, he still promoted their adoption now rather than later:

    “After reading about the three studies presented the reader may wonder whether it is worthwhile to adopt an EDR at this time. The answer is yes, provided the practice is willing to make the significant investment necessary to make the system work.”

    To be fair, he should call going paperless a significant risky investment.

    Regardless of the threat to Metlife’s competitiveness in the insurance industry, no dentist should be tricked into risking bankruptcy on a digital records system that is admittedly more difficult to use than paper and helps insurers and informatics departments more than anyone.

    Considering the well-known danger that EDRs present to both dentists and patients, their promotion has always been unwise and arguably counter to the Hippocratic Oath. What’s more, the danger of storing patients’ Protected Health Information on dentists’ computers has become only worse in the last few years, not better. Recently, a Ponemon Institution study showed that thieves are now increasingly targeting patients’ medical identities – reportedly altering medical histories to steal insurance, and leaving no trace of the changes. That life-threatening danger simply does not happen with paper medical histories – even if the rest of the dental practice is paperless. Of all people in academia, the Director of the Center for Dental Informatics is probably aware of that by now, and working on a solution.

    Although the publication date of his article wasn’t offered, I found two hints of its old age. First of all, the latest study cited in “Resources,” is a comparison of four EDR systems: Dentrix, Eaglesoft, PracticeWorks and SoftDent – co-authored by Schleyer, and dated 2008. For technology, that’s old.

    The other hint of stubble is that there is not a single mention the growing security problems that were present with all EHR systems even when he wrote the article four years ago. I’m certain if Dr. Schleyer were to write the same article today, rather than recklessly push EDR adoption, he would undoubtedly recommend waiting until the growing danger of data breaches has been resolved. He’d do so to protect the welfare of dental patients as well as dentists.

    What’s more, due in part to the poor fit of EHRs to dentistry that is described by Dr. Schleyer, no systems offer dentists a return on investment, and HIPAA compliance will only become more expensive as Congress becomes more impatient with even more data breaches this year than last – causing audits and HIPAA consultants to become more common. You know I’m right. I’ve been right all along.

    D. Kellus Pruitt DDS

    Like

  9. Told you so – again

    For those few EHR stakeholders in dentistry who censor dentists’ and patients’ concerns for personal gain, this is a big I-TOLD-YOU-SO.

    “Billions Wasted On Faulty Obamacare Digital Health Record Experiment” (no byline) was posted on Judicial Watch a couple of days ago.

    http://judicialwatch.org/blog/2012/11/billions-wasted-on-faulty-obamacare-digital-health-record-experiment/

    “In a classic example of how government blows through your tax dollars, billions have been squandered on a faulty electronic medical records system that operates with no oversight and continues receiving big wads of cash from Uncle Sam.

    It gets better; by the time it’s all said and done—in about four more years according to government estimates—American taxpayers will have been fleeced $6.6 billion! It’s all part of the Obama Administration’s hostile takeover of the nation’s healthcare system. The idea behind this plan is to switch medical records from paper to digital to create a centralized system that supposedly improves the quality of health care.”

    As the media catches on to HIT’s shameful deception in healthcare, many will recognize the same concerns for dentistry I have been voicing for almost 7 years. And when the media catches up with ADA leaders’ nation-wide complicity in HIPAA – the grandest and most expensive blunder in the history of dentistry – the hijinks of the rascals could easily become fodder for a comedy sit-com about unresponsive/unaccountable not-for-profit bureaucrats.

    If Dad were alive, I know he’d be proud that I chose to sacrifice my 28 year membership in the Texas Dental Association rather than let the out-of-control Ethics Committee force my silence about the dangers of EDRs as part of a “probationary” membership. I never bow to tyranny. I ridicule it.

    Dr. Robert Faiella, President of the American Dental Association, there hasn’t been leadership in the ADA for over a decade. It’s a vacuum. What are you going to do to stop stakeholders from continuing to lie to dentists and vulnerable patients about the cost and danger of the electronic dental records they promote? When are you going to show us what you are made of, Doc?

    Darrell

    Like

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