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In Defense of the eDR Industry

10 Responses

1. D. Kellus Pruitt DDS, on November 3, 2011 at 12:07 AM said:

   My reply to Dr. Paul Child concerning ROI, HIPAA and finally de-identification of dental records.

   ————–

   Dear Dr. Child:

   I and others who are interested in the eventual success of interoperable electronic dental records appreciate your response. Do you know what they call an EDR system that doesn’t provide a return on investment? A hobby.

   The most important question a responsible business owner should always ask when shopping for a tool that costs tens of thousands of dollars is “Will it save more than it costs?” In defense of the suspicious absence of data showing ROI for purchasers of electronic dental records, you say: “…although a controlled study would be interesting, I’m not sure it would be an effective use of funds to prove something that is already proven in every other industry.” That hardly sounds like the principles of Evidence Based Dentistry. I’m certain readers recognize the weakness in your assumption that EDRs cost less than paper dental records simply because digitalization has cut overhead expenses elsewhere. Dentistry just might be unlike all other industries in the nation.

   The reason no one has offered proof of ROI for dentists is simply because there is no ROI. If EDR vendors and other stakeholders could provide evidence of savings over paper records, they would have done so by now repeatedly in press releases, and we wouldn’t be having this conversation. What’s more, for a respected leader to tell naive dentists they can expect a “high return on investment” from paperless practices without having a clue about the cost of compliancy is just reckless. Congress is fed up with unabated breaches of EHRs and nobody is putting downward pressure on the cost of HIPAA. If that’s not reason enough for dentists to consider waiting at least another year or two before going paperless, an unfortunate breach of 500 or more records these days can bankrupt a dental practice even before the fines are assessed.

   By the way, you said you know of no dentists who have returned to paper from digital. You haven’t been looking hard enough. I know of three dentists within 30 miles whose practices have suffered bankruptcy-level breaches and at least two say they will never return to digital. One said it was the most horrible experience of his career. Over two years, it cost him over $100,000 to recover, and many patients never returned. Since dentists are as much the victim as those whose identities have been fumbled, I think it’s a crime that not one dental leader in the nation has stepped forward to warn dentists about the liability of EDRs.

   The bottleneck in most dental offices has always been the speed of the small business owners’ hands rather than those pulling charts. An EDR system packed with patients’ Protected Health Information (PHI) is nothing more than a handy but dangerous communications tool. The telephone, fax and US Mail are indeed more reliable, cheaper and safer than EDRs. Most importantly, one doesn’t have to be a HIPAA-covered entity to use them. This distinction will become increasingly more important as HHS starts HIPAA inspections this year.

   I’ve seen variations of every one of your rationalizations for adopting EDRs before and still, not one of them can tolerate transparency. Since most are somewhat related to the first three, I’ll address them for now. If you are especially confident in any of the other selling points, show us your best arguments that dentists should adopt EDRs now rather than later, and I will shoot them down individually.

   You say EDRs offer “legible records vs. scribbles, or worse off, incomplete records.” Since we are both just guessing, I contend that careless keystroke errors that never occur with a ball-point pen wipe out all gains realized by eliminating careless handwriting – making the keyboard far more dangerous to patients’ welfare than the pen. After all, isn’t it easier to accidentally touch the wrong key than to draw a 4 when one intends to draw a 5? Until this morning, I hadn’t seen the bad handwriting reason for EDRs in more than a year. So what happened to “we should save the forests,” and “fewer paper cuts”?

   And what is your basis for claiming that digital will magically create more complete records than paper? If you cannot show proof that laziness is a problem with paper records that computers overcome, I have to say this is as silly as the one about sloppy handwriting.

   The fact is, long before computers arrived in dental offices, very efficient, large dental practices succeeded for decades using pegboards, ledger cards and lots of carbon paper. To this day, paper remains the gold standard of cost and security in the dental industry.

   You might not realize it yet, Dr. Child, but because HIPAA is an absurd, open-ended mandate in dentistry, you’re fighting a losing battle. Unless the records are de-identified, EDRs will never provide US dentists a return on their investment. What’s more, as identity thefts continue to increase – and they will – dental patients will trust the safety of our records less and less. Before you know it, the nation’s access to huge, reliable collections of safe, de-identified data that could have pointed the way to seemingly miraculous cures in dentistry within years – will be delayed for another generation. We cannot squander our patients’ trust.

   D. Kellus Pruitt DDS

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2. D. Kellus Pruitt DDS, on November 3, 2011 at 10:20 AM said:

   Searching for ROI

   Every now and then, I still hear the rumor that EDRs are cheaper than paper dental records, yet nobody will reveal the proof behind their claims. Dr. Paul L. Child’s report of a “high return on investment” is the latest empirical benefit. I sent him and QSI Vice President Kathleen Noll an email about the mystery today.

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

   ———–

   Dear Dr. Paul L. Child:

   In your article “Digital dentistry: Is this the future of dentistry?” you state that Eaglesoft (Patterson), Dentrix (Schein), PracticeWorks (Carestream Dental), and Web-based software such as Curve Dental “offer a high return on investment.” Does that also include the cost of HIPAA compliancy?

   I’ve heard rumors for years that EDRs are cheaper than paper dental records, but when I ask experts for proof no one responds. Just a couple of months ago, at this year’s National Dental Benefits Conference, Kathleen Noll, Vice President of QSIDental, also claimed that electronic dental records cost less. It is reported that in support of her claim, she provided the audience a “worksheet” revealing the savings that dentists can expect from going paperless. I sent her and QSI CEO Steve Plochocki numerous emails requesting the worksheet but they never responded.

   Could you please share your information about the ROI with me and others?

   D. Kellus Pruitt DDS

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3. D. Kellus Pruitt DDS, on November 3, 2011 at 6:52 PM said:

   Lessons Learned

   A lesson is being silently learned this week by dental leaders far and wide: Social networks don’t favor stakeholders who evade accountability for misleading dentists. As it turns out, open communication discourages deceptive advertisements from being posted in our community in a natural way. Transparency’s a bitch.

   Yesterday, when CR Foundation CEO Dr. Paul Child discovered I publicly shared our discussion of his public claim that EDRs offer a “high return on investment” – just like I told him I would in my first email – he sent me a heated message accusing me of unfairly tricking him. I’d share that one as well, but Dr. Child concluded it with the following legal warning that he hadn’t posted in previous correspondence. (You’ll just have to trust me when I say he made a good decision):

   NOTICE OF CONFIDENTIALITY

   This e-mail message and its attachments (if any) are intended solely for the use of the addressee hereof. In addition, this message and the attachments (if any) may contain information that is confidential, privileged and exempt from disclosure under applicable law. If you are not the intended recipient of this message, you are prohibited from reading, disclosing, reproducing, distributing, disseminating or otherwise using this transmission. Delivery of this message to any person other than the intended recipient is not intended to waive any right or privilege. If you have received this message in error, please promptly notify the sender by reply e-mail and immediately delete this message from your system.
   —————-

   I replied:

   “I clearly signified numerous times in my emails that I am sharing our conversation with others. I’m afraid you are just angry because I’m holding you personally accountable for what you say, Paul. There are no dirty tricks.”

   By the way, why would it make a difference in what you tell me privately, and what you would tell others? Do you form your responses according to your audience? Don’t be silly. Those days are long gone.

   But, the modern lesson doesn’t end there. It turns out that this one’s got legs of its own. This morning I discovered that the Medical Executive-Post (with a readership of almost 340,000) picked up our conversation and posted his careless reply as an essay. What’s more, the ME-P included Dr. Child’s photo which I suppose was found on the internet in a CR Foundation publication.

   In Defense of the eDR Industry

   Whether you approve of more transparency in the dental industry or not, I’m pretty sure other EDR stakeholders will gain insight from Dr. Child’s experience: Until you can put a price on HIPAA compliance, you should never tell trusting dentists that EDRs cost less than paper dental records without including a notice of confidentiality.

   D. Kellus Pruitt DDS

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4. Mary, on November 3, 2011 at 8:34 PM said:

   A Logic Disconnect?

   Mommy – a ten year old recently cried. “Can I have sex, cut class, get a tattoo and use drugs today?”

   Sure thing darling, responded mom! “Everyone else is – and you’re a lemming.”

   Paul, can’t you do better than that?

   Mary

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5. Dr. David Edward Marcinko MBA CMP™, on November 4, 2011 at 10:18 AM said:

   An Open Letter to Drs. Darrell Pruitt and Paul Child
   [Issuing a “Point” versus “Counter-Point” Challenge]

   The Medical Executive-Post is a growing professional publication that is filling a need in the integrated practice management and health economics electronic eco-space for all medical professionals; including dentists. It does not, nor do we need to, practice treachery, chicanery or related ignoble forms of “gotcha” or “ambush” journalism. We do advocate for transparency and related health 2.0 forms of modern professional networking for our target audience – whose boundaries of propriety are expanding. And, we give individual voice to the silent majority who often hold solid opinions over more vociferous corporate entities. Such strong opinions are always welcomed; scurrilous accusations are not! We are all colleagues with a common goal.

   For example, although only in ME-P operations since 2007, I personally have been in the e-publishing industry for a decade, serving as a print editor for two before that, as a writer for three decades earlier, and a content contributor to various media formats for four. These clinical and non-clinical essays, articles and reports have appeared in referred and non-referred periodicals and medical journals like:

   … Managed Care Executives, Healthcare Informatics, Medical Interface, Plastic Surgery Products, Teaching and Learning in Medicine, Orthodontics Today, Chiropractic Products, Journal of the American Medical Association, Podiatry Today, Investment Advisor Magazine, Registered Representative, Financial Advisor Magazine, CFP™ Biz (Journal of Financial Planning), Journal of the American Medical Association (JAMA.ama-assn.org), The Business Journal for Physicians, and Physician’s Money Digest;

   … and for companies and professional organizations like the Medical Group Management Association (MGMA), American College of Medical Practice Executives (ACMPE), American College of Physician Executives (ACPE), American College of Emergency Room Physicians (ACEP), Health Care Management Associates (HMA), and Physicians Practice.com;

   … and in academic institutions like the UCLA School of Medicine, Northern University College of Business, Creighton University, Medical College of Wisconsin, University of North Texas Health Science Center, Washington University School of Medicine, Emory University School of Medicine, and the Goizueta School of Business at Emory University, University of Pennsylvania Medical and Dental Libraries, Southern Illinois College of Medicine, University at Buffalo Health Sciences Library, University of Michigan Dental Library, and the University of Medicine and Dentistry of New Jersey, among many others. Many have be redacted in the Library of Congress, National Institute of health and/or Library of Congress.

   And so, in order to provide balance to the eDR conundrum we are facing, the ME-P would like to offer you both a platform for further discussion on an informative non-contentious forum. This may take the form of a web-cast, pod-cast, debate, simple prose format, IM or QA session, etc.

   It might even be similar to the Borges versus Kvedar debate: https://medicalexecutivepost.com/2009/08/12/borges-versus-kvedar/.

   This would allow ME-P readers to decide the issue for themselves based on the cogent and logical nature of each argument.

   I trust each of you will publicly accept this ME-P challenge. We will leave the meaning of a declination or non-response to the personal interpretation our readership. So, please advise Executive-Director Ann Miller RN MHA at your earliest convenience for scheduling purposes.

   Candor – Intelligence – Goodwill

   Cordially,
   David
   Dr. David Edward Marcinko; MBA, CMP™
   [Founder and Publisher-in-Chief]

   Former, American Society of Health Economists (ASHE) member
   Former, American Health Information Management Association (AHIMA) member
   Former, Healthcare Information and Management Systems Society (HIMSS) member

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6. D. Kellus Pruitt DDS, on November 4, 2011 at 10:48 PM said:

   Dear Ann Miller RN, Executive-Director, Medical Executive-Post:

   I enthusiastically accept Dr. Marcinko’s challenge to participate a public discussion concerning the cost and safety of EHRs in dentistry. Open, frank conversation which Dr. Marcinko has always encouraged is especially needed in dentistry – a niche industry that’s been hidden for decades. Thank you for your interest in the profession I love, Dr. Marcinko.

   Since marketplace conversation is much more likely to benefit our patients than silence, I respectfully appeal to Dr. Child to give our friendship another chance. I hope he will join me in bringing transparency to important and timely issues concerning EDRs that have never been openly discussed anywhere. If not now, when? If not the CR Foundation, who?

   Because of the flexibility in scheduling, any written form is fine with me.

   Sincerely,

   D. Kellus Pruitt DDS

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7. D. Kellus Pruitt DDS, on November 9, 2011 at 11:44 AM said:

   A Hard Lesson for CR Foundation

   Since late 2009, Dr. Gordon Christensen’s CR Foundation, long-respected for unbiased reports on methods and materials in dentistry, has used their Facebook Wall almost exclusively to advertise their continuing education courses and to attract subscribers to their monthly “Clinicians Report” – not unlike a “Consumer Reports” for dentists.

   https://www.facebook.com/pages/CR-Foundation/160588080492?sk=wall&filter=1

   The reasonable question I asked this morning is only their third post from a fan in two years: “Dear CR Foundation: Has anyone yet published a study showing that electronic dental records offer dentists a return on investment?”

   Even though open discussions have never occurred on the CR Facebook, one might assume officials of Dr. Christensen’s independent research foundation would naturally welcome any and all questions from practicing dentists – especially those concerning the cost and liability of electronic dental records. However, crucial, logical questions like mine continue to be ignored by stakeholders who would rather risk squandering dentists’ and patients’ trust than to admit they’ve long been overly optimistic about the benefits of the mandated EDRs they push.

   After bumping hard into CR Foundation CEO Dr. Paul Child on the internet a few days ago, it is clear to me that behind a façade of talk about the principles of evidence-based dental research, the CR Foundation is really nothing more than a secretive command-and-control dinosaur – an insensitive relic with bad habits from a time when limited media access was controlled by CEOs who protected favored stakeholders by ignoring the troublemakers who were on to their deceit.

   Mr. Get Watson, my ag teacher in high school, knew how to handle common deception. He warned us that if he caught us smoking at the school barn, we could expect to be asked for a cigarette right in front of our parents at the most inopportune time. Like the internet, Panhandle, Texas is a surprisingly small, networked community.

   Very few of the 119 fans CR Foundation has attracted to its Facebook in two years are aware that I caught the CEO trying to hide the bad news about EDRs. To those paying attention, I’m just an innocent customer in the front of Dr. Christensen’s store asking reasonable questions. How long do you think CR officials can get away with pretending I’m not bumming a cigarette from them?

   D. Kellus Pruitt DDS

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8. Ann Miller RN MHA, on November 15, 2011 at 10:57 AM said:

   Update on the Clinician’s Report [CR] Foundation for Dentists

   Dr. Paul Child is out, according to this investigative reporter.

   On the Leadership Shake-Up at the “Clinician’s Report” Foundation

   Contact http://www.cliniciansreport.org for futher information.

   Ann Miller RN MHA
   [Executive-Director]

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9. D. Kellus Pruitt DDS, on December 28, 2011 at 8:24 PM said:

   There is Money in Journalism

   When nameless editors working for Dental Economics and CNN allow bias in their reporting on dental products, is it always due to ad revenue? Or perhaps they are simply too busy to fact-check every little item, and it only coincidentally favors big business over dental patients’ interests – every damn time.

   On Monday, Dental Economics announced that Dr. Paul Child’s article “Digital dentistry: Is this the future of dentistry?” was chosen by 8 nameless DE editors as one of the two most important articles for dentists in 2011 (no byline).

   http://www.dentistryiq.com/index/display/article-display/9721317527/articles/dentisryiq/hygiene-department/2011/12/best-of_2011_articles.html

   As it turns out, weeks before the editors made their choice, Dr. Child was actually fired from his job as CR Foundation CEO because of his baseless claims in the heralded Dentistry iQ article which advises dentists to quickly purchase EDRs: “Dentists who have not yet adopted [electronic dental records] should do so now! Daily advances and improved software adapted from other industries allow this technology to be affordable, attain the fastest adoption rate, and offer a high return on investment.” Oblivious to their world around them, the 8 editors casually promoted the former CEO’s reckless advice, and nobody can be held accountable.

   Then today, Jake Winebaum, founder and CEO of Brighter.com was featured as one of CNNMoney.com’s “12 entrepreneurs reinventing health care” (no byline). CNN says, “These 12 startups are working to make medical care more affordable and efficient — a change that could save billions of dollars and save lives.”

   http://money.cnn.com/galleries/2011/smallbusiness/1112/gallery.health-care-entrepreneurs/

   Just like Dental Economics’ employees, CNN’s editors are either asleep or on sale. I responded:

   Dear CNNMoney reporter:

   Have finances become so tight that like Dental Economics, CNN must take in revenue by selling press releases that look like journalism? When you proclaim that Brigther.com CEO and founder Jake Winebaum is saving billions of dollars and lives through his discount dentistry brokerage, it’s obvious that CNN doesn’t fact-check articles submitted with cash instead of a byline.

   Your most superficial investigation would have revealed that Mr. Winebaum is selling discount dentistry with no quality control. Perhaps because “Winebaum likens the model to Costco’s,” you were tricked into forgetting that dentistry is intricate handwork in tender mouths that cannot be rushed, rather than an off-the-shelf product made in China. Since the Mr. Winebaum cannot be held personally accountable for the quality of care Brighter dentists provide his clients, what kind of dentists do you think Brighter.com, without quality control, typically attracts? Let’s look.

   In November, in a conversation with a Brighter.com representative, she told me that Brighter rates its contracted dentists according to “great sources” of information to establish the quality of their care: Yelp reviews and “likes” on Facebook – neither are limited to actual patients of the dentists. She promised, “If we get negative feedback from our customers, we research the situation and will go as far as removing bad dentists from our listings.” According to the Better Business Bureau, it would be wrong to assume Brighter.com customers aren’t complaining.

   Let’s look how well Brighter.com is doing in Austin, Texas. Several weeks ago, I performed some quick research of Brighter dentists’ reputations and discovered that 4 of Brighter.com’s top 10 dental practices in Austin were Omni Dental and Castle Dental centers, which I then investigated on the Austin Better Business Bureau website.

   Even after alerting CEO Jake Winebaum that Brighter’s high rated franchise dental clinics have a shameful complaint history with the Austin Better Business Bureau, it made no difference at all. Castle Dental, even with a grade of F from the BBB because of horrible complaints from the community, didn’t lose their contract with Brighter.com. In fact, since I suggested to Mr. Winebaum that he might want to consider dropping the franchise clinics for quality reasons, a third Castle Dental Center made it to Austin Brighter.com’s top ten practices. The Austin BBB doesn’t think too much of them either.

   “Trusted Dentists. Best Prices.”

   Now, Omni and Castle dental centers occupy 5 of Brighter.com’s 10 top rated practices in Austin. CNNMoney reporter, whoever you are, at least one of the entrepreneurs you praise would have you purchase your dentistry at Costco where you can “leverage” your buying power.

   D. Kellus Pruitt DDS

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10. D. Kellus Pruitt DDS, on January 3, 2012 at 3:20 PM said:

    Let’s do business, Jake

    I’m pleased to see interest in my business proposal to Brighter.com CEO Jake Winebaum. A few readers have even encouraged me to poke him just a little harder. I’d have done it anyway, but nevertheless, thanks. I see no reason he can’t respond to me. After all, he needs dentists.

    About a week ago, I told Jake I would participate in offering discounts to Brighter members as soon as there is more honesty in Brighter’s dentist rating system – favoring patients’ preferences over notorious franchise dental clinics that sport failing grades even with the local Better Business Bureau. Today, I again encouraged him to dump malleable Yelp reviews and Facebook “likes” and base Brighter’s ratings instead on DR.Oogle’s solid, reliable patient-only reviews (doctoroogle.com). I sent this follow-up to the CEO through the contact link on the Brighter website.

    http://www.brighter.com/

    ————-

    Dear Jake Winebaum:

    I hope you are having a nice holiday. I sent a proposal to you last week through the Brighter blog because your website page was down. I trust you received it. I feel like I know your anonymous moderator by now, and I’ve sort of grown fond of her silent, thoughtful rejection of some of my comments in our conversations, but not others. (I shared this note with her as well in the usual way). Until we met on the Brighter blog a few months ago, I had never before experienced involuntary real-time editing of my internet conversation with an anonymous person. I’ll call her “Shirley” for convenience.

    Seriously, Jake. If Shirley didn’t forward my message to you, the very best thing you can do for your investors is to fire her before 2012 rolls around. As a matter of fact, do you realize that when I asked to speak to her supervisor because of her rudeness, the unaccountable employee simply deleted my request? Even Wal-Mart employees show customers more respect than that. But then, they sort of have to because unlike Shirley, Wal-Mart employees wear name tags instead of leaving those for customers to choose.

    Have you considered that you might be getting bad advice from someone on your team? Investors have pumped millions of dollars into your discount dentalcare brokerage, yet it doesn’t look like you have yet followed the advice of a single dentist. That’s unfortunate. From the first time I saw Brighter.com, I thought you had come up with a brilliant idea that could potentially bring transparency to pricing in my profession at last. However, you blew it. You lost consumers’ trust when you cashed in much too prematurely by going for cheap instead of value.

    For example, you still don’t seem to understand that Castle Dental franchises are so notorious for treating their patients badly that the instant Brighter.com customers see several listed as your top rated dentists, they realize they’ve been ripped off. What’s more, you never even hear from those who investigate Brighter.com before purchasing a membership. If Shirley forwarded the message like I requested, you already know that Castle sports an F rating with the Austin Better Business Bureau.

    Your unfamiliarity with the dental market is scaring away not only customers, but also more desirable dental practices that also need new patients. For example, How long have you been boasting, “Over 25,000 Brighter dentists nationwide!”? At least 3 months, am I right? That’s not the growth your investors want, Jake.

    Very few dentists want to be listed on the same page as a Castle Dental franchise – putting even more downward pressure on the quality of your product. Mouths are tender. Sometimes dentistry discounted 65% is still short of a bargain. Any dentist could have warned you about this decades ago!

    Though you never responded to my offer, yesterday my Google alert let me know you were featured in CNNMoney’s article “12 entrepreneurs reinventing health care.” Your photo is even featured on the first page. The comment I submitted criticizing your business ethics was rejected by CNN without explanation, which I thought was rude. Nevertheless, it was picked up by the Medical Executive-Post titled, “There is Money in Journalism.” I don’t know how many readers CNNMoney has, but the ME-P has over 350,000.

    In Defense of the eDR Industry

    Consider this. If you were to switch ratings of Brighter dentists from Yelp’s unqualified reviews to the much more reliable DR.Oogle patient reviews, Brighter.com could offer the discounted services of the top two rated dentists in Fort Worth: Dr. Peter Ku and me. Even though I’m not yet participating on Brighter.com, Dr. Ku is. And even though 135 of his patients think enough of him to encourage others to give him a try, he is listed on the second page on Brighter.com behind a couple of Monarch dental franchises which like Castle Dental, also aren’t respected much by patients or the Better Business Bureau. And THAT is why Brighter.com attracts dental franchises instead of dentists your clients might like, Jake.

    I hate to see your good idea fall apart because of short-sighted, rookie mistakes. Maybe the next entrepreneur who comes along with a good idea will ask a dentist or two some questions about their plans before diving in.

    D. Kellus Pruitt DDS

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