Paper Medical Records Keep Good Dentists [and Physicians] Honest

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Good Fences Keep Good Neighbors

[By D Kellus Pruitt DDS]

“Changes to an EHR (electronic health record) can go unnoticed and can be harder to trace than changes made to paper records”

Sen. Mark Leno [D-San Francisco, the author of SB 850]

Yesterday, Kendall Taggart posted “Bill would require ‘track changes’ on electronic medical records” on California

It seems there is a growing problem with providers in California who cannot be held accountable for altering patients’ digital health records to protect themselves rather than their patients. With paper records on the other hand, erasures, ink and even handwriting can be scrutinized should a court of law need reliable evidence. What’s more, Sen. Leno’s feel-good law will not make EDRs any cheaper. Meanwhile, the multifaceted safety of paper dental records is not only proven by a very long track record, but it is irrefutable and free. Hard evidence is the innocent dentist’s friend. Otherwise it’s “he said, she said” and an unpredictable jury that might not like dentists anyway.

Tagggart writes: “A bill working its way through the state Legislature would make it more difficult for health care providers [including dentists] to modify or delete electronic medical records and leave no record of the change … The bill would require providers to automatically record any change or deletion of electronically stored medical information and identify who made the change. Furthermore, the bill would make it possible for patients to see the changes if they requested their medical records.” Do Democrats from California ever consider the price tag of their ideas? Is there any wonder why healthcare costs continue to rise?

Kaiser Responds 

Teresa Stark of Kaiser Permanente responds: “Our system can’t do that, and we’re not aware of any system that can. Given the level of investment required to bring our EHR up to that level, is this really what we want to be spending our money on?”

Regulatory expenses in healthcare are like tsunamis to dentists. Big boats like Kaiser in deep water might hardly notice the swell that will overwhelm our inflatable water wings in the shallows.

And, if it is too expensive for Kaiser – one of the largest healthcare systems in the nation with thousands of staff – imagine how expensive and time-consuming the new law will make electronic dental records? Since California often leads the nation in swell regulatory ideas, will California dentists be the first to flee to paper records should the costs of digital keep rising?

Even before California’s latest regulatory patch is slapped on EDRs, they offer no return on investment. That means paperless practices are more expensive to maintain than paper practices, and ultimately, patients will pay an increased price for paperless dentistry.


Micromanagement of small practices is expensive even if performed using the EDRs dentists themselves purchase. Swell ideas from well-meaning lawmakers are pricing miracle discoveries from safely interconnected EDRs out of reach. Why is HIT incompatible with common sense?


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5 Responses

  1. Can Health IT Do More Harm Than Good?

    A doctor’s brain can sometimes be fooled into seeing a disease pattern when none really exists.

    And, by extension, so can a computerized diagnostic program.



  2. Continued influence effect of EDR misinformation

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

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

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

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

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

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

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

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

    D. Kellus Pruitt DDS


  3. What’s your choice, Doc? Pegboard or waterboard?

    Can you imagine returning to pegboard bookkeeping and the US Mail just to sidestep HIPAA’s increasing costs? It seems that almost daily now, I read even more bad news about HIPAA that makes me thankful that I choose not to become a Covered Entity.

    Today, Dom Nicastro, writing for HealthLeadersMedia, described an entirely new threat to CEs that I know dentists with NPI numbers are clueless about: “HIPAA Access Reports Could Aid Malpractice Attorneys.”

    It’s not enough that the disclosure rule is so burdensome that it will push the price of EDRs even further out of dentists’ reach, but nothing is holding down their liabilities either. Nicastro writes: “The right to request an ‘access report’ as outlined in the Office for Civil Rights’ proposed HIPAA accounting of disclosures rule could be an asset to attorneys in HIPAA civil suits and malpractice cases, privacy experts say.” He also notes that a malpractice attorney could possibly use the disclosure record that the doctor pays for and provides the court, to determine if the doctor spent an adequate amount of time studying a patient’s EHR before treatment.

    So how much harmful intrusion into one’s business will dentists tolerate before they abandon technology for pegboards, ledger cards and carbon paper – which are not only cheaper than EDRs, but safer for both dentists and patients?

    If you value EDRs, computerization or even digital radiography, and you long for the discovery of miracles from real-time Evidence Based Dentistry on an internet platform, it’s time someone somewhere takes de-identifying EDRs seriously.

    (Note: To determine whether the idea is worth pursuing, it is essential that more than one unshaven dentist discuss it).

    D. Kellus Pruitt DDS


  4. Controversial EDRs?

    PennWell editor Mark Hartley breaks from the crowd by calling electronic dental records “controversial” – twice.

    The tension that HIPAA adds to dentalcare further complicates a fascinating dilemma involving the profitability of EDRs. There is no doubt that HIPAA-covered dentists value the convenience of their computers and prefer not to have to return to pegboards and ledger cards to stay competitive with non-covered dentists. Nevertheless, dentists who don’t risk putting their patients’ identities on computers avoid the added expenses of non-productive HIPAA requirements and bankruptcy-level fines. What’s more, since nothing is holding down the cost of compliance, and ambitious stakeholders are still piling on expenses, even if EDRs were cheaper than paper dental records (which they are not), HIPAA-covered dentists will always have to charge more to make the same profit as non-covered entities – even as dental patients learn that they can limit their risk of identity theft by avoiding controversial EDRs.

    Unlike in years past, industry publications like PennWell no longer have the power to bury unpopular news to protect ad revenue. The fact is, EDRs have always been dangerous products which offer dentists no return on investment, and the ugly truth is bubbling to the surface for natural reasons in the land of the free.

    Last week, Mark Hartley, editor of PennWell’s RDH magazine, posted an article on Dentistry iQ titled, “Amalgam losing in voting on greatest dental inventions.”

    In spite of the survey results cited in his article which show that still-popular EDRs have taken over as the “greatest dental invention,” Hartley describes them as “controversial” twice in one paragraph:

    “Amalgam restorations, which became the dental restoration of choice in the 1800s and for much of the 1900s, is paired against the controversial innovation of electronic health records. EHRs, which are still under development due to controversy over security issues while facing looming federal mandates, led the voting 56% to 44%. EHRs are projected to benefit patient care by improving communication between various health-care providers.”

    As far a I know, the editor’s acknowledgement of “controversy” is the first negative comment concerning EDRs that PennWell or any other dental publication has published. That’s progress. I salute your courage, Mark Hartley.

    D. Kellus Pruitt DDS


  5. Health Care Cost Savings by Treating / Managing Gum Disease

    According to a study by The American Journal of Preventitive Medicine, oral wellness reduced annual medical costs for applicable patients through treatment of gum disease follows:

    • Patients with Type 2 Diabetes: 40.2% ($2,840)
    • Patients with Cerebral Vascular (Stroke) Disease: 40.9% ($5,681)
    • Patients with Coronary Artery (Heart) Disease: 10.7% ($1,090)
    • Patients who are Pregnant: 73.7% ($2,433)
    • Hospital admissions decreased: 39.4% (Diabetes), 21.2% (Cerebral Vascular), 28.6% (Coronary Artery).

    Source: United Concordia Dental


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