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

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In Defense of the eDR Industry

One Dentist Consultant’s Opinion

By Paul L. Child Jr, DMD, CDT
CR Foundation
3707 North Canyon Road, Building 7
Provo, UT 84604

Three days ago, I shared the email I sent to Dr. Paul Child and Kathleen Noll concerning their claims that electronic dental records offer dentists a return on investment (ROI). Dr. Child responded yesterday.

Darrell K. Pruitt DDS

———————————————

Dear Dr. Pruitt,

Thank you for your recent communication and questions regarding my recent article in Dental Economics, specifically your question: Does the ROI for Practice Management systems include the cost of HIPPA compliancy?

In regards to your communications with QSI, I cannot comment as I do not represent them. Unfortunately, I too am not able to give you the “proof” you are seeking, as I do not have a specific chart nor do I plan on fabricating one to “prove” the efficacy of computers in the dental office (although a controlled study would be interesting, I’m not sure it would be an effective use of funds to prove something that is already proven in every other industry).

However, I will provide you with information from thousands of our readers at CR as well as many more in our lectures worldwide.

The section of the article to which you are referring is under the title of: Practice and patient records management and patient education. Specifically, the paragraph states:

“Implementation of computers into each operatory and throughout the practice is the first and most frequent adoption of digital dentistry. In North America and most developed countries, this has reached the “early majority” stage as all of the criteria for being an advantage have been met. Dentists who have not yet adopted this prerequisite for digital dentistry should do so now! Daily advances and improved software adapted from other industries allow this technology to be affordable, attain the fastest adop¬tion rate, and offer a high return on investment. Current and highly effective systems include Eaglesoft (Patterson), Dentrix (Schein), PracticeWorks (Carestream Dental), and Web-based software such as Curve Dental” (underlines added for emphasis).

Please note that the sentence in which “high return on investment” is mentioned is referring to “advances and improved software adapted from other industries”. As such, other industries (too many to count) have proved without a doubt, the massive improvement in return on investment in the following areas: improved efficiency (eg. Legible records vs. scribbles, or worse off, incomplete records), improved accuracy of records, use of computers for rapid recollection of stored data, rapid recording of data, time savings, standardization, and many more. A brief look at the medical industry and literature (our closest industry – of which we are a part of) can demonstrate the above. In addition, the observations I made are directed to the use of computers in a practice.

Finally, proper implementation of practice and patient management systems can easily improve ROI, via better record taking, accurate financial statements that can be easily generated daily for better practice management, treatment planning with all options, benefits, and risks recorded – then printed for the patient, and most of all – time savings. What is a dentists time worth? My time is priceless (as is most dentists I know). Yes, there are clearly unknown aspects of this digital transformation from paper to digital. Government and controlling organizations may make new rules and regulations that can positively or negatively affect this process.

But, from our observations of thousands of other dentists that have made this transition, very few – if any, would even think about reverting back to paper.

To your question regarding HIPPA compliance, YES, the overall ROI would include even this. HIPPA compliance is still relatively new to many dentists, even though it has existed for years. This compliance in important for all the reasons you already know. As dentistry evolves and new technologies are introduced (and ruling bodies continue to make new rules and regulations), this digital evolution will continue to prove itself an EXCELLENT ROI for today’s and tomorrow’s dentists.

Best regards,

Paul L. Child Jr., DMD, CDT

Conclusion

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On Dental Economics and Truth in Advertising

About Dentistry iQ

D. Kellus Pruitt DDS

I just read a misleading press release on Dental Economics subsidiary Dentistry iQ that is presented as a credible article titled “Guardian Recognized as One of the Nation’s Leading Dental Carriers by Benefits Selling Magazine Readers” (no byline).

http://www.dentistryiq.com/index/display/news-display/1307102704.html

“NEW YORK, Nov. 19, 2010 (GLOBE NEWSWIRE) — The Guardian Life Insurance Company of America (Guardian), one of the largest mutual life insurers and a leading provider of employee benefits, today announced that it has been recognized by the readers of Benefits Selling magazine as one of the nation’s leading dental insurance carriers for the second consecutive year…”

My Research 

I did some quick research on Guardian’s discount dentistry plans and I have some questions for Dental Economics Vice President Lyle Hoyt – the official who approved the advertisement deal (as far as anyone can tell). First of all, how come at least 19 out of the 25 Austin, Texas dentists listed in their DentalGuard Preferred Provider list work for “clinics”? 12 of them work for Castle Dental.

http://www.geoaccess.com/guardian/po56/DisplayResults.asp

It took me 3 minutes to come up with this information. I ask you, Lyle, did you do any fact checking before you took Guardian’s money? I also glanced at Guardian’s PPO lists from other cities with the same result – If one purchases DentalGuard, one should be prepared for McDentist.

My Bias 

But maybe I judge Castle Dental too harshly. After all, I am admittedly biased. To me, a name on the door of a business connotes accountability backed up by transparency and a suggestion of permanence. Guardian officials should know that their clients don’t like to change dentists, so why are so many of them sent to Castle – 12 months per contract period? And how good of a job is Castle doing? So, I checked the Austin Better Business Bureau to see if Castle Dental has a history with them. Indeed they do! Of the 5 encounters Castle Dental has had with the Austin BBB, they were awarded grades of 3 Bs and 2 Fs.

http://austin.bbb.org/Find-Business-Reviews/

If Castle Dental’s dentists had college grades like that, they would have never made it to dental school. Although, if they lived in New Mexico, I hear one can do discount dentistry as a dental therapists with little more than a high school education … sorry. I digress.

The Advertisement 

The ad for Guardian’s discount dentistry continues: “Benefit Selling’s readership of 55,000 benefits brokers voted Guardian as one of the top dental carriers in the 2010 Readers’ Choice Awards, which were announced in the magazine’s November issue. With more than 70,000 dentists, Guardian boasts one of the largest dental networks in the country and was cited by one participant as ‘the most innovative carrier for dental and a great partner for all ancillary products from life to DI and vision.’”

So Guardian is both “Innovative” and “a great partner” in dentistry? Really-Lyle? Those who stand to profit from dental therapists in New Mexico say the same things – based on an experiment in Alaska that involved 5 therapists and 300 patients … Sorry. There I go again.

My Business Policy Interpretation  

Please allow me to share my interpretation of Dental Economics business policy: If it’s a paid ad with no byline and no opportunity for troublemakers to comment – thus protecting Dental Economics VP Lyle Hoyt – nobody spends any effort checking for misleading and harmful information their bosses promote. After all, even if someone were to demand personal accountability from an online publisher like Dental Economics, what harm could they possibly do to such a well-established news outlet’s credibility? Let’s just see.

Assessment 

I know Dental Economics has to make money somehow, but you should show more respect to dentists and more compassion for dental patients, Lyle Hoyt.

Conclusion

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Some Dental Consultants Say the Most Incredible Things

Are Dentists like … Rodney Dangerfield? 

By Darrell Kellus Pruitt; DDS

“Let’s face it — in our world dentists do not get the respect they deserve. They are not perceived to be ‘real’ doctors … Perhaps the lack of sex appeal in dentistry is part of why dental coverage for everyone is an afterthought in the national health care conversation.”

Gary Kadi DDS, DentistryiQ

http://www.dentaleconomics.com/index/display/article-display/4196579430/articles/dental-economics/volume-100/issue-5/features/the-cavity_in_the.html

Even if Dr. Kadi is correct, and the barrier between a 12 year old and his toothbrush is a world-wide lack of respect of dentistry, that hardly means that electronic dental records (eDR) are going to make the kid brush any better. Experience tells me that if mom’s nagging won’t motivate the stinker, the computer won’t either.

eDR Rationalization?

For those who read the article, did you notice how Dr. Kadi, a dental practice consultant, attempts to subtly insert a fat rationalization for adopting eDRs into the middle of a comment lamenting dentistry’s lack of respect? Tricks like Kadi’s make stakeholders look silly at times, and it bothers me that hardly anyone notices and appreciates the humor that these pros bring to marketplace conversation. That’s why I like to point out mistakes like Kadi’s when I come across them. It’s getting harder to find these kinds of articles about eDRs. My pleasure!

Working Both Sides of the Consulting Fence

As far as I can tell, all but a few dental consultants work both sides of the fence in order to please vendors who give them good deals, as well as dentists who pay for unbiased help. Sponsorship by vendors is the bottom level of a consultant career if one chooses to make a living at selling advice. In this way, the dental consultant business is a lot like the financial advice business. Some advisors push their favorite investments that serve them well no matter what happens to their clients’ money. If a client wants advice, but prefers not to pay full price, interested vendors can be counted on to quietly chip in on an advisor’s bill. And that is why the customer must always be cynical. What’s more, it is arguably one’s community obligation to publicly challenge such artists by luring them out into the open to explain further what they meant to say to naïve people. Dr. Kadi begins:

“The national health-care debate cannot be complete unless we include dental care as part of the discourse.”

He then presents oft-repeated, convincing findings which support the widely held conclusion that one’s overall health is dependent on one’s oral health. Even though this chunk of common sense has recently been supported with well-respected research, the news isn’t a revelation. Other stakeholders have proclaimed the findings as an example of ultra-modern “Evidence-Based Dentistry,” and proof of the need for thousands of their dental products. However, let’s not kid ourselves. A healthy mouth has less to do with computerization than the proper application of a low-tech toothbrush. 10,000 years ago, even buzzards recognized that bad breath from advanced gum disease smells like imminent death from a long way off if the wind is right. The results Dr. Kadi leans his reasons against only confirm traditional Evidence-Based Superstition.

eDR Lobbying 

By half-way through the article Dr. Kadi turned “The cavity in the health-care debate” into a PR piece for eDRs. He’s in so deep that he cannot recognize that his misplaced concerns about image have nothing to do with dental patients’ oral health. Image is only cosmetic.

“A validation [of bringing “sex appeal” to the profession] is the inclusion of dentistry in the recently mandated National Healthcare Information Infrastructure (NHII). The purpose of the NHII is to create an information network to facilitate the creation of an electric health record [eHR] for all aspects of health care. The primary impetus is to achieve interoperability of health information technologies used in the mainstream delivery of health care.”

Note: Dr. Kadi admits that the goal is HIT, and sharing health information is the tool – not the other way around. As anyone can see, that kind of nonsense will never work out well in the US. Why that would be as foolish as stuffing a certifying commission for eHRs with industry, government and academic leaders rather than providers – and then tossing billions of dollars that could otherwise be used for treating disease out in the street for the biggest and fastest stakeholders who grab the most. That would be simply ridiculous.

Dr. Kadi bravely continues: “This will enable an individual’s health care information to be shared by all the necessary health care parties in a secure manner, including dentistry. It will improve patient care and reduce the number of patients, currently 100,000 plus, who die each year due to a lack of accurate, complete, or timely information. The federal government estimates a cost savings of $85 billion to $100 billion per year with electronic health records [eHR].”

Is HIT – Or any IT – Really Secure? 

In a secure manner – really? There are so many other misleading statements in this paragraph as well. First of all, how can an eDR improve a dentist’s chance of successfully extracting a molar in one piece? It can’t. Secondly, how many of the alleged 100,000 victims died because of lack of electronic DENTAL records? Third, how many patients will die because of faulty information in interoperable records that would not have occurred if the records were paper? Fourth, to insinuate that patient information can only be shared over the Internet is plain silly. Telephone, fax and the US mail have been sufficient for dentistry for decades, and none involve HIPAA. Finally, the $85 to $100 billion in savings Dr. Kadi casually throws out is based on a five year old Rand study that’s been widely trashed for being biased in favor of the stakeholders who funded the research. That happens. It just amazes me that anyone in the healthcare industry who knows anything about HIT is foolish enough to still shop discarded garbage. And once again, regardless of the success of electronic medical records, how will eDRs save even $10 in dentistry? It’s impossible without re-defining “savings.”

Cost Savings

“Dentists and hygienists will play a vital role in this cost savings because people who go for regular cleanings will have their medical history updated in the shared system during each visit. In some cases, dental cleanings may be the only medical attention a person receives yearly.”

“Cost savings”? Where have I heard that term? And why didn’t Dr. Kadi simply say “savings”?

Now I remember. It was Dr. Robert Ahlstrom, the ADA’s eDR expert, who coined the handy buzzword in his testimony describing the benefits of paperless dental practices for the US Department of Health and Human Services in July of 2007. “Cost savings to providers and plans will translate in less costly health care for consumers. Premiums and charges will be lowered.” That would be the seventh of his 11 reasons that are each one so lame that other than Dr. Kadi, stakeholders never borrow them. Although it is undeniable that electronic records benefit insurers and the government more than the patient, if Ahlstrom hadn’t been coy, and had clearly stated that eDRs will save money in dentistry, his testimony would have been false. By calling it a “cost savings,” Ahlstrom technically concedes that using eDRs will indeed require an increase in cost of overhead – which dental patients will ultimately have to pay to obtain dental care. The saving part comes from “what could have been.” Whatever that could possibly mean, HHS Secretary Michael Leavitt bought it.

The PennWell Article

Because of a situation beyond my control, I am unable to provide a link, but to find more of my opinion of Ahlstrom’s testimony that is still used by lawmakers to establish national policy, simply google “Dr. Robert Ahlstrom.” My PennWell article from a year ago or so, “Dr. Robert H. Ahlstrom’s controversial HIPAA testimony,” is probably still his first hit. It could be on his first page the rest of his life.

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Assessment

If necessary, I’ll make a few more examples of insensitive HIT stakeholders who know better than to offer such crap to the nation’s lawmakers as well as providers who are too busy to pay attention to the welfare of their profession. The ADA should reassure the nation that there are cheap, effective low-tech ways dental patients can stay healthy that don’t risk their identities and won’t bankrupt a dental practice because of a stolen computer. But; they won’t do it.

Conclusion

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