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    As a state licensed life, P&C and health insurance agent; and dual SEC registered investment advisor and representative, Marcinko was Founding Dean of the fiduciary and niche focused CERTIFIED MEDICAL PLANNER® chartered professional designation education program; as well as Chief Editor of the three print format HEALTH DICTIONARY SERIES® and online Wiki Project.

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ANOSMIA, HYPERSOMIA, AGEUSIA, HYPOGEUSIA, DYSGEUSIA and the CORONA VIRUS?

WHAT IS “ANOSMIA”

By Darrell Pruitt DDS and David E. Marcinko MBBS, MBA

Anosmia, also known as smell blindness, is the loss of the ability to detect one or more smells. Anosmia may be temporary or permanent. It differs from Hyposmia which is a decreased sensitivity to some or all smells.

According to Wikipedia, Anosmia can be due to a number of factors, including an inflammation of the nasal mucosa, blockage of nasal passages or a destruction of one temporal lobe. Inflammation is due to chronic mucosa changes in the lining of the paranasal sinus and in the middle and superior turbinates. When anosmia is caused by inflammatory changes in the nasal passageways, it is treated simply by reducing inflammation. It can be caused by chronic meningitis and neurosyphilis that would increase intracranial pressure over a long period of time, and in some cases by ciliopathy, including ciliopathy due to primary ciliary dyskinesia. The term derives from the New Latin anosmia, based on Ancient Greek ἀν- (an-) + ὀσμή (osmḗ, “smell”; another related term, hyperosmia, refers to an increased ability to smell). Some people may be anosmic for one particular odor, a condition known as “specific anosmia”. The absence of the sense of smell from birth is known as congenital anosmia.

Ageusia is the loss of taste functions of the tongue, particularly the inability to detect sweetness, sourness, bitterness, saltiness, and umami. It is sometimes confused with anosmia – a loss of the sense of smell. Because the tongue can only indicate texture and differentiate between sweet, sour, bitter, salty, and umami, most of what is perceived as the sense of taste is actually derived from smell. True Ageusia is relatively rare compared to Hypogeusia – a partial loss of taste – and Dysgeusia – a distortion or alteration of taste.

ASSESSMENT:

If you should suddenly lose your sense of smell (anosmia), you might want to get tested for COVID-19 – even without the presence of other symptoms.

“A majority of COVID-19 patients experience some level of anosmia, most often temporary. Analyses of electronic health records indicate that COVID-19 patients are 27 times more likely to have smell loss but are only around 2.2 to 2.6 times more likely to have fever, cough or respiratory difficulty, compared to patients without COVID-19.”

See: “How COVID-19 Causes Loss of Smell – Olfactory support cells, not neurons, are vulnerable to novel coronavirus infection.” By Kevin Jiang for Harvard Medical School, July 24, 2020.

https://hms.harvard.edu/news/how-covid-19-causes-loss-smell

Your thoughts and comments are appreciated.

BUSINESS, FINANCE, INVESTING AND INSURANCE TEXTS FOR DOCTORS:

1 – https://lnkd.in/ebWtzGg

2 – https://lnkd.in/ezkQMfR

3 – https://lnkd.in/ewJPTJs

THANK YOU

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Keeping the CORONA VIRUS Out of Dental Offices?

Opinion-Editorial

[By Darrell K. Pruitt DDS]

The ONLY way to protect dentists, staff, patients and their families from the risk of fatal COVID-19 infections is to keep the virus out of dental offices. (See graph from the New York Times).

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Prediction: If quick and reliable testing is not available soon, within weeks after dental offices re-open for routine dental care – creating aerosols with high speed hand pieces, air/water syringes and ultrasonic scalers – dental offices will justifiably become known as reliable sources of COVID-19 infections, before being closed down again by the state.

Assessment: Your thoughts are appreciated.

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Product Details

 

Few of Us Remove Gloves Properly

MORE Corona Virus Precautions

By Dr. David Edward Marcinko MBA

Courtesy: www.CertifiedMedicalPlanner.org

If you wear gloves because of Covid-19, and if you don’t take them off properly, you just get everything that was all over the gloves, all over yourself and everything else. As a surgeon for almost two decades, I can tell you that taking gloves off correctly isn’t a trivial thing.

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HOW TO REMOVE: Briefly, you want to pinch one glove near the wrist and pull it over your hand so it ends up inside out. Then hold that in your gloved hand and carefully slip the fingers of your bare hand into the top of the other glove, let it turn inside out and cover the balled-up other glove.

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CDC: Check out this step-by-step CDC infographic. And, if you’re not disposing of them properly, you’re just potentially contaminating more surfaces and putting yourself at a much higher risk. Finally, don’t skip hand washing after you take them off, even if you’ve removed them right.

PODCAST: https://www.bing.com/videos/search?q=how+to+removesurgicalgloves&&view=detail&mid=2607568A504FC540B18D2607568A504FC540B18D&&FORM=VRDGAR&ru=%2Fvideos%2Fsearch%3Fq%3Dhow%2Bto%2Bremovesurgicalgloves%26FORM%3DHDRSC3

Assessment: Your thoughts and comments are appreciated.

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BUSINESS, FINANCE AND INSURANCE TEXTS FOR DOCTORS

1 – https://lnkd.in/ebWtzGg

2 – https://lnkd.in/ezkQMfR

3 – https://lnkd.in/ewJPTJs

THANK YOU

***

Asking questions others won’t

About Digital X-ray Manipulation!

[By Darrell K. Pruitt DDS]

Today, I shared a video which revealed how images produced by Computerized Axial Tomography [CAT] scanners can be imperceptibly manipulated for nefarious purposes.

Kinda like so-called “Photo-Shopping”

 Injecting and Removing Cancer from CT Scans

While this scary article is on my mind, I will ask a taboo question which will make me even less popular with most dentists: Can images of digital dental radiographs be manipulated to fool insurers into paying for unnecessary treatment?

If so, is there a technical solution capable of protecting the public from unnecessary dentistry based on doctored images? As harsh as it sounds, if it is possible to photoshop digital radiographs, it would be foolish to assume it is not being done.

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ImageProxy

Injecting and Removing Cancer from CT Scans

Assessment

There. I said it. Your thoughts are appreciated.

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Product DetailsProduct Details

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National Dentist’s Day 2019

Sorry we Missed it. Mea Culpa!

[By staff reporters]

National Dentist’s Day was established to show appreciation and thanks for dentists and raise awareness of dentistry so that people will know more about caring for their teeth.

National Dentist’s Day falls on March 6th every year. It was established as a way to show appreciation and thanks for dentists. It’s also a way to bring awareness to dentistry so that people will know more about how to care for their teeth. It also encourages people who may have avoided going to the dentist to come in for a checkup.

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MORE: http://nationaldentistsday.com/

Assessment: Our thanks to colleague Darrell K. Pruitt DDS for the reminder.

***

[PRIVATE MEDICAL PRACTICE BUSINESS MANAGEMENT TEXTBOOK – 3rd.  Edition]

Product Details***

 

The Doctor Will “SEE” You Now!

OR … Not!

[By staff reporters]

A Medical Office Exam – FROM THIS EMR VISIT!

Your privacy is not protected.

We  use Electronic Health Records.

paper

[Courtesy Dr. DK Pruitt]

A Medical Office Exam – TO THIS PMR VISIT!

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Assessment

Beware – No medical specialty is immune! Which office visit style do you prefer? Are we “Back to the Future?”

Conclusion

Your thoughts and comments on this ME-P are appreciated. Feel free to review our top-left column, and top-right sidebar materials, links, URLs and related websites, too. Then, subscribe to the ME-P. It is fast, free and secure.

Speaker: If you need a moderator or speaker for an upcoming event, Dr. David E. Marcinko; MBA – Publisher-in-Chief of the Medical Executive-Post – is available for seminar or speaking engagements.

Book Marcinko: https://medicalexecutivepost.com/dr-david-marcinkos-bookings/

Subscribe: MEDICAL EXECUTIVE POST for curated news, essays, opinions and analysis from the public health, economics, finance, marketing, IT, business and policy management ecosystem.

DOCTORS:

“Insurance & Risk Management Strategies for Doctors” https://tinyurl.com/ydx9kd93

“Fiduciary Financial Planning for Physicians” https://tinyurl.com/y7f5pnox

“Business of Medical Practice 2.0” https://tinyurl.com/yb3x6wr8

Product Details

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Deborah C. Peel MD on Patient Privacy [video]

An Audio-Video Presentation

[Submitted via Darrell Pruitt DDS]

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Conclusion

Your thoughts and comments on this ME-P are appreciated. Feel free to review our top-left column, and top-right sidebar materials, links, URLs and related websites, too. Then, subscribe to the ME-P. It is fast, free and secure.

Speaker: If you need a moderator or speaker for an upcoming event, Dr. David E. Marcinko; MBA – Publisher-in-Chief of the Medical Executive-Post – is available for seminar or speaking engagements.

Book Marcinko: https://medicalexecutivepost.com/dr-david-marcinkos-bookings/

Subscribe: MEDICAL EXECUTIVE POST for curated news, essays, opinions and analysis from the public health, economics, finance, marketing, IT, business and policy management ecosystem.

HOSPITALS:

“Financial Management Strategies for Hospitals” https://tinyurl.com/yagu567d

“Operational Strategies for Clinics and Hospitals” https://tinyurl.com/y9avbrq5

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Product DetailsProduct Details

EHRs = Opine “YES” or “NO”

EHRs = Opine “YES” or “NO”

A Binary Verbal Opinion Poll

OR

What grade would you give the state of EHR in 2018 on a national basis with physicians and hospitals, and are there aspects that have fallen well short of your past expectations of where we would be today?”

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TELL US WHAT YOU THINK?

On Private Equity-Owned Dental Practices

The boom and bust of private equity-owned dental practices in the U.K …. Lessons to be learned?

By Kellus Pruitt DDS

“Why the dental business became more and more like pulling teeth,” by Harry Wilson, City Editor of The Times (U.K.)

Describes problems caused by agreements made between investor-owned dental groups and the government. Neither the investors nor government officials – the stakeholders – will suffer the inevitable permanent harm. The losers are dentists and patients – the principals.

https://www.thetimes.co.uk/article/why-the-dental-business-became-more-and-more-like-pulling-teeth-vdrs0nwrr

Wilson:

If you are an NHS dental patient, there is a better than one in ten chance that you are a customer of Integrated Dental Holdings, better known as Mydentist.

The private equity-owned dental practice owner has grown nationwide in a dozen years of debt-fuelled buying that has made it the biggest dental services company not merely in Britain but Europe. In the past seven years alone, Mydentist has acquired 237 dental practices, increasing its network to more than 600.

Yet having grown so rapidly in the recent past, questions now are being asked about its future. Results last month showed why, as revenues fell for the third straight year, while pre-tax losses nearly doubled to £144 million. With more than £1 billion of debt, including hundreds of millions in shareholder loans to The Carlyle Group and Palamon Capital Partners, its private equity owners, Mydentist said that it would not be buying any more dentist surgeries for the time being. (more).

———————

Bringing it home:

Rumors of “Medicare for all” are in the air, making your support of Texas Dentists for Medicaid Reform very worthwhile, Doc.

https://www.tdmr.org/about-tdmr/

Conclusion

Your thoughts and comments on this ME-P are appreciated. Feel free to review our top-left column, and top-right sidebar materials, links, URLs and related websites, too. Then, subscribe to the ME-P. It is fast, free and secure.

Speaker: If you need a moderator or speaker for an upcoming event, Dr. David E. Marcinko; MBA – Publisher-in-Chief of the Medical Executive-Post – is available for seminar or speaking engagements.

Book Marcinko: https://medicalexecutivepost.com/dr-david-marcinkos-bookings/

Subscribe: MEDICAL EXECUTIVE POST for curated news, essays, opinions and analysis from the public health, economics, finance, marketing, IT, business and policy management ecosystem.

DOCTORS:

“Insurance & Risk Management Strategies for Doctors” https://tinyurl.com/ydx9kd93

“Fiduciary Financial Planning for Physicians” https://tinyurl.com/y7f5pnox

“Business of Medical Practice 2.0” https://tinyurl.com/yb3x6wr8

HOSPITALS:

“Financial Management Strategies for Hospitals” https://tinyurl.com/yagu567d

“Operational Strategies for Clinics and Hospitals” https://tinyurl.com/y9avbrq5

***

Risk Management, Liability Insurance, and Asset Protection Strategies for Doctors and Advisors: Best Practices from Leading Consultants and Certified Medical Planners™8Comprehensive Financial Planning Strategies for Doctors and Advisors: Best Practices from Leading Consultants and Certified Medical Planners™

 

Happy World Oral Health Day

Join Our Mailing List
Happy World Oral Health Day

[By Staff Reporters]

Today is March 20th – World Oral Health Day (WOHD), a day in which dentists and organizations worldwide are promoting oral health.

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dental

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According to the FDI WOHD website, 90% of the world’s population will suffer from oral diseases in their lifetime, and many of them can be avoided with increased governmental, health association and society support and funding for prevention, detection and treatment programs.

Product DetailsProduct Details

Dental EHRs are a Scam?

Electronic dental records are a scam. They have always been a scam.

By Darrell Pruitt DDS

“Microsoft & Google unable to detect new zero-day ransomware.” By Anthony Spadafora for ITProPortal, February 7, 2018
https://www.itproportal.com/news/microsoft-google-unable-to-detect-new-zero-day-ransomware/

Spadafora: “The ShurL0ckr ransomware was able to avoid detection by a majority of anti-virus engines and cloud applications. As organisations have adopted cloud services to increase their productivity and agility, so to have hackers who see cloud services as the next big target for distributing malware and stealing sensitive data from businesses and individuals.”

Over a decade ago, I warned the American Dental Association leadership about EHRs’ poor security. So did ADA leadership warn Congress? Oh hell no.

“Patient records will be adequately protected through organizational policies and technical security controls.”Dr. Robert H. Ahlstrom, representing the ADA in testimony before the National Committee on Vital and Health Statistics (NCVHS) on the benefits of EHRs in dentistry.

(See: “Testimony of the American Dental Association, National Committee on Vital and Health Statistics Subcommittee on Standards and Security July 31, 2007.”) http://www.ncvhs.hhs.gov/070731p08.pdf

Assessment

Conflict of interest caused unaccountable leaders to lie to us, Doc. How does that make you feel?

Conclusion:

Your thoughts and comments on this ME-P are appreciated. Feel free to review our top-left column, and top-right sidebar materials, links, urls and related websites, too. Then, subscribe to the ME-P. It is fast, free and secure.

Speaker: If you need a moderator or speaker for an upcoming event, Dr. David E. Marcinko; MBA – Publisher-in-Chief of the Medical Executive-Post – is available for seminar or speaking engagements. https://medicalexecutivepost.com/dr-david-marcinkos-bookings/

Contact: MarcinkoAdvisors@msn.com

Subscribe: MEDICAL EXECUTIVE POST for curated news, essays, opinions and analysis from the public health, economics, finance, marketing, I.T, business and policy management ecosystem.

The “CLOUD” Could Get Expensive for Health Care

 AND … DOCTORS

By Darrell K. Pruitt DDS

Without net-neutrality, cloud-based practice management (which is already more expensive than office-based) could cost even more.

The Impactful Industries

“4 industries that could be impacted by net neutrality – With a historic net neutrality vote set to take place tomorrow, people across the United States are rightly concerned about the future of the internet. Visions of price-tiered online spaces dancing in their heads, constituents all over the country are reaching out to their elected officials in a likely doomed effort to forestall what many see as the inevitable destruction of our mostly level digital playing field.”  Healthcare is one of the four.

Jack Morse for Mashable
[December 13, 2017]
http://mashable.com/2017/12/13/net-neutrality-impacts/#rypwq_M6Gmqi

Morse Speaks:

In addition to just being a pain in the ass, the repeal of net neutrality could do real harm to your health. That’s because the modern medical field has come to depend on that aforementioned free and open internet — something very much at odds with Federal Communications Commission chairman Ajit Pai’s plans.

These days, electronic health records are often kept in the cloud, and fast and reliable access to this data is vital to patient care. What’s more, telemedicine — remotely providing healthcare via some form of telecommunication — is super data heavy. Whether that’s remotely analyzing X-rays, or a rural patient connecting with a doctor in a far-off city, this stuff takes a lot of bandwidth.

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Assessment

Will your small-town hospital be able to compete with the Facebooks of the world when it comes to buying a piece of bandwidth pie? Unfortunately, we may soon have to find out.

Conclusion

Your thoughts and comments on this ME-P are appreciated. Feel free to review our top-left column, and top-right sidebar materials, links, URLs and related websites, too. Then, subscribe to the ME-P. It is fast, free and secure.

Speaker: If you need a moderator or speaker for an upcoming event, Dr. David E. Marcinko; MBA – Publisher-in-Chief of the Medical Executive-Post – is available for seminar or speaking engagements.

Book Marcinko: https://medicalexecutivepost.com/dr-david-marcinkos-bookings

Subscribe: MEDICAL EXECUTIVE POST for curated news, essays, opinions and analysis from the public health, economics, finance, marketing, IT, business and policy management ecosystem.

***

Did ADA Leaders Mislead Congress about EDR Security?

 Electronic Dental Records [EDR] Security?

By Darrell K. Pruitt DDS

“Terrifying Truth: Ransomware is Everywhere – At its basest level, ransomware is a form of kidnapping. Hackers effectively ‘kidnap’ a business’s data and information systems and threaten to destroy it unless the business pays a ransom for its safe return.”

Todd Lewis for Nibletz [October 24, 2017]
http://www.nibletz.com/security/ransomware

Lewis: “Healthcare and hospital networks are prime targets for these attacks. A patient whose medical service provider is unable to access critical patient information can be in a life-or-death situation unless the healthcare network is rapidly recovered and brought back on line. Cyberattackers take advantage of this urgency and realize that hospitals have greater incentives to pay a ransom to recover their systems and operations. Moreover, hospital networks operate on a 24-hour basis and are rarely taken down for maintenance and updating that might include patches for security holes. Ransomware attacks frequently take advantage of holes in networks that have not been patched with regular updates, and hospitals and medical centers are more likely than businesses in other industries to have failed to close those holes.”

ADA: “Dentists will have a more complete data set of the patient they are treating, enabling better care.”

Dr. Robert H. Ahlstrom, representing the American Dental Association and by default, all US dentists, in testimony before the National Committee on Vital and Health Statistics (NCVHS) on the benefits of EHRs in dentistry. His testimony is featured in an official document titled “Testimony of the American Dental Association, National Committee on Vital and Health Statistics Subcommittee on Standards and Security July 31, 2007.”

Click to access 070731p08.pdf

Insightful or clueless dentist?

Conclusion

Your thoughts and comments on this ME-P are appreciated. Feel free to review our top-left column, and top-right sidebar materials, links, urls and related websites, too. Then, subscribe to the ME-P. It is fast, free and secure.

Speaker: If you need a moderator or speaker for an upcoming event, Dr. David E. Marcinko; MBA – Publisher-in-Chief of the Medical Executive-Post – is available for seminar or speaking engagements.

Contact: MarcinkoAdvisors@msn.com

***

Dental EHRs are Coming to an End?

Dental EHRs are Coming to an End

By Darrell Pruitt DDS


The reckless third-party push for adoption of increasingly dangerous dental EHR systems is the most harmful scam in the history of dentistry.

But it’s almost over, Doc. Equifax was hacked.

“If a company like Equifax can make significant investments, have every incentive to keep the most sensitive kind of information secure, but still experience a breach … it stands to reason that our playbook needs a revision,”

Josh Mayfield: [Platform Specialist at Firemon Immediate Insight]. (See: “Equifax, U.S. consumers alike will struggle to overcome massive hack” By Tim Johnson for Mcclatchy, September 8, 2017).

Http://www.mcclatchydc.com/news/nation-world/national/national-security/article172078982.html

Why should anyone assume electronic dental records are any more secure than Equifax records?

Not only do digital health records subject Americans to increasing risk of medical identity theft – which can be lethal – but they are increasingly more expensive than paper dental records.

What’s more, electronic dental records offer dental patients NO TANGIBLE BENEFITS:  When is the last time you witnessed a practice advertise the benefits of digital records? On the other hand, you may have also noticed the appearance of paper files in the backgrounds of promotional photos.

A decade ago, I tried to persuade American Dental Association leadership to consider de-identification of dentists’ primary dental records. After all, if identities are unavailable, they simply cannot be stolen. ADA leadership summarily discarded the idea in favor of full disk encryption – which dentists summarily rejected in favor of luck …. And so here we are, Doc. “First, do no harm.”

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Dental EHR vendors simply will not survive transparency without fundamental changes in how patients’ welfare is guarded – which will further increase their cost and liability.

The future is obvious, yet I am the only dentist in the nation openly warning of the inevitable collapse of the electronic dental record industry. Unlike physicians, who treat four to five times as many patients a day and depend on quick interoperability with other physicians, dentists can safely return to paper. They won’t like the inconvenience of carbon paper, but following the Equifax breach of almost half of the nation’s consumers – virtually every one of them mad as hell – dentists will have no choice. Ehrs have become too costly.

Assessment

This week, a dentist on Facebook who tried but failed to defend the censorship habits of a popular dental consultant said I was on a “one-man crusade.” I don’t think he meant it in the good way. I ask you to remember that remark for future reference.

Conclusion

Your thoughts and comments on this ME-P are appreciated. Feel free to review our top-left column, and top-right sidebar materials, links, urls and related websites, too. Then, subscribe to the ME-P. It is fast, free and secure.

Speaker: If you need a moderator or speaker for an upcoming event, Dr. David E. Marcinko; MBA – Publisher-in-Chief of the Medical Executive-Post – is available for seminar or speaking engagements. Contact: MarcinkoAdvisors@msn.com

OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

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Health Information Technology [EMR] Update

2014 to 2017

 

 

 

 

 

 

By D. Kellus Pruitt DDS

Three years ago

“When Patients Fear EHR – When patients believe paper medical records are safer and more private than electronic ones, their health can suffer. Many members of the public mistakenly believe electronic health records (ehrs) are less secure than paper files. Magnified by misinformation and political distortion of facts, an unnecessary fear has taken root in the minds of many consumers — often with serious consequences.” 

-Mansur Hasib

Cybersecurity Professional – Author and Speaker in commentary for informationweek, July 28, 2014

Http://www.informationweek.com/healthcare/electronic-health-records/when-patients-fear-ehr/a/d-id/1297519

This week 

“Doctors claim medical records system puts patient safety at risk – PROBLEMS with Queensland Health’s electronic medical record system are angering health workers, with fed-up senior doctors circulating a document slamming the technology and those in charge of it.”

-Kara Vickery and Janelle Miles – The Courier-Mail, July 25, 2017.

Http://www.couriermail.com.au/news/queensland/doctors-claim-medical-records-system-puts-patient-safety-at-risk/news-story/dc18cb388552eb4d179629c298a28408

“300,000 records breached in ransomware attack on Pennsylvania health system – The breach on Women’s Health Care Group of Pennsylvania was discovered in May, but hackers had unauthorized access to the system as early as January.”

-Jessica Davis – Health Care IT News, July 26, 2017

Http://www.healthcareitnews.com/news/300000-records-breached-ransomware-attack-pennsylvania-health-system

“HIPAA Data Breaches, Cyber Attacks Reported by 47% of Orgs – KPMG found that there was a 10 percentage point increase in reported HIPAA data breaches or cyber attacks from 2015 to 2017.”

-Elizabeth Snell – Health IT Security, July 27, 2017

Https://healthitsecurity.com/news/hipaa-data-breaches-cyber-attacks-reported-by-47-of-orgs

“Doctors frustrated that electronic records steal time from patients – Dr. Rebekah Gardner has to make a choice each time she sees a patient in her Rhode Island office: she can scroll computer screens and click boxes, or she can focus on the patient and take home the computer work.”

-Ronnie Cohen – Reuters, July 28, 2017

Http://www.reuters.com/article/us-health-records-electronics-iduskbn1ad2gt

“Plastic Surgery Associates data breach: Patients’ records, payment card details possibly compromised – The company said it discovered that some of its systems were infected with ransomware in February.”

-Hyacinth Mascarenhas – International Business Times, July 29, 2017

Http://www.ibtimes.co.uk/plastic-surgery-associates-data-breach-patients-records-payment-card-details-possibly-compromised-1632555

Conclusion

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EHRs, ADA Leaders and Conflict of Interest

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A decade later ….?


By D. Kellus Pruitt DDS

In July 2007, Dr. Robert H. Ahlstrom, representing the American Dental Association and by default, all US dentists, testified before the National Committee on Vital and Health Statistics (NCVHS) on the benefits of EHRs in dentistry.

His testimony is featured in an official document titled:

“Testimony of the American Dental Association, National Committee on Vital and Health Statistics Subcommittee on Standards and Security July 31, 2007

http://www.ncvhs.hhs.gov/070731p08.pdf

Here are the ADA’s 11 selling points which Dr. Ahlstrom presented to HHS in support of electronic dental records:

  1. Dental office computer systems will be compatible with those of the hospitals and plans they conduct business with. Referral inquiries will be handled easily.
  2. Vendors will be able to supply low-cost software solutions to physicians/dentists who support standards-based electronic data interchange. Costs associated with mailing, faxing and telephoning will decrease.
  3. All administrative tasks can be accomplished electronically. Dentists will have more time to devote to direct care.
  4. Dentists will have a more complete data set of the patient they are treating, enabling better care.
  5. Patients seeking information on enrollment status or health care benefits will be given more accurate, complete and easier-to-understand information.
  6. Consumer documents will be more uniform and easier to read.
  7. Cost savings to providers and plans will translate in less costly health care for consumers. Premiums and charges will be lowered.
  8. Patients will save postage and telephone costs incurred in claims follow-up.
  9. Patients will have the ability to see what is contained in their medical and dental records and who has accessed them. Patient records will be adequately protected through organizational policies and technical security controls.
  10. Visits to dentists and other health care providers will be shorter without the burden of filling out forms.
  11. Consumer correspondence with insurers about problems with claims will be reduced.

Not one of Ahlstrom’s 11 promises has been fulfilled. None …. Total failure!

A decade later, it has become clear that the nation was misled by ambitious leaders of the American Dental Association who have since enjoyed power and/or profit from members’ misinformed adoption of digital records.

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 In my opinion, the grandest deception in the history of dentistry is clearly a result of a secretive not-for-profit corporation’s conflict of interest. This very important business lesson would have been lost to history if I hadn’t been documenting the true progress of EHRs in dentistry.

I (alone?) recognized very early that paperless was doomed simply because the needs of dentists and their patients was secondary to implementation of third-parties’ half-baked, selfish ideas. And I got spanked for that by the same ADA leadership behind Ahlstrom’s tainted testimony to Congress.

My ADA membership was suspended, and I still have not been told why. All the President of the Texas Dental Association would tell me is, “You know what you did.”

Assessment 

To this day, dental EHRs are both increasingly less secure than paper dental records as well as increasingly more expensive. What’s more, they offer no tangible benefits for the patients. ADA leadership failed my profession.

Transparency is accountability.

Conclusion

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HITECH: A politically-correct Scam?

Update on HITECH

By Kellus Pruitt DDS

“How bad science can lead to bad science journalism — and bad policy – This is what happens when news organizations don’t catch lousy studies.”

By Stephen Soumerai and Ross Koppel for The Washington Post, June 7, 2017/

Https://www.washingtonpost.com/posteverything/wp/2017/06/07/how-bad-science-can-lead-to-bad-science-journalism-and-bad-policy/?Utm_term=.631e0a2d022c#comments

Soumerai and Koppel:  “As researchers who focus on health care, we see news coverage of badly designed studies constantly. And we’re concerned that breathless reporting on bad science can result in costly, ineffective and even harmful national policies.”

You mean like HITECH?

Since the HITECH Act was passed in 2009, it has been well-documented that not only were the premises of the law fiction, but the law itself has always favored healthcare stakeholders like Cerner at the expense of patients and their doctors – the healthcare principals.

The grandest blunder in medical history gained traction in 1999 with an Institute of Medicine (IOM) report titled, “To Err is Human,” which promises that EHRs should have already saved 100,000 lives a year … Not even close. Not unlike the dangerous research bias described in Soumerai and Koppel’s article that was posted recently, several researchers have also pointed out that the studies cited in the IOM report did not show that people were dying from medical errors that health information technology could detect or correct.

The questionable IOM report was followed in 2005 by a tainted RAND Corporation report which promised savings of $77 billion annually… Wrong again!

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Shortly after the report was published, rumors quickly spread that the data for the study were cherry-picked by those with software to sell. By 2011, the passage of time revealed that RAND had clearly made a vendor-friendly mistake, forcing RAND to disown their study – but not before its optimistic conclusion was instrumental in the successful passage of the HITECH Act in 2009 (two years after Minnesota lawmakers had already passed the doomed EHR mandate based on the same tainted RAND results).

Political Fiat

Then presidential candidate Hillary Clinton was only one of many lawmakers to quote the RAND study. Almost everyone the nation was suckered in. Ultimately, it was revealed that the study’s vendor-friendly conclusion was largely financed by software giant Cerner, who continues to profit from years of misinformation.

(See: “In 2nd Look, Few Savings From Digital Records,” by Reed Abelson and Julie Creswell, New York Times, Jan. 10, 2013).

Http://www.nytimes.com/2013/01/11/business/electronic-records-systems-have-not-reduced-health-costs-report-says.html

In fact, it was announced last Monday that Cerner, which is responsible for the most dishonest research in the history of health information technology, has been awarded the Department of Veterans Affairs contract for the VA’s next-generation electronic health records system.

Assessment

Dishonesty wins.

Conclusion

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Why patients will soon prefer paper dental records?

Read for yourself why dental patients will soon prefer paper-based over paperless

[By Kellus Pruitt DDS]

Recently, Marianne Kolbasuk McGee (HealthInfoSec) posted, “Analysis: Are HHS Cybersecurity Recommendations Achievable? Experts Sort Through New Task Force Report.”

http://www.healthcareinfosecurity.com/analysis-are-hhs-cybersecurity-recommendations-achievable-a-9971

McGee: 

“A new Department of Health and Human Services report to Congress containing more than 100 recommendations for how healthcare can better address cybersecurity threats is stirring debate over whether smaller organizations will be able to take the recommended actions.”

Cha-ching!

Privacy attorney David Holtzman, vice president of compliance at the consultancy CynergisTek, tells Healthinfosec:

“The majority of information systems that create or maintain personally identifiable health information are owned and managed by small organizations whose capability or access to the people or technology to secure information systems is limited by financial constraints or ability to attract well-trained human resources,” he says. “At first glance, it is difficult to see how these small organizations can translate the recommendations in the report into tangible progress.”

As large, juicy healthcare organizations successfully harden their cyber-defenses, small healthcare entities – like dental offices – will attract identity thieves with smaller, juicy low-hanging fruit.

Or, as suggested in the article, taxpayers can subsidize cyber-protection for dentists and other small healthcare organizations. In my opinion, that simply won’t happen.

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Wary dental patients – many of whom have received breach notifications or have learned about identity theft the hard way – will find it increasingly easy to find a new dentist who does not put their identities on computers. After all, electronic dental records offer dental patients no tangible benefits anyway.

Assessment

If dental patients’ identities are unavailable, they cannot be stolen …. Still too early for de-identification, Doc? Give it time. I’ve got patience. 

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Conclusion

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Dental Managed Care is Substandard Care

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Dental Managed Care [DMC] is Substandard Care – count on it!

1-darrellpruittBy D. Kellus Pruitt DDS

Have you noticed most employer-sponsored dental plans boast savings of 30% and more on dental care, without mentioning how unsustainable discounts harms their employees?

Dental Managed Care [DMC] is substandard care: Discount dentistry, like virtually all underfunded handwork, has always been substandard … Or perhaps someone would like to argue that intricate surgery in sensitive mouths of nervous patients is improved when rushed.

Discounts are popular

Those who market obscure, hard to understand managed care plans to clueless, perhaps non-caring employers, do not control the quality of the discounted dentistry they sell.

Think about it: Discount dentistry without quality control. Can you think of a worse idea in healthcare?

What’s more, not one Delta Dental, Humana or Cigna executive can be held accountable for causing harm to equally clueless dental patients through underfinanced dentistry they sell. Employees who must choose their dentists from preferred provider lists have forfeited freedom of choice, whether they realize it or not. Their underfunded, substandard dentistry is subsidized by tax payers as a special tax-free benefit, benefiting unaccountable third parties most of all.

For example:

  • Want to know what you get with managed care dentistry? Quick prophys. 
  • How many of you get your teeth cleaned in 30 minutes or less? Do they feel clean?

One Hour

l always allowed my hygienists 1 hour to clean patients’ teeth simply because it often takes that long to do the job right – regardless what insurers say hygienists’ time is worth. The economic climate is tough on fee-for-service.

As I am considering signing on as a preferred provider – not because I want to – I notice that the fees allowed by insurers do not cover the hourly rate of most hygienists… unless they can “clean” teeth, take x-rays, take blood pressure, go over patients’ medical history, allow time for the doctor to do a quick exam and turn around the room in less than 30 minutes.

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retro dental exam room

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Assessment 

The motto of my practice is “Dentistry Unhurried.” I don’t want to compete in a race to the bottom which uninformed dental patients always lose.

Conclusion

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Speaker: If you need a moderator or speaker for an upcoming event, Dr. David E. Marcinko; MBA – Publisher-in-Chief of the Medical Executive-Post – is available for seminar or speaking engagements. Contact: MarcinkoAdvisors@msn.com

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Timeless Art by Pruitt

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My art is now featured on Etsy

I have now stocked my Etsy store with 14 works.

Please come visit me. Take a look around.

“Panhandle Depot” is the first of many

pruitt

[By Darrell K. Pruitt DDS]

The “Panhandle Depot”

Signed and dated, 8×10 print of a high resolution colored pencil painting depicting a Santa Fe locomotive approaching the Panhandle, Texas depot from the East.

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il_570xn_1109931506_siy7

[The painting is based on a photo I took in 1993. The piece was completed in November, 2016]

More: https://www.etsy.com/listing/487534416/panhandle-depot-color-pencil-print

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 Dental Mission

And, I came across a drawing from a dental mission that I don’t think I have shared.

 dsc02456

“Difficult Extraction”

[Based on a photo I took in 1992 during a dental mission to Tela, Honduras, on the Caribbean coast of Honduras]

***

Conclusion

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Recent EHR News

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1-darrellpruitt

Recent EHR News

By Darrell K. Pruitt DDS

“Cerber ransomware decryption tool was available for 1 day before hackers rendered it useless – The authors of Cerber fixed the flaw in the ransomware’s code that made decryption possible.” By India Ashok for International Business Times, August 18, 2016.

http://www.ibtimes.co.uk/cerber-ransomware-decryption-tool-was-available-1-day-before-hackers-rendered-it-useless-1576662

“HIPAA Breach Case Results in Record $5.5 Million Penalty.” By Aldrin Brown for MSP Mentor, August 18, 2016.

http://mspmentor.net/msp-mentor/hipaa-breach-case-results-record-55-million-penalty

“HIT Costs Rose 40% Per Physician Since 2009.” By Christine Kern, contributing writer, Health IT Outcomes, August 19, 2016.

http://www.healthitoutcomes.com/doc/hit-costs-rose-per-physician-since-0001

Kern:  “Healthcare organizations are facing serious financial challenges as they are forced to convert their practices and patient records to digital formats.”

“Office for Civil Rights to Increase Investigations of Smaller HIPAA Breaches.” By National Law Review, August 19, 2016

http://www.natlawreview.com/article/office-civil-rights-to-increase-investigations-smaller-hipaa-breaches

NLR:  “HHS Office for Civil Rights will cast a wider net and increase its investigations into smaller HIPAA privacy breaches starting this month. OCR announced a new initiative to increase its efforts examining breaches that affect fewer than 500 individuals. OCR Regional Offices already investigate every reported breach affecting 500 or more individuals, and will continue to do so, but now they will intensify efforts to scrutinize smaller breaches.”

“2016 is the year to Go Paperless’ – Stop putting it off, going paperless can save you tens of thousands of dollars.” By Larry Emmott for Emmott on Technology, August 19, 2016.

http://emmottontechnology.com/

Conclusion

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Speaker: If you need a moderator or speaker for an upcoming event, Dr. David E. Marcinko; MBA – Publisher-in-Chief of the Medical Executive-Post – is available for seminar or speaking engagements. Contact: MarcinkoAdvisors@msn.com

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Are Paper MRs Safer than EMRs?

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Paper is Safer!

1-darrellpruitt[By Darrell K. Puitt DDS]

“Ransomware Attacks Can’t Hide from HIPAA Anymore – Hospital and health system executives are on notice: Come clean about ransomware attacks as early as possible or be prepared to face sanctions.”

By Scott Mace, for HealthLeaders Media, July 19, 2016.

http://www.healthleadersmedia.com/technology/ransomware-attacks-cant-hide-hipaa-anymore#

Dean Sittig, a clinical informatics professor at University of Texas Health Science Center and the Houston UT-Memorial Hermann Center for Health Care Quality and Safety, tells HealthLeaders,

The new HHS guidance is going to really ratchet up people’s attention, because now you’re also talking about big fines from the government, as well as the effects of the ransomware.”

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ext

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Show Me the Money?

“Survey: Nearly Three Quarters of Physicians Say They Haven’t Seen ROI From Electronic Records.”

By Matt Goodman: [Dallas/Fort Worth Healthcare Daily, July 21, 2016]

http://healthcare.dmagazine.com/2016/07/21/survey-nearly-three-quarters-of-physicians-say-they-havent-seen-roi-from-electronic-records/

Conclusion

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http://www.BusinessofMedicalPractice.com

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PHI RansomWare Just Went Up!

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1-darrellpruitt

[By Darrell K. Pruitt DDS]

Expect malware entrepreneurs to charge what the market will bear, again and again.

“OCR Releases Guidance on Ransomware: ‘Your Money or Your PHI’”. By Dianne J. Bourque for The National Law Review,” July 12, 2016

http://www.natlawreview.com/article/ocr-releases-guidance-ransomware-your-money-or-your-phi

Bourque: “A key component of the guidance provides a ransomware attack that encrypts a Covered Entity’s ePHI is presumed to be a breach. As ransomware can infect a Covered Entity’s entire system, this presumption may lead to enormous breach notification obligations.”

Bourque adds: “OCR indicates that when ePHI is encrypted as a result of a ransomware attack, a breach has occurred because the ePHI encrypted by the ransomware was acquired (i.e., unauthorized individuals took possession of the information) and is thus a ‘disclosure’ not permitted under the HIPAA Privacy Rule has occurred.”

When patients are notified of data breaches – for any reason – many will quietly change providers. According to The Ponemon Institute, loss of future income is the most costly result of lawfully reporting data breaches…. and ransomware attacks are at “epidemic” levels. I have heard dentists are paying the ransom quickly.

The disincentives to do the right thing were overwhelming providers even before the OCR’s recent ruling. Such is the ugly nature of extortion.

Assessment

Cha-ching! 

Conclusion

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Speaker: If you need a moderator or speaker for an upcoming event, Dr. David E. Marcinko; MBA – Publisher-in-Chief of the Medical Executive-Post – is available for seminar or speaking engagements. Contact: MarcinkoAdvisors@msn.com

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Protect Privacy – DO NOT Use EMRs!

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OCR pays its own way

1-darrellpruittSubmitted By‏ Darrell Pruitt DDS

“OCR unleashes second wave of HIPAA audits, but will it diminish patients’ privacy and security expectations?

Healthcare entities should expect the Office for Civil Rights to levy fines that help fund the program.  And until OCR delivers a draft audit protocol breaches will continue at patients’ expense.”

By Tom Sullivan for HealthcareIT News

[March 23, 2016]

http://www.healthcareitnews.com/news/ocr-unleashes-second-wave-hipaa-audits-will-it-diminish-patients-privacy-and-security

Sullivan: “Here come the HIPAA audits. And even though OCR has yet to clearly outline what healthcare providers should expect exactly, one thing to anticipate is plenty of financial penalties.”

And David Harlow, a health lawyer, consultant and founder of The Harlow Group, tells HealthcareIT News,

“Who loses out as a result? Patients. The breaches continue, free credit monitoring services are offered, and we all move forward with a diminished expectation of privacy and security.”

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Conclusion

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Speaker: If you need a moderator or speaker for an upcoming event, Dr. David E. Marcinko; MBA – Publisher-in-Chief of the Medical Executive-Post – is available for seminar or speaking engagements. Contact: MarcinkoAdvisors@msn.com

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LinkedIn Ads Will Now Follow You Around The Web

View Ann Miller RN MHA CMP™'s profile on LinkedIn

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OVER HEARD IN THE DOCTOR’S LOUNGE

[LinkedIn Ads Will Now Follow You Around The Web – Here’s How to Opt-Out]

1-darrellpruitt

 [By D. K. Pruitt DDS]

Because we can’t go anywhere online without some social network tracking our data and using it to cash in on targeted advertising, LinkedIn has created its own online ad network that will allow advertisers to follow you around the web based on the information that LinkedIn knows about you.

BusinessInsider reports that the new LinkedIn Network Display service is selling ads not just on the career-oriented networking site but on 2,500 other sites, using data on LinkedIn’s 347 million registered users to carve out niches of as few as 1,000 users for advertisers to target, according to AdAge.

[Source: Chris Morran-Consumerist, February 19, 2015]

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Risk Management Protection Strategies for Doctors and their Advisors

[Best Practices from Leading Consultants and Certified Medical Planners™]

   Risk Management, Liability Insurance, and Asset Protection Strategies for Doctors and Advisors: Best Practices from Leading Consultants and Certified Medical Planners™
                                ***

Doctor-Patient RELATIONSHIPS in the MODERN Health 2.0 ERA

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[Can We Talk? – A Collaborative Shift in Bedside Manner]

By Mario Moussa PhD MS

By David E. Marcinko MBBS MBA CMP

By Jennifer Tomasik PhD MS

Jennifer Tomasik

“The single biggest problem in communication is the illusion that it has taken place.”

George Bernard Shaw 

Star Trek fans have seen the future of medicine.

Leonard McCoy, also known as “Bones,” describes himself as a “simple country doctor,” although he plies his trade using 23rd. century medical technology. A deeply caring humanist, Bones often spars with the hyper-logical Spock—half human, half Vulcan. But as the Star Trek saga unfolds through The Next Generation, Deep Space Nine, and finally Voyager, Star Fleet physicians become increasingly rational and less recognizably human. The Voyager’s “Doctor” is no person at all. “He” is an infallible computer program designed to mimic compassion, self-assurance, and other soulful qualities.[i]

Health/Web 2.0

Today, when patients communicate through instant messaging, Twitter, Facebook, and other Health/Web 2.0 electronic mediums, they might feel that health providers are already more like the virtual “Doctor” than the all-too-human “Bones.” Before long, according to one technology expert, 20% – 50% of all doctor-patient communication will be virtual.[ii] But we suggest you pause before rocketing ahead into this brave new future that advocates call Health 2.0—the application of social media tools to the health care environment.

Electronic technology

Electronic technology in all of its forms has obviously had a profound impact on medicine. We focus here on just one of its most notable effects: the changing doctor-patient relationship. We believe Health 2.0 has the potential to deepen this relationship—or not. It depends on how you use it.

There are an almost overwhelming number of social media tools for managing the doctor-patient relationship. How do you choose the right ones? We offer some guidance in this essay by focusing on three issues:

The issues

  1. What matters most in the doctor-patient relationship?
  2. What counts as a good relationship?
  3. How should you use social media tools to build a relationship?

We have found that there is no one best way to use Health 2.0 technology. But there is just one rule. As the novelist E.M. Forster said, “Only connect.”

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masks

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Conclusion

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Speaker: If you need a moderator or speaker for an upcoming event, Dr. David E. Marcinko; MBA – Publisher-in-Chief of the Medical Executive-Post – is available for seminar or speaking engagements. Contact: MarcinkoAdvisors@msn.com

  • Petrany, Stephen M. “Star Trek and the Future of Family Medicine.” Family Medicine 40.2 (2008): 132 – 133.
  • Silverman, Jennifer. “Impact of Virtual Visits on Doctor-Patient Relationship Unclear: an end to ‘true medicine’?” Ob.Gyn. News 38.21 (2003): 29.

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[PRIVATE MEDICAL PRACTICE BUSINESS MANAGEMENT TEXTBOOK – 3rd.  Edition]

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  [Foreword Dr. Hashem MD PhD] *** [Foreword Dr. Silva MD MBA]

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EHRs in the News – GAG!

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A Recent Round-Up

1-darrellpruitt[By D. Kellus Pruitt DDS]

“Feds push forward with controversial health rule – The Obama administration is moving ahead with controversial new rules that require doctors to switch to electronic health records or face fees, resisting calls from both parties to delay implementation.”

By Sarah Ferris for The Hill, October 6, 2015

http://thehill.com/policy/healthcare/256120-feds-push-forward-with-controversial-health-it-rule?utm_content=buffer9cd4b&utm_medium=social&utm_source=twitter.com&utm_campaign=buffer

“The Gag Clause is Killing Us – Doctors are barred from discussing safety glitches in software…  And what if doctors — your doctor — is unable to make problems with EHR programs public, due to a so-called ‘gag clause’ written into the contract with the software company, which forbids sharing and publishing, in any form, of potentially dangerous flaws in the IT systems? This is already happening.”

By Deirdre Reilly for HealthZette, October 6, 2015

http://www.lifezette.com/healthzette/gag-clause-is-killing-us/

 “Hackers target Australian health sector, selling records for A$1,000 – Hackers are targeting the Australian health sector, with fully populated digital health records sold on the black market for up to A$1,000 each [$720 US].”

By Beverley Head for ComputerWeekly.com, October 7, 2015

http://www.computerweekly.com/news/4500254986/Hackers-target-Australian-health-sector-selling-records-for-A1000 

 “Electronic health records software often written without doctors’ input – The reason why many doctors find electronic health records (EHR) difficult to use might be that the software wasn’t properly tested, researchers suggests.”

By Kathryn Doyle for Reuters, October 7, 2015

http://www.reuters.com/article/2015/10/07/us-health-software-ehr-idUSKCN0S11OY20151007

 “EHRs provide long-term savings, convenience.”

(no byline), American Dental Association, ADA News, December 6, 2013

http://www.ada.org/en/publications/ada-news/2013-archive/december/ehrs-provide-long-term-savings-convenience

 ***EHR

***

More:

  1. The Percentage of Office-Based Doctors with EHRs
  2. Do Nurses like EHRs?
  3. EHRs – Still Not Ready For Prime Time
  4. The “Price” of eHRs

Conclusion

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Speaker: If you need a moderator or speaker for an upcoming event, Dr. David E. Marcinko; MBA – Publisher-in-Chief of the Medical Executive-Post – is available for seminar or speaking engagements. Contact: MarcinkoAdvisors@msn.com

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***

[HOSPITAL OPERATIONS, ORGANIZATIONAL BEHAVIOR, HIT AND FINANCIAL MANAGEMENT COMPANION TEXTBOOK SET]

Product DetailsProduct Details

[Foreword Dr. Phillips MD JD MBA LLM] *** [Foreword Dr. Nash MD MBA FACP]

***

Is there a Migration of Patients to Paper-Based Dentists?

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Paper Medical Records Become Popular Again?

[By Kellus Pruitt DDS]

1-darrellpruitt

Starting long ago, I warned that as more dental patients are notified of data breaches – some more than once – we are likely to witness an event mandate stakeholders said would never happen: A migration of patients to paper-based dentists.

Now, because of the rapidly escalating costs and liabilities, defiant, slow adopters of electronic dental records [EDRs] can not only expect to provide dental care at a lower cost than “paperless practices,” but patients are on course to learn that some dentists do not put their patients at risk of medical identity theft by putting identities on computers.

Just sit back and watch!

The Ponemon Institute

In February, the Ponemon Institute published  their “Fifth Annual Study on Medical Identity Theft.”

 “Consumers expect healthcare providers to be proactive in preventing and detecting medical identity theft. Although many respondents are not confident in the security practices of their healthcare provider, 79 percent of respondents say it is important for healthcare providers to ensure the privacy of their health records. Forty-eight percent say they would consider changing healthcare providers if their medical records were lost or stolen. If such a breach occurred, 40 percent say prompt notification by the organization responsible for safeguarding this information is important.”

The Paper-Gold Standard? 

So if your patients start asking you not to put their identities – including medical records – on your computers, what will you do, Doc?

Since encryption is a non-starter in dentistry for solid, business reasons, and will make paperless practices even less competitive with paper-based, would you consider employing staff which knows how to use pegboard, ledger cards and lots of carbon paper (The gold standard of security)?

Or, would you prefer not to give up computerization, yet keep your patients safe?

*** paper

***

More:

Assessment

De-identification of primary electronic dental records is sounding better all the time. Am I right? If patients’ identities are not available, they cannot be hacked.

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Conclusion

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Dentists for De-Identification

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A Start-Up Idea

[By Darrell K. Pruitt DDS]

1-darrellpruittAn early, shoestring proposal for a non-profit dedicated to common sense security solutions.

Why? if patients’ identities are unavailable, they cannot be hacked.

Recently, I’ve considered starting a non-profit dedicated to keeping patients’ identities off of dentists’ computers where they are far too easily fumbled thousands at a time. I think I might call it “Dentists for De-identification.” What do you think?

My son Ryan and I have discussed putting together an educational YouTube cartoon – comparing the cost, convenience and security of encrypted Protected Health Information (PHI), to storing PHI, including medical information, only on paper in bulky metal filing cabinets – leaving only nameless, unencrypted dental records on the computer. De-identification is the “other” HIPAA Safe Harbor, meaning if patients’ de-identified dental information is stolen or hacked, nobody has to be notified. And, since the patients’ nameless dental records remain unencrypted, de-ID should not slow down work flow like encryption does.

***

eHRs

***

One could call employing in-house reference numbers to re-connect patients’ digital dental information to paper-based PHI a hybrid solution to an otherwise intractable security problem. The solution is nothing new, and has a long history of success. For decades, police departments have been substituting in-house reference numbers for citizens’ names to protect the owners. I see no reason it cannot work for dental radiographs as well.

Depending on staff’s familiarity with the alphabet, pulling a patient’s thin paper record from a loud filing cabinet might even take less time than correctly typing in an encryption key (on the first try). What’s more, since there is a limit to the number of patients even the fastest dentists can treat in one day, 4000 or so active patients per dentist is a reasonable estimate of the number of records in a  busy dental practice – which is probably one third of the records in the average physician’s practice. Since the dental information remains digital and only a couple of sheets of paper are needed to reveal the patients’ reference number along with a brief medical history, very little filing space should be needed.

The problems with encryption don’t end with correctly entering the key. Once permitted access to encrypted ePHI, it will take much more time to de-crypt one radiograph than it takes to open a manila folder. Depending on the number of radiographs and other digital images – including complex cone-beam radiographs – a patients’ encrypted diagnostic history could require several minutes to view.

I would want to witness the De-ID non-profit professionally investigate whether de-identification indeed offers a cheaper and more secure solution to data breaches from dental offices. I think we all know by now that full disk encryption will never be the answer.

***

Medical Charts

***

Assessment 

Still too soon? Give it time. The FBI assures us that more massive data breaches are just around the corner.

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Conclusion

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The “Selling-Out” of a Profession [Dentistry]?

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Dentistry …?

[By D. Kellus Pruitt DDS]

1-darrellpruittSeveral years ago, a president-elect of the American Dental Association proclaimed, “The electronic health record may not be the result of changes of our choice. They are going to be mandated. No one is going to ask, ‘Do you want to do this?’ No, it’s going to be, ‘You have to do this.’” (ADA News, October 2008).

Looking back, it is easy to recognize the ADA’s renegade capitulation to HHS as a warning sign of things to come.

The ADA is the same national healthcare institution whose leaders joined Delta Dental in persuading dentists to volunteer for HIPAA’s NPI numbers – never revealing what they are to be used for. It’s the same not-for-profit Chicago corporation which continues to protect non-dues revenue by misleading the nation about the “savings and convenience” of EHRs in dentistry. Among all healthcare organizations, the ADA is alone in their enthusiasm for EHRs and Meaningful Use requirements.

And to top it off, the ADA leadership has progressively become less accessible by the community it serves – NEVER entering into open discussions of urgent dental issues on the internet, even to the extent of ending its commitment to answering dental questions for visitors to Dr. Oz’s Sharecare.com. It’s only dentistry for crying out loud!

As a matter of fact, Dr. Maxine Feinberg, the new ADA President, recently suggested in an interview with the ADA’s Judy Jakush that telephone conversations are “The best kept secret of the ADA which members don’t understand.” What?

Dr. Feinberg: “The best-kept secret is that if you have a problem or complaint, you will likely walk away with a positive experience. And, on the rare occasion that the staff can’t help you, there is a good chance that you will speak to Dr. Kathy O’Loughlin, the executive director. That’s amazing customer service.”

***

Insightful or clueless dentist?

***

What’s not to understand? I understand that ADA membership numbers have taken a hit over the last few years, but nevertheless, the dues of a little over 150,000 dentists still help pay the salaries of ADA employees. That’s a lot of phone calls that will have to be transferred to the right person (the first time), scheduled to call back later or be completely ignored. Isn’t email, or even the US Mail a better idea? Or is lousy communication (unaccountability) with dentists and patients the goal?

About that NPI number

How do you feel about the ADA leading the effort to assess and report your value to your community without ever stepping into your office or talking with a satisfied patient? When you volunteered for your National Provider Identifier at the insistence of the ADA and Delta Dental, you agreed to CMS terms. What? Nobody mentioned that?:

“Spread the mission of the DQA – The DQA, formed in 2008 through a request from the Centers for Medicare & Medicaid Services, is comprised of multiple stakeholders from across the oral health community who are committed to development of consensus-based quality measures.” By Kelly Soderlund for the ADA News, November 3, 2014.

Does “multiple stakeholders” sound as costly to you as it does to me, Doc? I say we already have too many stakeholders. What about the principals (dentists and their patients) who pay the stakeholders’ bills?

***

eHRs

***

Does anyone disagree that DQA looks like the ADA’s desperate mission creep for cash? With the chronic drop in membership, the Chicago corporation has turned to vigorous pursuit of non-dues revenue – probably in the form of federal grants and stimulus money from HHS. The ADA (which prefers clumsy communication via telephone), is asking state and local dental leaders to put their own personal credibility at risk by persuading uninformed dentists to unquestioningly accept multiple stakeholders’ assessment of their value to society – just like clueless dentists cooperated in the NPI effort.

Dr. David Schirmer, chair of the DQA’s education committee, tells ADA News: “Eventually, all of dentistry will need to understand quality measures. But before we reach our grass roots membership, we need our leaders in dentistry to understand.” He adds, “I’m challenging those leaders to pave the way for their younger colleagues and help them understand the long-term impact this will have on dentistry.”

ADA Editor Soderlund: “The DQA has taken the lead on developing quality measures within oral health care. These measures touch every practicing dentist in the United States, and with dentistry, how it’s modeled and how it’s financed changes in the future — specifically as a result of the Affordable Care Act — they’ll become even more prevalent. The mission of the DQA is to advance performance measurement as a means to improve oral health, patient care and safety through a consensus-building process.”

“— specifically as a result of the Affordable Care Act —“ Since you never respond, ADA, how do we know you haven’t sold us out once again for taxpayers’ money?

Assessment

If it’s difficult for the ADA to hold onto membership now, just wait until the nation’s dentists figure out that Obamacare cannot give everyone A’s on their internet report cards. This means the majority of dentists are going to be pissed at the ADA for their bad grades, no matter what.

Conclusion

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The Benefits of Dentistry Unhurried

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And Medicine, too?

[By Kellus Pruitt DDS]

1-darrellpruittThe hidden truth about managed care dentistry: Unhurried dentistry is generally of higher quality than hurried dentistry; anyone up to challenging this economic law?

Dental Handiwork

Dental care includes intricate handwork performed to exacting tolerances in sensitive mouths of nervous patients. When dentists compete on discounts (fast dentistry) instead of quality (slow dentistry), fear of bankruptcy fuels the race to the bottom with clueless, vulnerable patients.

 “‘Slow medicine’ strikes a chord – Nearly 500 people — doctors, nurses and ordinary people with an interest in health care — attended a forum Thursday to hear Dr. Victoria Sweet, a physician and author, talk about how ‘slow medicine’ could improve the quality of life of patients. Sweet is Associate Clinical Professor of Medicine at University of California, San Francisco.”

Melinda Morales for the Visalia Times-Delta

[Visalia, California – October 16, 2014]

http://www.visaliatimesdelta.com/story/news/local/2014/10/17/slow-medicine-strikes-chord/17400861/

Morales writes: “When Sweet told the audience she had once wondered to herself, ‘If I could do one thing to improve the quality of health care, what would it be?’ and then followed it up with her solution, ‘I would put time back into the hands of physicians,’ the audience burst into applause.”

***

Insightful or clueless dentist?

***

Enjoy the Teeth

Dentistry is far more enjoyable for all concerned when it is not rushed in order to squeeze out a profit from unsustainable pay offered by unaccountable, conniving discount dentistry brokers … like CIGNA.

“Cigna to launch rating system that ADA calls scientifically flawed – Cigna will launch in 2015 what it calls a cost-effectiveness designation program that rates in-network dentists based on cost and utilization patterns. These ratings will appear as stars within Cigna’s provider directory. According to Cigna, dentists who receive a three-star rating have a fee schedule that results in greater potential cost savings within their geographical area.”

Kelly Soderlund

[ADA News, October 13, 2014]

http://www.ada.org/en/publications/ada-news/2014-archive/october/cigna-launches-rating-system-that-ada-calls-scientifically-flawed

Good reporting, ADA News

This isn’t the first time CIGNA has been busted for selling intentionally misinformed, captive patients discount healthcare with no quality control – depriving Americans of the opportunity to choose providers which most patients prefer. Seven years ago, CIGNA and other insurers were reprimanded for employing Ingenix, UnitedHealth Group’s wholly-owned ranking algorithm designed to drive clients from out-of-network providers to cheaper in-network providers:

“Attorney General Cuomo Announces Agreement With Cigna Creating A New National Model For Doctor Ranking Programs – NEW YORK, NY (October 29, 2007) – Attorney General Andrew M. Cuomo today announced an agreement with one of the nation’s largest health insurers, CIGNA HealthCare (NYSE: CI), as part of his industry-wide investigation into doctor ranking programs. Under the agreement, CIGNA will enhance its doctor ranking program, fully disclosing to consumers and physicians all aspects of its ranking system. Additionally, CIGNA will retain an oversight monitor known as a Ratings Examiner (‘Rx’) who will oversee compliance with all aspects of the agreement and will report to the Attorney General every six months.”

Eric T. Schneiderman

[Office of Current NY State Attorney General]

http://www.ag.ny.gov/press-release/attorney-general-cuomo-announces-agreement-cigna-creating-new-national-model-doctor

See also, “UnitedHealth Group Shenanigans – Ingenix’s Lack of Independence”

Dr. David Edward Marcinko MBA

[Medical Executive-Post, January 16, 2009]

https://medicalexecutivepost.com/2009/01/16/unitedhealth-group-shenanigans/

As you can see, history reveals that Cuomo fruitlessly reminded CIGNA that price is only one variable in “cost-effectiveness.” As dentists and their patients know, correcting careless mistakes is always more costly than doing the job right the first time with the best materials for reasonable pay.

***

slow down

***

CIGNA Speaks

Cigna spokeswoman Karen Eldred tells ADA News,

“Cigna remains committed to introducing enhancements to the mycigna.com’s dental network directory that provide customers with cost [but not quality] transparency and insights when using their dental benefits.”

If anyone in the ADA is allowed to consider non-member dentists’ advice, I would recommend publicly confronting CIGNA with an easy to document comparison of the popularity of CIGNA’s one, two and three star, cost-effective dentists with competitors using doctoroogle.com – arguably the most transparent dentist-rating site in the nation.

http://texas.doctoroogle.com/

Anyone who is interested in performing the simple, consumer-friendly study is almost certain to discover a direct correlation between the amount of time dentists can afford to invest in their work and their preference by patients in the community.

More:

Assessment

Have you ever experienced a cost-effective injection of local anesthetic?

Hurried Care?

Conclusion

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EHRs – AMA versus ADA

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Will Electronic Health Records Ever Be Usable?

[By Darrell K. Pruitt DDS]

1-darrellpruittThe American Medical Association

The AMA attempts to address the frustration EHRs create, especially for doctors and other healthcare workers. ‘It’s easy to use, once you know where everything is,’ the instructor said during an EHR training session I recently attended.

Most EHR companies seem to believe this is an acceptable way to design software. EHR usability has been greatly ignored by vendors, and last week the American Medical Association issued eight usability priorities in an attempt to address the issue.

This directive comes as a result of a joint study by the RAND Corporation and the AMA highlighting EHRs as a significant detractor from physicians’ professional satisfaction.” Commentary by Stephanie Kreml for InformationWeek, September 26, 2014.

http://www.informationweek.com/healthcare/electronic-health-records/will-electronic-health-records-ever-be-usable/a/d-id/1316071

The American Dental Association

On the other hand, “EHRs provide long-term savings and convenience,” no byline, ADA News, December 6, 2013.

http://www.ada.org/en/publications/ada-news/2013-archive/december/ehrs-provide-long-term-savings-convenience

boxing-gloves-1053702

[POW – SPLAT – BIFF – UGH]

More:

  1. The Percentage of Office-Based Doctors with EHRs
  2. Do Nurses like EHRs?
  3. EHRs – Still Not Ready For Prime Time
  4. The “Price” of eHRs
  5. Borges versus Kvedar Video eHR Debate

EHRs versus the Federal Government

Government mandated EHRs – what a waste!

“Doctors, Hospitals Went Digital, But Still Can’t Share Records – After spending billions to switch from paper to digital records — much of it taxpayer subsidized through the economic stimulus package — providers say the systems often do not share information with competitors.”

[Kaiser Health News, October 1, 2014]

http://www.kaiserhealthnews.org/Daily-Reports/2014/October/01/marketplace.aspx

Conclusion

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There’s a New HIPAA Sheriff in Town

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On OCR Director Jocelyn Samuels

1-darrellpruitt

[By D. Kellus Pruitt DDS]

When the explosions of breaches of patients’ medical identities occur – as predicted by the FBI and others – will the new OCR Director Jocelyn Samuels continue to be as sympathetic and forgiving as Leon Rodriguez has been?

Or; will she take on the role of bad cop?

 

The Replacement

Samuels, who is tying up loose ends in her current position with the civil rights division at the Department of Justice, has replaced Rodriguez as the new head of the HHS’ Office for Civil Rights – which prosecutes HIPAA violations. Many are wondering about her level of enthusiasm for enforcement, especially since data breaches are only getting worse, not better.

Privacy and security attorney Adam Greene, who once served as a member of the OCR staff, tells GovInfo that the challenge for Samuels is “to strike the balance where HIPAA is seen as having ‘teeth’ but covered entities and business associates can still count on OCR as being reasonable when there are areas of ambiguity or privacy or security issues occur despite good efforts at compliance.”

(See: “Impact of New HIPAA Enforcement Leader – Are New Strategies, Directions on the Horizon?” by Marianne Kolbasuk McGee for GovInfoSecurity.com, July 11, 2014).

http://www.govinfosecurity.com/impact-new-hipaa-enforcement-leader-a-7049/op-1

Healthcare Harm

Principals in healthcare – providers and patients – continue to be harmed by EHRs designed to satisfy third-parties’ questionable Meaningful Use requirements rather than principals’ needs. For example, on April 8, the FBI warned that EHRs are becoming increasingly vulnerable to hackers. (See: “Health Care Systems and Medical Devices at Risk for Increased Cyber Intrusions for Financial Gain”).

http://www.illuminweb.com/wp-content/uploads/ill-mo-uploads/103/2418/health-systems-cyber-intrusions.pdf

Under Rodriguez, OCR has arguably spared the rod (mostly), choosing instead to discuss and correct HIPAA violations in an informal, private, non-punitive manner. I think both Rodriguez and Secretary Sebelius backed off of more aggressive enforcement because they recognized that without cooperation from doctors and patients, EHRs are certain to fail – mandate or no mandate. Nevertheless, it has proven to be far too easy for stakeholders who cannot be held accountable to patients, to marginalize their needs.

Jocelyn Samuels

[New OCR Director Jocelyn Samuels]

Example

Rodriguez did his best to appease all sides. For example, it was under his watch that the name of the HHS website listing breaches of 500 or more patients’ identities was changed from “Wall of Shame” to the more benign “HHS Breach Reporting Tool.”

For hapless providers whose data breaches were unavoidable, the name change eliminates some of the shame associated with being nationally recognized as a careless doctor who cannot keep thieves from stealing patients’ identities.

Assessment 

As long as there is nothing holding down the cost and liability of HIPAA compliance, there will always be room for more regulation, and the cost of healthcare will never be cheaper.

Conclusion

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Can Politically-Correct Names Save Obamacare?

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Saving Electronic Health Record Interoperability?

1-darrellpruittBy D. Kellus Pruitt DDS

If HHS successfully persuades Americans to use happy names for its bad ideas, will the cheap trick save electronic health record interoperability which is critical to the success of Obamacare?

Healthcare Lexicon 

According to the government’s modernized healthcare lexicon, doctors have been demoted to “providers,” insurance companies, including Medicare/Medicaid, have been promoted to “payers,” and patients’ position in the hierarchy has diminished from “principals” to “stakeholders” – a rank on par with 3rd parties such as insurers, HHS and other unaccountable parasites.

Wall of Shame

Ominously, HHS recently changed the contentious name “Wall of Shame” to a more innocuous“ breach reporting tool,” to describe the public list of data breaches involving the medical records of more than 500 patients. It turns out that the growing list of major data breaches is unexpectedly shaming  far too many providers and payers – including Medicare/Medicaid. Imagine that!

In fact, since Americans’ growing disgust with privacy breaches threatens the very success of Obamacare, there is evidence that HHS has turned to betraying its lawful obligation to the nation by hiding breaches from those who are most vulnerable – Americans.

HIPAA Failure

The half-baked plan to shame providers who experience data breaches – perhaps through no fault of their own – is not working out like HHS had hoped. Due to HIPAA’s abysmal failure to halt data breaches, the Wall of Shame has become a national embarrassment and an obstacle to EHR adoption. I expect the public listing of major breaches to be quietly scrapped soon in favor of keeping patients in the dark concerning their risks of identity theft.

Dentistry 

In dentistry, on the other hand, common sense as well as market resistance evidently caused HHS and other stakeholders to give up trying to prohibit use of the 8 syllable “electronic dental records” in favor of the 14 syllable “electronic health records for dental practices.”

Nevertheless, holdouts (including Dissent Doe) still occasionally feel it is important to correct this dentists when I use “EDR” instead of “EHR.” You got to love ‘em.

Obama Care 

Assessment 

Transparent silliness suggests that HHS is failing in its duties. Due to lack of accountability, we can expect EHRs and EDRs to become even more expensive and more dangerous, possibly bringing an end to Obamacare.

Conclusion

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Are Dentists Satisfied with their EDRs?

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Major Discontent With EHR Adoption

[By D. Kellus Pruitt DDS]

1-darrellpruittUnlike physicians, dentists never complain. That means they are probably 100% satisfied with their electronic dental records.

What do you think, Doc?

MarketWatch 

Recently, the Wall Street Journal’s MarketWatch posted a press release titled, “Physicians Cite Major Discontent With Adoption And Use of Electronic Health Record Systems, Despite Government’s $27 Billion Incentive Program”

http://www.marketwatch.com/story/physicians-cite-major-discontent-with-adoption-and-use-of-electronic-health-record-systems-despite-governments-27-billion-incentive-program-2014-02-07

“CLEVELAND, Feb. 7, 2014 /PRNewswire/ — The $27 billion government experiment to incentivize physicians to convert to electronic health records (EHRs) has not been worth it, according to nearly 70% of physicians surveyed.

Medical Economics 

***

In fact, a national [Medical Economics] survey of nearly 1,000 physicians, set for release on February 10, 2014, shows widespread dissatisfaction related to the functionality and cost of these patient record systems. About 45% of physicians believe patient care is actually worse as a result of adopting EHR technology, two-thirds would not purchase their current EHR system again, and 43% of physicians say these systems have resulted in significant financial losses.

In addition, the current state of technology has not improved the coordination of care with hospitals, physicians say.”

***

It is probably better for HHS that very few dentists were able to participate in the ARRA stimulus giveaway. Otherwise, tax-paying citizens might have learned about the wastefulness of Meaningful Use requirements for dentists – which nobody has the guts to reveal. That pretty much rules out brilliant Meaningful Use ideas.

Those who might patriotically defend the benefits of the tasks would do so, if they were idiots.

So how do dentists feel about their electronic dental records? It’s hard to tell. Over 96% of them are HIPAA-covered entities, making them vulnerable to audits, which can be “random” now. As one can imagine, very few dentists openly discuss EDRs. Do you think the silence is more likely to improve or harm patient care?

doc

Even though thousands of physicians have participated in dozens of national surveys like Medical Economics’ over the last few years, as far as I know, not one survey of dentists’ opinions has ever been published. Perhaps someone can prove me wrong. I doubt it.

The Survey

The results from the Medical Economics survey include:

  • 67% say that system functionality influences their decisions to purchase or switch systems.
  • 48% say that cost is influencing their decisions to purchase or switch systems.
  • Nearly half of physicians say that implementation of EHR systems has made the quality of patient care worse.
  • 69% of respondents say that coordination of care with hospitals has not improved.
  • 45% say they have spent more than $100,000 on an EHR
  • 77% of the largest practices (more than 10 physicians) spent more than $200,000 on an EHR.
  • 38% doubt their systems will still be viable in 5 years.

Assessment

Not long ago, Wisconsin became the first state to outlaw paper dental records, which are both cheaper and safer than digital.

So, is it still too soon for dentists and patients demand more transparency in dentistry? When costs and danger are hidden in dental care, it is always the last in line who suffer the most – clueless, trusting dental patients.

Am I right, Doc?

More:

  1. Sales of Dental Equipment and eDRs Down
  2. Military Electronic Dental Records [eDRs]
  3. Dr. Pruitt Invites Dr. Cohen to Discuss eDRs
  4. Cyber Insurance for Dentists

Conclusion

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Pennsylvania dental patients’ stolen social security numbers posted online

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EDR Data breach in Williamsport, Pennsylvania

By D. Kellus Pruitt DDS

1-darrellpruittOver the last 7 years, I have absorbed a surprising amount of criticism for warning my community that electronic dental records continue to grow both more expensive and more dangerous than paper dental records. That chunk of bad news which not one dental leader is ready to acknowledge is becoming increasingly difficult for even the most popular practice management consultants and other 3rd parties to hide. Unresponsiveness from those who profit from EDR sales is unethical and has already harmed dental patients.

Vulnerability Notes

In the Vulnerability Notes that have been issued by the US Department of Homeland Security to dental software giant Dentrix in the last year, security expert Justin Shafer was thanked in both for alerting authorities to Dentrix’s weaknesses.

Though evasive EDR stakeholders were able to fend off transparency far too long, it is fast becoming obvious to the world that their free ride with no accountability has always been destined to end ugly, and greed is to blame. Unforgiving media coverage of the nation’s loss of confidence in EDRs just might start in day or so in the parking lot of dentist’s office near Williamsport, Pennsylvania. Take cover, Dentrix

Eyeing Dentrix 

In the last two years, Justin Shafer’s uninvited watchful eye over Dentrix’s vulnerabilities may have already helped protect millions of dental patients from identity theft. Nevertheless, Dentrix’s security problems which company officials apparently hide, continue to endanger the welfare of uninformed Americans. I have learned that Shafer doesn’t give up easily. He’s in HIT for the long haul.

Yesterday morning, he posted a heads-up on the City of Williamsport’s Facebook, as well four other local Facebooks, warning of the results of a dental office data breach of Dentrix software: Dental patients’ social security numbers have become available on a zip file from Piratebay.

Shafer: “I am willing to bet there are a lot of your citizens SSN’s in this database. Look at rsc_dat.dat and patient.dat… Seems a dental database ended up on piratebay. You may already know.. you may not.”

He explained it to me this way: “the practice info is in rsc_dat.dat, patient info is in pat_dat.dat. It’s a nightmare, and I told dentrix and the doctor a full year ago.”

Insightful or clueless dentist?

Assessment 

Did your opinion of censorship in dental care recently undergo change?

Conclusion

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The PP-ACA from Medicine to Dentistry

Obamacare and Dentistry

[By D. Kellus Pruitt DDS]

1-darrellpruitt It seems that problems with the PP-ACA have migrated from traditional medicine to the world of dentistry.

“MaineCare dentists hit with massive fines for minor clerical errors, they say – Some clinics face more than $200,000 in penalties under a new audit system that threatens to wipe out services for kids.”

-Joe Lawlor [Staff writer] Portland Press Herald [November 6, 2013]

http://www.pressherald.com/news/MaineCare_dentists_hit_with_massive_fines_for_minor_clerical_errors__they_say_.html

 “The new system gives auditors, who work for a private contractor, financial incentives to find small errors by paying them more for each mistake they discover.” Maine adopted the auditing system to comply with the federal Affordable Care Act, otherwise known as Obamacare.

 Lawlor continues: “The audits are intended to root out fraud and abuse, but dentists told the Portland Press Herald that auditors are finding typographical or clerical errors that do not compromise patients’ care or defraud the government.”

A Clawback?

Dr. Michael Dowling, co-owner of Falmouth Pediatric Dentistry, tells the Herald, “This is not finding fraud and abuse. This is a clawback. They (state officials) are trying to take back money that we billed them legitimately.”

Still want to help the poor so much that you are willing to take your chances with the ACA auditing system, Doc?

Dentists facing bankruptcy

According to Lawlor, some dentists are actually facing bankruptcy because of ridiculously expensive fines over minor errors. Other Maine dentists who are otherwise willing to work for charity-level fees in order to help children who have nowhere else to turn, are dropping out of MaineCare. President Obama’s plan to use outrageous fines to fund the state and federal coffers, as well as the bonuses of ambitious auditors, is destined to fail.

How can the Affordable Care Act [PP-ACA] possibly make care more affordable for children with toothaches, if it runs off all the dentists?

Mobile-Security

Assessment

Is it beginning to look to you like Obamacare might have been designed to serve the interests of unaccountable healthcare stakeholders rather than the interests of doctors and patients – the healthcare principals? Why do we put up with this crap, Doc?

Conclusion

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The RAND Corporation’s Health IT Legacy‏

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Understanding ObamaCare and HIT Data Breaches

[By Darrell K. Pruitt DDS]

1-darrellpruittTwo current topics in the HIT industry: (1) A dishonest 2005 RAND study set up lawmakers for disappointment in electronic health records, which are essential to Obamacare, and (2) I told you so.

The Reports

Just the other day, there were reports of two data breaches of EHRs involving over 734,000 patients in Texas and California.

http://www.ihealthbeat.org/articles/2013/10/23/health-facilities-in-california-texas-report-health-data-breaches

For reasons like this, the wisdom of an ambitious mandate for paperless healthcare by 2014 is beginning to be questioned by the same lawmakers who were sucked in years ago by RAND’s tainted 2005 study.

According to the vendor-friendly results gleaned from vendor-friendly data supplied by vendors, EHRs should have started saving 100,000 lives and $77 billion a year, years ago. Predictably, that has not happened. Far from it!

The Findings 

The happy findings – discredited even by RAND in January of this year – were paid for by Cerner and GE, who profited immensely from their RAND investment. Since nationwide adoption of EHRs became a bi-partisan goal with bubbly beginnings and millions of campaign dollars, the costs and danger of healthcare IT didn’t appear to bother conservatives until three months after RAND admitted the study was garbage.

In April, six GOP senators, led by Sen. John Thune (R-S.D.), released a detailed report criticizing HHS Secretary Kathleen Sebelius’ execution of a $35 billion initiative to promote EHRs as part of the ARRA stimulus package. (See: “GOP senators raise concerns with push for electronic medical records,” by Sam Baker, April 16, 2013, The Hill).

http://thehill.com/blogs/healthwatch/medicare/294273-gop-senators-raise-concerns-with-push-for-electronic-medical-records

Wither ARRA?

Have you ever wondered why ARRA was passed as a jobs bill rather than as part of healthcare reform? Any ideas?

More recently, with the conservatives’ failure to stop Obamacare even by shutting down government, EHRs have become recognized as the ACA’s next best weakness. Yesterday, Greg Scandlen, writing for RightSideNews.com, posted “The Tyranny of Electronic Systems.” It goes downhill from there.

http://www.rightsidenews.com/2013102333379/life-and-science/health-and-education/the-tyranny-of-electronic-systems.html

Even More

Also yesterday, Michelle Mailkin writing for Townhall.com, an ultra-conservative website similar to RightSideNews, posted, “Don’t Forget Obamacare’s Electronic Medical Records Wreck.

http://townhall.com/columnists/michellemalkin/2013/10/23/dont-forget-obamacares-electronic-medical-records-wreck-n1730172?utm_source=TopBreakingNewsCarousel&utm_medium=story&utm_campaign=BreakingNewsCarousel

Assessment 

Conservatives found traction: Without the anticipated healthcare savings from EHRs, Obamacare will not survive. These times are not as happy for EHR stake-holders as RAND led them to expect.

Conclusion

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On the Notice of Privacy Practices

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Encryption and HHS are Taking Hits

[By D. Kellus Pruitt DDS]

1-darrellpruittIt is bad politics for the President’s Department of Health and Human Services to get caught deceiving voters.

Word gets around much faster than it did before transparency sucked the power from the entrenched.

The NoPP

You know those Notice of Privacy Practices (NoPP) forms we are asked to sign in doctors’ offices? Since it makes no difference to anyone whether patients sign them or not, why needlessly waste everyone’s time? The NoPP is not an agreement, and just because virtually everyone is tricked into signing it, does not mean anyone reads it. HIPAA has become a source of danger to patients, with no redeeming value.

HHS Estimates 

According to the US Department of Health and Human Services own recent estimate:

“… many centuries of time—nearly 35 centuries, in fact, or just short of 30.7 million hours—will be devoted each year by healthcare providers and patients for the dissemination to patients and their acknowledgement of HIPAA notices of privacy practices [NoPP] for protected healthcare information, HHS estimates. Even at just 3 minutes apiece, with 613 million of these routine privacy notices to be delivered, signed and stored, the time adds up…”

-Joseph Conn

… “HHS estimates 32.8 million hours of interaction required to comply with privacy, security rules” …

-ModernHealtcare.com [September 5, 2013]

http://www.modernhealthcare.com/article/20130904/BLOG/309049995?AllowView=VW8xUmo5Q21TcWJOb1gzb0tNN3RLZ0h0MWg5SVgra3NZRzROR3l0WWRMWGJYZjBGRWxyd01qUzMyWmVpNTNnWUpiV2s=&utm_source=link-20130904-BLOG-309049995&utm_medium=email&utm_campaign=hits

Censorship Concerns? 

I tried to bring attention to this absurdity over a year ago – back when HHS was still keeping unfavorable news about EHRs hidden from voters using censorship:

… “Put another way, the ONLY reason for a doctor to ask patients if they feel like signing the NoPP is to protect already busy doctors from a HIPAA fine. How is that not senseless, yet admittedly humorous bureaucratic waste?” …

On July 3, 2012, my opinion of the waste that HHS recently confirmed was censored by an HHS employee from the taxpayer-supported Linkedin site, Health IT and Electronic Health Records. If that is not against federal law, it damn sure should be.

http://www.linkedin.com/groups/IT-in-Healthcare-Why-Building-3993178.S.216432610?qid=bafac2e5-fb9c-4a39-8348-5a3074abff67&trk=groups_items_see_more-0-b-ttl

Among the items that HHS requires providers include in Notices of Privacy Practice is a one-sentence statement addressing data breaches:

…“We will let you know promptly if a breach occurs that may have compromised the privacy or security of your information [unless it is encrypted]”…

http://www.hhs.gov/ocr/privacy/hipaa/npp_booklet_hc_provider.pdf

Now that it is widely known that encryption is no longer acceptably secure, protection from accountability is encryption vendors’ only remaining selling point. HIPAA stipulates that if breached patient information is encrypted according to standards set forth by the National Institute of Standards and Technology (NIST), doctors are freed from the tremendous cost of notifying (former) patients – even though patients’ privacy and security have been nevertheless compromised.

For example, two weeks ago, the NIST abandoned the very encryption standards that HIPAA demands. Oops! (See: “Government Standards Agency ‘Strongly’ Suggests Dropping its Own Encryption Standard,” by Jeff Larson and Justin Elliott, ProPublica, September 13, 2013).

http://www.propublica.org/article/standards-agency-strongly-suggests-dropping-its-own-encryption-standard

###

eMR Privacy

###

NSA Secrets 

US spy agency NSA’s secret success at decrypting previously impenetrable codes – which was revealed by former NSA contractor Edward Snowden – proves that today’s best encryption is tomorrow’s crossword puzzle. What’s more, once an individual’s medical identity is lost in the cloud, it can never be reeled back in.

And, when DNA records are included, a breach today could put the welfare of generations of Americans at risk.

A Gut-Check 

The ultimate gut-check: If your encrypted identity were fumbled, wouldn’t you want to be notified? Of course you would.

Assessment 

In my opinion, the HIPAA Rule should be immediately amended to demand notification of all individuals involved in all data breaches unless they allow opt out. Who knows? Some might prefer not to be bothered.

What is your opinion; doctor, patient and/or consultant?

Conclusion

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Did the NSA End Obamacare?

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Did ambitious NSA officials unintentionally end Obamacare years ago?

[By D. Kellus Pruitt DDS]

1-darrellpruittIf loss of trust in encryption ends Obamacare, can whistleblower Edward Snowden be blamed for that as well? Yep.

What’s even more ominous, the former National Security Agency contractor’s news that encrypted medical records are no longer secure reached Alaska on a weekend.

“Risky electronic health records: Alaska should make information exchange system safer – Imagine: The National Security Agency slips into your doctor’s office and peeks at your medical records,”

by Alaska ACLU executive director Joshua Decker was posted hours ago on Newsminer.com, out of Fairbanks.

http://www.newsminer.com/opinion/community_perspectives/risky-electronic-health-records-alaska-should-make-information-exchange-system/article_a9947eb0-1863-11e3-8153-001a4bcf6878.html

Decker questions the security of the state’s Health Information Exchange (HIE), and offers common sense but costly steps which arguably lessen the danger of privacy breaches – including giving patients the choice of “opting-in” to permit their encrypted, but increasingly vulnerable identities to be shared online via Obamacare’s exchanges.

My POV 

In my opinion, if informed Americans are given the choice of volunteering to risk identity theft, HIEs won’t be around a year from now, and neither will Obamacare. If informed Americans are not given a choice, the costs are even greater. Americans deserve honesty.

National Obamacare Hangs in the Balance

In a related, slow-burning game-changer, Obamacare hangs in the balance, not just for Alaska, but for the nation.

It was September 5th when the Guardian Weekly posted: “Revealed: how US and UK spy agencies defeat internet privacy and security,” written by James Ball, Julian Borger and Glenn Greenwald, and based on top secret NSA information Snowden stole.

http://www.theguardian.com/world/2013/sep/05/nsa-gchq-encryption-codes-security

Snowden told the Guardian that years ago, the NSA joined with the UK’s spy agency GCHQ (Government Communications Headquarters) to successfully make encryption obsolete – including for medical records.

Naturally, if properly informed Americans fear that secrets they tell their doctors might be breached, incorrect EHRs become less than worthless. They become dangerous.

More on Health Information Exchanges

What’s more, even before the added expense of waiting for Americans to opt-in to the exchanges – instead of discouraging them from opting-out – the very funding for the increasingly-battered Obamacare is based on a rumor of savings.

Starting years ago, health IT lobbyists, including former Speaker of the House Newt Gingrich, told lawmakers to expect annual savings of $77 billion and 100,000 lives – quoting the results of a once popular, EHR-friendly 2005 RAND study which was funded by General Electric and Cerner Corporation.

Obamacare

As you can see, while we were not paying attention, we were had!

The RAND Study

Predictably, both GE and Cerner profited immensely from the development and sales of EHR systems before the RAND study was widely discredited months ago – even by RAND.

According to a NY Times article from January, “Cerner’s revenue has nearly tripled since the report was released, to a projected $3 billion in 2013, from $1 billion in 2005.”

(See: “In Second Look, Few Savings From Digital Health Records by Reed Abelson and Julie Creswell, January 10, 2013).

http://www.nytimes.com/2013/01/11/business/electronic-records-systems-have-not-reduced-health-costs-report-says.html?_r=0

Assessment

Last weekend’s bad news for Obamacare is still under the radar, but I predict within days it will become apparent that the mounting obstacle between President Obama and healthcare reform will be in regaining trust his administration squandered while helping GE and Cerner profits at the expense of soon-to-be pissed off American patients.

Conclusion

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The Danger of Used Health Information Technology

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Remember to destroy that hard drive!

By D. Kellus Pruitt DDS

1-darrellpruittNEWS FLASH!

Affinity Health Plan to Pay $1.2 Million+ for HIPAA Violations -The HHS Office for Civil Rights on August 14 sent the industry a message on the importance of erasing protected health information on hardware being sold, recycled or returned,” by Joseph Goedert, HealthDataManagement.

http://www.healthdatamanagement.com/news/breach-notification-hipaa-privacy-security-affinity-46483-1.html

Talk about bad luck

A photocopier once leased by Affinity Health was purchased by CBS Evening News – which discovered that the copier’s hard drive contains 344,579 individuals’ unencrypted Protected Health Information.

The Response

In response to the federal investigation triggered by the CBS discovery, the Office of Civil Rights announced: “OCR’s investigation indicated that Affinity impermissibly disclosed the protected health information of these affected individuals when it returned multiple photocopiers to leasing agents without erasing the data contained on the copier hard drives.

Moreover ….

In addition, the investigation revealed that Affinity failed to incorporate the electronic protected information stored on photocopier hard drives in its analysis of risks and vulnerabilities as required by the Security Rule, and failed to implement policies and procedures when returning the photocopiers to its leasing agents.”

Assessment

Before disposing of used technology, remember to destroy the hard drive.

Conclusion

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Dental Insurance Doesn’t Exist [video]

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Don’t be Fooled?

By D. Kellus Pruitt DDS

1-darrellpruittDowney, California dentist John McCallister DDS has produced a splendid video which blows apart myths which keep dental “insurance” companies in business.

The more appropriately called, “discount dentistry brokers” – who casually hide dentists’ concerns – simply cannot survive transparency.

The Video: http://www.youtube.com/watch?v=PPo4XsYhHPk&feature=youtu.be

Quality?

Let’s face it. Purchasing rushed dental work which Delta Dental discounts more than 30% – or even faster dentistry that is discounted up to 65% by Brighter.com – will always be a foolish investment in one’s health simply because managed care dentistry has NO QUALITY CONTROL.

What’s more, neither Steve Olson, CEO of Delta, nor Brighter.com CEO Jake Winebaum can ever be held accountable for the shoddy work they sell.

Share the Cartoon

The Hippocratic thing to do, Doc, is to share Dr. McCallister’s cartoon with everyone.

As for me, I especially look forward to publicly taunting Delta Dental Insurance Company through @DeltaDentalins on Twitter, as well as CEO Jake Winebaum via @Brighter.com.

Jake blocked me from following @Brighter.com years ago after I asked him about Brighter.com’s quality control measures (There are none. Isn’t that right, Jake?)

Assessment

I pick on Delta Dental and Brighter.com not just because they are unresponsive to dentists’ concerns, but Steve Olsen and Jake Winebaum run the two most harmful examples of sleazy discount dentistry businesses.

Conclusion

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Do Nurses like EHRs?

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Do RNs like using electronic health records?

[A seldom considered POV]

1-darrellpruitt

BY Darrell K. Pruitt DDS

Some Facebook comments:

Big problems when you have unexpected “downtimes”.

July 15 at 3:10pm · Like · 4

It is an absolute train wreck. I haven’t seen one record of mine that is not riddled with mistakes. Especially the allergies, they show me taking meds I’m allergic to and not taking meds I’m actually on. A true mess!! And now the records are all intertwined. I don’t like it at all!!

July 15 at 3:10pm · Like · 2

It is a nightmare!

July 15 at 3:18pm · Like

I retired just in time so I don’t have to deal with this fiasco.

July 15 at 3:19pm via mobile · Like · 2

IT SUCKS

July 15 at 3:19pm · Like

I don’t like them; my doctors don’t like them; how it will affect patient care is still a ‘jury out’ matter, but we can guess it will NOT help.

July 15 at 3:30pm · Like

Our Rural Community Healthcare system is just now switching over to this .. along with our hospital switching over to a totally new computer system .. the 2 systems do not talk to each other..In my personal experience I find that the “computer” world takes us away from Direct Patient Care (to busy playing “ring around the Rosie” on the computer).

July 15 at 3:40pm · Like · 4

I like them, but it is frustrating having “downtime.”

July 15 at 3:41pm · Like

I hear patients stating things like “my doctors don’t know who I am because they don’t look at me they are glued to the computer”. It saddens me patients feel less valued. I’ve worked in places where they’ve had paper charts and places computerized. Seems the computers are redundant and I personally prefer paper charts. Chart one assessment not one assessment 4 different places.

July 15 at 3:44pm via mobile · Like · 3

It looks to me like physicians are cutting and pasting old histories and physicals, complete with the errors. Doctors in a local ER charted complete physicals on me when they did not get closer than 5 feet away. The records are difficult to read, difficult to find information; and it is not number in chronological order.

July 15 at 3:47pm · Like

I dislike it. Besides the down time, I find it very impersonal. I don’t feel as if I am giving my full attention to my pt, nor do I feel my PCP is hearing what I’m saying . They are too busy putting in info on the computer. As for the down time you then have to work late to put in the info gathered while the system is down.

July 15 at 3:47pm via mobile · Like · 2

eHRs

Assessment

https://www.facebook.com/friendanurse/posts/654085127954821

More: On DIgital Deaths

http://www.bloomberg.com/news/2013-06-25/digital-health-records-risks-emerge-as-deaths-blamed-on-systems.html

(50+ other comments)

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On the Future of Dentistry?

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Not good for the profession … as we know it!

By D. Kellus Pruitt DDS

1-darrellpruittIf you have not yet noticed, the future doesn’t look good for the dental profession as we know it.

Like far too many neighborhood primary care physicians who can no longer make a profit on their own, managed care is having its way with dentists as well.

Unfortunately, our patients remain clueless about downsides to discounted care sold by huge, insensitive corporations manned by executives who cannot be held accountable for their favorite providers’ level of care.

Since as a dentist I am somewhat transparent anyway, I would like to share some feelings with friends about an awkward subject that is on the minds of more dentists than one might expect, yet (almost) none feel comfortable revealing it: Regardless of the public’s perception of dentists’ wealth for the last few decades, it does not look like the anticipated economic recovery is likely to include the small dental practice down the street.

Schadenfreud

Not unlike Schadenfreude, I am certain at least some of dentistry’s disappointed customers may find this news addictingly pleasing to savor – up until one needs a dentist for a problem that cannot be handled safely by their designated dental therapist preferred by insurance MBAs.

I watch the dental news closer than most dentists, and sadly, my studied predictions have always proven to be very accurate, even if unpopular. Today I confidently predict that the profitability most dentists enjoyed for decades will not return for years – perhaps a decade or more.

On the other hand, as it becomes increasingly difficult to find dentists who allow time for gentle injections, patients should expect to pay them better than most. When an imbalance in the free market becomes unsustainable by artificial means such as managed care’s pay-for-performance algorithms, this is the way competition regulates quality in a natural way.

Personally, I’ve dealt with the downturn by working part time as an associate of another practice to make ends meet, and I feel fortunate to have found such a wonderful opportunity with a wonderful, patient-centered team. Marci, my wife, seems to be happier as well.

Assessment

Sorry if today’s news was a bummer, Doc. Maybe it is time others spoke up as well. Our leaders’ obvious lack of interaction on the internet exposes a tremendous vacuum, and they are incapable of rescuing the profession with silence… and neither will rushed therapists in huge dental clinics.

It’s up to you and me, Doctor. Come on out. The air is fine.

Conclusion

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Cyber Insurance for Dentists?

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Are we de-facto targets?

By D. Kellus Pruitt DDS
pruitt

Have you purchased cyber insurance yet, Doc?

If you are a HIPAA covered entity, you’re going to need it.

Press release: “AIG among insurers seeking more sales as small firms get hacked” (no byline).

“Smaller companies [including dental offices] are learning that, as more data is shared online, they, too, can be targets for the kinds of attacks that larger firms endure. American International Group Inc. and Travelers Cos. are among insurers tailoring cybersecurity products to those customers.”

http://www.delawareonline.com/article/20130322/BUSINESS09/303220034/AIG-among-insurers-seeking-more-sales-small-firms-get-hacked

The Expert Speaks

Bob Parisi, network security and privacy practice leader at the insurance brokerage of Marsh & McLennan tells DelawareOnline that small and mid-size companies are “where we’re going to see some of the most aggressive growth in the next couple of years, because it’s been a part of the market that was ignored.”

The ad describes how a California-based online print shop was targeted by hackers who exposed clients’ names, addresses and credit-card numbers last year. Much like dentists whose EDRs are hacked, after discovering the breach, business owner David Handmaker had to notify affected customers. The Ponemon Institute predicts that 20% or more of the customers notified will instantly become former customers.

“We’re just much, much more aware of the fact that being a small company” makes us more of a target,” Handmaker tells DelawareOnline. He adds that larger businesses have “more resources, and so I think their security practices are maybe a little more evolved.”

Assessment

Small businesses such as print shops and dental practices have become de-facto targets – and according to security experts, easy pickings. I’m not wrong. I’m early.

More

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Healthcare Adversaries [video]

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Of HHS and AHIP

By Darrell K. Pruitt DDS

pruitt6If HHS and AHIP continue to give doctors the bum’s rush, what languages can we expect migrant providers to speak well?

The Conference

Last week, I came across a video of a health care conference held a month ago at the University of Miami. During a discussion period, a Miami spinal surgeon named Dr. Nordham warned that more Medicare pay cuts will make small, solo practices like his unsustainable.

Karen Speaks

Panelist Karen Ignagni, who is president and the CEO of America’s Health Insurance Plans (AHIP), reacted defensively in favor of continued unsustainable discounts – but with a hasty, disingenuous response: “We’re seeing out of network charges of 95 times Medicare fees.” While as if on cue, former HHS Secretary Donna Shalala, who is also president of the university, offered her cold interpretation of the small business owner’s legitimate fears: “He’s really complaining that the price is going down [according to law].”

Shalala Speaks

After also ignoring the physician’s plea, “There needs to be more transparency,” Shalala and Ignagni continue an irrelevant, buzzword-filled discussion with each other using flowing hand gestures while shutting out the doctor’s attempts to bring the conversation back on topic. Then abruptly, without giving Dr. Nordham the opportunity to say another word, Shalala slammed the door: “…. I think we’ll take the next question, thank you.” Then she threw him a bone, “It’s a very important question, though.”

###

MD with eHR

Assessment

The 4 minutes of unvarnished disrespect of Dr. Nordham is so transparent that one wonders whether Shalala and Ignagni were even aware that their half-baked PR game was being recorded for C-span.

http://www.c-spanvideo.org/event/214023 (from 2:09:53 to 2:13:42)

They probably thought nobody stays up that late.

More: Chapter 13: IT, eMRs & GroupWare

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The Flaws of Electronic Records

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Reporting on an Op-Ed by Drexel University’s Scot Silverstein

By Darrell K. Pruitt DDS

pruittRecently, on Philly.com, I read the following interesting essay and counter-opinion.

“The flaws of electronic records – Drexel University’s Scot Silverstein is a leading critic of the rapid switch to computerized medical charts, saying the notion that they prevent more mistakes than they cause is not proven.”

by Jay Hancock, writing in:

KAISER HEALTH NEWS.

http://www.philly.com/philly/entertainment/20130218_The_flaws_of_electronic_records.html

Do you recall that I advised dentists to wait a year or so before purchasing electronic dental records?

Dr. Silverstein warns Hancock that we’re in the midst of “a mania” as traditional patient charts are switched to computers. “We know it causes harm, and we don’t even know the level of magnitude. That statement alone should be the basis for the greatest of caution and slowing down.”

Silverstein Speaks

Silverstein tells Hancock that he doesn’t discount the potential of digital records to eliminate duplicate scans and alert doctors to drug interactions and unsuspected dangers.

“But, the rush to implementation has produced badly designed products that may be more likely to confound doctors than enlighten them, he says. Electronic health records, Silverstein believes, should be rigorously tested under government supervision before being used in life-and-death situations, much like medical hardware or airplanes.”

Physician George Lundberg, editor at large for MedPage Today, says Silverstein “is an essential critic of the field,” and that “It’s too easy for those of us in medicine to get excessively enthusiastic about things that look like they’re going to work out really well. Sometimes we go too far and don’t see the downside of things.”

Hancock Writes

Hancock writes. “Many say he comes on too strong.” Remind you of anyone? It’s easy to fall into a habit of “coming on too strong” once politeness proves ineffective and not nearly as much fun.

Silverstein points out that since the government doesn’t require caregivers to report problems, “many computer-induced mistakes may never surface.”

In dentistry, EHR stakeholders bury computer-induced mistakes even deeper by ignoring and even censoring dentists’ concerns about cost and safety.

Shah Opines

Furthermore, ME-P thought-leader Shahid N. Shah MS opines in Chapter 4 of the book: www.BusinessofMedicalPractice.com

Chapter 13: IT, eMRs & GroupWare

And … Pruitt Wonders?

I sincerely wonder how many dentists have been kicked off of DrBicuspid, DentalTown, Dental Economics and LinkedIn for pointing out dangerous flaws in advertisers’ dental products. I offered to start a listing of the censored, but got no response. Nevertheless, I bet I’m not the only one.

Assessment

More opinions from ME-P contributors and essayists:

Conclusion

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How I Lost my Battle Against the NPI

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Refusing a National Provider Identifier Number

By Darrell K. Pruitt DDS

pruittI can no longer refuse to apply for a National Provider Identifier (NPI). I lost that long battle. Anyone rejoicing?

I’m spent. My leverage has vanished. Telling insurers “I have no NPI” held much more inherent power than “I have an NPI but I won’t share it with you on principle.” Far too many words. My profession has become dominated by unresponsive, unaccountable 3rd parties that dental leaders in the ADA welcome as policy. Working together, they promote and commandeer the technology dentists purchase and clueless patients pay for in increased fees. I have painfully learned that principles are only for dentists who can still afford them, and it’s a bad economy for luxuries.

Non-HIPAA Entity

Since I am not a HIPAA-covered entity and therefore not required by law to adopt an NPI, my capitulation to extortion disappoints me as an American citizen. I still find it hard to believe that an anti-consumer HIPAA rule enthusiastically enforced by the dental benefits industry could force me to “volunteer” for a PERMANENT identifier. As I and 96% of dentists become jerked around by our NPIs, I hope dental historians note that I am the ONLY dentist who publicly asked “Why?” instead of “Why not?” After 6 years, I’m still awaiting an answer to that question from leaders who continue to promote the NPI to dentists while ignoring their questions.

Dental Benefits Providers

I was able to hold out up until Aetna, Delta Dental and other dental benefits providers deprived my office of access to details of patients’ dental benefits unless I have an NPI. I’m waiting for someone – anyone – to tell me how the identifier can possibly improve the dental care of those who pay Aetna and Delta Dental premiums, especially if their benefits are intentionally kept secret from their dentists. I am certain that if the nation’s employers who purchase dental benefits were aware of the transparent nonsense, they would never purchase such products. Where’s the US Chamber of Commerce? Where’s the FTC? How about the US Constitution?

This is exactly why there needs to be more openness in our profession, Doc. The cockroaches who were invited to quietly overrun dentistry cannot withstand transparency, yet I don’t know how much longer I can fight for it without further risking the health of my practice.

As anyone can understand – and as anticipated by corporate executives in the insurance industry as well as by those with vested interests in the ADA Department of Dental Informatics – to have to explain to new patients why I cannot estimate how much they will owe for treatment would destroy my practice. Outside the US, other societies deem it unethical to deny patients informed consent to treatment for any reason. The NPI is such an egregious blunder that I never expect those who promoted to accept ownership.

###

NPI

Assessment

If I lost the battle, who won? Do EDR enthusiasts in the ADA call this a glorious victory and a likely source of ADA pride for decades to come? Or is it much more shameful? Since I lost freedom, I want to know who won?

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Confusion About “Meaningful Use” Reigns

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Are Doctors Embracing or Ignoring ARRA?

By D. Kellus Pruitt DDS

pruittAre physicians embracing ARRA Meaningful Use cash incentives or ignoring them? That depends on whom one asks.

Doctors versus the Feds

National progress towards Meaningful Use of expensive EHRs depends on whether one talks to federal employees whose jobs depend on the stimulus mandate, or doctors who purchase EHRs to improve care rather than to use them … Meaningfully.

The Feds

Today, Joseph Conn, writing for ModernHealthcare, posted a rosy outlook for MU adoption according to researchers working for HHS’ Office of the National Coordinator (ONC). They base their optimism for job security on a recent National Center for Health Statistics (NCHS) survey:

“A growing number of office-based physicians are using more-robust EHRs that have higher-level functions needed to help the doctors qualify for federal EHR incentive payments [for Meaningful Use] and assist them in providing better, safer care for patients, the researchers reported.” (See “Researchers: More doctors using more-sophisticated EHRs”).

http://www.modernhealthcare.com/article/20121212/NEWS/312129956/researchers-more-doctors-using-more-sophisticated-ehrsJust

eMR and HIT Security

The Doctors

However, yesterday, in an InformationWeek article by Ken Terry titled, “Meaningful Use Doesn’t Drive Doctors’ EHR Selection,” doctors suggested a more depressing future for MU sophistication based on the same NCHS survey:

“Jason Mitchell, MD, assistant director of the Center for Health IT at the American Academy of Family Physicians (AAFP), told InformationWeek Healthcare that he found [the lagging adoption of MU-capable EHRs] puzzling. While there’s no doubt that Meaningful Use has driven much of the increase in EHR use, he said, it seems strange that so many physicians would buy and implement EHRs that could not be used to show Meaningful Use.”

http://www.informationweek.com/healthcare/electronic-medical-records/meaningful-use-doesnt-drive-doctors-ehr/240144093

Assessment

Whom should doctors believe – HHS employees who give away billions of stimulus dollars for Meaningful Use, or family physicians who have determined that the subsidy isn’t worth the cost and effort?

Conclusion

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Doctors’ Use of For-Profit Algorithms Considered UnSportsManLike Conduct

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On Protecting Medical Coding Jobs

By Darrell K. Pruitt DDS

The US government moves quickly to protect tedious upcoding jobs from being taken over by upcoding software.

Medical Billing and Coding for Dummies

In coding expert Karen Smiley’s July 2012 book, “Medical Billing and Coding for Dummies,” she writes: “It really does pay to be a certified medical biller/coder, no matter what designation you choose to pursue. Surveys conducted by the AAPC [American Academy of Professional Coders] indicate that coder salaries have continued to increase despite economic downturns. One possible reason for this is that getting payers to pay claims is becoming increasingly difficult.”

Call me cynical, but to me, her defense of the coding profession confirms that healthcare’s increasing demand for highly-paid coders (who have nothing to do with directly providing care to patients) is artificial, and originates with an administration which complicates providers’ payments in order to create new, high-paying jobs in the HIT industry – quietly adding to the cost of healthcare to cosmetically boost employment figures before an election. Who ultimately pays the bill for all non-productive healthcare costs?

Amazon Morphs

Less than 3 months following the appearance of “Medical Billing and Coding for Dummies” on Amazon for under $25 (paperback), EMR software suddenly changed or morphed the entire game, and the administration reacts by changing the rules to protect political investments.

Similar to algorithmic trading’s proven advantage over low-tech investors on Wall Street, the computation capabilities of modern EMRs allegedly provide an unfair advantage to doctors and hospitals, and at taxpayers’ expense – according to HHS and Justice Department officials.

Enter Eric Holder and Kathleen Sebelius

“On Monday [September 24], Attorney General Eric Holder and HHS Secretary Kathleen Sebelius sent a strongly worded letter warning that the Obama administration will not tolerate hospitals’ attempts to ‘game the system’ by using EHR systems to boost Medicare and Medicaid payments.” – iHealthBeat, September 26, 2012.

http://www.ihealthbeat.org/articles/2012/9/26/stakeholders-react-to-warning-on-use-of-ehrs-for-upcoding.aspx#ixzz29fYzjPUH

This was followed by an article posted yesterday, also on iHealthBeat titled, “Mostashari To Launch Review of Using EHRs for ‘Upcoding,’”

http://www.ihealthbeat.org/articles/2012/10/17/mostashari-to-launch-review-of-using-ehrs-for-upcoding.aspx#ixzz29fDElIKL

Enter the NCHIT

“National Coordinator for Health IT Farzad Mostashari MD plans to launch an internal review to determine whether electronic health record systems are prompting some health care providers to overbill Medicare by selecting higher-paying treatment codes, a process known as ‘upcoding,’ the Center for Public Integrity reports.”

Apparently, it only recently occurred to lawmakers that the EMRs they promote greatly simplify Medicare’s intentionally tedious and time-consuming reimbursement requirements mentioned by Karen Smiley – making profits much easier for providers without having to hire even more staff just to get paid for work done long ago. In addition, the alleged upcoding software threatens to eliminate the need for recently-graduated coding professionals – whose education was backed by ARRA stimulus (taxpayer) money. While our nation’s leaders might wink at institutional investors’ highly-profitable algorithmic trading on the stock market, unemployed coding specialists with outstanding college loans would only increase the potential embarrassment for the administration should doctors and hospitals be permitted to computerize billing decisions – leading to payment for services previously given away because they weren’t worth the hassle and expense of documentation!

Assessment

Unlike investors playing the stock market, according to Medicare’s emerging rules, doctors’ use of algorithms to increase profits is considered unsportsmanlike conduct. With the election only days away, can you blame them?

Conclusion

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