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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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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Challenging a Naive eDR Advocate

An Open Letter to Dr. Margaret Scarlett

By D. Kellus Pruitt; DDS

For the last few weeks, I’ve been challenging a naive EDR advocate. They are becoming increasingly hard to find. Here is what I posted today on her blog.

Dear Dr. Margaret Scarlett

This open conversation on your Medscape Connect blog not only alerts the nation to the possibility of imminent failure of interoperability in post-computerized dentistry, but it also features dialogue introducing potential solutions around otherwise insurmountable problems the industry is encountering.

http://boards.medscape.com/forums?128@884.9VVBadZEUsj@.2a077212!comment=1

Courageous 

A forum such as yours that invites frank discussion about the faults of EDRs is almost unprecedented and entirely politically-incorrect. But then, that is why it is incredibly meaningful. Thank you for your courage, Dr. Scarlett.

Collegial

Let’s keep it collegial but challenging.

First of all, in your April 21st response, you justifiably expressed concern that EHR/fax hybrids might increase danger of data breaches over the incredible risk that already exists in digitalized healthcare. I assume that now that you know more about cloud-based companies such as Sfax, you agree that your security concern is unfounded. Fax, telephone and the US Mail will always be more secure than the internet – an often-forgotten fact. Any arguments?

A large part of your response concerned interoperability and aggregation problems that will be easily solved by the Health Information Exchanges (HIE) and EHR/fax companies. Why would their product not be seamless like any other digital transmission? From our perspective as dentists, your concern is a non-issue. Anything that can be printed on paper can come up on a computer screen and vice versa. Fortunately for our patients, you and I don’t have to worry ourselves about the technological magic of common office equipment.

I just have to say that when I read about your concern for “dependence on ink supplies, phone connections, or the availability of personnel to handle pieces of papers without any mistakes,” I noticed you didn’t say anything about saving the forests and paper cuts. Quite frankly, I think even you recognize that these lame arguments against a new idea are disingenuous stretches. Who’s to say there will be fewer keystroke errors on digital records than paper? See what I mean?

Lastly, in your April 21st response, you seem to suggest that unless the vast majority of dentists spend tens of thousands of dollars to purchase EDRs which will raise the cost of the care they provide, huge pools of data stored in HIEs that you claim somehow “assure patient-centered care,” will not be available to dentistry. You’ve got to be kidding. How many years away is that science? Let me repeat: Dental patients are fortunate that EDRs are going nowhere because of dentists’ solid business reasons in the land of the free. Until EDR advocates base sales claims on evidence rather than hearsay, they are only entertaining themselves with the fantasy.

Assessment 

I only wish the anonymous EHR experts in the ADA who are quietly influencing lawmakers would step out and introduce themselves to the community they serve. Can you think of any possible reason that the ADA can’t answer a few questions about what they have been doing on our behalf. Or should that not concern dentists?

Conclusion

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Book Review of “Cyber War”

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A Book Review 

[By Darrell K. Pruitt; DDS]

I’m reading “Cyber War” by Richard A. Clark. He served the Pentagon, the State Department, and the National Security Council under Presidents Reagan, Bush, Clinton and Bush. It’s sobering to learn that North Korea has already successfully pulled cyber-war tricks against a vulnerable US. But; to learn that North Korea doesn’t have any Internet vulnerabilities is frightening.

China

And what about China – want to see sophistication? Clark says that within the last year, Canadians discovered a highly sophisticated program they named “GhostNet.” It had infected over an estimated 1300 computers at several countries’ embassies around the world. Get this: The program had the capability to remotely turn on a computer’s camera and microphone without alerting the user and to send the information back to China. So how could such capabilities affect you and me?

GhostNet 

GhostNet had been working for almost 2 years before it was discovered. About the same time, US Intelligence leaked news that Chinese hackers had penetrated the US Power grid and left behind programs that can shut the grid down. Clark suggests that the Chinese intended us to find their program as a deterrent to our national will to intervene if China should find it necessary to annex Taiwan or even the Spratly Islands in the South China Sea – where the reefs shelter some of the largest remaining stocks of fish in the world, in addition to undeveloped oil and gas reserves that rival Kuwait’s.

Gates Speaks

Clark says that according to Defense Secretary Robert Gates, cyber attacks “could threaten the United States’ primary means to project its power and help its allies in the Pacific.”  Clark adds, “The problem is, however, that deterrence only works if the other side is listening. U.S. leaders may not have heard, or fully understood, what Beijing was trying to say. The U.S. has done little or nothing to fix the vulnerabilities in its power grid or in other civilian networks.”

Assessment

If they shut down our power grids, it will be chaos. Are we as a nation flying far too fast into the cloud?

What does this say about eMRs and eHRs, regional health information exchanges, cloud computing, and related health 2.0 initiatives and/or information technology? Sobering thoughts for the weekend.

Conclusion

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Queries for the ADA Member Service Center

Four Questions for Consideration

[By Darrell K. Pruitt; DDS]

Dear ME-P Readers

I’m considering these four questions for the ADA Member Service Center to break the ice. What do you think?

Question 1 – The FTC’s Red Flags Rule is due to be enforced on June 10. If the Rule is not delayed for a fifth time and a dentist has a contractual relationship with CareCredit/GE or similar healthcare financing service, will that mean he or she will become a covered entity obligated to additional paperwork, liability and expense?

Question 2 – According to the “ADA National Oral Health Agenda” found on the Advocacy page, it states that one of the ways the ADA intends to reduce the cost of dental care is to promote health information technology. This goal was first posted several years ago. Considering the ever increasing liability of data breaches in healthcare, can consumers still expect to save money in dental care by visiting a paperless practice?

Question 3 – Am I correct to assume that soon the ADA.org Website will include the capability for direct discussions between members and leadership?

Question 4 – If interactive functions are indeed to be included in the new ADA Website, will there be any topics concerning ADA policy that will be closed to questions from membership?

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Conclusion

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