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Don’t Co-operate with eDR Vendors, Doc!

25 Responses

1. D. Kellus Pruitt DDS, on February 15, 2012 at 9:52 PM said:

   EHRs or security?
   [EHRs or safety: You can’t have both]

   So if it’s the duty of HHS to both promote adoption of EHRs as well as to halt data breaches of “epidemic proportions,” and Obama must cut funding to balance the budget, would you expect HHS to spend less on security or promotion?

   “President Obama’s proposed fiscal 2013 budget calls for an overall 8 percent increase in spending for the Department of Health and Human Services, but a 5 percent cut in spending for the unit that enforces HIPAA. The cut reflects improved efficiency at the HHS Office for Civil Rights, the budget proposal contends.” (From “Budget Cuts Would Hit HIPAA Enforcer – President’s Budget Would Trim Office for Civil Rights Spending” by Howard Anderson for GovInfoSecurity.com, February 14, 2012).

   http://www.govinfosecurity.com/articles.php?art_id=4500

   Adam Greene, a former OCR official, told GovInfoSecurity: “The HITECH Act added breach notification to OCR’s workload. I have to imagine that, despite claims of improved efficiencies, the increasing load from the HITECH Act and the decreasing budget is going to have a real impact, such as longer delays during investigations.” He adds, “It will be interesting to see whether the budget reduction and the expressed interest in continuing the HIPAA audit program will lead to more aggressive pursuit of settlements or fines.”

   Two years ago, the growing security problems didn’t keep President Obama from promising that EHRs are a “panacea” for the nation’s unemployment problems. And as far as I know, only one person has ever been prosecuted for HIPAA violations since the Rule was enacted in 1996. So why start now?

   D. Kellus Pruitt DDS

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2. D. Kellus Pruitt DDS, on February 16, 2012 at 3:51 PM said:

   Discouraging QSI lies?

   Quality Systems Inc. is an electronic dental records vendor that has ignored this dentist’s repeated requests for proof that their product offers dentists a return on investment over paper dental records like they advertise. Today, QSI (NASDAQ: QSII) posted at least three press releases hoping to attract investors in products they hope to sell to dentists… like me. I’m hoping to scare attentive QSI investors away with the truth about QSI following every “Forward looking statement” that allows comments.

   http://www.mdtmag.com/News/FeedsAP/2012/02/implant-partnership-provides-dental-organizations-nationwi/

   Investors as well as consumers deserve honesty. I see no reason why QSI should be immune from accountability, do you?

   Quality Systems Inc. states, “For more than 35 years, QSI has provided dental technology solutions for the dental market that increase productivity, reduce risk, minimize costs and improve patient care.”

   Yet in August, 2011, after QSI Vice President Kathleen Noll promised an audience at the ADA’s Annual Dental Benefits Conference that her company’s electronic dental record system offers dentists a return on investment, Noll, as well as CEO Steve Plochocki, ignored my repeated requests for data to support the outrageous claim. I ask you, is evasion any more honorable than a lie?

   It’s never a good idea to invest in a company that won’t respond to customers’ requests for proof backing advertising claims. In fact, both the SEC and the FTC frown on dishonesty, Mr. Plochocki.

   The truth is, it’s well known in the dental industry that EDRs are not only universally more expensive than paper dental records but they are more dangerous to both dentists and patients as well. A few months ago, Dr. Paul Child lost his job as the CEO of the widely respected CR Foundation in Utah for making the same dishonest claim about ROI. But then, Dr. Gordon Christensen’s widely-respected CR Foundation has higher standards than Plochocki’s QSI.

   Do you know what they call an EDR system that doesn’t offer a return on investment? A hobby.

   D. Kellus Pruitt DDS

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3. D. Kellus Pruitt DDS, on February 21, 2012 at 12:07 AM said:

   EDRs lose value
   [EDRs lose value increasingly faster – especially in California]

   On Friday, I read Jill Nesbitt’s article, “Make the most of the Dentrix booth at the Chicago MidWinter meeting” on her Dental Practice Coaching blog, and posted the following, sensible question about EDRs that is still “awaiting moderation.”

   http://dentalpracticecoaching.com/dentrix/make-the-most-of-the-dentrix-booth-at-the-chicago-midwinter-meeting/

   “Jill Nesbitt, if you get the chance, would you please ask a Dentrix representative if it is true that electronic dental records offer no return on investment in addition to being more dangerous for both the dentist and patient than paper dental records? Surprisingly, I cannot get an answer to those most important customer questions! Maybe you can.” No response.

   There’s simply no other way to put this: Both dentists and patients should become alarmed when a dental practice consultant pushing dentists to purchase dental software chooses to censor concerns about cost and safety – hiding the answers from her uninformed customers. Sadly, Ms. Nesbitt is hardly the first.

   EDR cost-drivers

   The frequency of data breaches from healthcare facilities doubled between 2010 and 2011. Some expect it to double again in 2012. Congress is already angry about the poor security in healthcare and there is nothing holding down HIPAA/HITECH compliancy. That’s a huge, bipartisan cost-driver that’s not going away.

   Anyone can see that if the epidemic level of data breaches of dental patients’ financial and medical identities continues to be ignored by EDR industry leaders, it will lead to more uninformed dentists and patients who will be needlessly harmed to protect politically connected stakeholders’ power and profits. In addition, inexpensive, common sense, consumer-friendly solutions to the ever rising costs of EDRs will never be considered and liabilities will continue to increase exponentially.

   Speaking of cost-drivers, the HIPAA/HITECH Act Omnibus Final Rule is rumored to become issued in March. Offhand, do you think it will raise or lower the cost of using EHRs in dentistry?

   As incredible as it must seem to dentists who have never used paper dental records, not far down the road is a point where consumers will learn that dentists who use pegboards, ledger cards and the US Mail deliver dentistry cheaper and safer than dentists with computers. If there are practicing dentists who disagree with that statement, they’ve been suspiciously quiet for years. And as readers will see, even stakeholders no longer disagree with me. However, some are still learning that censorship is aggression, and must be used carefully.

   It gets worse fast

   Just this morning, I read “Sizing Up Impact of Class Action Suits – Will Breach-Related Lawsuits Lead to a Change in Behavior?” by Howard Anderson on HealthcareInfoSecurity.com.

   http://www.healthcareinfosecurity.com/interviews.php?interviewID=1386

   “Class action lawsuits have been filed following a number of healthcare information breaches, including those involving the TRICARE military healthcare program, Sutter Health, Stanford Hospital and Clinics, WellPoint and Health Net.” Cost-driver.

   Anderson continues: “The threat of multi-million dollar class action lawsuits might lead some organizations to think twice before notifying authorities of a breach when the risk of harm to individuals appears marginal, says Robert Belfort, partner at Manatt, Phelps & Phillips.” That is why some expect dentists’ discretionary patient notification loophole to be closed by the Final Rule in March. Understandably, the loophole has become unpopular with customers who are concerned by the news that stolen medical identities now bring $50 each. Customers are always right, you know.

   If the loophole is closed, we can expect an increase of devastating, HIPAA/HITECH-mandated press releases warning communities of local data breaches involving 500 or more dental patients. They will begin within 60 days following the enforcement date of the Final Rule. What’s more, if you practice in California, Mr. Anderson warns that a statute enables the filing of class action lawsuits seeking damages of $1,000 per individual affected by breaches caused by negligence, “even in the absence of actual harm.”

   Since California likes class-action lawsuits, that would make the West Coast statute the mother of all cost-drivers. Sit back and watch it sweep the nation, taking Dentrix with it.

   D. Kellus Pruitt DDS

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4. D. Kellus Pruitt DDS, on February 21, 2012 at 11:36 PM said:

   Dr. Schleyer posts my questions
   
   Dr. Titus Schleyer acknowledges questions concerning EDR cost and safety. Now if I can only get him to take the next step and respond.

   Today, Dr. Titus Schleyer, Assoc. Professor and Director, Center for Dental Informatics at the University of Pittsburg School of Dentistry, posted “Should dentists adopt electronic dental records?” on the Dental Informatics Online Community blog.

   Novel Medical Practice Valuation Approaches

   Dr. Schleyer writes, “We [the nation] are currently in the process of phasing out the tried-and-true method of documenting patient care in favor of electronic dental records. This is simply a statement of fact, not a value judgment about which medium is better.” Then he offered the value judgment about which medium is better – at least for dentists whose practices are located near the coast:

   “Do you believe that you are better off using electronic than paper records? There are some areas where the computer clearly beats paper – anytime. Just ask any dental office that has lost its records during hurricane Katrina.”

   The transparently lame “Hurricane Katrina” reason for replacing tried-and-true paper dental records with dangerous-and-expensive EDRs is almost never used by otherwise credible stakeholders these days, and makes even less sense as a reason for adopting EDRs than “dentists’ sloppy handwriting” – a long-ago discarded rationalization, wisely not chosen by Dr. Schleyer. Nevertheless, even though several hours have passed and Dr. Schleyer hasn’t taken the next brave step and answered my questions, I’m thankful that he accepted them as a comment following his article:

   “Dr. Schleyer, isn’t it true that electronic dental records are not only more expensive than paper, but that they are also more dangerous for both dentists and patients?”

   Naturally, my next goal is to obtain a response from the EDR stakeholder. So I posted my follow-up comment a few minutes ago. Even so, it’s been 7 hours. Since he hasn’t reacted by now, I’m afraid he’s already spit out the hook:

   The two most prudent questions American consumers should ask concerning any expensive, life-changing purchase are: “How much does it cost?” and “Is it safe?” Even the FTC recognizes that transparency is a must for fairness in the marketplace. Yet in dentalcare, patients are most at risk of harm by EDRs because they are intentionally kept uninformed of their danger by stakeholders. Thanks for posting my questions, Dr. Schleyer. That’s progress.

   As a practicing dentist and potential electronic dental records customer, I’ve repeatedly asked logical questions about cost and safety to others promoting EDR adoption, and have been mostly ignored. The few who have argued that EDRs offer dentists savings over paper dental records have never been able to provide data supporting the claim. In fact, when the former CEO of the widely-respected CR Foundation made a reckless proclamation that EDRs offer dentists a “high return on investment” in a Dentistry iQ article in November, he was fired within days, and co-founder Dr. Gordon Christensen took over as CEO.

   As for safety – nobody claims EDRs are safer than paper dental records. More alarming still, though the frequency of data breaches from healthcare facilities is said to be at “epidemic proportions,” and doubling every year, stakeholders who are promoting them are not taking the responsibility to warn dentists and their patients of the rapidly increasing risk of financial and medical identity theft.

   Did you know that stolen medical identities now bring $50 each while social security numbers only bring $5? When medical histories are stolen, they are often imperceptively altered to reflect the thief’s allergies rather than the victim’s. Like keystroke errors, that life-threatening danger simply never occurs with paper dental records.

   So if EDRs are indeed more expensive than paper dental records, aren’t the stakeholders, who stand to gain power and/or profit from their sales, bound by business ethics as well as common decency to warn customers to expect an increase in cost to provide care? And how much do you think HIPAA compliancy adds to the cost of dentistry? HHS isn’t saying.

   And if the EDRs are indeed more dangerous than paper dental records, and dentists fail to routinely warn patients to watch for unexplained changes in their digital medical histories, isn’t that counter to the tenets of the Hippocratic Oath?

   D. Kellus Pruitt DDS

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5. Darrell Pruitt (@Proots), on February 22, 2012 at 5:04 PM said:

   ‎”Those who the privilege to know, have the duty to act”
   – Albert Einstein

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6. D. Kellus Pruitt DDS, on April 6, 2012 at 12:06 PM said:

   EDRs are unsustainable
   [Are you betting your practice on a weak password, Doc?]

   Today, amednews.com posted “Data breaches of small businesses, including doctor offices, on the rise – A report says cyber criminals are seeking what they consider easy targets,” by Pamela Lewis Dolan

   http://www.ama-assn.org/amednews/2012/04/02/bisf0405.htm?utm_source=twitterfeed&utm_medium=twitter

   Marc Spitler, senior risk analyst of RISK Intelligence for Verizon which published the report, told amednews that automated attacks searching for remote Internet access services combined with weak passwords have become successful against smaller businesses, and is one of the reasons breaches at doctor offices are on the rise.

   Pamela Dolan writes that according to the Verizon report, healthcare practices and other small businesses indeed represent the largest number of data breaches in 2011. Larry Clinton, president and CEO of Internet Security Alliance, told amednews that “cyber criminals are just one threat to health care data.” He said, “Lost devices and inside jobs also are responsible for a growing number of data breaches.”

   Clinton adds, “Attackers are businessmen themselves. They look for the greatest return on investment, and that would be to attack medical professionals that have little to no security defenses.” That’s us, Doc.

   Believe it or not, the shy ADA leaders who years ago stopped pushing members to embrace paperless practices, HIPAA and NPI numbers will eventually have to admit responsibility for selfishly allowing the ever-increasing liabilities of data breaches to destroy the value of EHRs in dentistry.

   De-identify now. It’s the ONLY answer to safe, inexpensive interoperable dental records.

   D. Kellus Pruitt DDS

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7. Clayton, on April 11, 2012 at 6:50 PM said:

   Hospitals must be more ‘proactive’ about data breach prevention

   Darrell – Hospitals and health organizations need to be more proactive about preventing health data breaches, concluded the authors of the recently released “2012 HIMSS Analytics Report: Security of Patient Data.”

   Click to access Kroll-HIMSS_2012_-_Security_of_Patient_Data_040912.pdf

   Basically, the report said most facilities are too wrapped up in compliance issues to focus on keeping patient data protected.

   Nuff said.

   Clayton

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8. D. Kellus Pruitt DDS, on April 18, 2012 at 4:51 PM said:

   Profitable informatics
   [Dental informatics prove profitable for some]

   “Can dental informatics improve your bottom line?” by DrBicuspid Editor in Chief Kathy Kincade was posted today. I don’t want to ruin the end of her sweet story, Doc, but unless you have business interests in informatics or insurance, the answer is “No.”

   http://www.drbicuspid.com/index.aspx?d=1&sec=sup&sub=pmt&pag=dis&ItemID=310323

   Aside from the fact that electronic dental records are both more expensive and more dangerous that paper records to begin with, even proper coding will never help a dentist extract a tooth faster or do a filling better. Even though there are stakeholders who feel informatics is complex enough to be considered a recognized medical specialty, it is nothing more than a handy tool for performing analytics – not dentistry. In fact, at its best, the demands of informatics only complicate dentists’ jobs. Errors in tedious coding will ALWAYS delay payments from insurers for work already done. And if interest rates rise like some predict, a dentist’s coding errors mean even more windfall profits for insurers at the expense of dentists… who in turn will have to raise the fees they charge patients to stay in business.

   There’s no wonder that Delta Dental, BCBSTX and even the ADA encourage dentists to adopt NPI numbers. Electronic filing of claims using copyrighted ADA codes shifts data entry from insurance headquarters to dental offices. What’s more, without the non-dues income the ADA receives from coding royalties, members’ dues would double – meaning far fewer ADA members.

   You see, informatics offers something worthwhile for everyone… except HIPAA covered dentists and their patients.

   D. Kellus Pruitt DDS

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9. D. Kellus Pruitt DDS, on May 13, 2012 at 6:41 PM said:

   Challenging Larry Emmott

   Question: If a dentist were to purchase an EDR system because dental practice consultant Dr. Larry Emmott deceptively promises a return on investment, should the disappointed customer contact the Better Business Bureau or the FTC? My comment is awaiting moderation on Larry’s website, Emmott on Technology:

   “It is possible to create a completely paperless dental record. And going paperless can save you tens of thousands of dollars.” – Larry Emmott.

   http://emmottontechnology.com/dental-speaker/technology-on-the-rocks-2012/

   Can you finally provide evidence to support this claim, Larry?

   D. Kellus Pruitt DDS

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10. D. Kellus Pruitt DDS, on July 10, 2012 at 12:07 PM said:

    Smoke ’em if you’ve got ’em

    These days, “electronic dental record” hardly ever triggers my Google Alert. But sometimes I get lucky anyway.

    It may come as a who-cares surprise to those whose interests are in other, more popular areas of the HIT industry, but in the last year, electronic dental record salespeople disappeared from the internet. From what I can tell, they’ve completely stopped publicly posting comments to attract sales – much less deny the increased danger and cost of their products over paper dental records (which they can’t). On the payer side of the EDR “mandate,” I attribute dentists’ silence about their disappointment to the fact that up to 95% of them are HIPAA covered entities.

    Justifiably or not, no covered entity wants to risk attracting a HIPAA audit for describing how poorly the bipartisan goal of interoperability is progressing in dentistry. Audits are no longer complaint-driven.

    Here’s my conspiracy theory: When virtually any disappointed dentist considers that an Office of Civil Rights’ subjective finding of “willful neglect” carries the most obscene level of HIPAA fines, it’s far too easy to safely say nothing at all – hoping some other dentist will risk complaining. Such vendor-friendly silence caused by fear of capricious government fines has proven to be a successful form of subtle tyranny for which nobody can be held personally accountable (in the short term). Really now. Who couldn’t see that coming at least as far back as 2003, when the 1996 HIPAA Rule was upended?

    This weekend, I did manage to scare up a rare Linkedin conversation about EHRs in dentistry with Don and Jerry – two HIT stakeholders who assumed I know less about HIT than they know about dentistry. Smoke ’em if you’ve got ’em.

    http://www.linkedin.com/groupItem?view=&gid=4467744&type=news&item=5625470802393591887&commentID=87145871#commentID_87145871

    Dear Don and Jerry:

    I’m not challenging the need for EHRs in hospitals, physicians’ offices or even large, corporate-run dental franchises spanning multiple states – which regularly must replace burned-out dentists and staff. Those are all very complex businesses with a huge need for internet interoperability, template answers and HIPAA trained/certified professional help.

    But that hardly describes sole-proprietor dental practices – approximately 85% of the practices in the US. One should understand that dentistry is intricate handwork performed in sensitive mouths of squirmy 10 year olds. This means that dentists can only treat a dozen or so patients a day without painfully compromising the quality of care.

    “Maybe it’s a matter of educating the users…” Don, you suggest that by simply educating dentists, their bankruptcy-level problems with security will be solved? My respect for the concept of evidence-based research in healthcare – which seems to be unheard of in the HIT industry – forces me to point out that the overall HIT transition is hardly going as smoothly as taxpayers and patients were led to believe. For example, in order to get the American Recovery and Reinvestment Act (ARRA) stimulus passed, stakeholders’ lobbyists leaned hard against a 2005 RAND study that predicted a yearly savings of $100 billion and 100,000 lives from EHRs. As it turns out, the flimsy study was found to be biased in favor of the very HIT stakeholders who supplied the data… And oh how it shows.

    I’m sure this dentist isn’t telling you anything new, but HHS is spending $30 billion in bonuses to persuade physicians (but not dentists) to use health IT products that they would not otherwise use. What’s more, those who orchestrated the RAND study couldn’t have been expected to foresee that HIT security is now costing hospitals alone $6 billion a year, while data breaches from healthcare organizations cost Americans $6.5 billion. So rather than saving $100 billion a year in healthcare as promised, the Congressional Budget Office (CBO) says we can expect HIT to COST $100 billion over the next 10 years. That’s money that arguably would have been better spent actually healing people. I think we at least agree that there needs to be much more transparency in the HIT industry – even if it exposes unpopular truth about waste.

    Rather than pretending that Meaningful Use is the best thing that’s ever happened to healthcare, one could argue that the stimulus was never intended to save money or it would have been part of the health reform bill (ACA). To this dentist, it looks like HITECH was spliced on to the ARRA as a jobs bill – making the interests of patients and providers secondary to stakeholders’. Even President Obama has said that HIT is the “panacea” for unemployment. Where does the money come from?

    On a more serious note, it’s only fair that dental patients be warned that due to rising frequency of medical identity thefts, EDRs are far more dangerous than paper dental records. In addition, a paper-based practice depends on staff knowledge of their ABCs rather than HIPAA. Finding and pulling a dozen paper charts from filing cabinets takes less time than it takes to track down an ever-changing password in order to even log on to an EDR.

    So Jerry, if EHRs already fail to save money in dental care, how much more do “HIPAA trained/certified” professionals cost than alphabet-competent high school students working after school for minimum wage?

    D. Kellus Pruitt DDS

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11. D. Kellus Pruitt DDS, on July 23, 2012 at 8:00 PM said:

    Is Patterson’s Eaglesoft EDR system cheaper than paper dental records?

    Hey, Patterson Dental PR Team. Which one of you anonymous employees wants to take personal responsibility for causing dentists to expect Eaglesoft electronic dental records to save money over paper records? Misleading consumers like that hardly worked out well for the CR Foundation’s former CEO.

    http://www.dentalproductsreport.com/dental/article/now-you-can-effectively-share-treatment-plans-patients-without-wasting-time

    Let’s disregard the FDA and/or FTC’s interest in predatory misrepresentation of a product’s cost and safety for profit. Here’s a story EDR stakeholders like Dr. Larry Emmott should consider before continuing to promise savings to dentists: Less than a year ago, Dr. Paul Child lost his job as CEO of the highly-respected Utah dental research firm CR Foundation because he carelessly stated on Dentistry iQ that EDRs offer dentists a “high return on investment.”

    http://www.dentaleconomics.com/articles/print/volume-101/issue-10/features/digital-dentistry-is-this-the-future-of-dentistry.html

    When the CEO was subsequently asked on the CR Foundation’s Facebook to support the claim of savings over paper dental records – similar to the claims made by Dr. Larry Emmott in Patterson ads – he also had nothing to show. Unlike Dental Products Report officials, credibility with the nation’s dentists has always been highly valued by leaders of the CR Foundation. That’s why Dr. Christensen took over duties as CEO in January, and Dr. Child moved on down the road.

    Many in PR who are involved in efforts to intentionally mislead dentists and patients for profit, still think they are beyond the reach of accountability – just like in the good ol’ days before the internet robbed control of the media from big businesses. The insensitivity of slow-moving, fat dinosaurs is sad, yet also humorous in an ornery way if one knows which tender spots to poke with a sharp stick, again and again.

    D. Kellus Pruitt DDS

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12. D. Kellus Pruitt DDS, on August 1, 2012 at 5:46 PM said:

    EHR industy censorship

    According to a recent survey conducted by Xerox, only 26% of Americans want their personal information stored in electronic medical records.

    http://eon.businesswire.com/news/eon/20120731005334/en/Xerox/Electronic-Health-Records/Survey

    Considering that this is discouraging news for those who profit from the sale of reportedly dangerous EHRs, what’s your opinion of the ethics of stakeholders in the business who hide information from consumers for selfish reasons?

    David A. Feinberg, the moderator of HIPAA 411 Linkedin group, is president of Rensis Corporation – an EHR consultant firm located in Seattle. He is one of three Linkedin moderators who blocked readers from witnessing findings that might hurt his business. How Hippocratic is that?

    Another biased moderator with selfish motives is Mary Yakas, who makes her living as executive director of The Dental Advisor out of Detroit – an EHR consultant company which markets digital records to uninformed dentists. She shields members of Dental Geeks Linkedin group from viewing results of studies that don’t serve her employer’s needs. She’s devoted.

    The third moderator to censor the link to the discouraging findings is Christy Choi from Washington DC, who is the protective moderator of the HIT Linkedin group. While David Feinberg and Mary Yakas are employed by private industry, Ms. Choi serves as the Web Manager at the Office of the National Coordinator for Health Information Technology (ONC) – her salary is paid by the taxpayers she censors.

    While censorship by private business to protect profits is repulsive and clearly unethical, censoring US citizens by government employees is not only tyranny, but it’s against the law. As a taxpayer, it’s my opinion that Christy Choi should be fired from the Department of HHS immediately.

    D. Kellus Pruitt DDS

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13. D. Kellus Pruitt DDS, on August 12, 2012 at 1:07 AM said:

    Latest on EDR mandate
    [EDRs are mandated – True or False?]

    I learned today that the ADA leadership changed their answer to this question for the third time just two months ago.

    On June 24, dentists were told in a Colorado Dental Association online news article that contrary to what “vendors” have been saying, electronic dental records are NOT mandated. The CDA’s opinion directly contradicts 2 out of the 3 articles about the mandate that have been published by the ADA in the last 4 years. Confusing? You bet! But it’s coming to a head. The truth will soon emerge on its own.

    For those keeping track of the ADA’s argument with itself, the count stands at 2 apiece and we are awaiting a tie-breaker opinion from ADA Headquarters, or perhaps another courageous state Association. I’ve found it fascinating to observe this awkward development of national embarrassment from a safe distance. It’s sort of like watching an undisturbed zit achieve its inflamed, indurated potential.

    Mandated

    September, 2008 – ADA President-elect Dr. John Findley: “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.’”

    http://www.ada.org/members/resources/pubs/adanews/081006_findley.asp (Note: The link is no longer valid. Dr. Findley’s interview with Judy Jakush is now only available in print editions of the October 2008 ADA News).

    Not Mandated

    January, 2012 – ADA News: “Dentists and their employees may have heard rumors [see September, 2008 above] of federal mandates requiring dentists to adopt electronic health records (EHRs),… There are no such mandates or deadlines for dentists who do not submit claims to Medicare, or who do not see large numbers of Medicaid patients.”

    http://www.ada.org/5348.aspx

    Mandated

    May, 2012 – ADA News: “Dentistry has joined a growing list of domains…. in preparing for the legally mandated transition from paper records to electronic health records.”

    http://www.ada.org/news/7087.aspx (Note: It’s my opinion that this link could one day become a dead end).

    Not Mandated

    June, 2012 – CDA online News: “Electronic health records are not required – not now and not in 2014. The American Recovery and Reinvestment Act of 2009 (commonly known as the ‘stimulus bill’) offers some incentives to encourage healthcare providers to switch to electronic records systems, including grants of stimulus money for the purchase of electronic records systems. However, the legislation explicitly states that participation in the installation of electronic records systems is voluntary.”

    http://cdaonline.org/index.php?option=com_content&view=article&id=564:aredentalofficesrequiredtousedigitalx-raysystemsby2014&catid=1:latest-news&Itemid=129

    Contrary to what the CDA would have members believe, the “vendors” are not the ones responsible for hatching the rumor of a mandate – not directly. As anyone can see, it was the ADA. Considering that I arguably uncovered a policy of deception in a national healthcare organization, can you think of a more convincing reason for demanding transparency in the dental industry?

    In defense of Dr. Findley’s abject surrender of my profession to vendors, HHS and other stakeholders who don’t care for my patients, he is otherwise known as a smart, capable leader and is well-respected by dentists I respect. That is why I think the man was pressured into promoting others’ ambitious interests rather than his own. Nevertheless, he knew before running for the highest office in the profession that the ADA’s traditional business model is designed to strip vetted leaders of apparent intelligence. The notorious unresponsiveness of ADA officials hints that their freedom of openness and even self-determination are forfeited for the good of the organization. It’s an increasingly rare command-and-control business strategy out of the 1950s that still thrives deep in dentistry’s hidden niche.

    That’s my opinion. What’s yours?

    D. Kellus Pruitt DDS

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14. Darrell, on August 21, 2012 at 9:13 PM said:

    EDR scam

    Is there evidence that electronic dental records are better than paper? No.

    After years of fruitlessly searching for evidence-based studies comparing the cost and safety of EDRs to paper dental records, in the last few days I’ve come to the conclusion that there are no studies. And the reason there are no studies is because entities which would fund such research fear the truth – keeping it hidden to preserve power and/or profit.

    Think about it. If you were an EDR vendor and you could prove that your product is better than the status quo, don’t you think you would have financed a study long ago?

    I’ll go a step further: I think the push for EDRs is the biggest scam in the history of dentistry. For example, Doc. If you had reason to believe that EDRs cost more and are more dangerous than your paper dental records, would you still have purchased them?

    If at some point, history reveals that such critical information was intentionally withheld from dentists by EDR stakeholders, would that not constitute a scam? A huge, stinking, national scam?

    Darrell

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15. D. Kellus Pruitt DDS, on August 22, 2012 at 8:13 PM said:

    Selling EMRs for profit

    “Selling Records for Profit Alleged – Hospital Staffer Targeted Accident Victims’ Records, FBI Says”

    http://www.healthcareinfosecurity.com/selling-records-for-profit-alleged-a-5054?rf=2012-08-22-eh&elq=b18adb7bc1ba4eb6ab38ca4091ca943a&elqCampaignId=4279

    “A former staff member at Florida Hospital Celebration was arrested last week for allegedly inappropriately accessing more than 760,000 electronic health records with the intent to disclose, transfer or sell certain information for personal gain.”

    I started warning about the black market value of stolen medical records years ago, and have been mostly ignored by the dental community. As a matter of fact, there are still a few industry leaders who would silence me only for the sake of appearances. When dentists complain about even lousy products it somehow seems unprofessional.

    D. Kellus Pruitt DDS

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16. Darrell, on August 25, 2012 at 4:25 PM said:

    Yin-yang communications
    [EDR vendors and dentists: A comparison of communication preferences]

    During my struggle to bring transparency to the long-hidden EHR effort in dentistry, I’ve naturally put many stakeholders on the spot. Over the last year, a half dozen or so presidents and CEOs of software companies who refused to respond to my questions publicly, privately invited me to instead call them on the phone, “at your convenience.” I always decline.

    This illustrates a dichotomy I’ve noticed in the dental HIT industry: When discussing cost and safety with dentists, EDR vendors, whose products allow patients’ identities to be shared far too easily, prefer the security that comes with the limited portability of telephone conversations. Ironically, I prefer easily-shared internet conversations with vendors and private telephone conversations with my patients for the very same reasons.

    I’ve discovered the yin-yang of dental communications.

    D. Kellus Pruitt DDS

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17. Darrell, on September 10, 2012 at 10:13 PM said:

    Dental patients’ identities: Extortion bait

    Does it seem to you that bad news about EDRs is coming in nasty clumps these days? “Could hijackers hold your electronic medical records for ransom?” by Erica Cohen was posted on Philly.com yesterday.

    http://www.philly.com/philly/blogs/healthcare/Could-hijackers-hold-your-electronic-medical-records-for-ransom.html#ixzz25EYhFaIr

    “With data breach issues plaguing even the largest of companies, individuals are understandably concerned that their personal information could be leaked to unauthorized users. Release of personal health information is especially concerning because of the information’s private nature.

    However, your medical records also face another kind of risk. Someone could ‘kidnap’ them and hold them for ransom. That someone could make it so that no one, not even your doctor, can access crucial information like your lab results and exam history.”

    Cohen illustrates her point with three documented extortion attempts targeting HIPAA-covered entities. Considering the potential HIPAA fines, state lawsuits and reputational harm that results from notifying (former) patients, how many providers do you think choose to self-report such a data breach rather than quietly pay the ransom, at least once? What do you think most dentists are likely to do if one receives an email from eastern Europe – revealing an accurate sample of his or her dental patients’ identities, along with a demand for thousands of dollars?

    It’s obvious to me that if dentists wish to continue to enjoy the convenience of computerization, the increasingly popular vulnerability to extortion must be stopped. As word gets around about potential profits with little risk of prosecution, it’s easy to predict that extortion from dental offices will only become more common if we remain traditionally silent.

    I’m asking everyone to encourage traditionally unresponsive dental leaders to at least investigate the feasibility of de-identification of electronic dental records. What could it hurt? If patients’ identities are not part of stolen EDRs, the lack of re-sale value makes extortion less likely. In addition, unlike medical records which can be re-identified, the ONC doesn’t consider the loss of dental histories a data breach. That makes fighting extortion far less painful, and much better in the long run for dentists and patients than quietly giving in to criminals again and again.

    D. Kellus Pruitt DDS

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18. Darrell, on September 23, 2012 at 7:22 PM said:

    EDRs: Out of sight, out of mind

    Did you know that even though Wikipedia has lots of information about electronic medical records – including strong criticism about their cost and safety – Wikipedia doesn’t even recognize electronic dental records?

    How good is that, Doc?

    Darrell

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19. Darrell K. Pruitt DDS, on September 25, 2012 at 8:33 PM said:

    eDRs [Cloud vs. Tangible]
    If cloud-based electronic dental records vanish into thin air, will patients seek more tangible records?

    As tedious, non-productive requirements included in HIPAA/HITECH increasingly complicate adoption of EDRs – and as the liabilities and costs of maintaining on-site proprietary EDR systems balloon, encrypted, “cloud-based” EDRs that are maintained in off-site data centers make much better business sense for dentists than proprietary systems… But perhaps not for long.

    My long-held favorable opinion of cloud-based EDR systems was shaken as I read today’s NY Times article, “THE CLOUD FACTORIES – Power, Pollution and the Internet,” written by James Glanz.

    “A yearlong examination by The New York Times has revealed that this foundation of the information industry is sharply at odds with its image of sleek efficiency and environmental friendliness.”

    Glanz adds: “Most data centers, by design, consume vast amounts of energy in an incongruously wasteful manner, interviews and documents show. Online companies typically run their facilities at maximum capacity around the clock, whatever the demand. As a result, data centers can waste 90 percent or more of the electricity they pull off the grid, The Times found.”

    If we are all stewards of the Earth, dentists should be made aware of how much more environmental harm cloud-based systems cause than EDR software running on office computers.

    Even if cloud-based EDR systems are cheaper than proprietary systems (but not paper dental records), how dependable will they be as their energy demands increase beyond availability? Glanz reports that the number of federal data centers grew from 432 in 1998 to 2,094 in 2010. He writes: “Worldwide, the digital warehouses use about 30 billion watts of electricity, roughly equivalent to the output of 30 nuclear power plants.”

    His investigation reveals that diesel generators for Silicon Valley data centers run constantly to guard against power failures – polluting the air we breathe with so much exhaust that many appear on California’s list of stationary diesel polluters. But if the data centers go offline, dental patients’ records could vanish. (Computer crashes never affect paper dental records).

    Mark Bramfitt, a former utility executive who consults for the power and information technology industries, tells the Times, “It’s just not sustainable. They’re going to hit a brick wall.” Glanz: “Some analysts warn that as the amount of data and energy use continue to rise, companies that do not alter their practices could eventually face a shake-up in an industry that has been prone to major upheavals, including the bursting of the first Internet bubble in the late 1990s.”

    Talk about industry upheavals! Imagine the chaos if hundreds or thousands of patients sitting in dental chairs suddenly realize that their electronic dental records are unavailable to their dentists. Secretive dental leaders should be warned that Americans are already only one or two well-publicized data breaches away from seeking dentists with paper dental records. Cloud failure could also trigger patient migration, in my opinion.

    Whether leaders have prepared for patients’ rejection of EDRs is hard to tell because incredibly, they have never been held accountable for misleading dentists about costs and dangers in the first place. Coincidentally, it’s been years since I’ve seen a selling point stating that paperless is more environment-friendly than paper dental records. I suspect most EDR stakeholders have known for a long time that they are in trouble.

    Since EDRs are arguably not only more dangerous and expensive than paper dental records, but also more harmful to the environment, I know a handful of vendors who are in for lean times if they continue to ignore the interests of their customers: dentists and patients.

    D. Kellus Pruitt DDS

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20. D. Kellus Pruitt DDS, on January 17, 2013 at 7:58 PM said:

    On eHR Vendors

    Now, even the EHR vendors are calling for an industry slow-down. Is that not a clear sign that the HIT bubble is now a spent whoopie cushion?

    Today, an article by Zina Moukheiber titled “Government Should Slow Down Race To Implement Electronic Health Records” was posted on Forbes.

    http://www.forbes.com/sites/zinamoukheiber/2013/01/17/government-should-slow-down-race-to-implement-electronic-health-records/

    D. Kellus Pruitt DDS

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21. Darrell, on March 11, 2013 at 10:18 AM said:

    I wasn’t wrong … I was early

    Yesterday, “U. S. Electronic Health Record Initiative: A Backlash Growing?” was posted on ieee spectrum by Robert N. Charette.

    http://spectrum.ieee.org/riskfactor/computing/it/u-s-electronic-health-record-initiative-a-backlash-growing

    Charette says the backlash began to publicly surface in September shortly after HHS accused physicians of unethically using EHRs to “game the system,” when in fact, the EHRs made it convenient to charge for services that were previously given away. Charette notes that in November came HHS’s admission that the EHR incentive program administered by the Centers for Medicare & Medicaid Services was “vulnerable” to fraud. This called for tighter regulation of technology that has failed to save money or lives, and now, providers seeking federal help must submit even more proof that they are meeting the Meaningful Use requirements – that are arguably not meaningful. Even before the increased risk of audits, the future of EHRs looked bleak. There hasn’t been any good news about EHRs since the 2005 RAND study.

    “The backlash gained momentum when RAND published a new EHR study in January of this year that basically repudiated a key RAND EHR study from 2005. The 2005 study, paid for by several large EHR vendors, claimed that the U.S. could save at least $81 billion per year in health care costs, as well as drive down the rate of healthcare spending, through the widespread use of EHR systems. The study was a major point behind selling Congress on the U.S. EHR initiative.

    For EHR vendors, the 2005 study was money well spent. However, the latest RAND study now admits that it was overly optimistic—or, more to the point, hopelessly unrealistic—as its critics at the time said. RAND’s latest report has studiously avoided putting any numbers on how much EHRs reduce (or increase) costs.”

    Charette writes, “’EHR: money loser, or federal government audit magnet?’ is not exactly a good marketing slogan.”

    Darrell

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22. D. Kellus Pruitt DDS, on June 15, 2013 at 5:17 AM said:

    Scoundrels in the clouds

    If you are considering signing a contract with an EHR cloud service provider, you should first read what Michael Uretz has to say.

    It is no secret that this dentist has expressed major disagreements with dangerously biased, EHR vendor-friendly articles written by Michael Uretz, Founder and Executive Director of EHR Group. Nevertheless, Mr. Uretz’s DrBicuspid article titled, “EHR Countdown: Beware the fine print,” which was posted today, is a must read for any dentists considering turning over their patients’ records to a cloud EHR service provider.

    Uretz warns dentists to read those contracts carefully. There are sleazy people in the EHR industry who are not above legally yet egregiously holding dental patients’ records hostage for thousands of dollars should dentists want to change cloud providers.

    http://www.drbicuspid.com/index.aspx?sec=sup&sub=pmt&pag=dis&ItemID=313540

    Nice job, Mike.

    D. Kellus Pruitt DDS

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23. Dr. Pruitt, on August 8, 2013 at 9:51 AM said:

    Dealing with anonymous Dentrix employees

    I’ve got good news and bad news. The good news: “Tokenization/de-identification of the data is the easy part.” The bad news: “Tokenization/de-identification of the data is the easy part.”

    At the moment, I’m still trying to find someone capable of helping this layperson explain to TokenEx how the Dentrix application works and where TokenEx can “hook into.” In an era of open-source cooperation, I find it discouraging that Dentrix’s proprietary hold on information blocks the safe interoperability dental patients desire.

    So does anyone out there know of EDR vendors who might be interested in common sense solutions to data breach dangers – which just might work?

    Darrell Pruitt DDS

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24. Darrell K. Pruitt DDS, on October 4, 2013 at 11:47 PM said:

    UAHN tells its physicians to lie
    [UAHN tells its physicians to lie to patients about EHRs]

    Dr. Scot Silverstein reveals that University of Arizona Health Network physicians are encouraged to say only nice things about Epic’s electronic health record system.

    “Words that Work: Singing Only Positive – And Often Unsubstantiated – EHR Praise As ‘Advised’ At The University Of Arizona Health Network.”

    http://networkedblogs.com/PHCEW

    Dr. Silverstein reports that yesterday in the “Weekly update for UAHN employees,” physicians were told to exaggerate and even lie to patients about the benefits and safety of the network’s Epic electronic health record system. Dr. Silverstein:

    This is shameless. Many of these claims are unsubstantiated or in significant doubt in the literature. They left out issues such as these:

    • The software is tested and validated for safety by nobody, including traditional medical device safety testers.

    • No postmarket surveillance for problems, either.

    • Transparency about problems that can cause patient harm is severely impeded by systematic impediments to information flow (as per IOM’s 2012 study of health IT safety at http://hcrenewal.blogspot.com/2012/03/doctors-and-ehrs-reframing-modernists-v.html, FDA via their leaked Internal Memo on HIT safety as at http://hcrenewal.blogspot.com/2010/08/smoking-gun-internal-fda-memorandum-of.html , the Joint Commission in their Sentinel Events Alert on Health IT as at http://hcrenewal.blogspot.com/2008/12/joint-commission-sentinel-events-alert.html , and others.)

    • Problems known are only the “tip of the iceberg” (FDA, ECRI Institute), as at http://hcrenewal.blogspot.com/2010/02/fda-on-health-it-adverse-consequences.html and http://hcrenewal.blogspot.com/2013/02/peering-underneath-icebergs-water-level.html

    Of the claims they do make:

    • Efficient – see aforementioned links as well as “Common Examples of Healthcare IT Difficulties” at http://cci.drexel.edu/faculty/ssilverstein/cases/

    • Convenient – as above. According to whom? Compared to what? Pen and paper?

    • Improves patient safety and quality – see IOM report post at http://hcrenewal.blogspot.com/2011/11/iom-report-on-health-it-safety-nix-fda.html . We as a nation are only now studying safety of this technology, and the results are not looking entirely convincing, e.g. ECRI Deep Dive Study of health IT safety at http://hcrenewal.blogspot.com/2013/02/peering-underneath-icebergs-water-level.html . 171 health IT mishaps in 36 hospitals, voluntarily reported over 9 weeks, with 8 reported injuries and 3 reported possible deaths is not what I would call something that “improves patient safety and quality” without qualifications.

    • The Cadillac of its kind – according to whom?

    • Patients at hospitals using this system love it – Do most patients even know what it, or any EHR, looks like? Have they provided informed consent to its use?

    • Exciting – clinician surveys such as by physicians at http://hcrenewal.blogspot.com/2010/01/honest-physician-survey-on-ehrs.html and by nurses at http://hcrenewal.blogspot.com/2013/07/candid-nurse-opinions-on-ehrs-at.html shed doubt on that assertion.

    • The best thing for our patients – again, according to whom?

    • Sophisticated new system – “New”? Not so much, just new for U. Arizona Health. “Sophisticated”, as if that’s a virtue? Too much “sophistication” is in part what causes clinician stress and burnout, raising risk; see this summary of a new, not-free JAMIA article “Electronic medical records and physician stress in primary care: results from the MEMO Study”, J Am Med Inform Assoc amiajnl-2013-001875 at http://www.beckershospitalreview.com/healthcare-information-technology/the-relationship-between-emrs-and-physician-stress.html . From that summary:

    … Compared with physicians at clinics with low-function EMRs, physicians at clinics with moderate-function EMRs experienced significantly more stress and had a higher rate of burnout. Additionally, physicians at clinics with moderate- or high-function EMRs felt less satisfied with their current position overall.

    and:

    … Results also showed a significant relationship between time pressure and physician stress in the cohort with high-function EMRs, and only in this cohort, suggesting physicians at these clinics may be particularly pressured for time during patient encounters in the face of a large number of EMR functions. “This ‘made sense’ to us in thinking about the possibility that those in the high-use group had more to do in the EMR” [say the authors].

    • Smartest program out there – “Smartest” meaning what, exactly? According to whom? Who performed the comparison?

    • Streamlined – compared to what?

    • Thank you for your patience – even if the effects on clinicians gets you or your loved ones maimed or killed?

    • Safe and secure network – really? No break ins, ever, considering multiple breach stories like those at http://hcrenewal.blogspot.com/search/label/medical%20record%20privacy?

    • Keeping you informed is our priority – informed of what?

    • Specially trained staff – like these: http://hcrenewal.blogspot.com/2010/08/epics-outrageous-recommendations-on.html ?

    and this:

    • Take Responsibility – I ask, should clinicians “take responsibility” for IT-related disruptions that impair care such as “use error” (as opposed to user error), i.e., what the National Institute of Standards and Technology has called operator error due to poor usability and other features of bad health IT? (See “NIST on the EHR Mission Hostile User Experience” at http://hcrenewal.blogspot.com/2011/10/nist-on-ehr-mission-hostile-user.html .) What about “glitches” and bugs that corrupt or lose data? Should clinicians also ‘take responsibility’ for those? (See for example the posts on the wild things that happen when IT malpractice leads to clinical mayhem at http://hcrenewal.blogspot.com/search/label/glitch .)

    ———————————————

    Why do we empower such slimy business practices from the HIT industry, Doc?

    Darrell K. Pruitt DDS

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25. D. Kellus Pruitt DDS, on January 25, 2014 at 7:59 PM said:

    A peek at transparency – It isn’t pretty, but we’re winning

    By now, many recognize that I have personally been struggling to bring more transparency in dentistry for many years. Please take a look at what I and others have accomplished. Honesty in the marketplace naturally benefits dental patients the most because lacking representation, they become the most vulnerable to hidden greed.

    This week, I was credited by Dissent Doe with causing Dentrix to issue a retraction of its misleading, harmful, Dentaltown ad – which successfully claimed for 14 months that its G5 dental software is encrypted. Even though it was a soft, carefully-worded retraction, it is nevertheless an acknowledgment that Dentrix’s encryption claim was… how do I put this… a lie. Not an innocent, accidental one, but a strategic whopper designed by people who knew better, and intended to sell dangerous software to dentists who don’t know the difference between data camouflage and encryption.

    http://www.dentaltown.com/Dentaltown/Article.aspx?i=304&aid=4146

    But unlike Dentaltown, Dentistry iQ’s competitor in the dental industry publications market, evidence suggests that even if Dentistry iQ ads are found to be misleading, they are never retracted. From an ethics standpoint, misleading, undated Dentistry iQ ads are permanent – like regrettable, ugly tattoos that come back again and again to embarrass you. On the other hand, from a marketing standpoint, there is value in ads which sell products indefinitely – regardless who gets hurt.

    Think about it, Doc. What could possibly go wrong with that marketing fart? Give up? Let me show you.

    Starting in October 2011, I have repeatedly warned Dr. Gordon Christensen’s CR Foundation that Dr. Paul Child, acting as CEO, continues to assure Dentistry iQ readers that EDRs provide dentists a “high return on investment.” Yet Dr. Child offered no evidence to base the claim, even upon request…. That’s because there simply is no evidence. If before making the claim on behalf of CRF, the CEO of the world’s most widely respected dental product research firm had only superficially investigated the rumor of savings over paper dental records, he would have quickly recognized that EDRs are indisputably and increasingly more expensive. (See: “Digital dentistry: Is this the future of dentistry?” by Paul L. Child Jr., DMD, CDT, CEO CR Foundation, Dental Economics, undated).

    http://www.dentaleconomics.com/articles/print/volume-101/issue-10/features/digital-dentistry-is-this-the-future-of-dentistry.html

    By January 2012, Dr. Christensen re-took control of CRF from Dr. Child. I suspect the unsupported claim on Dentistry iQ played a role in his sudden career change. Nevertheless the undated, misleading article remains as fresh as the day it was posted, and continues to cause trusting dentists to assume, 1. EDRs offer HIPAA-covered dentists a high return on investment, and 2. Dr. Paul Child is still CEO of Dr. Gordon Christensen’s CR Foundation (Now called Clinicians Report).

    Yesterday, I learned of another undated, misleading Dentistry iQ advertisement for electronic dental records that might live forever as well. This one takes up where Dentrix’s Dentaltown ad left off – keeping alive the enticing rumor that G5 is encrypted: “The move to make Dentrix G5 an open platform for third-party applications was made possible by its new SQL database with encryption that improves performance while adding advanced security to patient data.” (See “Henry Schein Dentrix G5,” no byline, Dentistry iQ, undated)

    http://www.dentistryiq.com/articles/2012/03/henry–schein-dentrix.html

    One comment follows the press release: “The information in your article is obsolete. The correct term is ‘Data Camouflage’ not encryption.”

    The feedback is from Justin Shafer himself – the security expert credited with warning the US Department of Homeland security about Denrix’s weaknesses in both Vulnerability Notes.

    http://www.kb.cert.org/vuls/id/948155

    http://www.kb.cert.org/vuls/id/900031

    So how do you think Dentistry iQ officials will respond? Will they retract one or more lies about EDRs, or will they risk doing nothing – thereby accepting the liability of empowering harm to dentists and patients… forever? Ugly progress.

    D. Kellus Pruitt DDS

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