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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.

***

***

 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.

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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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***

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

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

***

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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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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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)

Conclusion

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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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Medical Identity Theft on the Rise

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Open Up Dentists – and Physicians, Too!

[By D. Kellus Pruitt DDS]

If I tell you that your patients’ insurance identities can be sold for $50 each, how much will you trust your employees on Monday, Doc?

The Experts Speak

According to a panel of cyber-security experts at a recent Digital Health Conference, medical identity theft has become one of the most lucrative forms of identity theft. “DHC: EHR Data Target for Identity Thieves” by MedPage Today Associate Staff Writer Cole Petrochko, was posted last week

http://www.medpagetoday.com/PracticeManagement/InformationTechnology/30074

“Presentations at the Digital Health Conference here indicated that a single patient’s electronic health records can fetch $50 on the black market — a much fatter target than more familiar forms of identity theft, such as Social Security numbers ($3), credit card information ($1.50), date of birth ($3), or mother’s maiden name ($6).”

eMRs Not Like Credit-Cards

“And, unlike a credit card number, patients’ healthcare records cannot be cancelled or changed to prevent stolen data from being used by criminals”, said John DeLuca, of EMC Corp., an information technology company.

The Street Value of eDRs 

What do you want to bet that medical identities downloaded from dentists’ computers bring $50; as well. I’d like to share a special, visceral sentiment with my shy, HIPAA covered colleagues:

I warned you, damn it! And, I assume, just like virtually all other silent dentists in the nation, you’ve done NOTHING to safeguard your patients’ identities. Even if you don’t like truth served bluntly, this dentist has your reputation in mind when I warn that if your practice experiences a reportable data breach of over 500 records, and your patients’ identities aren’t encrypted, those who choose to remain with your practice will never trust you as much as they do today – even if you properly report the breach. Of the estimated 20% who will never return, many will probably look for a gentle dentist who doesn’t store patients’ Protected Health Information (PHI) on computers …. Like me. (Yea, that was a sales pitch. As one might expect, I certainly welcome discussion of it with anyone).

ADA Laggards 

After 5 years of awaiting responses from unaccountable leaders inside and outside the American Dental Association concerning HIPAA and EDRs, It feels really good to aggravate 9 out of 10 dentists still reading this – challenging those who normally take offense with professional stoicism to loosen up and share their feelings with everyone for once … God help me, I do love this so.

More About the Black Market 

The black market price for EHRs has increased ten-fold in the last 5 years. In 2006, I warned in a guest column on WTN that it only takes one dishonest employee needing a couple of thousand quick dollars to potentially bankrupt a practice almost without risk of being caught. Back then, the black market price for a stolen medical identity was estimated at only $5 (See: “Careful with that electronic health record, Mr. Leavitt,” WTN News, October 18, 2006).

http://wtnnews.com/articles/3407/

It’s no secret that reticent ADA officials like President-elect Dr. Robert Faiella have suspiciously failed in their duty to be transparent with dues-paying members about the liabilities of the EHRs – even as they continue to recklessly promote paperless practices. The result: Almost all dentists in theUSstill maintain patients’ unencrypted medical identities on their office computers – often guarded by a flimsy password that is still cute a decade later. (Did I hear a gasp?).

Consider This!

Consider this, Doc! If a practice has 3000 active patients with identities worth $150,000, all one dishonest employee needs for dreams to come true is a flash drive and private time with your computer.

Assessment

Show me a dentist who thinks the benefits of EHRs to dental patients still outweigh the liabilities and I’ll show you a dangerously naive healthcare provider who probably doesn’t know about KPMG Auditors. Let’s face the facts bravely, Doc. Now would be a terrible time to invest in an EDR system – even cloud based. The proven, avoidable danger EDRs bring to American dental patients is unacceptable and only getting worse. Give it a year or so.

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