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Challenging a Naive eDR Advocate

16 Responses

1. D. Kellus Pruitt DDS, on April 26, 2011 at 10:24 PM said:

   I posted this follow-up letter to Dr. Margaret Scarlett as a comment following her blog request, “What’s Your Experience with EDRs?”

   http://boards.medscape.com/forums?128@659.YUIgaBG3T3u@.2a077212!comment=1

   I say the ADA is trapped behind the barriers it erected to protect itself from the public. What do you think?

   ————————–

   Dear Dr. Scarlett:

   There’s been a unique, small-world kind of event on the internet related not only to the electronic dental record topics we have been discussing, but also this, your MedScape blog.

   According to ADA News staff writer Kelly Soderlund’s Aprill 22 article “ADA teams with Dr. Oz website, Sharecare.com,” the ADA Board of Trustees recently approved a new business partnership with the commercial, moderated, healthcare website.

   http://www.ada.org/news/5738.aspx

   She writes: “The ADA has entered into an agreement with Sharecare, a new online resource that invites the public to submit health-related questions and have them answered by health professionals.” As one might expect, I’ve already started my list of questions for the ADA’s experts. In fact, yesterday I submitted my first question – inspired in part by our recent conversation: “Which are safer for dental patients – electronic dental records or paper records?”

   In a couple of weeks, when the ADA team starts responding to dental-related questions submitted to Sharecare.com, one or more of the 25 credentialed experts will find that my simple question is particularly difficult to handle, and will probably choose to ignore it – which will be the worst choice for the ADA. Have you ever seen the “Just show me the Carfax” commercial?

   I assume most realize that If the ADA representative says EDRs are safer than paper, well… that would be a lie. Yet if he or she were to admit that the ADA has knowingly caused dentists to endanger dental patients’ welfare by encouraging them to switch from paper, that could cause demands for resignations. For the sake of dentists with NPI numbers who still have no clue about the ADA blunder into HIPAA and are easily misled by HIT stakeholders, I intend to report the ADA’s response or evasion. If they choose to ignore the question about patient safety, I’ll consider taking it up with Oprah – one of the investors in Sharecare.com. I think she’s the kind of business owner who listens to customer complaints.

   Soderlund continues: “The website (www.sharecare.com), was created by Mehmet Oz, M.D., a physician who first began fielding questions on ‘The Oprah Show’ and now hosts ‘The Dr. Oz Show.’” Here’s the small-world part: The co-creator of Sharecare is Jeff Arnold, founder of WebMD, which owns the copyright to your MedScape blog. See what I mean?

   I wonder if Mr. Arnold is following our conversation about EDRs and HIPAA. I could probably pick out a dozen or so questions for ADA experts from the places we’ve been.

   D. Kellus Pruitt DDS

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2. D. Kellus Pruitt DDS, on April 30, 2011 at 6:09 PM said:

   EBD Now!

   On April 18th – 2011, Dr. Margaret Scarlett posted an article on her MedScape blog titled “Science Gets Partial Answers Slowly.”

   http://boards.medscape.com/forums?128@0.vak0aDAfWOD@.2a08e250!comment=1

   Without reading a word of her article, I recognized the opportunity to reveal how the managed care business model and human nature cause harm to clueless American dental patients. Any arguments, Delta Dental? How about it, CEO Kim Volk? You never responded to my Facebook friend request. So shouldn’t you be moving on already?

   _______________

   Dear Dr. Scarlett:

   I understand your point in the title “Science Gets Partial Answers Slowly.” It indeed seems that way, but I would add “ … For Long Periods of Time.” With your background, I’m sure you’re aware that the history of microbiology alone offers many instances when vast amounts of previously unattainable information suddenly became available to geeky researchers – leading to “miracles cures” directly attributable to new knowledge. For example, I bet it wasn’t long after Van Leeuwenhoek invented the microscope that new data arrived so quickly that 17th and 18th century geeks couldn’t keep up. Partial answers coming in really, really fast are as good as it gets with Evidence Based Dentistry as well.

   Just imagine the miracles in dentistry that would drop out of the sky if terabytes of dental claims data – already sorted and organized in digital format by insurers and ready to plug into algorithms – were suddenly available to geeks. Can you think of a worthwhile study or two? I can.

   Here’s a hypothesis: Changing dentists causes fillings.

   It might surprise some to learn that such a study isn’t unprecedented. I was in the audience of about a hundred dentists and dental industry representatives on the morning of August 15, 2008 – the first day of the annual National Dental Benefits Conference in ADA Chicago Headquarters. We heard Delta Dental Plans Association (DDPA) representative Maxwell H. Anderson DDS say “The greatest hazard to teeth is changing dentists.” For some reason, that chunk of useful information was not reported in the ADA News article covering the conference, so if you weren’t there, you missed it. That’s why traditional media are so inferior to the internet.

   Dr. Anderson was referring to an unpublished, in-house study of the dental claims Delta had collected over 11 years. The results reportedly confirmed what one with a knowledge of human nature would expect: Patients who are forced to change from dentists they prefer are likely to receive more fillings than those whose continuity of care isn’t limited to 12 month contracts. It’s my opinion that this suggests that Delta Dental has knowingly caused unnecessary dentistry for millions of clients at least since 2008.

   In the discussion period following Dr. Anderson’s now long-forgotten revelation, several in the audience seemed interested in learning more about Delta’s claims data. When asked if they could be shared with qualified research institutions, another Delta rep who appeared to be taken aback by Dr. Anderson’s statement said Delta could not release the data. He reasoned that making proprietary information public would give competitors like BCBS a business advantage. (Unlike dentists, Delta Dental isn’t covered by the Hippocratic Oath).

   For American dental patients to have to wait on EBD miracles until interoperability never happens as fantasized seems silly to me considering the dental insurance industry already holds up improvement in dental care for proprietary reasons. Even before Dr. Anderson intentionally (?) tickled the interest of the audience in ADA Headquarters in 2008, we’ve known dental insurance companies hide enough data to keep geeks busy for a years – who in turn are sure to fascinate us with answers.

   Other than revealing that preferred provider lists have been harming vulnerable clients for decades – what other results can Delta Dental, BCBS and other discount dentistry brokers be justifiably afraid of? How about this hypothesis: “Managed care produces fewer satisfied patients than fee-for-service dentists.”

   Though you and I both know that our colleagues privately talk about these and other managed care issues often, so far nobody in the industry has discussed the unethical businesses model on a public venue. So let’s blow the socks off management, Dr. Scarlett. What do you say? I think we could attract some interest in what’s said on the MedScape blog.

   D. Kellus Pruitt DDS

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3. D. Kellus Pruitt DDS, on May 3, 2011 at 10:39 PM said:

   Ready to see something ornery today? I posted the following challenge to Dr. Margaret Scarlett on her MedScape blog.

   The biggest reason I want to get under her skin is simply because she is trying her best to maintain her composure and just ignore my invitations to conversations about taboo topics. She has made it clear several times that she holds a high regard for “collegiality” on her blog … What’s that?

   http://boards.medscape.com/forums?128@112.ZSYBa8FhWrp@.2a08e250!comment=1

   —————————

   Dear Dr. Scarlett:

   Recently I heard a rumor that Delta Dental intends to open company dental clinics in Washington State.

   http://thedentalwarrior.com/2011/04/30/damn-the-torpedoes-full-speed-ahead-washington-dentists/

   That wasn’t the first time I’ve heard about Delta’s intention to unfairly compete head-to-head with sole-proprietor dentists – leveraging its vertical business model and discounted fees. If such rumors are true, you simply must agree that if nobody exposes the avarice of the corporate giant with proven disregard for patients’ welfare, Delta will profit from cruel intrusion into dentist-patient relations – putting even more naïve Americans at the mercy of Delta’s notoriously flawed ethics.

   Since organized dentistry ignores Delta’s insult to the Hippocratic Oath – possibly because of their revolving door employment policy – I say that leaves it up to you and I to help protect clueless Washington patients. Let’s make this blog relevant for once instead of chatty and ignored. What do you say?

   Image is superficial. Only honesty is professional. Loosen up a little, Dr. Scarlett. Tell us how you really feel about Delta Dental and the importance of doctor-patient relationships.

   D. Kellus Pruitt DDS

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4. D. Kellus Pruitt DDS, on July 12, 2011 at 1:23 AM said:

   Electronic Dental Records

   The “ADA Dental Minute” with Dr. Maria Lopez Howell that was posted on YouTube today is a deceptive, unethical one-minute ad.

   Some knucklehead in the ADA intends to create market demand for dangerous electronic dental records – not from the dentists who must purchase and guard them, but rather from naïve, uninformed dental patients whose identities are at risk of being stolen.

   That is why I feel it is important for Dr. Howell to answer the question I posted following her ad: “Which are safer for dental patients – electronic dental records or paper records?” So far, she hasn’t responded. If she ignores me, I’ll get back to the San Antonio dentist.

   D. Kellus Pruitt DDS

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5. D. Kellus Pruitt DDS, on August 3, 2011 at 12:56 PM said:

   “Congress, the Government Accountability Office and the Department of Health and Human Services now all agree that electronic health records are NOT more secure than paper records. HHS has conceded that no electronic health information system can be made secure. Where did you locate someone who thought otherwise?” – Privacy attorney Jim Pyles, July 28, 2011.

   My discussion taking place on ComputerWorld with someone who calls herself SpawnyWhippet continues.

   http://www.computerworld.com/s/article/9218652/E_health_records_still_scare_most_of_us#comment-267648509

   SpawnyWhippet, I appreciate your responses. However, with all due respect, it shows that your expertise is in hospital IT and not dental practices. Just so naïve readers won’t leave our discussion with your uncontested bad information, let’s nail down some facts. Who knows? A little transparency about dentistry might also save you from personal embarrassment should you someday choose to be not-anonymous.

   As a friend, let me warn you that for credibility sake, you should drop your argument that dentists carelessly leave their patients’ charts where passers-by can snoop through them – even if for some reason they had the desire to do so. To attempt to improve the value of EHRs by discounting the value of paper records with baseless claims is far too common from EHR vendors and it is always aggravating. It’s sort of like an insult.

   Let’s talk about fires and other risks to dental records: Which is more likely to withstand an intense electromagnetic impulse from a nuclear detonation? Paper or digital? Even though there have been no nuclear blasts anywhere close to my office, I have also never suffered a fire.

   It’s always serious when dental patients’ records are lost or destroyed whether they are paper or digital. As you can imagine, it has to be a very hot fire for a very long time to destroy tightly-packed paper files in a closed metal filing cabinet. Thankfully, even the total loss of dental records isn’t nearly as serious as the loss of the medical records you sell. For one thing, everyone should have a new set of x-rays and a complete exam every 3 to 5 years anyway. Nevertheless, to provide a few thousand patients such a service free of charge would be quite expensive. That is why since 1982, I’ve been covered by very inexpensive insurance for lost records. Fires in dental offices are so rare that the loss of records was hardly discussed at all until EDR vendors discovered their products wouldn’t sell on their own merits.

   Let’s turn this around: Since there have been no fires or nuclear wars, how long do you think it has it been since a virus had its way with one of your EHRs? Imagine this: A hacker (easily) breaks into a physician’s computer, copies the records and then deletes them. What would you suggest the doctor do? Should he or she call the FBI, HHS and notify thousands of patients of the breach? Or just pay the ransom and hope for the best? As far as we know, this has already happened hundreds of times. As long as patients’ digital PHI are so easy to steal, such extortion will never be a problem with paper records.

   By the way, where did you get the idea that security “is improving massively year on year”? You are the only person I know of who has EVER made that claim, SpawnyWhippet.

   “Or how you would know if somebody sneaked into your office overnight and photocopied the records of a patient?” Are you kidding? Just how far do you want to stretch your already strained credibility? That’s absurd. Are sales really that bad?

   “Or what if you wanted to do research…” It’s obvious you’re working hard to find a use that justifies your product. I do dentistry. Not research. And even if I wanted to do research, I would never endanger my patients by putting their Protected Health Information on my computer. Again, that’s a disingenuous selling point you should have just kept in your pocket.

   “How much do you spend on the personnel cost in maintaining, duplicating, searching and creating your paper records?” You are so clueless about dentistry. As I told you before, it doesn’t cost much to file 15 to 20 charts a day. You are again attempting to use a baseless claim to push a dangerous and expensive product that most dentists simply don’t want to purchase. One more time: EDRs have never shown a return on investment for dentists who purchase them, and there is nothing holding down the cost of HIPAA compliance.

   By the way. Did you know that if a data breach occurs and it involves more than 500 dental patients, not only do all patients have to be notified, but the dentist must purchase a press release announcing the breach in the local media. The Ponemon Institute says notification will cost a dental practice over $200 per patient including $150 in lost reputation. How much does an EDR save a bankrupt dentist?

   http://www.ponemon.org/news-2/23

   “As security and IT systems are improving so rapidly, it is only a matter of time before the health industry gets dragged kicking and screaming into the 20th Century.”

   Are you making this up as you go, SpawnyWhippet?

   D. Kellus Pruitt DDS

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6. D. Kellus Pruitt DDS, on August 9, 2011 at 11:27 AM said:

   Is your fantasy about EDRs over yet, ADA?

   If the unpopular truth about the danger and expense of electronic medical records is finally being publicly acknowledged, how much longer until ADA officials stop deceiving America about the value of electronic dental records?

   Yesterday, the Pittsburgh Post-Gazette, posted “Electronic records no panacea for health care industry – Studies show errors, inefficiencies still occur in medical services,‘ by Bill Toland.

   http://www.post-gazette.com/pg/11219/1165767-114-0.stm?cmpid=nationworld.xml

   Toland writes: “More and more studies are questioning the efficacy of electronic health records, and the U.S. Food and Drug Administration has begun collecting reports involving electronic health and IT errors, some of which have resulted in death.”

   He adds, “Despite the political — and computer industry — push to adopt electronic health record systems, there are plenty of researchers who want to see proof before investing billions of dollars.” He says such proof is one of the suspicious ironies in healthcare: “For an industry that relies on data and evidence-based measurements to make decisions on the clinical and pharmaceutical side, there isn’t a lot of evidence supporting the notion that electronic health records produce cheaper care or better outcomes.”

   “Health IT lacks the scientific rigor of medicine itself” – Scot M. Silverstein, a medical IT expert and adjunct professor at Drexel University, College of Information Science and Technology, Philadelphia.

   “The nation is investing a huge amount of money on a hope and prayer.”- Ken Adler, medical director of information technology at Arizona Community Physicians, told Health Data Management Magazine.

   It is clear that if HIT experts in the medical field conceded that Americans have been lied to about the cost, effectiveness and safety of EHRs which physicians need much more than dentists, just how much sense does it make for dentists to adopt EDRs? In addition, how long before American dentists can once again depend on the ADA for unbiased information?

   Let’s face it. The ADA Electronic Health Record Workshop, chaired by ADA Trustee Dr. Robert Faiella, proves its irrelevance with stone-silent unresponsiveness to ADA members’ concerns. The damage to his reputation has already been done. Dr. Faiella will never regain the trust of members even if by some unfortunate circumstance he is elected President-elect this fall.

   Then again, his election would be just one more in a long string of egregious ADA blunders by officials who are increasingly out of touch with the community they serve – and proud of it.

   D. Kellus Pruitt DDS

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7. D. Kellus Pruitt DDS, on August 30, 2011 at 10:07 PM said:

   So if EDRs are inevitable, why isn’t anyone discussing them?

   In 2008, ADA President-elect Dr. John Findley told Judy Jakush in an ADA News interview that: “The electronic health record may not be the result of changes of our choice. They are going to be mandated, No one is going to ask, ‘Do you want to do this?’ No, it’s going to be, ‘You have to do this.’”

   So if trusted ADA experts are correct, 170,000 or so independent-minded small business owners in the nation can expect any day now to be forced by law to purchase and use EDRs in their dental practices. What’s more, according to Dr. Findley, it makes no difference if EDRs are more costly and dangerous than paper dental records. Since it’s a mandate, there is simply nothing anyone in the free world can do about it.

   If American dentists and patients are indeed facing the inevitable consequences of a bad idea that is too big to die, doesn’t it seem suspicious to anyone that the ADA leaders who encouraged members to quickly volunteer for NPI numbers now evade all discussion of EDRs as well as HIPAA?

   If you recall, over a week ago I pointed out a teaser that appeared in the ADANews introducing an article titled, “Insurance, electronic health records top agenda at National Dental Benefits Conference.”

   https://www.ada.org/news/6125.aspx (ADA members only).

   I sure wish we could witness what was said about the electronic health records in ADA Headquarters this month. Don’t you? Who would deny dentalcare principals (dentists and patients) the right to know the plans of dentalcare stakeholders (everyone else)?

   D. Kellus Pruitt DDS

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8. Darrell, on September 21, 2011 at 7:10 PM said:

   Cornering EDR Stakeholders

   Cornering slippery EDR stakeholders: Watch how much better modern transparency works than letters to the editor.

   I can only hope that you two realize that others are watching us, Dr. Jeffrey Glaizel and Dr. Robert Faiella. As leaders in dentistry, you should be polite to those you serve. You could discover that you need our support someday.

   On the other hand, if Glaizel and Faiella haven’t a clue about this and other complaints concerning their unresponsiveness that I’ve posted on Sharecare.com – where both are ADA-approved members – the added tension increases the entertainment value.

   From my personal experiences with typical command-and-control ADA officials and other equally-proud dentalcare stakeholders, I can only imagine that modern internet transparency makes them sorely miss those days when they could marginalize troublemakers by simply ignoring them. It’s surprising how many ADA leaders – including at least one President-elect candidate – still just don’t get it.

   In yesterday’s comment, “Dogging the trail of a creeping mission – Whose interests do ADA leaders serve?” I described how experts Dr. Glaizel and Dr. Faiella have both repeatedly ignored this dentist’s sincere questions concerning the electronic dental records they promote. I don’t care who you are, such poor public behavior is uncivil and will NEVER solve cost and safety issues that have stopped interoperable dental records cold.

   Even though ADA officials intentionally hold themselves separate from those they serve as part of being “vetted,” it is never right for designated leaders to treat anyone in the community with disrespect. Everyone deserves a response to dentalcare questions, even if it’s to say: “ADA policy and/or profits don’t permit me to publicly compare the cost and safety of EDRs to paper records.”

   Transparency in the nation’s dental industry means unprecedented personal accountability from leadership whether the can stand it or not. Even their ADA-approved colleagues in the Sharecare community expect that Dr. Jeffrey R. Glaizel and Dr. Robert Faiella have read every word of my complaints about their evasion. As a matter of fact, one would expect that their true friends have already forwarded this complaint as well.

   Even though ADA leaders say EDRs are mandated and that there is nothing anyone can do to stop dentists from being forced to purchase certified dental software, don’t you also want to know what stakeholders inside and outside the ADA are desperately trying to keep secret from us? Since it’s the welfare of dentists and patients that stakeholders put at risk for their profit, mandate or not, we have the right to know the bad news. Right?

   This just in: An article by Nicole Lewis titled “HHS: Patient Data Breaches Have More Than Doubled” was just posted on InformationWeek.com.

   http://www.informationweek.com/news/healthcare/security-privacy/231601760

   EDRs are even more dangerous to dentists and patients than I thought they were at the start of this article!

   D. Kellus Pruitt DDS

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9. Darrell, on November 11, 2011 at 2:45 AM said:

   More on eDRs

   Any leader in dentistry not yet encouraging dentists to delay adopting EDRs can no longer be trusted.

   Following years of our leaders’ summary evasion of dentists’ questions about the cost and danger of politically-correct EDRs, data breaches from small healthcare facilities including dental offices have become so rampant that once arrogant stakeholders inside and outside the ADA can no longer get away with deceiving dentists and patients to protect their investments. Their credibility is spent.

   According to “Congress examines health data thefts” that was posted yesterday by Jeremy Herb, lawmakers are furious about the increasing number data breaches and intend stop the carelessness the only way they know how by increasing the severity of the punishment… As if raising the fine to something like $2 million from $1.5 million is going to make a difference in a dentist’s decision to change passwords occasionally. Why not really scratch that itch with a fine of $10 million?

   http://www.startribune.com/politics/national/133580613.html

   Expect the increased fines and new non-productive documentation requirements to not only be ineffective at protecting patients’ privacy, but the next round of feel-good, punishing legislation is sure to raise the cost of HIPAA compliance even more. You didn’t think increasing federal regulation of dentists would make fillings cheaper did you?

   I know it aggravates early adopters when I say this, but security issues are steadily causing paperless practices to become less competitive with small, traditional practices which still use safe, cheap paper records – like mine and Dr. Tom Coburn’s.

   Herb writes: “Sen. Tom Coburn, R-Okla., the subcommittee’s ranking member, questioned whether switching to electronic records was worth it. He raised concerns about hackers finding a way to take sensitive records. ‘They gotta get into my office to get it when it’s on a piece of paper,’ said Coburn, who is a physician.”

   Imagine that! Dr. Tom Coburn, a US Senator from Oklahoma and I share respect for paper health records’ long track record of proven safety. Upon learning that Sen. Coburn recognizes common sense in healthcare, I can now say the future looks safer for both dentists and their patients than I thought it did earlier today.

   What dentistry really needs are leaders who are confident enough in their values to embrace transparency. I know they’re out there. Many are my personal friends. They just need more motivation to speak up. That will painfully develop.

   Give it up, ADA. You know you want out of your ill-advised HIT blunder, and it will be much less embarrassing for Delegates and Trustees to consider realistic solutions to the profession’s growing security problems now than later. There are around 160,000 dental practices in the nation which store patients’ unencrypted Protected Health Information on inadequately protected computers. Most of the very small business owners pay dues to the ADA. They depend on you for advice, yet are still unaware that they could be a breach away from bankruptcy. You know I’m right, ADA. You should speak up now.

   D. Kellus Pruitt DDS

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10. D. Kellus Pruitt DDS, on December 21, 2011 at 2:05 PM said:

    ADA – EHR Primer

    A few days ago, I learned from the Minnesota Dental Association Facebook that after years of sharing almost nothing with membership about electronic dental records, the ADA recently published a members-only article describing pros and cons. As you read what unnamed members of the ADA “Electronic Health Records Member Advisory Group – Council on Dental Practice” whisper to dentists about EDRs, you’ll understand their preference for keeping their secrets anonymous – just in case an ADA member spills them to someone knowledgeable about EHRs.

    https://www.ada.org/ada/login/loginv2.aspx?ReturnUrl=%2fmembers%2f6212.aspx

    The password-protected link offered to the public can only be accessed by members, yet ADA officials are notorious for exaggerating the benefits while discounting the liabilities of EDRs. So when I suggested to friends that it’s in dentists’ and patients’ best interests that people outside the ADA be given the opportunity to scrutinize what naïve dentists are being told in private, several naturally agreed and thankfully provided transparency to the members-only article, “Electronic Health Records—A Primer.” Here is the opening paragraph:

    “There are many reasons for implementing an EHR. Some dentists and physicians want to have quicker access to patient information and others want to be able to communicate more easily with their labs and pharmacies.”

    Anyone else notice bias starting with the classic “There are many reasons…”? To me, the introduction looks like an ad written by an EHR stakeholder’s PR expert who has never set foot in a dental office. Even those who aren’t familiar with evidence-based protocol that is followed elsewhere in the ADA should immediately notice that there is no evidence to back up the selling point that EHRs allow dentists quicker access to patient information – one of many misleading statements found in the members-only article, as well as in the accompanying PDF written in slideshow format. (Not password-protected).

    Click to access ehr_primer.pdf

    To properly study the claim of quicker access to digital records, one would need to include the time it takes to log on and enter a password (that is changed regularly for security reasons), plus the time for the proper window to open – versus finding, removing and opening a folder kept in (mostly) alphabetical order in a filing cabinet. I think the Council made another mistake one would expect from a biased stakeholder by failing to take into account that software, hardware and the internet are far less reliable than even the cheapest metal filing cabinets. In addition, since dentists generally maintain a tenth of active charts as physicians, and rarely order lab tests, care should be taken when comparing dentists’ HIT needs to physicians’. HIT doesn’t scale down well.

    I think protection from accountability is also partly to blame for the Council’s defiance of common sense. How can one communicate more easily with the lab or pharmacy than with a telephone call? You don’t have to log on for a phone call. You simply pick up the phone and dial the number. If it’s a frequently-used number, speed dial reduces the effort to pressing two buttons. What’s more, one doesn’t have to be HIPAA compliant to make phone calls, and they pose no risk of identity theft. That certainly cannot be said for EHRs. According to a recent study, 96% of providers have experienced data breaches in the last 2 years.

    As I continue to fact-check statements about EHRs in the ADA’s “Primer” in the days to come, you will recognize other clues that members of the Electronic Health Records Member Advisory Group hide the seriousness of data breaches for dentists and patients. That’s unfortunate for those of us who want to witness safe, affordable, interoperability in our lifetime. If dental patients lose trust in a dentist’s digital records now, they’ll never return. They’ll search for and find dentists with paper records who can also sell dentistry cheaper than HIPAA-covered entities with NPI numbers.

    As for communicating with labs, wouldn’t it cause fewer mix-ups if hand-written notes are simply included with relevant models and impressions that are picked up by the delivery person than to send the prescriptions separately over the internet? How complicated is the ADA Council on Dental Practice willing to make the practice of dentistry in order to justify the expense and danger of the EHRs the not-for-profit favors?

    What I find most discouraging about misleading and harmful articles written by anonymous people is that their reckless damage cannot be halted if nobody takes ownership. You wouldn’t believe how many dentists still think they must purchase an EDR system before 2014, just because 3 years ago, an ADA President said “You have no choice.”

    More soon. Count on it. We’ve only gotten through the first paragraph.

    D. Kellus Pruitt DDS

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11. D. Kellus Pruitt DDS, on January 9, 2012 at 9:24 PM said:

    You can tell us, Dental Economics. We’re doctors

    Over the last several months, I’ve politely asked knowledgeable Dental Economics experts for their opinions of the value of electronic dental records to dentists. In fact, I’ve more than once directly asked Dr. Paul Feuerstein, DE’s designated digital expert, about the abysmal safety record of EDRs. Yet he ignored this practicing dentist’s questions even as the frequency of data breaches from dental offices has increased 32% in the last year! I don’t think Dr. Feuerstein cares.

    In my opinion, if a stakeholder who accepts public recognition as an EDR expert allows unimpeded deception to mislead naïve dentists and patients, the “expert” no better than the source of the lie. It naturally leads me to ask how many vendors Dr. Feuerstein is shielding from accountability to protect DE ad revenue. How well does that thankless job pay?

    Other than editor Kevin Henry, I haven’t met a single DE official who has enough confidence to utter a peep about EDRs – leaving dentists and patients at the mercy of EDR proponents like the former CEO of CR Foundation who blatantly lied about EDRs’ “high return on investment” in an article published by DE.

    I feel Kevin recognized the absurdity of silence long ago, and has done everything he can do to bring openness and common sense to DE reports on EDRs. Nevertheless, Kevin isn’t a dentist, and there is only so much an editor can do. After all, he’s not hired to make news.

    Today, a link to “Dr. Joe Blaes’ Pearls For Your Practice” was posted on Dental Economics Facebook. I got right to the point with my question: “What does Dr. Blaes think of electronic dental records? Come on, Dental Economics. Quit avoiding the topic of Electronic Dental Records. Their dangers are not going to disappear, and neither will I.”

    https://www.facebook.com/pages/Dental-Economics/27744647284?sk=wall&filter=1

    I’m bone tired of waiting on the courtesy of answers from rude dentalcare stakeholders who profit off sales of dangerous products to dentists, yet hide from accountability. I’ve tolerated deceptive ads much longer than most informed, dissatisfied customers would. So expect me to get nastier, DE. After all, what is Dental Economics Senior Vice President Lyle Hoyt from Tulsa going to do? Respond?

    Come on out, Lyle. I’ve got some questions for you about your censorship policies as well as the safety of EDRs.

    
    D. Kellus Pruitt DDS

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12. D. Kellus Pruitt DDS, on January 10, 2012 at 5:28 PM said:

    Dear Dr. Larry Emmott:

    Your article, “Dental High Tech Predictions for 2012,” that lists the advances which you lament will not occur, reveals dentists’ underlying quiet disappointment in the progress of EDRs that have been discussed only privately until now.

    http://myemail.constantcontact.com/Predictions-for-2012-that-will-Never-Happen.html?soid=1102570573881&aid=tGSY88q38fI

    Since this makes you the second dentist in the nation to publicly acknowledge the unpopular truth about EHRs in dentistry, we now have the minimum number necessary for conversation – should you be interested. Regardless, I salute you, Larry. What you did took courage.

    I empathize about lack of progress in interoperable electronic dental records. I too wanted to witness the miracles of Evidence-Based Dentistry SAFELY data-mined – with permission – from dentists’ computers. But it doesn’t look like real-time magic will happen in 2012 or perhaps even in our lifetime If dentists don’t communicate with each other.

    As you know, until the horrendous security problems with EDRs are mitigated, dentists will never enjoy interoperability simply because consumers will not cooperate. Once dentists lose patients’ trust in EDRs, they will simply seek dentists who use paper records, and interoperability will take at least another generation.

    I’ve studied the security problem extensively. Common sense says that if patients’ Protected Health Information (PHI) is unavailable, it cannot be stolen by burglar, hacker or dishonest employee. Only then will EDRs be safer than paper dental records.

    Have you and I ever discussed de-identifying EDRs?

    D. Kellus Pruitt DDS

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13. D. Kellus Pruitt DDS, on February 9, 2012 at 11:44 AM said:

    The End of an Era

    We’ve reached the end of an era of unquestioned trust in EHR stakeholders’ promises. Bipartisan threats will probably begin soon.

    As the going price for stolen medical identities climbs along with cost of HIPAA compliancy, public fear of identity theft helps push providers well beyond the reach of obsolete EHR sales pitches, and you can forget about Bush’s 2014 deadline for interoperability. Without Americans’ support, his harmful, costly, naïve mandate is no better than a self-limited attempt at tyranny in the land of the free that our grandchildren can hardly afford.

    In the past, when I challenged dedicated EHR stakeholders with questions concerning the growing problem of data breaches of patients’ medical histories, more than one assured me that while they personally have nothing in their boring record to hide from anyone, they completely agree that an exposure of personal information can be traumatic for certain people, but that patients’ embarrassment doesn’t justify holding up the universal adoption of life-saving EHRs – which not only solve sloppy handwriting problems, but also survive hurricanes better than paper records. Presidential candidate Newt Gingrich used to say, “Paper kills.” But not so much anymore.

    When I pressed stakeholders a little harder, of the few who stayed in the discussion, some would typically discount public fear of identity theft from doctors’ computers as largely irrational, alarmist, and even Luddite – pointing out that occasional breaches of social security numbers and birthdates had all but become an accepted tradeoff for progress in healthcare, and that rising numbers of identity thefts “haven’t slowed down the growth of online banking…. So get over it.”

    Then this fall, the Ponemon Institute revealed the growing problem with medical identity theft that previously had only rarely been mentioned in the media. Most people who are sharp enough to make a living at EHR sales are also smart enough to recognize that the giddy salad days of comparing the dangers of stolen socials with imperceptively altered medical histories will never return.

    Today, as if to punctuate the end of an era of discounting public fear, Rick Kam, President and CEO, ID Experts and Christine Arevalo, director of healthcare identity management, ID Experts posted “A glimpse inside the $234 billion world of medical ID theft.”

    http://www.govhealthit.com/news/glimpse-inside-234-billion-world-medical-id-theft

    “With its serious health risks, medical identity theft is far more dangerous than the more well-known consumer or financial identity theft. When a victim’s records are merged with a thief using the same identity, for instance, that record becomes ‘polluted,’ and the victim may be denied treatment or be misdiagnosed based on this inaccurate information. In addition, patients may be denied life insurance or billed for services not rendered. “

    The authors then listed a few real-world examples to illustrate danger that has been ignored by unresponsive stakeholders for far too long:

    – In Oregon, a pregnant woman delivered a baby addicted to crack using another woman’s social security number—and then abandoned the baby. Police arrested the victim and put her children into protective custody.

    – A hospital’s billing department notified a pregnant woman in Washington that someone had used her social security number to be treated for a crack overdose at the ER of the same facility where she was about to deliver her baby.

    – A patient in Texas used a California man’s medical identity to obtain radiation treatment and other care. When the thief’s records and the patient’s records merge, healthcare providers will think the patient has a condition he doesn’t have.

    – One woman used her sister’s medical ID to receive treatment for a serious sports injury. When chronic problems arose, she was denied coverage for further treatment because there was no record of her initial treatment.

    – Another woman couldn’t get physical therapy following neck surgery because a Miami clinic that she had never visited claimed her insurance benefits had been maxed out.

    – A teenager was denied the opportunity to give blood because the Red Cross flagged her social security number as belonging to a person who had tested positive for HIV. Another person had used her social security number at a free AIDS clinic in another state, and the clinic did not ask for physical copies of identification.

    ————

    I first warned of medical identity theft in a guest column written for WTN News on October 18, 2006 titled “Careful with that electronic health record, Mr. Leavitt.”

    http://wistechnology.com/articles/3407/

    Two days later, HHS Secretary Michael Leavitt was in Las Vegas to hand down to the ADA House of Delegates the nation’s bipartisan long term plans for dentistry during the national ADA convention. By the time he walked to the podium, my column appeared as his first news hit when one googled his name. It remained number one for several days following the convention.

    I like to think I am the reason that the Cabinet Secretary was especially pissed at the nation’s dentists when he threatened to sick his MBAs on us. (See “Health standard setting: ‘If the DDSs don’t do it, the MBAs will’” – ADA News, October 20, 2006).

    http://www.ada.org/prof/resources/pubs/adanews/adanewsarticle.asp?articleid=2177

    We have recently discovered that Leavitt’s favorite MBAs work for the W.K. Kellogg Foundation, and they intend to eliminate finicky consumers’ unscientific choices in dentists. Well-meaning people who know a lot about algorithms but little about the business of dentistry intend to replace Adam Smith’s 17th century ideas of competition with a computerized, gestalt rewards system tuned for cost-effectiveness based on dental claims data. Garbage in – garbage out. Let the games begin!

    It looks like the MBAs are every bit as cruel as the Secretary of Health and Human Services promised us over 5 years ago.

    D. Kellus Pruitt DDS

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14. D. Kellus Pruitt DDS, on February 16, 2012 at 7:12 PM said:

    Encrypted EDRs – a non-starter

    Encryption of electronic dental records is a non-starter – HHS is betting that encryption is secure enough for electronic health records even if cryptographers are nervous about it.

    HIPAA doesn’t require covered entities to notify patients of data breaches if their Protected Health Information is encrypted. Nevertheless, if you and your family’s encrypted medical identities were fumbled, wouldn’t you prefer to be warned so that you could watch for potentially life-threatening alterations in your medical history by a thief who might not share the same allergies? Or would you rather not be bothered?

    What if you learned this week that an international team of cryptographers is uneasy about encryption’s reliability? Wouldn’t you want your doctor, hospital or insurer to at least give you a heads up, even though it’s not required by the HIPAA Rule? Of course you would! (Unless you have invested heavily in Health Information Technology like the rest of Wall Street).

    According to John Markoff’s article “Flaw Found in an Online Encryption Method,” published this week in the NY Times, “A team of European and American mathematicians and cryptographers have discovered an unexpected weakness in the encryption system widely used worldwide for online shopping, banking, e-mail and other Internet services intended to remain private and secure.”

    James P. Hughes, an independent Silicon Valley cryptanalyst, worked with a group of researchers led by Arjen K. Lenstra, a widely respected Dutch mathematician and professor at the École Polytechnique Fédérale de Lausanne in Switzerland. He told the NY Times: “This comes as an unwelcome warning that underscores the difficulty of key generation in the real world. Some people may say that 99.8 percent security is fine,” he added that he doesn’t consider it secure.

    I was told long ago that dentists will never go back to paper records. I’m not so sure. As more and more medical as well as financial identities are stolen from dental offices, lawmakers will eventually mandate encryption of all PHI handled by all HIPAA covered entities. EDRs are already much more expensive than paper dental records, and encryption certainly won’t make them cheaper or easier for dental staff to use.

    Forget about encryption for dentistry. If EDRs are not de-identified, dentists with paper dental records like mine will enjoy an increasing market advantage over highly-regulated and fined HIPAA covered dentists. Who couldn’t see that coming? (answer: American Dental Association HIT experts).

    D. Kellus Pruitt DDS

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15. D. Kellus Pruitt DDS, on February 18, 2012 at 10:35 PM said:

    Kellogg’s flakes
    [The W.K. Kellogg Foundation and other corn flakes]

    Do you agree with Kellogg that cutting corners in dentalcare for a few captive consumers is an ethical compromise if it’s for seriously inconvenient budgetary reasons? Doesn’t sound Hippocratic to me.

    “Dental professionals should be monitored more closely and be reimbursed differently, and more dentistry should be done by nondentists, argue the authors of a new report funded by the Kellogg Foundation and the DentaQuest Institute.” – Laird Harrison, author of “Report Says Dentists Should Be Paid by Outcomes,” posted in Medscape Medical News, February 2, 2012.

    http://www.medscape.com/viewarticle/757975

    Let’s assume the bad news Harrison was fed by the Kellogg group is unbiased, and it has indeed become too expensive for American taxpayers to provide our poor with fully-trained dentists’ care. Since their money-saving plans for controlling the cost of dentists’ time depends heavily on “Telehealth” interconnected electronic dental records, do you find it suspicious that not one stakeholder in the Kellogg group responded to this dentist’s direct questions about EDRs’ cost and safety? Yet they still promise donors, politicians and desperate people with no choice that they can deliver cheap, 2nd tier dentistry by “nondentists” who can be quickly trained in as little as 18 months if necessary.

    The poor, whose health is generally more fragile than most dental patients in the nation, also can least afford avoidable complications caused by inadequately trained, poorly supervised and perhaps scared nondentists doing unplanned exploratory surgery hundreds of miles from their “telehealth” dentist who shares patients’ EDRs online. That’s cruelty.

    And, where’s the savings?

    Not even considering the bankruptcy-level cost of a data breach to dentists, patients and taxpayers, it appears to me that nobody in the group has actually determined how much the necessary EDRs will cost. In addition, as Congress loses its patience with data breaches of “epidemic proportions,” the cost of HIPAA compliance is guaranteed to climb even faster. Nothing can hold down the cost of mandates when even complications attract more stakeholders with expensive solutions. So if you are still a HIPAA covered entity, expect lots of complications. Just keeping up with the increasingly tedious and futile federal and state security requirements are destined to eat up any savings from using nondentists and Telehealth instead of dentists and paper records. Even if as promised, nondentists will work in patients’ mouths mostly for the fun of it and expect very little pay.

    From what I’ve seen, nobody disagrees that electronic dental records are not only increasingly more expensive than paper dental records, but EDRs are also increasingly more dangerous for both dentists and their clueless patients – whom both nondentists and dentists must ethically protect from financial, and especially medical identity theft, regardless of stakeholders’ interests.

    Telehealth is not a safe substitute for direct supervision by a dentist on site and immediately available when limited training leads nondentists in dangerous directions.

    Second only in danger from unleashing unsupervised nondentists on poor children who have no choice, perhaps the most ambitious of the half-dozen flaky proposals listed in the DentaQuest study is “Innovation in payment, monitoring, and incentive mechanisms tied to the oral health of the population served.”

    Let the computer games begin!

    I wish to warn vulnerable American dental patients that the noun “patient,” as in “a dental patient’s preferred dentist,” isn’t listed once in either the MedScape article or DentaQuest’s study.

    As a fan of the teachings of the Father of Economics, Adam Smith, I’m thankful that I live in a nation that promotes hands-off, fair competition for discerning customers on a level playing field. I’m certain others agree that when Americans are free to see dentists of their choice, energetic competition between dentists naturally keeps the market clean, up until the FTC fails to prevent unfair, predatory business practices from interfering in dentist-patient relationships – such as the half dozen ideas suggested by the W.K. Kellogg Foundation, the DentaQuest Institute (a dental insurer) and a dental school instructor from California named Paul Glassman DDS.

    Doc, these dangerous outsiders intend to use your office equipment to “scientifically” determine and publish your cost effectiveness according to the permanent NPI number you were persuaded to volunteer for by the ADA. I warned about the suspicious 10-digit identification six years ago after an ADA Senior Vice President refused to respond to simple questions about it.

    What’s more, the Kellogg stakeholders are so confident about the money that can be saved by applying their strategic algorithms to data from HIPAA covered dentists’ EDRs, that once their new incentive system is the only game in town, dentists’ devotion will turn away from their patients’ finicky interests – successfully isolating the profession from unscientific free market influences – leaving control instead in the hands of dental school instructors who in turn, are uninfluenced by even the concerns of practicing dentists and their patients.

    This effectively moves dental patients’ interests from 1st in line to 3rd, and their emotion-laden opinions of who they prefer to do their dentistry in their tender mouths won’t be allowed to affect computerized dentists’ grades one way or the other – which will be posted on an ADA-approved national report card. I suspect if you are caught charging more for your time than your rating allows according to the increasingly downward pressure from the algorithms finely tuned for the common good, your grade will prominently reflect computer-confirmed evidence of ambitious, unpatriotic greed.

    If someone had warned you years ago, would you have still “volunteered” for the permanent, 10-digit NPI number without asking what it is to be used for?

    On January 26, the W.K. Kellogg Foundation purchased a press release announcing, “The report – the latest in a growing number of analyses of the oral health care system – was released this week at a national meeting of oral health professionals, government leaders, consumer advocates and others convened by the Kellogg Foundation and DentaQuest Institute that was intended to launch a national dialogue on quality improvement and increased access to dental care.”

    If the members of the Kellogg group are so interested in launching a national dialogue concerning dentistry, why won’t Dr. Paul Glassman answer my email concerning the cost and safety of the EDRs the dental school instructor would have me purchase as a nose ring?

    D. Kellus Pruitt DDS

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16. D. Kellus Pruitt DDS, on March 8, 2013 at 3:56 PM said:

    EHR nirvana?

    Recent survey results posted on Medical News Today confirm that physicians are so fed up with “buggy” EHRs that they eagerly share their growing dissatisfaction on surveys: “Decrease In User Satisfaction With Electronic Health Records Revealed By Survey Of Clinicians” (no byline) was just posted .

    http://www.medicalnewstoday.com/releases/257271.php

    Michael S. Barr, MD, MBA, FACP, who leads the American College of Physician’s Medical Practice, Professionalism & Quality division, tells Medical News Today, “Dissatisfaction is increasing regardless of practice type or EHR system.” He adds, “These findings highlight the need for the Meaningful Use program and EHR manufacturers to focus on improving EHR features and usability to help reduce inefficient work flows, improve error rates and patient care, and for practices to recognize the importance of ongoing training at all stages of EHR adoption.”

    Additional key findings include:

    – The percentage of clinicians who would not recommend their EHR to a colleague increased from 24 percent in 2010 to 39 percent in 2012.

    – Clinicians who were “very satisfied” with the ability for their EHR to improve care dropped by 6 percent compared to 2010 while those who were “very dissatisfied” increased 10 percent. (Surgical specialists were the least satisfied group. Primary care physicians were more satisfied than medical subspecialists.)

    – 34 percent of users were “very dissatisfied” with the ability of their EHR to decrease workload – an increase from 19 percent in 2010.

    – Survey responses also indicated that it is becoming more difficult to return to pre-EHR implementation productivity. In 2012, 32 percent of the responders had not returned to normal productivity compared to 20 percent in 2010.

    – Dissatisfaction with ease of use increased from 23 percent in 2010 to 37 percent in 2012, while satisfaction with ease of use dropped from 61 to 48 percent.

    Any comments.

    D. Kellus Pruitt DDS

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