As a former Dean and appointed University Professor and Endowed Department Chair, Dr. David Edward Marcinko MBA was a NYSE broker and investment banker for a decade who was respected for his unique perspectives, balanced contrarian thinking and measured judgment to influence key decision makers in strategic education, health economics, finance, investing and public policy management.
Dr. Marcinko is originally from Loyola University MD, Temple University in Philadelphia and the Milton S. Hershey Medical Center in PA; as well as Oglethorpe University and Emory University in Georgia, the Atlanta Hospital & Medical Center; Kellogg-Keller Graduate School of Business and Management in Chicago, and the Aachen City University Hospital, Koln-Germany. He became one of the most innovative global thought leaders in medical business entrepreneurship today by leveraging and adding value with strategies to grow revenues and EBITDA while reducing non-essential expenditures and improving dated operational in-efficiencies.
Professor David Marcinko was a board certified surgical fellow, hospital medical staff President, public and population health advocate, and Chief Executive & Education Officer with more than 425 published papers; 5,150 op-ed pieces and over 135+ domestic / international presentations to his credit; including the top ten [10] biggest drug, DME and pharmaceutical companies and financial services firms in the nation. He is also a best-selling Amazon author with 30 published academic text books in four languages [National Institute of Health, Library of Congress and Library of Medicine].
Dr. David E. Marcinko is past Editor-in-Chief of the prestigious “Journal of Health Care Finance”, and a former Certified Financial Planner® who was named “Health Economist of the Year” in 2010. He is a Federal and State court approved expert witness featured in hundreds of peer reviewed medical, business, economics trade journals and publications [AMA, ADA, APMA, AAOS, Physicians Practice, Investment Advisor, Physician’s Money Digest and MD News] etc.
Later, Dr. Marcinko was a vital and recruited BOD member of several innovative companies like Physicians Nexus, First Global Financial Advisors and the Physician Services Group Inc; as well as mentor and coach for Deloitte-Touche and other start-up firms in Silicon Valley, CA.
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***
Assessment
Your thoughts are appreciated.
RESOURCES:
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***
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Filed under: Information Technology, LifeStyle | Tagged: dental records, eDRs, EMRs | Leave a comment »
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.”
Conclusion
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***
Filed under: Information Technology, Op-Editorials, Pruitt's Platform | Tagged: American Dental Association, D. Kellus Pruitt DDS, Did ADA leaders mislead Congress about security?, Dr. Robert H. Ahlstrom, eDRs, National Committee on Vital and Health Statistics, Todd Lewis | 2 Comments »
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.”
***
***
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
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Filed under: Information Technology, Pruitt's Platform | Tagged: Darrell K. Pruitt DDS, Dental EHRs are Coming to an End?, eDRs, EHRs | 3 Comments »
2015 … Really?
By Darrell K. Pruitt DDS
***
“By 2015, health care is scheduled to be chartless. The federal National Health Information Infrastructure (NHII) is already formulating the parameters for this future. Chartless records are not a choice. The year 2015 is less than seven years away. We have seen hospitals, physicians’ offices, and other health-care providers moving in this direction.
In dentistry, only about 25% of practices are using computers chairside and only 1% is chartless. The American Dental Association is taking a proactive role in NHII. Individual dentists must also take part in the coming changes or once again be victims to others’ choices.”
-Patti DiGangi, RDH, BS
[Dental Economics, 2009]
***
***
***
Conclusion
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Filed under: iMBA, Inc. | Tagged: ADA Department of Dental Informatics, eDRs, electronic dental records, EMRs | Leave a comment »
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.”
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.
***
***
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.
***
***
Conclusion
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***
Filed under: Information Technology, Practice Management, Pruitt's Platform | Tagged: ADA, D. Kellus Pruitt DDS, dental electronic records, dental records, eDRs | 4 Comments »
Paper Medical Records Become Popular Again?
[By Kellus Pruitt DDS]
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?
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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
How does this relate to emails? 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.
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Filed under: Information Technology, Practice Management, Pruitt's Platform, Risk Management | Tagged: Are Dentists Satisfied with their EDRs?, D. Kellus Pruitt DDS, De-identification, digital medical records, eDRs | 4 Comments »
Saving Electronic Health Record Interoperability?
By 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.
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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Filed under: Information Technology, Pruitt's Platform | Tagged: ACA, Darrell K. Pruitt DDS, dental records, Dissent Doe, eDRs, EHRs, electronic dental records, electronic medical records, HIPAA, ObamaCare, PP-ACA | 23 Comments »
Major Discontent With EHR Adoption
[By D. Kellus Pruitt DDS]
Unlike 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”
“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?
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:
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:
Conclusion
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Filed under: Information Technology, Pruitt's Platform | Tagged: Are Dentists Satisfied with their EDRs?, D. Kellus Pruitt DDS, eDRs, EHRs, HIPAA, meaningful use, Medical Economics | 9 Comments »
EDR Data breach in Williamsport, Pennsylvania
By D. Kellus Pruitt DDS
Over 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.”
Assessment
Did your opinion of censorship in dental care recently undergo change?
Conclusion
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Filed under: Information Technology, Pruitt's Platform | Tagged: Darrel Pruitt, Dentrix, eDRs, electronic dental records, HIT, Justin Shafer, Vulnerability Notes | 14 Comments »
Remember to destroy that hard drive!
By D. Kellus Pruitt DDS
NEWS 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.
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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Filed under: Information Technology, Pruitt's Platform | Tagged: eDRs, EHRs, health information technology, HIT | 1 Comment »
Reporting on an Op-Ed by Drexel University’s Scot Silverstein
By Darrell K. Pruitt DDS
Recently, 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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Filed under: Information Technology, Op-Editorials, Pruitt's Platform | Tagged: dental economics, DentalTown, DrBicuspid, Drexel University, eDRs, EHRs, electronic dental records, electronic medical records, Flaws of Electronic Records, George Lundberg, Jay Hancock, KAISER HEALTH NEWS., MedPage Today, Scot Silverstein | 8 Comments »
Attention Medical Professionals, HIT Specialists and EHR Devotees
[By Staff Writers]
Question: What is LulzSec?
LulzSec, short for “LulzSec Security”, is a hacker group that claims responsibility for several high profile attack.
LulzSec has gotten attention since May 2011 for targeting high profile website with poor security.
Assessment
The most prolific anti-EHR / anti-EDR contributor to this ME-P is investigative reporter Darrell K. Pruitt DDS; friend or foe of HIPAA and HIT data security?
Conclusion
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Filed under: Ethics, Information Technology | Tagged: Adrian Lamo, Black Hat Hackers, eDRs, EHRs, ePHRs, Jonathan James, Kevin Mitnick, Linus Torvalds, Richard Stallman, Tim Berners Lee, White Hat Hackers, Wozniak | 15 Comments »
Truth or Consequences?
Assessment
Truth or consequences; let ME-P readers and subscribers decide.
Conclusion
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Filed under: Information Technology | Tagged: eDRs, EHRs, electronic health records, electronic medical records, EMRs, The Future of eMRs | 6 Comments »
Fear of HIPAA Sells
[By Darrelkl K. Pruitt DDS]
“The HHS Office for Civil Rights (OCR) can show up at your door and ask to perform an audit on short notice, and your organization will need to be ready, or face fines of up to $50,000 per day for each regulatory provision violated.”
– Gene Kraemer [Customer Relationship Director at The Coding Institute]
The most successful of opportunistic HIPAA consultants are the scariest
As a dentist for almost 30 years, I’ve noticed that along with even rumors of mandate enforcement, ambitious compliance consultants’ fear-inspiring ads start interrupting happier thoughts. It happened with OSHA’s push into dentistry 20 years ago and we clearly see the aggressive sales pitches with HIPAA as well.
The scariest part of Gene Kraemer’s description of HIPAA’s tedious requirements and bankruptcy-level liabilities is that he is simply telling the truth. So if you are a HIPAA covered dentist, be scared.
On the other hand, if you don’t store or send your patients’ digital PHI – choosing instead to use the US Mail – you are increasingly fortunate in the dentistry market. For one thing, our patients are fed up with identity thefts, and paper dental records are the gold standard in security. In addition, nothing is holding down your competitors’ costs for HIPAA compliance and it is increasing much faster than the cost of postage.
De-identify now or lose computerization, Doc. If your patients’ PHI is not present it simply cannot be hacked by an identity thief. Guaranteed more secure than Cloud. Arguably more secure than even paper dental records.
Or … You can hire The Coding Institute.
You can bet Gene Kraemer isn’t someone who would hold down the cost of compliance.
From: Gene_Kraemer@mail.vresp.com
Subject: HIPAA Audits & Enforcement: New Penalties & Push for Compliance – Final Notice!
Good Morning,
The US Department of Health and Human Services (HHS) is currently implementing audits to meet requirements in the HITECH Act in the American Recovery and Reinvestment Act of 2009 (ARRA) for performing periodic audits of compliance with the HIPAA Privacy and Security Rules, and up to 150 random HIPAA compliance audits will be performed by the end of 2012. While in the past, audits had been performed only at entities that had had a complaint filed against them, the new rule calls for audits whether or not there is a complaint. This means, the HHS Office for Civil Rights (OCR) can show up at your door and ask to perform an audit on short notice, and your organization will need to be ready, or face fines of up to $50,000 per day for each regulatory provision violated.
Join us for this live audio conference on Tuesday, April 24, 2012 at 1 pm ET | 12 pm CT | 11 am MT | 10 am PT. This conference is being presented by Jim Sheldon-Dean, the founder and director of compliance services at Lewis Creek Systems, LLC, a Vermont-based consulting firm founded in 1982, providing information privacy and security regulatory compliance services to health care firms and businesses throughout the Northeast and nationally. He serves on the HIMSS Information Systems Security Workgroup, the Workgroup for Electronic Data Interchange Privacy and Security Workgroup, and co-chairs the WEDI HIPAA Updates sub-workgroup. Sheldon-Dean is a participating member of the advisory board of Vermont Information Technology Leaders (VITL), and has participated in VITL’s Vermont Health Information Technology Plan working group, VITL’s Physician EMR adoption project, and the Security Workgroup of the New Hampshire/Vermont Strategic HIPAA Implementation Plan (NHVSHIP).
Highlights of the session :
• Fines and penalties for violations of the HIPAA regulations have been significantly increased and now include mandatory fines for willful negligence that begin at $10,000 minimum.
• HIPAA Audits have been few and far between in the past, but that’s now changing – the HHS will be auditing HIPAA covered entities and business associates even if there have been no complaints or problems reported.
• What HHS OCR is likely to ask you if you are selected for an audit, and what you’ll have to have prepared already when they do.
• The rules are that you need to comply with will be explained. Learn about the policies you can adopt that can help you come into compliance and be prepared for an audit.
• How the HIPAA rules have changed and how you may need to change. How you work to keep up with them.
• How having a good compliance process can help you stay compliant and respond to audits more easily.
• The documentation needed to survive an audit and avoid fines will be described.
• A discussion on what you’ll need to think about to deal with current and future threats to the security of patient information.
If interested, please click the following link to register and get your early bird discount : –
Please apply discount code “GENE20” at checkout to get your $20 discount on early registration.
Looking forward to having you onboard here.
Thanks,
Gene Kraemer
Customer Relationship Director
The Coding Institute LLC
2222 Sedwick Drive,
Durham, NC 27713
************************************************************************************8*************************
Conclusion
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Filed under: Health Law & Policy, Information Technology, Op-Editorials, Practice Management, Pruitt's Platform, Quality Initiatives | Tagged: eDRs, EHRs, Enter the HIPAA Fear Mongers, Gene Kraemer, HHS, HIPAA, OCR, PHI, The Coding Institute LLC | 15 Comments »
Fun on a Slow Day [will that be paper or electrons?]
[By Darrell K. Pruitt DDS]
As anyone following the ME-P knows by now, Dental Economics’ officials have been suspiciously unhelpful in locating experts capable of responding to concerns about the cost and safety of EHRs in dentistry – quite the opposite.
The CR Foundation
In addition, Dr. Gordon Christensen’s CR Foundation has also suspiciously avoided discussion of EDRs with this dentist. Nevertheless, I’m certain that like most other EDR stakeholders, employees of DE and CRF at least secretly agree that this consumer has tolerated good ol’ boy behavior in the marketplace far longer than any vendor anywhere else in the free world could ever expect – no matter how important.
Dentrix, too!
At some point, Dental Economics, CR Foundation and Dentrix will either have to answer at least one dentist’s sincere questions about EDRs or censor me from their Facebooks. Over time, not-anonymous censorship would be second only to anonymous censorship as the worst possible choice. If I’m given the opportunity, I’ll prove it.
As readers can tell, sometimes on slow days, even silence from rude people who profit off of my profession irritates me – causing me to want to grab them by the attentions. I’m feeling especially itchy today, so I also posted the following on Dental Economics Facebook:
Dear Dental Economics:
If the AMA finally admits that EHRs are a poor substitute for thinking, don’t you agree it’s time for shy stakeholders in dentistry to accept ownership of their products’ weaknesses? And for other stakeholders to either help me or get out of the damn way?
“EHRs Linked to Errors, Harm, AMA Says — Clinicians can introduce errors when they copy and paste sensitive patient data into electronic health records, according to AMA research.”
http://www.informationweek.com/news/healthcare/EMR/232400325
Or, do you think if dentists remain silent like good little professionals, those who profit from EDRs and related advertisements will suddenly become honest with our patients? I’m not that optimistic. I think if interoperable EDRs are ever to succeed, dentists must pester the unresponsive leaders even while hangers-on would shield them for their own selfish reasons. For example, dentists are unlikely to ever read in Dental Economics the following hints of the imminent failure of EHRs in dentistry: 96% of EHR systems have been breached in the last 2 years and the frequency of breaches rose 32% in the last year – costing over $6.5 billion. The fantasy is over, DE. It’s becoming increasingly difficult for even stakeholders to get giddy about EDRs.
Once the high risks of identity theft from dental offices can no longer be suppressed by stakeholders, our patients’ trust will be forever lost – just to protect the most selfish of people in the healthcare industry from accountability.
Where are you Dentrix?
And what’s the opinion of your CRF investigators, Dr. Gordon Christensen? Are EDRs cheaper than paper dental records or not? As you know, a few months ago your former CEO stated in an article on Dentistry iQ that EDRs offer dentists a “high return on investment,” yet failed to produce evidence supporting his incredible claim.
Regardless of an institution’s reputation and market share, deceiving doctors and patients for personal gain is just wrong.
Since the misleading statement from the influential CEO has never been corrected, his lie which is still featured on Dentistry iQ continues to harm naïve dentists and clueless patients – but not without the help of 8 Dental Economics editors who voted the CEO’s article as a tie for the “Most important story for the dental profession in 2011.”
Assessment
Way to go, Dental Economics editors! Any of you have enough confidence to discuss why you chose the former CEO’s article? I think your readers would like to hear your reasons. I certainly would. What could it hurt?
Conclusion
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Filed under: Information Technology, Pruitt's Platform | Tagged: ADA, AMA, CR Foundation, Darrell K. Pruitt DDS, Dentrix, Dr. Gordon Christensen, eDRs, EMRs | 6 Comments »
About their Hidden Costs – I’m Talking PHI Breaches
By D. Kellus Pruitt DDS
If the rumor is true about Bluebell Ice Cream’s “e-claim-only” dental benefit plan that is to go into effect in March, how many in the east-central Texas town of Brenham (pop. 16,000) will be properly warned about the danger to themselves, their families and Bluebell officials’ reputations because of reckless policy?
Transmissions Risks
Each time their dentists send an electronic dental claim (e-claim) over the internet to insurance employees in Chicago as a favor to a patient – and especially the insurer – the Bluebell employee’s digital medical identity which is worth fifty bucks on the black market, rides along to destinations unknown. It’s my guess that very few Bluebell employees are yet aware of the increasing risk of medical identity theft from dentists’ e-claims – much less given the opportunity to opt out of the risk by simply visiting a dentist who still uses the telephone, fax and US Mail.
Security Risks Growing
It certainly won’t improve my popularity with 9 out of 10 dentists for saying this, but risks of identity theft from HIPAA-covered dental offices are climbing daily. In the introduction to a recent interview with Larry Ponemon, chairman and founder of the Ponemon Institute, GovernmentIT.com editor Tom Sullivan ominously described the ever-increasing risk of a massive “data spill” of perhaps millions of patients’ protected health information (PHI):
“The street value of health information is 50 times greater than that of other data types. Even worse, the healthcare industry is among the weakest at protecting such information. With organized criminals trying to steal medical IDs, sloppy mistakes becoming more commonplace, mobile devices serving as single sign-on gateways to records and even bioterrorism now a factor, healthcare is ripe for some a wake-up call – one that just might come in the form a damaging ‘data spill.’” (See: “Q&A: How a health ‘data spill’ could be more damaging than what BP did to the Gulf.”
Tom Sullivan – Editor [December 05, 2011]
http://govhealthit.com/news/qa-how-health-data-spill-could-be-worse-what-bp-did-gulf?page=0,0
According to Dr. Ponemon:
“The basic issue, when you think about data theft not data loss – because it’s hard to know whether that lost data ultimately ends up in the hands of the cybercriminal and all of these bad things occur – but in the case of identity theft, the end goal has been historically to steal a person’s identity, and just like getting a financial record, getting a health record probably has your credit card, debit card, and payment information contained in that record.”
Of Credit Cards … and More!
But that’s not all. Credit cards are just chump change. He continues:
“The financial records are actually lucrative for the bad guy, but the health record is actually much, much more valuable item because it not only gives you the financial information but it also contains the health credential, and it’s very hard to detect a medical identity theft. What we’ve found in our studies is that medical identity theft is likely to be on the rise and, of course, there’s an awareness within the healthcare organizations that participate in our study that they’re starting to see this as more of a medical identity theft crime. It’s not just about stealing credit cards and buying goodies, it’s about stealing who you are, possibly getting medical treatment and, therefore, messing up your medical record.”
Dr. Ponemon suggests that the victim may not know about the theft until he or she “stumbles on something that alerts them their medical identity was stolen.” Perhaps something like death following anaphylactic shock from a medication that was once digitally highlighted as “Allergic to.” Understandably, Ponemon adds that respondents recognized altered medical histories as an emerging threat they believed was affecting the patients in their organizations. Such danger for dental patients is almost non-existent if their dentists simply don’t put PHI on office computers.
Should a data breach of Bluebell Ice Cream employees’ identities occur in Brenham or Chicago, which is more likely than not, the fact that electronic dental records do nothing to improve the quality of dental care won’t make Brenham citizens any happier with local Bluebell officials.
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Filed under: Health Insurance, Health Law & Policy, Information Technology, Practice Management, Pruitt's Platform | Tagged: D. Kellus Pruitt DDS, eDRs, EMRs, HIPAA, PHI, Ponemon Institute, protected health information | 1 Comment »
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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Conclusion
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Filed under: Information Technology, Pruitt's Platform, Risk Management | Tagged: ADA, Cole Petrochko, Darrell Pruitt DDS, Digital Health Conference, Dr. Robert Faiella, eDRs, EMRs, HIPAA, John DeLuca, Medical Identity Theft on the Rise, protected health information | 12 Comments »
Dentists should be furious with Gingrich for commandeering the ADA
By D. Kellus Pruitt DDS
On This Week roundtable discussion this morning [Sunday], George Will began his comments about Newt Gingrich, now a frontrunner, by saying that he “embodies everything disagreeable about modern Washington.”
Dentists should be furious with not only Gingrich, but with our inattentive dental leaders as well.
Why?
A couple of days ago, Steve Chapman posted “Gingrich’s corruption” on the ChicagoTribune.com.
http://www.chicagotribune.com/news/opinion/chapman/chi-gingrichs-corruption-20111118,0,4581968.story
Chapman writes:
“Conservatives may be able to forgive Newt Gingrich for being an adulterer and for his flip-flops on climate change and mandatory health insurance. They are willing to put those aside because they think he’s shown a fierce attachment to their cause. But, the latest revelations will be harder to digest, because they suggest that his allegiance is for sale.”
He punctuates the condemnation with a quote from USA Today:
http://www.usatoday.com/news/politics/story/2011-11-16/newt-gingrich-think-tank-opeds/51246512/1
“In a series of op-eds stretching over several years, Gingrich repeatedly advocated for various health-care related issues, including electronic health care records, ways to improve the health care sector, and medical malpractice reform without acknowledging the issues were directly connected to members of the Center for Health Transformation, a for-profit think tank he founded in 2003.”
Newt, for a Freddie Mac historian, you’re pretty sly!
According to information that Center for Health Transformation [CHT] spokeswoman Susan Meyers provided USA Today, healthcare stakeholders participating in Gingrich’s “think tank” can expect to pay Gingrich between $5,000 and $200,000, “depending on how many employees attend the center’s meetings and use other services.”
Wouldn’t you just love to ask Ms. Meyers if Gingrich’s think tank members are more likely to realize a return on their investment than their software offers dentists?
I suggested to the editor of the Chicago Tribune to specifically ask ADA President-elect Dr. Robert Faiella questions about the cost and safety of EHRs in dentistry. Then I followed the comment with,
“And, be sure to tell Dr. Faiella that D. Kellus Pruitt DDS referred you to him. Though we’ve never met, he knows who I am. If you get around to it, you might ask him how much HIPAA compliance raises the cost of dentistry. There are thousands of dentists who would find the President-elect’s answer to that question truly enlightening.”
I Do Find this Fun
Psst…! Chicago Tribune Editor; want a hot tip? I know of a local but far-reaching lead concerning the malignant, corporate corruption described by Steve Chapman in his article. A reporter wouldn’t have to travel far to aggravate employees of a secretive, command and control organization. The ADA National Headquarters is just down the street at 211 East Chicago Avenue. In 2004, the widely-overlooked, not-for-profit’s lack of transparency made it especially vulnerable to Gingrich’s deceptive selling points!
ADA Officials
I think everyone agrees that asking ADA officials reasonable questions about the cost and safety of any high-tech dental product they recommend – including electronic dental record systems – is not unreasonable.
In fact, now that Steve Chapman has shown Newt Gingrich’s profit motives for misleading our dental leaders, caution seems prudent.
This could be ornery-fun if, like me, someone on your staff gets a kick out of asking shy good ol’ boys questions they are hardly ready to answer. I wish the Tribune luck getting past anonymous, unaccountable gatekeepers who shield ADA officials from accountability. I suggest sending your questions to Dr. Robert Faiella. He is not only the unresponsive Chair of the ADA Electronic Health Record Workgroup, but he is the ADA’s latest insensitive President-elect.
Dentists should be furious with Newt Gingrich for commandeering the ADA
Psst…! Chicago Tribune Editor! You interested in another hot tip? I know of a local but potentially far-reaching lead concerning the malignant, corporate corruption described by Steve Chapman in his article exposing Newt Gingrich’s poor manners.
Should you choose to do so, you won’t have to travel far to aggravate employees of a stoic, command and control organization. The national headquarters for the American Dental Association is just down the street at 211 East Chicago Avenue. The widely-forgotten, not-for-profit’s traditional lack of transparency made it especially vulnerable to Gingrich’s deception back in 2004.
I think everyone agrees that asking ADA leaders reasonable questions about the cost and safety of any high-tech dental product they recommend – including electronic dental record systems – is not unreasonable.
In fact, now that Steve Chapman has shown us Newt Gingrich’s motives for misleading our dental leaders, caution seems prudent.
This could be ornery-fun if someone on your staff gets a kick out of asking shy good ol’ boys questions they are not yet ready to answer.
Nevertheless, the ADA will refuse to respond to questions, Editor. Even while I was still a member of the professional organization up until a year ago, it clearly aggravated dental leaders when I repeatedly questioned the cost and safety of EDRs on local, state and national levels of the organization.
I always find evasion intriguing. Maybe you will have better luck getting past anonymous, unaccountable gatekeepers who shield the good ol’ boys from transparency.
Assessment
Here’s the official to whom I suggest you futileyly address your questions: Dr. Robert Faiella. He is not only the unresponsive Chair of the ADA Electronic Health Record Workgroup, but he is theADA’s latest insensitive President-elect.
Conclusion
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Physician Financial Planning: http://www.jbpub.com/catalog/0763745790
Medical Risk Management: http://www.jbpub.com/catalog/9780763733421
Healthcare Organizations: www.HealthcareFinancials.com
Physician Advisors: www.CertifiedMedicalPlanner.com
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Filed under: Health Insurance, Health Law & Policy, Information Technology, Pruitt's Platform | Tagged: ADA, ADA Electronic Health Record Workgroup, Center for Health Transformation, Chicago Tibune, D. Kellus Pruitt, eDRs, George Will, HIPAA, Newt Gingrich, Robert Faiella, Steve Chapman, Susan Meyers, USA Today | 10 Comments »
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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Filed under: Information Technology, Pruitt's Platform | Tagged: CDT, CR Foundation, Darrell Pruitt, dental economics, dental electronic records, DMD, eDRs, HIPAA, Paul L. Child Jr | 10 Comments »
In Dentistry – if only it were that easy
By D. Kellus Pruitt DDS
I like the concept of a Practice-Based Research Network for teasing out latent miracles from dentalcare data, but I’m afraid any hope of networking success is limited by insurmountable cost and safety concerns of EDRs that few in the dental industry are yet willing to recognize.
Dr. Schleyer
Titus Schleyer, DMD, PhD, Associate Professor and Director, Center for Dental Informatics, University of Pittsburgh published “The feasibility of an electronic dental practice-based research network” a few days ago.
“The long-term goal of our research is to use data from EDRs to improve patient care and its outcomes. The objective of this project is to develop a generalizable method for extracting EDR data for practice-based clinical research, using Dentrix as the test system.
In our first specific aim, we will determine the utilization of clinical data elements useful for research by practitioners by mining the electronic dental records of 100 Dentrix users and generating summary statistics about patient documentation patterns by data field.
The second specific aim will develop a technical Infrastructure for extracting data from Dentrix and integrating them with manually collected research data. The main outcome of this project will be the electronic Dental Practice-Based Research Network (ePBRN), a generalizable method for extracting clinical data from EDRs and reusing them for practice-based research. This project is a first step in making the increasing amount of electronic clinical data available for improving research, clinical care and patient outcomes.”
-Abstract: September 30, 2011
http://halley.exp.sis.pitt.edu/comet/presentColloquium.do?col_id=2348
I agree with Dr. Schleyer. However, until dentists perceive value in EDRs instead of liabilities, the dreams that he and I share about real-time, evidence-based research on an internet platform will be nothing more than just a cool-sounding fantasy of a handful of geeky dentists hoping to get a better peek at an obscure healthcare niche.
On Transparency
Transparency in dentistry, rather than NPI numbers, has a better chance of revealing cost-effective solutions for painful and even life-threatening health problems. In addition, nothing is holding down the cost of HIPAA compliance, and data breaches from healthcare facilities – including dental offices – are only becoming more common.
Assessment
Sidestep liability. De-identify now. If a dentist’s EDR system is breached, yet it contains no Protected Health Information [PHI], who cares?
Conclusion
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Healthcare Organizations: www.HealthcareFinancials.com
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Filed under: Information Technology, Practice Management, Pruitt's Platform, Quality Initiatives | Tagged: Center for Dental Informatics, D. Kellus Pruitt, DDS, dentistry, Dentrix, eDRs, electronic Dental Practice-Based Research Network, electronic dental records, ePBRN, HIPAA, NPI, Titus Schleyer | Leave a comment »
Dr. Raymond Gist
By Kellus Pruitt DDS
I just found a US News Health article by Angela Haupt titled, “The Era of Electronic Medical Records.”
Even though dentistry wasn’t mentioned even once, I took liberties with the comment I posted. Besides, dentistry is never mentioned anywhere in the healthcare press, and that’s just not healthy. That is the point I hope I got across to Angela Haupt when I suggested she become Dr. Gist’s 7th Facebook friend.
Dear US News and World Report:
Last year, President Barack Obama promised that digitizing America’s health records will go beyond just improving care. He said transforming from paper to digital is a “panacea for the economy.” Somehow, illness became a renewable national resource.
I’m pretty sure neither the President nor US News have a clue about the business of dentistry.
Defying your common, misinformed bias for EHRs over paper records, here is a bite of reality from a dentist who actually treats patients: Other than me, the nation’s other 170,000 dentists are stone-silent about adoption of electronic dental records. Don’t you find that odd? What’s more, stakeholders inside and outside the American Dental Association, including even software vendors, avoid public discussions of EDRs. Dr. Oz’s Sharecare.com won’t even touch the topic. Why?… a reporter might ask.
Do you trust that the widely-respected ADA always represents first and foremost the safety of dental care for both dentists and their patients? Let me fix that for you: ADA President Dr. Raymond Gist recently opened a Facebook, and two days ago, I was fortunate enough to be his second fan and the first to post a comment.
https://www.facebook.com/pages/Raymond-F-Gist/165275266868843
I took advantage of an unprecedented opportunity to speak directly to a vetted ADA official and asked the President, “Are electronic dental records more or less dangerous for dentists and patients than paper records?” I’m disappointed that Dr. Gist still has not responded. Why did he even bother opening a Facebook, one might ask.
Here’s what I think:
Because of the cost and safety issues with digital records that I warned each ADA President about since 2006, EDRs, and especially HIPAA, have become so difficult to defend in a free-market that nobody even tries any more. I think a handful of ADA leaders expected pigs to fly much sooner than this.
Assessment
Want to do some real reporting, US News? Become Dr. Raymond F. Gist’s 7th Facebook fan and ask him on behalf of your publisher if EDRs are safer than paper dental records. Sure. It’s unconventional, and as far as journalism goes, it’s kind of kinky to post a question on someone’s Facebook. Nevertheless, it could be fun to watch a USN&WR reporter be treated with the same level of respect ADA officials offer dues-paying members.
Conclusion
And so, 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.
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Medical Risk Management: http://www.jbpub.com/catalog/9780763733421
Healthcare Organizations: www.HealthcareFinancials.com
Physician Advisors: www.CertifiedMedicalPlanner.com
Subscribe Now: Did you like this Medical Executive-Post, or find it helpful, interesting and informative? Want to get the latest ME-Ps delivered to your email box each morning? Just subscribe using the link below. You can unsubscribe at any time. Security is assured.
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Filed under: Information Technology, Pruitt's Platform | Tagged: ADA, Angela Haupt, DDS, dentists, Dr. Raymond Gist, eDRs, EHRs, EMRs, Kellus Pruitt DDS, The Era of Electronic Medical Records | 4 Comments »
Trusting the American Dental Association?
[By D. Kellus Pruitt DDS]
In January 2011 – the same month a new Minnesota law demanded dentists purchase e-prescription software whether they want it or not – the ADA Standards Committee on Dental Informatics published White Paper No. 1070: “Implementation of the Electronic Prescription Standard for Dentistry.”
Minnesota lawmakers who logically turned to the respected ADA for what they expected to be reliable and unbiased professional advice, were assured by the Committee that e-prescribing will not only “insure the elimination of illegible prescriptions” but it will also “reduce preventable errors such as drug to drug interactions, drug-allergy reactions, dosing errors, therapeutic duplication, and other error types.”
http://www.ada.org/sections/scienceAndResearch/pdfs/ADA_White_Paper_No._1070.pdf
Really, ADA? On what evidence did the ADA Department of Dental Informatics base their self-serving claims?
This week, MedicalNewsToday.com reporter Christian Nordqvist posted “11.7% Medication Error Rate In E-Prescribing,” which directly contradicts the ADA’s advice to trusting Minnesota lawmakers and ADA members. Nordqvist writes: “The chances of mistakes occurring in prescriptions sent electronically are no lower than in those written out by hand, a researcher from Massachusetts General Hospital in Boston wrote in the Journal of American Medical Information Association. This will be a disappointment for health reform experts and policymakers [and ADA officials] who assured that E-prescribing would have fewer medication errors, as well as saving the government billions of dollars.”
http://www.medicalnewstoday.com/articles/230296.php
If one considers the JAMIA a credible Journal, research clearly suggests that e-prescribing is a bust for physicians who write many more prescriptions than dentists. Yet ADA officials continue to encourage dentists to adopt paperless practices without mentioning that e-prescriptions not only produce just as many errors as paper, but that they are hundreds of times more expensive because of the cost of computers, software and HIPAA requirements.
In addition, if a dentist’s computer is stolen or hacked – even if he or she properly reports a breach of e-prescription records – the tragedy can easily bankrupt a practice between the HIPAA fines, state attorneys general lawsuits, patient notifications and local media coverage of the breach (as required by HIPAA/HITECH). The Ponemon Institute estimates the cost to be over $200 per dental patient. And the price is only increasing. I just read that HHS is to conduct 150 HIPAA audits in 2012. Ka-ching!!!
That announcement from HHS should also conveniently boost sales of “The ADA Practical Guide to HIPAA Compliance” (on sale now at ADA.org for $220 while supplies last).
Sounding the Alarm
I personally started warning ADA leaders about this over 5 years ago. Yet as far as I can tell, they continue to blissfully ignore the IT disaster in dentistry. They don’t have to listen to nobody. And it shows.
As illogical as it sounds for an organization whose only purpose is to serve the interests of dues-paying members, the ADA hasn’t a single “vetted” EDR expert who will allow him or herself to be accessed on the internet. One such rumored expert is long-time ADA Trustee Dr. Robert Faiella. Since the Osterville, Massachusetts periodontist is so secretive with the ADA members he serves, like Soviet leaders of the 1970s, it’s hard to tell for sure if he is still in power or even alive.
Suspiciously, in these days of rapidly-expanding openness through social networks, the ADA cannot even contribute experts’ answers to Sharecare.com as promised – much less open a Facebook with over 12,000 waiting fans. So instead of ADA members’ questions about e-prescribing being answered by ADA experts on a convenient venue like a Facebook, ADA members must turn to irrelevant, Committee-approved publications… just like the Soviet Union of the 1970s.
I have personally found it is easier to obtain responses from my US Senator John Cornyn than from shy ADA officials. But then, I’ve discovered that Senator Cornyn is a remarkably caring individual. Not an evasive not-for-profit apparatchik with nice teeth.
Assessment
How long before dentistry’s handful of entrenched ADA leaders apologize for the harm they’ve caused and stop deceiving Americans about electronic dental records? It’s the least Dr. Robert Faiella could do before resigning his ADA position.
As long as obsolete ADA officials wink at a bankrupt policy of deception, can the reclusive not-for-profit organization ever regain America’s trust?
Conclusion
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Filed under: Ethics, Information Technology, Pruitt's Platform | Tagged: ADA, Darrell Pruitt, eDRs, EMRs, HIPAA, JAMIA | 13 Comments »
Good Fences Keep Good Neighbors
[By D Kellus Pruitt DDS]
“Changes to an EHR (electronic health record) can go unnoticed and can be harder to trace than changes made to paper records”
Sen. Mark Leno [D-San Francisco, the author of SB 850]
Yesterday, Kendall Taggart posted “Bill would require ‘track changes’ on electronic medical records” on California Watch.com.
http://www.chron.com/disp/story.mpl/deadbymistake/ca/6555170.html
It seems there is a growing problem with providers in California who cannot be held accountable for altering patients’ digital health records to protect themselves rather than their patients. With paper records on the other hand, erasures, ink and even handwriting can be scrutinized should a court of law need reliable evidence. What’s more, Sen. Leno’s feel-good law will not make EDRs any cheaper. Meanwhile, the multifaceted safety of paper dental records is not only proven by a very long track record, but it is irrefutable and free. Hard evidence is the innocent dentist’s friend. Otherwise it’s “he said, she said” and an unpredictable jury that might not like dentists anyway.
Tagggart writes: “A bill working its way through the state Legislature would make it more difficult for health care providers [including dentists] to modify or delete electronic medical records and leave no record of the change … The bill would require providers to automatically record any change or deletion of electronically stored medical information and identify who made the change. Furthermore, the bill would make it possible for patients to see the changes if they requested their medical records.” Do Democrats from California ever consider the price tag of their ideas? Is there any wonder why healthcare costs continue to rise?
Kaiser Responds
Teresa Stark of Kaiser Permanente responds: “Our system can’t do that, and we’re not aware of any system that can. Given the level of investment required to bring our EHR up to that level, is this really what we want to be spending our money on?”
Regulatory expenses in healthcare are like tsunamis to dentists. Big boats like Kaiser in deep water might hardly notice the swell that will overwhelm our inflatable water wings in the shallows.
And, if it is too expensive for Kaiser – one of the largest healthcare systems in the nation with thousands of staff – imagine how expensive and time-consuming the new law will make electronic dental records? Since California often leads the nation in swell regulatory ideas, will California dentists be the first to flee to paper records should the costs of digital keep rising?
Even before California’s latest regulatory patch is slapped on EDRs, they offer no return on investment. That means paperless practices are more expensive to maintain than paper practices, and ultimately, patients will pay an increased price for paperless dentistry.
Assessment
Micromanagement of small practices is expensive even if performed using the EDRs dentists themselves purchase. Swell ideas from well-meaning lawmakers are pricing miracle discoveries from safely interconnected EDRs out of reach. Why is HIT incompatible with common sense?
Conclusion
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Filed under: Information Technology, Pruitt's Platform | Tagged: California SB 850, eDRs, EHRs, electronic medical records, EMRs, Kaiser Permanente, Kendall Taggart, Sen. Mark Leno [D-San Francisco], Teresa Stark | 5 Comments »
Plugging my Interview and Otherwise Clogging Things
[By D. Kellus Pruitt DDS]
Where are the EDR cheerleaders when I need them? On Tuesday May 31st, I’ve got a show to put on!
http://www.blogtalkradio.com/thewholetooth
Where are the EDR Cheerleaders?
Every now and then I still come across EDR vendors on the internet who would mislead naïve dentists about their product to make a sale. Today, I held FirstEMR representative Robert Evans accountable for self-serving misinformation he posted on EMR and HIPAA forum. (My dad would be proud that I told him “Get that garbage out of here!”). Then, remembering my manners, I invited Mr. Evans to please call into The Whole Tooth Blogtalkradio program on May 31 to further discuss the future of EHRs in dentistry. Unfortunately, because of things like the reflexive “garbage” statement, I don’t think he’ll show.
I try my best to be “collegial,” but I simply cannot pretend unethical sales techniques are acceptable in my neighborhood, and I want to help my friends easily recognize them… so what if I have a little fun.
Of Robert Evans
Thanks for your response, Robert Evans.
As I read your list of 6 rationalizations for electronic dental records here on the EMR and HIPAA forum , it occurred to me that you haven’t had a chance to read my detailed post on this thread from November 22 (Number 14) in which I de-bunked 28 similar myths – substantially including your 6. But since I never tire of doing this, let’s once again go through the details of a popular national blunder in dentistry you and other well-intentioned stakeholders in the HIT industry were sucked into.
“My personal background is medical administration and operations.” That would explain your misconceptions about EHRs in the unique field of dentistry.
For your first mistake, you say “Dentists can qualify as eligible providers for ARRA incentives” You really should have gone on to explain that for a dentist to qualify for the stimulus money, 30% of his or her practice has to be from Medicare/Medicaid. Since you surely should have known that, to fail to mention it could easily be interpreted as deceptive.
This is just a guess, but I’d say less than 10% of the dentists in the nation in private practice would make it on that qualification alone even if it made business sense to accept government money and the expensive demands that come with it. Since you are in the EHR business, you may have more accurate figures on that. What’s more, our grandchildren’s money will be gone long before the stimulus makes it to dentistry. You should already know that as well.
“All of our clients, including Dentists, Endodontists, Periodontists, Implant Surgeons and more are extremely pleased that they made the transition “ All of them, Robert? Really?
The ME-P Forum
This ME-P forum right here is full of stories about disappointed providers – perhaps other than your clients – who are finding huge problems with the transition. De-installations are far too common. It seems like a while back it was close to 30%. Then again, since you are in the business, you probably have more accurate figures for that as well.
Even the stimulus money isn’t sufficient subsidy for physicians to realize a return on investment in EMRs. And virtually nobody is interoperable as planned. That means the office tools you sell raise the cost of healthcare rather than lower it. What’s more, physicians stand to benefit from interoperability much more than dentists regardless of stimulus money. And if a dentist can’t expect ROI from an office tool, it’s called a hobby.
By the way, have you looked at the Stage 2 Meaningful Use requirements that stand between dentists and disappearing ARRA money? Well-meaning outsiders with plans for the common good just don’t realize that someone has to enter every piece of irrelevant detail about dental patients that CMS requires in order to receive full payment.
It’s a trap, Robert. And it’s not very well hidden. Dentists don’t take candy from strangers.
The Benefits
“The benefits to your office are numerous and too many to mention here; but, please take into account the following”:
1. Never having to worry about compliance issues, as we are 100% compliant with all standards and formats that CMS is mandating.
– You are 100% scary. As long as a provider stores or transmits electronic PHI he or she clearly must be concerned about HIPAA compliance issues. What’s more, as a Business Entity for the dentists you serve, if your computer system is hacked or someone on your end otherwise fumbles or steals 500 or more of a dentists’ patients’ PHI, all of the dentist’s patients must be notified of the danger of identity theft. In addition, federal law stipulates that news of the data breach must be broadcast as a press release in the dentist’s local media. This can easily bankrupt a dentist… You just had to know about this before today.
Your compliancy claim is not only wrong, but it is irresponsible and unethical advertising. You are not 100% compliant. Since the Rule is intentionally vague, nobody is. Get that garbage out of here!
2. Greatly reduce or even eliminate human error. Some offices have brought back billing into their control and terminated the outsourcing.
– Are you kidding? Eliminate human error? Someone put you up to this didn’t they. And “outsourcing”? Once again, this is misleading and irresponsible information, Robert. What about keystroke errors? Only frustrated vendors wish computers would replace human intelligence.
3. Facilitate lab and prescription orders. Offices using e-scribe services are already on board into accepting the benefits of an EMR.
– So does this mean that when the lab delivery person comes to my office to pick up plaster models of a patient’s teeth, the prescription for the restoration must be sent separately by email instead of inserting a short hand-written note in the package… with the relevant patient’s models?
– I don’t sign enough prescriptions to make e-prescribing worth it. I really, really don’t. So how expensive would you make dental care?
4. Simple and efficient scheduling. The reception and schedulers are not tied to the telephone, fax and charting tasks as well as insurance verifications.
– That’s never before been a significant problem. Dental offices were run surprisingly efficient for decades before computers were around. Since dentistry is intricate handwork, the bottleneck in dental offices isn’t the front desk. It’s the dentist.
– What’s so wrong with telephone and fax, by the way? One doesn’t have to be a HIPAA-covered entity to use those tools.
– As for insurance verification, is the EDR intended to help the patient or the insurance company?
5. No fumbling for charts, paperwork, etc. (significant cost savings)
– Prove it.
6. Gain 15+ hours per week, back!
– Where did find this chunk of information? Please don’t insult us with wild, irresponsible statements to improve sales of your product. That would be unethical.
“Again, there are too many to list here, but contact me anytime for a quick on-site or online demonstration and let us prove to you that FirstEMR is the most appropriate solution to meet your required EMR needs.”
eDR Mandate?
Did you intentionally say my “required” EMR needs? You wouldn’t be implying that EMRs are somehow “mandated” in dentistry are you, Robert? That would be called a rookie mistake and you would be about a year behind information published in the ADA News, which was wrong to mislead members on this point in 2008.
Rather than contacting you for a quick on-site or online demonstration, I’ll do you one better. I am to be interviewed on “The Whole Tooth” blogtalkradio on May 31 concerning the future of EHRs in dentistry. It promises to be an unprecedented discussion about the obscure topic, and is certain to be educational to thousands of dentists who have been misled for years about HIPAA and EDRs.
http://www.blogtalkradio.com/thewholetooth
Assessment
When the time comes, a telephone number will be provided for live questions. I invite you to call in, Robert, and we can discuss EHRs in dentistry before an audience of around 15,000.
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
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Filed under: Information Technology, Pruitt's Platform | Tagged: ARRA, Darrell Pruitt, eDRs, EHRs, electronic medical records, FirstEMR, HI-TECH, Robert Evans, Whole Tooth blogtalkradio | 6 Comments »
Let’s End the Silence
By D. Kellus Pruitt DDS
Hey, Doc. How can your silence possibly serve your patients’ best interests?
For my colleagues in the audience who have quietly examined the critical and timely issues I’ve repeatedly offered for discussion – adults with post-graduate degrees who might have briefly considered publicly responding to what I write, but who still cannot take ownership of an opinion – what on Earth is holding you back? Whatever it is, I say there are only lame, self-serving excuses for dentists to continue to betray patients’ trust. So how does that make you feel, Doc? A little angry maybe? Indignant? Let’s work on that professional nerve a little more. Maybe I’ll get a rise out of you yet.
Where Have You Been?
As a healthcare provider whose trusting patients depend on you to protect their interests from stakeholders who cannot be held accountable – where have you been? Do you really believe dentists’ stoicism upholds and promotes the ideals of the healing profession? What about the Hippocratic Oath? How?
Or, is your shyness perhaps the manifestation of a character weakness revealing little confidence in your own personal ethics? You can’t blame me if that pisses you off. As long as you are silent, it’s impossible for me to tell a thing about you. So please, feel free to describe how my observations make you feel. You could easily change my opinion by merely speaking up to defend your silence … which promises to be an interesting argument.
ADA Members
Or, maybe, as an ADA member, or more so a vetted official, professional silliness isn’t your choice at all. Perhaps you are torn between supporting common sense and honesty in your community and a professional dedication to the ADA’s committee-approved slogan “Speaking with one voice.” What looks to me like a cheap PR hack’s piece of art – purchased by either a clueless or nasty-cynical ADA official – is intended to not only keep members in their place as policy, but to also give state and national politicians the impression that all dentists unquestioningly unite behind any and all ADA ideas – sight unseen. (Public discussion of policy with membership is never permitted, even though it’s just dentistry). Elsewhere in the world, that would be called tyranny. It’s also easy to see that “one voice” is a generous exaggeration of our current dental leaders’ influence in Washington.
Stage 2 Meaningful Use
If anonymous leaders who secretly manage a silent profession insulated from the community were the least bit effective at protecting dental patients’ welfare, dentists who actually provide dentistry for the poor wouldn’t be faced with absurd and overwhelming Stage 2 Meaningful Use documentation requirements that will be enforced by CMS in 2012:
Rising Above Politics
As healthcare professionals, our patients depend on us to rise above political correctness and petty, cheap slogans. Indeed, how good is it for healthcare when doctors evade unpopular issues? Can anyone in the audience explain how our patients are better served by PR hacks than dialogue? Anyone?
Assessment
Face it. The absurdity of Meaningful Use [MU] requirements in dentistry proves that our non-responsive leadership is incapable of protecting our dental patients. From now on, only you and I can do that on our own as individuals. But to make a difference, you must be heard.
Conclusion
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Filed under: Health Law & Policy, Information Technology, Pruitt's Platform | Tagged: ADA, Darrell Pruitt, DDS, eDRs, EHRs, electronic dental records, EMRs, Meaningful Use in Dentistry, Stage 2 Meaningful Use | 6 Comments »
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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Filed under: Information Technology, Pruitt's Platform | Tagged: ADA, Darrell K. Pruitt, DDS, Dr. Margaret Scarlett, eDRs, EHRs, electronic dental records, EMRs, Health Information Exchanges, HIE, Medscape Connect, Sfax | 16 Comments »
Long Before Reaching … Dentistry
[By Darrell K. Pruitt DDS]
HCPlexus recently partnered with Thompson Reuters to conduct a nationwide survey of almost 3,000 physicians about their opinions of the quality of health care in the near future considering the Patient Protection and Affordable Care Act (PPACA), Electronic Medical Records, and their effects on physicians and their patients. (See “5-page Executive Summary”)
http://www.hcplexus.com/PDFs/Summary—2011-Thomson-Reuters-HCPlexus-National-P
Results:
“Sixty-five percent of respondents believe that the quality of health care in the country will deteriorate in the near term. Many cited political reasons, anger directed at insurance companies, and critiques of the reform act – some articulating the strong feelings they have regarding the negative effects they expect from the PPACA.”
What’s more, one in four physicians think eHRs will cause more harm than help. So what’s the accepted threshold for the Hippocratic Oath to come into play?
Do you also find excitement in healthcare reform’s surprises? Experiencing the sudden, last minute turns healthcare reform has taken lately is like riding shotgun with Mayhem behind the wheel, texting. Here’s other discouraging news from the same HCPlexus-Thompston Reuters survey: “A surprising 45% of all respondents indicated they did not know what an ACO is, exposing a much lower awareness of ACOs versus the broader implications of PPACA. It appears there has been a lack of physician education in this area.”
ACOs Defined
Since I also had no idea what an ACO is, I searched the term and came across a timely article that was posted on NPR only days ago titled, “Accountable Care Organizations, Explained.”
http://www.npr.org/2011/01/18/132937232/accountable-care-organizations-explained
Author Jenny Gold writes: “ACOs are a new model for delivering health services that offers doctors and hospitals financial incentives to provide good quality care to Medicare beneficiaries while keeping down costs.” Does that remind anyone of insurance HMO promises just before the bad idea collided with surprisingly intelligent consumers in the early 1990s? Kelly Devers, a senior fellow at the nonprofit Urban Institute, is quoted: “Some people say ACOs are HMOs in drag,” There’s a sharp turn nobody warned us about.
HMO Differentiation
Further blurring the difference between ACOs and HMOs, Gold adds “An ACO is a network of doctors and hospitals that shares responsibility for providing care to patients. Under the new law, ACOs would agree to manage all of the health care needs of a minimum of 5,000 Medicare beneficiaries for at least three years.” I wonder if we’ll see a resurrection of HMO gag orders preventing physicians from discussing effective but expensive treatment alternatives not offered by the ACO.
As expected, not only are hospitals and doctors competing for the opportunity to run ACOs, but so are former HMO insurance agents. Devers explains, “Insurers say they can play an important role in ACOs because they track and collect data on patients, which is critical for coordinating care and reporting on the results.” As a provider, do you trust UnitedHealth’s Ingenix data mining tendencies? A few years ago, NY State Attorney General Andrew Cuomo spanked the company for selling insurers pseudo-scientific excuses to cheat out-of-network physicians.
Just like Health Maintenance Organizations don’t maintain health, insurer-based Accountable Care Organizations will not bring accountability to care any more than the Patient Protection and Affordable Care Act provides patient protection and affordable care. And since I’m exposing blatant bi-partisan deceptions, there is no privacy or accountability in the Health Insurance Portability and Accountability Act, and the “HIPAA Administrative Simplification Statute and Rules Act” doesn’t.
HITECH Funding
Gold suggests that because HITECH rules were written intentionally vague in order to push the envelope of stakeholders’ imaginations, similar to HIPAA’s ineffective security rules I suppose, the doctors’ predictable ignorance of ACOs is understandable.
But then again, all this may not even matter in a few months. According to Howard Anderson, Executive Editor of HealthcareInfoSecurity.com, HITECH funding itself is threatened. He recently posted “GOP Bill Would Gut HITECH Funding – Unobligated HITECH Act Funds Would be Eliminated.”
http://www.govinfosecurity.com/articles.php?art_id=3306
Assessment
While Obama’s healthcare reform teeters between two houses, I encourage consumers to plead with their lawmakers to stop being suckered in by cheap, meaningless buzzwords sprinkled in the titles of bills. I’m hoping we can at least get them to read a little deeper. Be on your toes. Mayhem is “recalculating.”
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.
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Filed under: Information Technology, Practice Management, Pruitt's Platform | Tagged: ACA, ACOs, ADA, Darrell Pruuitt, eDRs, EHRs, EMRs, HIPAA, HIT, HITECH, Jenny Gold, Kelly Devers, Patient Protection and Affordable Care Act | 3 Comments »
I told you so … wow! That felt really, really good!
By D. Kellus Pruitt DDS
If you haven’t been following the bad news for electronic health records that has broken in the popular media in the last few days, you may be unaware of recent studies that are about as welcome in Washington DC as Wikileaks revelations of diplomatic farts – but much more serious. Healthcare reform itself is in the balance, and President Obama’s credibility with mandates is already shot.
Records will show that a few politically-incorrect troublemakers knew all along that EHRs will fail to save money or improve the quality of healthcare – ever – unless doctors and patients are involved in their development. This troublemaker warned dentists 5 years ago about how HIT stakeholder and former Speaker of the House Newt Gingrich deceived naïve ADA Delegates about benefits of eHRs to dental patients. In turn, 3 years later, the ADA’s HIT stakeholder, Dr. Robert Ahlstrom, deceived Bush’s HHS Secretary Michael Leavitt with biased, self-serving testimony he gave to the NCVHS. (See “Dr. Robert H. Ahlstrom’s controversial HIPAA testimony” that I posted in 2008.)
http://community.pennwelldentalgroup.com/forum/topics/dr-robert-h-ahlstroms
Do you still not agree that long ago, I told you so?
At a time when President Obama’s healthcare reform is teetering between the Houses, just wait until lawmakers catch the news I’m bringing to you hours, days or even weeks ahead of Fox News: Transparency just caused a huge chunk of anticipated funding for reform to evaporate like American’s property values. After billions of stimulus dollars have been gleefully spent benefiting influential healthcare stakeholders rather than principals, the bi-partisan feel-good digital fantasy is bankrupt. Pop goes the bubble.
Although there have been minor news reports of growing disappointment in eHRs for years, the results of two recent studies by Public Library of Sciences (PLoS) and Stanford clearly expose the lack of value of eHRs for Americans. We’ve been had.
The WSJ
On January 21, the Wall Street Journal posted an article titled, “Study Looks For, Can’t Find Much Evidence of E-Health’s Benefits,” by Katherine Hobson.
Hobson writes: “With the U.S. and the U.K. heading full steam towards electronic medical records and other health IT applications, how much evidence is there that they improve care?
Not a whole lot, according to a review of existing research on the topic published this week by PLoS Medicine. While governments and other proponents are claiming that digitizing health records can save lives and increase efficiency, the review’s ‘key conclusion is that these claims need to be scrutinized before people invest quite large sums of money in these technologies,’ Aziz Sheikh, lead author of the study and a professor of primary care research and development at the Center for Population Health Sciences at the University of Edinburgh, tells the Health Blog.’”
US News & World Report
And; only hours ago, US News & World Report posted a story titled “Electronic Record-Keeping Alone May Not Boost Health Care.” (no byline).
“Electronic health records have so far done little to improve the quality of health care in the United States, a new study states.
Researchers from the Stanford University School of Medicine analyzed data on use of electronic records from 2005 through 2007. The data came from a nationwide physician survey that encompassed nearly 250,000 outpatient visits.”
The ADA 
So how does the truth about eHRs affect ADA leadership’s stubborn push for paperless practices in dentistry? Well, if as a trusting ADA member, you haven’t already swallowed the propaganda, now wouldn’t be a good time to convert to paperless.
eDRs
Though my unpopular but accurate statements about eDRs eventually got me in secret trouble with vetted, anonymous Texas Dental Association officials, I predicted this week’s bad news years ago on the TDA online forum. Unfortunately, my warnings to other TDA members about the ADA’s biggest blunder in history were censored by the TDA Executive Director without warning or explanation. Why? She isn’t accountable to anyone and “Image is everything.” (ADA/IDM slogan).
Just how difficult can it be to recognize that eHRs are inefficient in dental practices for simple, common sense reasons? First of all, dental records which involve prevention and treatment of disease in the lower third of the face rarely include laboratory test results like medical records which concern the whole body. In addition, dentists maintain tenfold fewer thin patient charts than physicians’ thick ones. So if the value of eHRs are questionable for hospital care involving millions of charts, I think dentists are safe to ignore Presidential eHR mandates. The bottleneck in dental offices isn’t the front desk, it’s the dentist … or at least it should be. As for thumbing your nose at a Presidential mandate, I wouldn’t get too concerned. Obama also mandated that the prison at Guantanamo Bay was to be closed over a year ago. It didn’t happen, and nobody went to jail.
Unfunded Mandates
Unfunded mandates just don’t carry the respect they once did when they were less common and actually made sense. Considering the absurdity of eHRs in dentistry, worse things could happen for trusting, clueless Americans.
Those who represent our concerns in government probably don’t yet realize that in the last four days, the price of healthcare reform skyrocketed even further out of reach, and we simply cannot borrow any more money from our grandchildren just to throw it away on expensive hi-tech crap. As for myself, I’m sending this ME-P to my national and state representatives: Cornyn, Hutchison, Barton, Burgess, Harris, Davis, Patrick and Veasey, I hope you will contact your representatives as well. The Internet makes it so easy these days to educate those who would otherwise determine our future based on deception from healthcare stakeholders.
Assessment
I publicly challenge Dr. Robert Ahlstrom, who is currently a member of the ADA Council on Dental Practice and chair of the Members Advisory Group to an Internet discussion concerning electronic health records in dentistry. It’s the same unanswered challenge I issued to the influential dentist over 3 years ago: I still say electronic dental records are an expensive hobby paid for by dental patients in higher fees, and they do nothing to improve patient care. What do you have to say about that, Dr. Robert Ahlstrom? You know you’re going to have to face me again and again, so please don’t disappoint ADA members by continuing to hide. It makes the whole ADA look cowardly.
Conclusion
Always remember: I told you so, Dr. Robert Ahlstrom. And so, your thoughts and comments on this ME-P are appreciated. How do you select an eMR consultant? 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 and http://www.springerpub.com/Search/marcinko
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Healthcare Organizations: www.HealthcareFinancials.com
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Filed under: Information Technology, Practice Management, Pruitt's Platform | Tagged: ADA, Aziz Sheikh, Darrell Pruitt, eDRs, EMRs, michael leavitt, NCVHS, Newt Gingrich, Robert Ahlstrom, Texas Dental Association | 9 Comments »
About My Tell-All Book?
By D. Kellus Pruitt DDS
One day, I’m going to write a tell-all book about quality control dentistry … But, for all I’ve been told, it might be fiction.
The Quality Mandate
Here’s something I find entertaining about the “quality” reporting mandate that was quietly written into HIPAA about the time President Clinton amended the 1966 Freedom of Information Act – making doctors’ records no longer proprietary business information. The 1996 HIPAA Rule is modular, and around every corner, we’ve learned there is an exploding surprise that was slipped into a thick bill long ago. The bolus technique of passing difficult legislation is not unlike the way the 2000 page healthcare reform bill was handled. It gets crap through the system too quick to be read, understood and debated by principals in healthcare who aren’t paying attention anyway. It’s a rule-making policy that simply favors stakeholders rather than doctors and patients. Depending on the campaign contributions, silliness can catch fire like a Madoff investment.
Dental Quality Compliance
I don’t know about physicians, but dentists have never been warned about the quality control part of compliance. Now that it’s an integral part of healthcare reform’s imaginary funding, it’s a sure bet that no ADA official is willing to discuss the egregious blunder even anonymously.
ADA Department of Informatics
Soon enough, ADA members will learn about the clandestine quality control efforts of the ADA Department of Informatics – the brainchild of former ADA Sr. Vice President Dr. John Luther, who I hear is no longer part of the organization. Although I’m a persistent, nosey outsider peeking into a secretive not-for-profit organization (?), from what I can tell, the ADA’s interest in quality control began about 6 years ago following a visit to the ADA Headquarters by Newt Gingrich – which evidently favored the ADA Department of Dental Informatics with federal funding to replace dependence on finicky members’ dues. Had ADA members who were busy treating dental patients actually known the directions the ADA took the ADA’s mission statement for easy money, Dr. Luther’s career with the organization would have been even shorter.
Anonymous ADA Leaders
Knowing that anonymous ADA leaders’ blunders no longer stay hidden forever, don’t you find the shyness of today’s dental leaders amusing? Don’t you just know the trusting early-adopters of interoperable eDRs will be pissed off when they discover that long ago, the ADA could have warned them about ambitious stakeholders’ plans for the profession?
Assessment
Who’s going to break the sweet news to dues-paying members before CMS, insurers, and quality control consultants (today’s dental insurance consultants), are granted a back door to HIPAA-compliant dentists’ interoperable computers allowing access for real-time quality control authorities, as well as fraud, HIPAA, FTC and other inspectors working on commission? It’s a dark tale.
Conclusion
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Healthcare Organizations: www.HealthcareFinancials.com
Physician Advisors: www.CertifiedMedicalPlanner.com
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Filed under: Information Technology, Practice Management, Pruitt's Platform, Quality Initiatives | Tagged: ADA, ADA Department of Informatics, Darrell Pruitt, Dr. John Luther, eDRs, HIPAA | 8 Comments »
Why Does the ADA Promote eDRs?
By Darrell K. Pruitt DDS
Not so Fast!
Before a dentist trustingly accepts the recommendation of the American Dental Association and unwittingly converts his or her practice to paperless, one should read the story I copied below which was posted on VillageSoup.com yesterday.
Unlucky dentist loses everything …
Worst Way to Start Off the Year
I have been on my own for last 7 yrs. We have a small business server (windows 2003) 6 work stations, completely paperless using Dentrix 11 and Vixwin platinum. One morning, when we returned to work, we could not access the server. Went into panic mode! Not able to get anything! Not knowing the schedule. Who is coming what they are coming for, etc. It was decided that my server crashed. It was set up w/2 hard drives to mirror each other and also had an external drive back up (Seagate). We ended up rushing the drives to a data recovery company in (data doctors). They sounded very promising claim 90% success). I agreed to pay additional $4100 to rush case! We were led to believe all is well once they diagnosed case. A few hrs later every thing changed. We got the bad news that both drives are not recoverable since they found a minute scratch on one of the plates. Also we are not able to recover anything from the external drive.
At this point I have lost all patient records including x rays going back 7 yrs. I have no access to schedule, ledgers, notes, insurance, X-rays, anything. This is leading both me and my wife into depression. We are very stressed, at a loss. This is a catastrophic loss. Not sure how to move forward?
I am worried about the liability on top of everything else. How do I tell my patients? How do I know who paid for what balances on work that needs to be done, etc. I keep waking up at night thinking of all the possible problems.
This is the lowest point in my career. I don’t even want to go into the office from stress. If any one can offer any advice I would really appreciate it. I know in the past you guys lifted me up. I love forum name.
Thank you.
Assessment
On top of the anguish this person already suffers, the HIPAA violation must be reported to the Department of Health and Human Services. Thanks to HITECH, an expensive inspection is likely to follow. The dentist’s letter reminds me of a desperate private note from a dentist a few months ago describing his HIPAA violation. He lost a laptop computer he was using as a daily backup device. Since there were thousands of his patients’ unencrypted PHI on the computer, he was similarly paralyzed by the same cold and lonely panic a professional feels when optimistic career plans suddenly crumble into a dark void that includes abject business failure. People sometimes hurt themselves and others when even choosing to do the right thing leads to ruin. A person with any compassion can tell from reading the dentist’s plea for help that the newer harsher penalties from HHS and state Attorneys General for data breaches will only further destroy the lives of innocent dentists and their families. HITECH is cruel nonsense in dentistry and ADA leaders are stone-cold heartless.
Although encryption is strongly advised in the “ADA Practical Guide to HIPAA Compliance,” If ADA officials dared to keep track of their failure in promoting safe digital dental records, I bet their own data would show that less than 3% of US dental patients’ PHI is encrypted. Yet proud leaders in my profession remain stoically unresponsive to members’ and patients’ concerns about risks of data breaches. They call their aloofness “professionalism.” It infuriates me that shy ADA officials hide from personal accountability for the careless harm they cause dentists and dental patients.
“Image is everything” – ADA/IDM slogan
The nation’s ambulatory healthcare providers – including dentists, podiatrists, chiropractic doctors and physicians – cannot continue to blindly trust our professional organizations to protect our practices from the dangers of the electronic health records they promote for their personal benefit. We’ve been sold out.
Assessment
As far as I can tell, selfish ADA leaders with careers invested in dental informatics just can’t tolerate truth. When I consider the pain they cause at no risk to themselves, I say the parasites should be encouraged to move on down the road and look for their power in a field where they won’t endanger others.
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
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***
Filed under: Information Technology, Op-Editorials, Practice Management, Pruitt's Platform | Tagged: ADA, Darrell Pruitt DDS, DDS, eDRs, EMRs, HIPAA, VillageSoup.com | 10 Comments »
Essay on eDR and eHR Data Integrity
By D. Kellus Pruitt DDS
“ADA Tip: Password protection is the responsibility of each workforce member. Strong alphanumeric passwords provide a strong defense against unauthorized electronic system intrusion. Passwords that cannot be guessed, that are not publicly posted, and that are changed on a regular basis will help your practice avoid the occurrence of security incidents.”
– 2010 ADA Practical Guide to HIPAA Compliance, Chapter 4, page 26.
Not So Fast, ADA
I read a recent article on lifehacker.com titled “How to Break into a Windows PC (And Prevent It from Happening to You).” The unnamed author tells a different story.
http://lifehacker.com/5674972/how-to-break-into-a-windows-pc-and-prevent-it-from-happening-to-you
Running on Windows®
Apparently, if a healthcare provider’s office computer runs on Windows and it is not encrypted, password protection is worse than ineffective security. Passwords are false security. If lifehacker.com is correct, all a dishonest employee needs to download thousands of patient identities to sell for a few hundred bucks is a Linux CD and 10 minutes of snuggle-time with an office terminal.
What’s more, it is unlikely that if the thief will ever be caught if he or she sports common sense. Months or years following the silent heist, the doctor could learn of a rash of neighborhood identity thefts from a federal investigator with a badge – waiting in the reception room for the doc’s next break between patients. Please remember this gaping hole in security the next time a HIT stakeholder like the ADA assures Americans that HIPAA is swell protection from identity theft. HIPAA empowers identity theft. The amendments to the 1996 Rule in 2002 gave too much away to campaign contributors, in my opinion.
About De-identification
Now then; since you’ve made it this far, is anyone ready to consider a different path to the benefits of electronic dental records? It’s called de-identification. My goal has always been to stimulate open discussion of de-identifying dental records because it is so common sense to remove fuses from bombs. In 5 years, I’ve had very little success attracting sincere discussion about de-identification other than privately. Nevertheless, over the years I entertained an adequate amount of ridicule that stopped a few months ago. Like Charlie Brown and his persevering faith in the Great Pumpkin, I’m resolute.
HIPPA Data-Breach Liability
Physicians might not be able to get away with sidestepping HIPAA and data-breach liability using de-identification because it is so easy to re-identify owners of medical records. And insurance company CEOs who don’t know the difference between cost control and quality control will fight de-identification of dental records before giving up the exclusive right to bend proprietary algorithms toward bonuses.
Here Comes the Pitch!
Is America interested in better dental care through a transparent 2.0 platform that incentivizes value-based competition for dental patients instead of paid ads? I have a better solution than HIPAA: Drop the PHI identifiers from dental records and store volatile health histories on one or two well-guarded flash drives. It’s that simple. Want to see miracle discoveries in dentistry? Offer the boring but safe raw, de-identified dental data to anyone who cares to perform Evidence-Based Dental research. Interoperability will still be incredibly tedious and expensive, but at least the effort won’t be doomed by dangerous and expensive HIPAA regulations.
Assessment
So how about it? Imagine the incentives for self-improvement if dentists could privately compare their treatment results with competitors’ – without risk of harming their patients or practices – on an “opt-in” basis rather than a mandated fantasy of a “pay-for-performance” [P4P] model run by stakeholders with investors to answer to. If our grandchildren are to benefit from unbiased Evidence-Based Dental research mined from facts rather than manicured dental claims, passwords won’t allow them a return on ARRA investment and encryption is just one more layer of expensive and futile complication.
Conclusion
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Filed under: Information Technology, Op-Editorials, Practice Management, Pruitt's Platform, Risk Management | Tagged: ADA, D. Kellus Pruitt, eDRs, EHRs, EMRs, HIPAA, HIT, HIT security, lifehacker.com, P4P, password protection PCs, PHI | 5 Comments »
An ME-P Exclusive – Almost
By D. Kellus Pruitt DDS
I really, really love being provocative in my neighborhood that I know so well. It just doesn’t seem fair. In fact, for five years, I’ve watched the electronic dental record [eDR] market very closely, and I tell you, something big is moving under the radar. If you recall, in the last couple of weeks I brought your attention to unexplained interest blips appearing on the Medical Executive-Post www.MedicalExecutivePost.com concerning eDRs. I suggested that Internet interest in the topic following years of silence from even the ADA, could be a sign that important news about electronic health records in dentistry may be breaking soon.
CCHIT Seeking Comments
Just a couple of hours ago, Andis Robeznieks posted “CCHIT seeks comments on specialized EHRs” on ModernHealthcare.com.
http://www.modernhealthcare.com/article/20101119/NEWS/311199996/#
Robeznieks writes: “The Certification Commission for Health Information Technology has opened a public comment period for its proposed oncology and women’s-health electronic health-record certification criteria and test scripts. The comment period will end December 10th at 5 pm CT.”
Meaningful Dental Use
Is it possible that following the establishment of “meaningful use” guidelines for these specialists, dentistry could be next in line? The nature of the approaching bolus of news concerning eDRs is pure speculation, but rest assured I’ll be right in the middle of it – which brings me to the next sign that eDR stakeholders are getting restless: An almost unheard of conversation about eDRs appeared today on the Internet. Since the only news about eDRs on the Internet are press releases from Dentrix – the largest vendor in the nation – conversations about value of electronic dental records only rarely break out. But, when they appear, I always try my best to be provocative – just to tease out new rationalizations I might have otherwise missed.
I think I found promising opportunity this morning following an article by “John” titled, “EMR Stimulus Q and A: EMR Stimulus Money and Dentists.” It was posted yesterday on the EMR and HIPAA blog.
My Comments
I’ve looked into whether stimulus money will be available to dentists. Many in your audience won’t like it, but here’s your answer:
Dentists will not receive any ARRA stimulus to help pay for electronic dental records – even if a practice is 30% Medicaid as required. For one thing, it’s already too late to collect on the biggest portion of our grandchildren’s money unless the practice can prove utilization of an ONC-certified eDR in a “meaningful” way by this time next year. And, that’s simply impossible because there are no ONC-certified eDRs, and meaningful use has still not been defined by HHS – with help from the ADA. Eventually, someone from the ADA will either have to promote computer busywork as meaningful use, or concede that meaningful use of eHRs in dentistry simply does not exist.
Example
For example, do you want to log on to a password-protected, HIPAA-compliant computer just to notify the lab that you have a pick-up? For dental practices, speed-dial on the telephone – or fax machine – is much more meaningful, and neither requires the dentist to be a HIPAA-covered entity. In addition, none of the conventional ways of communicating put patients’ identities at risk like digital records on a stolen or hacked computer. That’s Hippocratic meaningful.
Digital Drawbacks
Here’s another drawback to digitalization: Even though electronic dental records are cutting-edge cool, they have yet to show a return on investment for dental practices, and data breaches will continue to make them more and more expensive. Without ROI, paperless is a hobby paid for by clueless patients in higher fees. Bet you haven’t heard that chunk of honesty very often. Honesty about hi-tech non-solutions is repressed even in the ADA because it is so politically incorrect to admit that our dental leaders who misled members were misled themselves by HIT stakeholders and Newt Gingrich. It’s really difficult for high officials inside and outside dentistry to stand up and say, “Oops! We were wrong.”
See: “Is ARRA Stimulus Money for Dentists?”
https://medicalexecutivepost.com/2010/11/16/is-arra-stimulus-money-for-dentists/
Assessment
I happened to post the article on the Medical Executive-Post two days before John’s article was posted here on the EMR and HIPAA forum. I invite you to read it, and tell me what you think. Other than here, nobody talks about these issues. That can’t be good for dental patients.
Conclusion
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Filed under: Information Technology, Op-Editorials, Practice Management, Pruitt's Platform | Tagged: ADA, ARRA, CCHIT, Certification Commission for Health Information Technology, Darrell Pruitt, dental meaningful use, eDRs, HIPPA, ONC | 12 Comments »
Estimating Financial Damage Often Difficult
By D. Kellus Pruitt DDS
Dom Nicastro just posted an article on HealthLeaders Media titled “HITRUST: HIPAA Breaches Near $1 Billion.”
http://www.healthleadersmedia.com/content/TEC-255015/HITRUST-HIPAA-Breaches-Near-1-Billion##
“Covered entities and business associates reporting breaches of unsecured personal health information (PHI) affecting 500 or more individuals to the Office for Civil Rights (OCR) together could spend nearly $1 billion because of those breaches.” Nicastro continues:
“HITRUST used the 2009 Ponemon Institute study that found the average cost for a compromised record to be approximately $144 in indirect costs and $60 of direct costs, for a total cost of $204.”
Fort Worth Star-Telegram
Just days ago, Jan Jarvis described a data breach in the Fort Worth Star-Telegram titled “Fort Worth medical clinic spends $15,000 notifying patients of theft.”
http://www.star-telegram.com/2010/08/06/2389717/fort-worth-medical-clinic-spends.html#ixzz0wIaU5AQa
Jarvis writes,
“In June, employees at a Fort Worth allergy clinic discovered that the office door had been kicked in and four computers containing patients’ personal information including Social Security numbers and birth dates had been stolen.”
Jarvis reports that 25,000 records were involved, and it only cost $15,000 to notify them. That’s only 60 cents per record instead of 60 dollars each as estimated by the Ponemon Institute. Instead of it costing the clinic $1.5 million for direct costs, it only cost them $15,000. That’s a savings of 99%.
Assessment
So what’s the deal? Is the Ponemon Institute that far off in their estimates?
Conclusion
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Filed under: Information Technology, Practice Management, Pruitt's Platform, Research & Development | Tagged: Dom Nicastro, eDRs, EHRs, EMRs, Healthcare Data Breaches, HealthLeaders Media, HIPAA, Jan Jarvis, OCR, PHI, Ponemon Institute | 11 Comments »
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
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.
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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Filed under: Op-Editorials, Practice Management, Pruitt's Platform, Quality Initiatives | Tagged: ADA, Darrell Pruitt, DDS, dental consultants, dental economics, dentistry, DentistryiQ, DMD, Dr. Robert Ahlstrom, eDRs, EHRs, EMRs, Gary Kadi DDS, HIPPA, HIT, NHII, PennWell | 37 Comments »
Data Breaches More Common than Realized
By Darrell K. Pruitt; DDS
Here is an article titled “Report: Healthcare Organizations may have a False Sense of Data Security,” written by Neil Versel for FierceHealthIT.
Versel describes the results of a study commissioned by Nashville, Tenn-based Kroll Fraud Solutions. Kroll estimates that 19% of healthcare organizations in the nation suffered a data breach in the last 12 months. That number is up from 13% a year ago. It is based on this information that I estimate that in the last year, at least 24 million dental patients in the nation have been unknowingly exposed to the danger of identity theft. Everyone agrees that the only ethical thing for a dentist to do if he or she knows that patients’ identities have been exposed is to notify the patients and HHS. The shameful fact is, data breaches in dentistry are not being reported.
Enter the Dentists
But, who can blame American dentists for underreporting breaches without first blaming the heavy-handed, stakeholder-friendly system that forces honest professionals to be dishonest? If a dentist self-reports a breach of 500 or more patients’ Protected Health Information (PHI) it can easily bankrupt a practice. The harm to one’s reputation in the community is just too great a disincentive for even the best of us, even without the added expense of patient notification, subsequent fines and lawsuits. It’s ugly, but that’s the hard, hidden truth about HITECH-HIPAA in dentistry – a piece of lame, one-sided “feel good” legislation that rather than preventing data breaches in dentists’ offices, it drives them underground. As healthcare providers, we should have warned our patients about the growing danger from electronic dental records long ago. Besides me, there are no practicing dentists discussing the topic. Why?
Accepting Ownership of the Dilemma
Would anyone like to argue that the bi-partisan federal mandate for an interoperable, national eHR system relieves dentists of their obligations to the Hippocratic Oath? Let’s face it: Dentists’ computers continue to threaten up to 20% of dental patients in the nation. We cannot ignore it any longer, doctors. Once we finally accept ownership of our problem, what are we going to do about it? I’ve suggested that we use common sense and simply remove the dangerous information from dental patients’ files. Anyone see any problem with this idea? Anyone have a better solution?
Assessment 
So what do the leaders of the ADA think of de-identification?
Conclusion
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Filed under: Information Technology, Pruitt's Platform | Tagged: ADA, Darrell Pruitt, eDRs, EMRs, HHS, HIPAA, HITECH, Kroll Fraud Solutions, protected health information | 7 Comments »
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?
Editors Note: The incredible power of the internet is illustrated with this post relative to the phenomenon of “crowd-sourcing.” In this context, the term means to harvest the reach of social networking, like this ME-P, to solve a problem, or ask for input or opinions.
IOW: A knowledge seeker asks a question and participants respond. PeerClip.com is an example of how “wisdom of the crowds” allows you to follow the latest opinions on interesting topics. In the medical practice management arena, you can also participate at the: www.BusinessofMedicalPractice.com, our newest 850 page book available this Fall.
Channel Surfing the ME-P Have you visited our other topic channels? Established to facilitate idea exchange and link our community together, the value of these topics is dependent upon your input. Please take a minute to visit. And, to prevent that annoying spam, we ask that you register. It is fast, free and secure.
Conclusion
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Filed under: "Ask-an-Advisor", "Doctors Only", Healthcare Finance, Information Technology, Op-Editorials, Pruitt's Platform | Tagged: ADA Member Service Center, ADA National Oral Health Agenda, ADA. DDS, ADA.org, CareCredit/GE, Darrell K. Pruitt, dentists, eDRs, EMRs, FTC, red flag rules | 9 Comments »
Come on out Kim E. Volk – CEO of Delta Dental
By Darrell K. Pruitt; DDS
Today, Julie Frey posted “Dentist & Dental Insurance: No Love Lost” on Jim Du Molin’s Blog.
http://www.thewealthydentist.com/blog/1186/dentist-dental-insurance/
Frey hosts dentists’ frank criticism of dental insurance – their harsh sentiments backed up with fresh results from yet another of the blog’s timely studies that nobody else can compete with. Frey writes “Half of dentists have mostly or completely stopped accepting dental insurances, according to this survey.” One dentist captured the mood of the dentists with the statement, “Do the math … somebody is making hell of a lot of money on these plans, and it is not the dentist!” I smelled blood and posted the following comment.
Bloody Sunday
Anonymous members of the obscure National Association of Dental Plans (NADP) are losing the fat, collective thumb they once oppressed us with – even using our own ADA News to present their non-negotiable terms. Apart from common sense appearing in the marketplace about the same time as transparency, multiple other interconnected factors are causing dental insurance companies to lose business. The bad economy, corporate greed and pride are a few of their more serious handicaps that come to mind. Wasteful, deceptive insurance practices have aggravated my patients and me for decades before modern networked recourse became available on the Internet through progressive Websites like Jim Du Molin’s Blog. I’ll go out on a limb and say it is not unprofessional for us to enjoy protecting those we serve by showing no mercy to unfair stakeholders like the NADP.
There. I said it. In fact, as US citizens and taxpayers I think blowing the whistle on unneeded expense and danger in the nation’s healthcare delivery is the least we can do for meaningful healthcare reform. I say do your part. Make an insurance CEO like Delta Dental Plans Association’s Kim E. Volk feel discomfort on the Internet. Do you know that Kim E. Volk is the only person who has ever refused to accept me as a friend on Facebook?
http://www.jbpub.com/catalog/9780763733421/
Assessment
We really don’t want to allow Delta Dental, UnitedHealthcare, United Concordia and others to dictate fees for non-covered dental services, do we? I also don’t think they deserve continued protection from FTC anti-trust litigation. I say we punish the NADP hard every chance we get until the repeal of the McCarran-Ferguson Act and finally make such in-your-face collusion illegal for crying out loud.
Conclusion
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Filed under: Career Development, Ethics, Health Insurance, Practice Management, Pruitt's Platform | Tagged: ADA, Darrell Pruitt DDS, DDS, delta dental, dental insurance, eDRs, FTC, Julie Frey. Jim Du Molin, Kim E. Volk, McCarran-Ferguson Act, NADP, National Association of Dental Plans, United Concordia, UnitedHealthcare | 13 Comments »
By Darrell K. Pruitt; DDS
[picapp align=”none” wrap=”false” link=”term=doctors+computers&iid=131173″ src=”0127/4caf5e52-a89a-4ddb-a0b2-bf4b6789c92b.jpg?adImageId=11344576&imageId=131173″ width=”414″ height=”413″ /]
Two days ago, ADVANCE for Health Information Executives’ managing editor Bob Mitchell publicly criticized the author of last week’s Parade Magazine article, “Electronic Health Records Face Critics.” Personally, I thought it was cowardly for the editor to accuse Drew Jubera of journalistic recklessness without mentioning his name.
http://community.advanceweb.com/blogs/hx_1/archive/2010/03/16/critics-ehrs-don-t-save-money.aspx
According to Jubera
Jubera wrote:
“A new Harvard Medical School study suggests that electronic health records do not save hospitals money—and in fact often end up increasing costs. The Obama Administration has allocated $19 billion in federal stimulus funds to facilitate the shift from paper to electronic records – a move the Rand Corporation has projected could save up to $80 billion a year. Yet the Harvard study found no evidence of savings so far and little evidence that electronic records improve care.”
Dis-Respects Harvard
Incredibly, Bob Mitchell discounts the Harvard Medical School study as being dated research – even though it is less than 5 months old. “I did some research and found that this study was released back in November 2009, even before meaningful use of an eHR had been defined by [ONCHIT] – or the Office of National Coordinator of Health IT.” As if defining meaningful use was meaningful! That’s humor.
Dis-Respects Parade
Furthermore, editor Mitchell has taken on the responsibility to shield his readers from harm caused by Parade Magazine authors whose ethics fall short of acceptable.
He writes:
“I’m concerned that the public is not being served and they will get the wrong impression of computers in health care, especially if it’s being reported by Parade, which reports celebrity, entertainment and health news.”
Of Healthcare Providers
Not so fast with those tricky pronoun phrases, Bob. Rather than being merely a healthcare stakeholder like you, I’m actually the healthcare provider whom you would have fund your enthusiasm. I think your broad statement that “all of us in healthcare know that digital is much better than paper” is journalistically foolish. In addition, your creativity threatens society much more than alleged exaggerations in Parade Magazine. You not only write about HIT as a career, but people generously call you a managing editor.
eMRs in Dentistry
The next time you feel important enough to quietly insult writers on behalf of providers like me, remember that eMRs in dentistry will not save money over paper records and will unnecessarily increase the risk of identity theft for my patients … unless you disagree.
It would thrill me if you want to publicly debate the value of electronic dental records (How much do you know about dentistry?)
Assessment
For example, do you realize that if a computer containing thousands of patients’ identifying data is stolen in a burglary, and the dentist, or physician, does the right thing and reports the data breach, he or she will likely be bankrupt even before the HIPAA inspections and lawsuits?
The Ponemon Institute estimates that it will cost about $50 per record just to notify affected patients. A few weeks ago, the HHS was obligated to release information that a burglar stole a computer containing more than 9,000 records from a Missouri dental practice. Just to notify the affected patients will cost the practice almost half a million dollars. But wait. That’s not all. Since the loss involves over 500 individuals, news of the breach must be provided as a press release to the local media. As goes the dentist’s reputation, so goes the dentist’s career – all because of a simple burglary.
Conclusion
So what were you saying about dangerous, biased articles in Parade Magazine? The author whose ethics you criticize has a name. It is Drew Jubera. He’s an award-winning staff member of the Atlanta Journal-Constitution, in Atlanta GA – home of this ME-P. I’ll make sure he also gets this message.
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Filed under: Ethics, Information Technology, Op-Editorials, Pruitt's Platform, Quality Initiatives | Tagged: ADVANCE, ADVANCE for Health Information Executives, AJC, Bob Mitchell, Darrell Pruitt, Drew Jubera, eDRs, EHRs, EMRs, HIPAA, meaningful use, Obama care, Office of National Coordinator of Health IT, ONCHIT, PARADE magazine, Rand | Leave a comment »
A Note to Diane Rehm
[By Darrell K. Pruitt; DDS]
Dear Diane Rehm,
I always enjoy your show.
You add value to my drive to work.
As a dentist, I was especially interested in your March 10 show “Electronic Medical Records.”
In all the excitement that surrounds the 19 billion dollars our grandchildren have unwittingly granted to physicians and hospitals for “meaningful” adoption of certified eMRs, you probably haven’t noticed that nobody is talking about including dentistry in the conversion from paper to digital. Do you find that odd?
Small and Mid Sized Practices
Like small and mid sized physicians’ practices, small dental practices are intended to be part of the federal mandate for interoperable eMR adoption – even without the help from stimulus money that physicians receive. You probably weren’t aware that the stimulus money will run out before HHS gets around to defining “meaningful use” of eMRs in dental office. That would be impossible, but nevertheless, I anticipate that the attempts will be entertaining. Physicians in small practices typically have tens of thousands of paper charts as thick as phone books. On the other hand, a busy solo dental practice, like the majority of practices in the US, might have 5,000 files that are very thin in comparison to files that involve the whole body instead of just the bottom third of the face. That makes sense, doesn’t it?
Marginal Benefits May Not Exceed Marginal Costs
I listened to your guest Dr. Carol Horn, who practices internal medicine in private practice, as well as others involved in the actual delivery of healthcare. They list not only the benefits of eMR adoption, but in fairness, they also described the expense and liability of digital records that continue long after the tedious and dangerous conversion from paper to digital. In other words, it appears that the benefits for physicians barely make the effort worth the price, even with 19 billion dollars in help.
Editor’s Note: In economics, we say that the marginal benefits may not exceed the marginal costs; all things being equal.
Assessment
And so, it occurs to me that if dentists are to be included in the plans for digital interoperability, we will be very, very slow adopters for natural reasons: like eMRs in physicians’ offices, eMRs in dentists’ offices are more expense and trouble than they are worth – even before considering the bankruptcy-level liability of a data breach.
Most of those who champion eMRs for the entire healthcare system in the nation don’t realize that the bottleneck in dental offices isn’t the front desk. It’s the dentist who is hopefully taking his or her time providing care with those hands instead of working a keyboard.
Conclusion
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Filed under: Information Technology, Pruitt's Platform | Tagged: ADA, ARRA, carol horn, CCHIT, Darrell Pruitt, DDS, dentists, diane rehm, eDRs, electronic dental records, electronic medical records, EMRs, HHS, HIMSS, HITECH Act, meaningful use | 11 Comments »
Peterson Dental Supply Reveals a Decline
By Darrell K. Pruitt; DDS
Yesterday, Kevin Henry posted “Dental news of the day for Thursday, Feb. 18” on the DentistryiQ Blog.
The source for the day’s dental news was a sales report provided by Patterson Dental Supply.
http://community.pennwelldentalgroup.com/profiles/blogs/dental-news-of-the-day-for
Soft Sales
“Sales of dental equipment and software declined 10% from the year-earlier level, which was consistent with Patterson’s forecast for this period.”
If one remembers the economy at the last of 2008, it is not difficult to understand why Patterson’s analysts forecast that sales of dental equipment would drop. But, how did they know that sales of Patterson EagleSoft, their clinical and practice management software would also fall by 10%? I find it interesting that their accurate prediction was made shortly after Patterson announced the release of EagleSoft Version 15.00 on October 10, 2008. That must have been discouraging to EagleSoft employees.
When is the last time you’ve heard of a company roll-out of a new version of software – expecting it to be even less successful the previous version? That’s interesting.
Health Policy and Politics
What makes Patterson’s valiant prediction of a decline in software sales even more remarkable is that a year ago, President-elect Barack Obama was giddy enthusiastic for digital health records, which includes Patterson’s EagleSoft. Not to say I told you so [maybe-a-little], but Patterson’s analysts obviously recognized what I did long before: Digital dental records are losing popularity among dentists. What’s more, none of my patients have ever said that they wish I had digital dental records. Dental patients simply do not desire them.
As a matter of fact, some have expressed relief that my paper records are more secure than anyone’s digital records. They also like not having to sign HIPAA forms – a meaningless waste of trees and appointment time.
Assessment
A year after Patterson privately admitted doubt about paperless dental practices, the slow-moving ADA House of Delegates met in Hawaii in October ‘09 and officially encouraged ADA members to adopt eDRs. Why doesn’t the American Dental Association know at least as much about dentistry as Patterson Dental?
This is an intriguing time in dental history. I can’t wait until the ADA opens up about their mistakes in dental informatics. One of these days we’ll all have a good laugh about their lame, expensive shenanigans.
Conclusion
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Filed under: Information Technology, Practice Management, Pruitt's Platform | Tagged: ADA, ADA Department of Dental Informatics, DDS, dental records, DentistryiQ Blog, EagleSoft, eDRs, EMRs, healthcare reform, HIPAA, Kevin Henry, obama, Patterson Dental Supply | 7 Comments »
Some Doctors Get Buyer’s Remorse
By D. Kellus Pruitt; DDS
Dear Huffington Post Investigative Fund
As a dentist, I read Emma Schwartz’s “Shopping for Health Software, Some Doctors Get Buyer’s Remorse” with interest.
It was like watching a slow, grinding train wreck from a still safe, but shrinking distance.
http://www.huffingtonpost.com/2010/01/29/shopping-for-health-softw_n_442651.html
Duped Physicians
The numerous stories about physicians who lost hundreds of thousands of dollars because of bad software purchases – including the case where some doctors alleged they were locked out of their patients’ medical records – is awe inspiring if one isn’t mandated to live the misery. I hope it’s a long, long time before paper dental practices are outlawed. If as Ms. Schwartz describes, broad-band interoperability fails to save money for physicians where it makes sense, I promise that dentists will never invest in interoperability beyond occasionally purchasing a new fax machine, telephone, or postage stamps. Dentistry simply isn’t emergency room medicine, and non-productive technology is especially costly if it fails to function properly.
A Volatile Industry
Steven Lazarus, president of consulting company Boundary Information Group, was quoted:
“This is a very volatile industry. Any product doctors buy could be bought or changed within two years.”
You want to see volatile? Try explaining that to thousands of disappointed dentists in solo practices – one disagreeable SOB at a time.
A Canadian Illustration
Believe it or not, there’s still more kinetic energy behind the train wreck – even without mentioning data breach bankruptcies. As illustrated by Schwartz’s example of Canada-based MedcomSoft, even if a company’s EHR system is CCHIT-certified, bankruptcy can occur unexpectedly – again leaving doctors holding the bag. To stay in business, providers who lose money on EHRs either must cut corners or increase fees to cover the loss … volatile!
A Dentist’s Question
Why, oh why, would a dentist want to spend $40,000 on software including thousands of man-hours in transition, just to risk pulling this tangled, expensive mess down on top of one’s practice? And – for what? There is no return on investment beyond the stakeholders in the EHR industry – which is ultimately paid by unrepresented patients through their healthcare in higher medical fees. As one can imagine, dentists are staying away from EHRs in droves.
For example, what does it mean that there are few if any advertisements for electronic dental records in industry journals, junk mail ads or Internet venues? I think it means that the Father of Economics Adam Smith is quietly warning ambitious, would-be dental software salespeople that their dangerous and expensive products will get them thrown out of dental offices.
The ADA
But then again, I could be wrong. Here is what Dr. John Findley, the immediate past president of the American Dental Association, told ADA Reporter Judy Jakush in a September 2008 interview a month before taking office:
“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.’ That’s why we absolutely need the profession to be represented in the discussions about EHR to make sure our ideas are enacted to the greatest extent possible.”
To me, that’s scary. It smells a lot like tyranny.
Conclusion
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Filed under: Career Development, Health Economics, Information Technology, Pruitt's Platform | Tagged: ADA, Boundary Information Group, CCHIT, Darrell Pruitt, eDRs, EHRs, Emma Schwartz, EMRs, Huffington Post, john findley, Judy Jakush, MedComSoft, Steven Lazarus | 1 Comment »
Where is the ADA’s Representative?
By Darrell K. Pruitt
; DDS
He or she should have been talking with me long ago. I have the audience and I’m giving you that opportunity I promised you, Dr. Donald Cohen.
Rest Easy
I’m aware that I possibly make you uncomfortable, considering how “unprofessionally” I’ve publicly treated lesser devoted HIPAA consultants. Rest easy! As soon as I read your article, I could tell that you’re different from your colleagues I’ve met. First of all, like me, you’re a dentist. That’s very important. Secondly, your credentials are impressive and reveal that compliancy is not a hobby for you like it is for others. Nobody can accumulate a history as impressive as yours without professional dedication. The last point, and the most important of the three, you seem honest about HIPAA compliance.
A Professional
It wasn’t lost on me that in your article you were professionally non-judgmental of the Rule. Instead of trying to justify a defenseless law, your job is to help dentists comply with the mandate as it is written or risk significant fines. Like tax-collecting, someone’s got to do the job of delivering bad news. You have a legitimate purpose to be involved in the dental industry, even if what you teach makes little difference at all if a dentist’s records are breached. I argue that following the inevitable bankruptcy from a breach, HHS fines are hardly a deterrent. And that is the issue: eDRs containing patient identifiers are too risky for the marketplace.
Electronic Dental Records
I think you would have to agree that eDRs are going nowhere until records are safe, and encryption is not going to be sufficient to protect dentists against dishonest employees. Ambitious bureaucrats in waiting, such as HIPAA consultants Travis Criswell, Sharalyn Fichtl, Kelly Mclendon and Olivia Wann – not a dentist among them – hooked their careers to the HIPAA mandate to avoid the tough sales jobs competition otherwise demands in the free market. All four share an authoritarian misconception that since it is the law, dentists will be forced to purchase their products – even if they are utterly senseless. I think we both know that they are oh so wrong. I promised earlier to give you an opportunity to publicly support truth in eDRs if you so choose. Perhaps we could rationally discuss in front of everyone how dentists can wriggle free of the approaching mess. There is no pressure here, other than this is public invitation. Since you haven’t made unrealistic claims about eDRs like others have, I am not interested in hounding you further. I simply ask you to consider responding to the article I posted in your name on PennWell titled “Dr. Donald Cohen’s opportunity.”
http://community.pennwelldentalgroup.com/forum/topics/dr-donald-cohens-opportunity
Assessment
I sincerely appreciate the respect you have shown me, and I pledge to afford you the same. Of all the consultants I have approached with my concerns about HIPAA and eDRs, you are the first to even acknowledge a problem simply by posting my concerns. I think you have the courage to face the realities of the marketplace, while others foolishly think dentists are a captive market.
Note: I submitted this to be posted following an August 28th press release posted by HIPAA consultant Dr. Donald Cohen titled, “Dentists Should Know about New HIPAA Rules.”
If you are interested in discussing the topics of interoperability with fax machines, de-identified eDRs and security that surpasses paper records, in front of you is the opportunity to address your largest audience yet, Dr. Cohen. I’m self-syndicated.
Note: Do you realize that if Dr. Cohen takes me up on the offer, this will be the first time two dentists have openly discussed eDRs on the Internet? Do you think it’s about time?
Conclusion
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Filed under: Information Technology, Practice Management, Pruitt's Platform, Quality Initiatives | Tagged: ADA, American Dental Association, Darrell Pruitt, DDS, dental records, DMD, doctoroogle.com, Dr. Donald Cohen, eDRs, EHRs, ePRs, health information technology, HHS, HIPAA, HIT, IT, kelly McLendon, medical records, Olivia Wann, PennWell, Sharalyn Fichtl, Travis Criswell | 11 Comments »
Video Clip from the HIMSS Meeting
By Ann Miller; RN, MHA
[Executive-Director]
There is a major controversy in the modern healthcare community over eMRs and how to pay for them; or even if they are effective in improving medical outcomes. Of course, by eMRs we mean interoperable medical records that span the pan-healthcare ecosystem; and not just the stand-alone digital records that many, if not most, physicians use in their daily practices to some degree or another.
Link: https://healthcarefinancials.wordpress.com/2009/03/10/on-the-hitech-act-of-2009/
Proponents
As readers of the ME-P are aware, one vocal camp supports certification and eMR industry mandates, standards, and governmental initiatives, etc. The recent $20 billion taxpayer input from the Obama Administration, courtesy of HITECH, further emboldens CCHIT and related wonks.
Opponents
One the other hand, one vocal ME-P opponent is dentist Darrell Pruitt. He and many others believe that current eMRs may be too expensive, unwieldy, and counter-productive. This camp advocates a mix of other data sources, technology processes and doctor/patient education to get us where we need to be in terms of improving medial outcomes; quicker and less expensively.
Assessment
Rather than read, research and write more on this controversy, which was apparently a red-hot topic at the recent HIMSS meeting, we have embedded a video link of Glen Tullman [CEO of Allscripts] and Mark Leavitt, [Chair of CCHIT], below.
It even includes a clip of Jonathan Bush, CEO of AthenaHealth. And, although they don’t all agree; some common ground may be developing in this controversial issue.
Source: This link originally appeared on The Health Care Blog [THCB], by Matthew Holt.
Disclaimer:We are members of AHIMA, HIMSS, MS-HUG and SUNSHINE. We just released the Dictionary of Health Information Technology and Security, with Foreword by Chief Medical Information Officer Richard J. Mata; MD MS MS-CIS, of Johns Hopkins University; and the second edition of the Business of Medical Practice with Foreword by Ahmad Hashem; MD PhD, who was the Global Productivity Manager for the Microsoft Healthcare Solutions Group at the time.
Conclusion
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Filed under: Breaking News, Career Development, Experts Invited, Information Technology, Interviews, Videos | Tagged: AHIMA, Ahmad Hashem, Allscripts, AthenaHealth, CCHIT, CMIO, Darrell Pruitt, Dictionary Health Information Technology Security, eDRs, EHRs, EMRs, Glenn Tullman, health information technology, HIMSS, HIT, HITECH, IT, Johns Hopkins, Jonathan Bush, Mark Leavitt, Matthew Holt, Microsoft Healthcare Solutions, MS-HUG, MSFT, obama, Richard Mata, SUNSHINE, THCB, www.healthdictionaryseries.com | 20 Comments »
Good Content and “Fly” Beats the Competition
By Dr. David Edward Marcinko; MBA, CMP™
[Publisher-in-Chief]
Last month, Steve Brawner [Steve Brawner Communications, a free-lance journalist for the Medical Business News, Inc., and the publisher of Medical News of Arkansas] contacted me to talk about hospitals, healthcare economics and the current financial dilemma in medical care. The interview will appear, as a special report, in April
But, after discussing answers to his top ten questions, we at the Institute of Medical Business Advisors, Inc www.MedicalBusinessAdvisors.com posited another interesting query. It was not on any particular subject area of our expertise, but aimed at us as electronic-publishers, reporters and health journalists.
The Future of Journalism
In other words, the question was:
“What do we think is the future business model for health journalism?”
Now, we’ve been mulling this thought over some time now, and our opinion goes something like this:
“We don’t – the old media is collapsing.”
And, while I don’t pity the likes of Chicago billionaire Sam Zell [the so-called “grave-dancer” for his penchant to buy distressed companies on the cheap and revitalize them for profit] – poor Sam – he was a very successful real-estate entrepreneur and the Chairman of Equity Group Investments. He thought this knowledge or luck was transferrable to the publishing industry, it wasn’t.
But, I do feel for distressed print newspapers like the Seattle Post Intelligencer, Chicago Tribune and especially the Baltimore Sun; as a native Balti-moron. I have both a favorite uncle, and older cousin, whose entire careers were spent in the print and ink business, there.
Link: https://healthcarefinancials.wordpress.com/2009/03/09/healthcare-experts-versus-health-journalists/
New Media “Fly”
How has this happened? Well, Google destroyed the advertising model for most media, and blogs and social networks have democratized the commentary / opinion playing field to some greater / lesser extent. Think: Mark Zuckerberg [Facebook] of Harvard, whose parents are both physicians – incidentally Mark’s got “fly” – Zell does not. We got the electrons at the ME-P, but little cash.
The Problem
The problem is that not many “new” media outlets, like the Medical Executive-Post, can afford to take on the interesting part of publishing; which is paying real investigative journalists. Think: The Huffington Post. Something I would love to be able to do; as there’s lots of muck to be raked in health economics, finance, administration, health IT; as well as medically focused financial planning, Wall Street and related personal investing activities for doctors – an integrated oeuvre of topics to say the least.
www.HealthDictionarySeries.com
Our Own Investigative Reporter
About the closest we have to a true investigative reporter is Darrel K. Pruitt; DDS. And, although he is no Bob Woodward or Carl Bernstein; he does occasionally do a good job. Think: William Mark Felt as FBI agent “deep-throat”.
Of course, as regular readers of the ME-P are aware, Darrell broke the dental profession’s [allegedly dufus] conspiracy with CCHIT [allegedly faux], and regularly reports on the folly of eHRs, eDRs, NPIs and eMRs. Think: citizen doctor journalist.
Link: https://healthcarefinancials.wordpress.com/2009/03/02/avi-baumstein-and-hipaa-compliancy/
Link: https://healthcarefinancials.wordpress.com/2009/03/04/don%e2%80%99t-rush-ehrs/
Assessment
But, when the ME-P gets financially solid enough to hire others, and put them into the mix of expertise, commentary and free-labor entrepreneur punditry we now have on the site; then there’ll be no need for the current newspapers [at least insofar as our covered topic channels are concerned]. Until then; we don’t know what the answer is, but it, like the economy, doesn’t look good for the print media space.
Link: http://www.shirky.com/weblog/2009/03/newspapers-and-thinking-the-unthinkable
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Conclusion
And so, your thoughts and comments on this Medical Executive-Post are appreciated. What is our best-of-breed business model for print and the internet? Should we charge for our electronic content – and if so – how much? OR, shall it remain an informal and complimentary companion to the $535 annual print guide? Please opine.
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My Search for Truth – 2009
[By Darrell Kellus Pruitt; DDS]
Do the leaders of the American Dental Association [ADA] encourage critical thinking by membership? Or; do they fear my opinion of what appears to be destructive and self-serving institutional bias in my ADA that favors businesses peripheral to the care of dental patients, and at patients’ expense? I think it is clear that there are a few good ol’ boys imbedded in the fat ADA who prefer to hide behind a comfortable, but obsolete command-and-control ADA business model. The mighty ostrich stuck its head in the sand. Then along came a noisy, gasoline-powered weed-whacker. Never saw it coming.
Evidence-Based Dentistry Champion Conference
On May 29-30, the First Annual “Evidence-Based Dentistry (EBD) Champion Conference” will be convened in ADA Headquarters in Chicago. Just like last year, the meeting with a brand-new name is sponsored by Procter & Gamble and The Journal of Evidence-Based Dental Practice with Dr. Michael G. Newman as its Editor and Chief. Even though this effort is enthusiastically supported by large corporations with products to sell, like P&G, managed care insurance companies such as Delta Dental, and electronic health records vendors such as Allscripts, the power of the reclusive stakeholders is further amplified by bureaucrats inside and outside the ADA – siphoning off my professional organization’s credibility. That is my opinion based on actual contact with a few characters in this group.
Evidence-Based Dentistry: 3rd International Conference
I attended the meeting last year when it was called “Evidence-Based Dentistry: 3rd International Conference” – I assume that in the last year, it lost its “international” status, and now caters only to “EBD Champions” (cheerleaders). Last year, they were also looking for Champions for their EBD ideas, but the bias was better concealed. I reported on the meeting in an article called “Evidence-Based Dentistry – My search for truth.”
http://community.pennwelldentalgroup.com/forum/topics/evidencebased-dentistry-my
Shortly into the meeting on May 4, 2008, I could tell by a show of hands from attendees that as a dentist who actually puts his hands in patients’ mouths as a regular part of his job; I was virtually alone in the auditorium. This was confirmed by the volume of “Boo” directed at me later that day. The Champions who had been selected months before the conference had already met that week and they were pumped. One could smell the zeal for EBD – whatever it means.
Journal of Evidence-Based Dental Practice
In his introduction to last year’s conference, Dr. Michael G. Newman, Editor in Chief of the Journal of Evidence-Based Dental Practice, told attendees that P&G is providing all the information about EBD to all the dental schools in the nation. I will be honest with you. Being booed last year for addressing what I think is the inferior quality of managed care dentistry during the final discussion period may have affected my attitude about EBD. In addition, being subsequently blocked from responding to a hurt and angry managed care discount dentistry broker by an ADA employee named Dr. Ron Zentz also disappointed me in my ADA. Dr. Zentz told me “This is not the place for this” as he stood between me and the microphone. Later I could not get Zentz to concede the indisputable fact that quality is proportional to reward. When I pressed him for an answer to the managed care question, he stoically repeated exactly what the insurance representative said: “Whether the dentistry is managed care or not, it makes no difference in the quality of care.” Here is something cute: The event was an “Evidence-Based” conference on the second floor of the Headquarters of the ADA, and Dr. Zentz is employed in the ADA’s “unbiased” science department. Get it? Now that’s funny!
Trouble-Makers Don’t Get Invited Back
My bad behavior last year may have something to do with why I was not invited to attend this year, even though I worked hard on the prerequisite essays which I will share with you later. Nevertheless, I have to warn that ADA-approved propaganda from P&G doesn’t strengthen this dentist’s confidence that our leaders are protecting the future of dentistry, friends. Take a look at what healthcare parasites have quietly done over the last decade or so to physicians’ practices with the blessing of the AMA, and counter to the interests of patients. Those same parasites were in ADA Headquarters on May 4, 2008. Our house at 211 East Chicago Avenue reeked.
EDB Vagueness
Like the HIPAA Rule on which Newman’s favorite interpretation of EBD leans hard, the beauty of EBD is in its vagueness. Both HIPAA and EBD can mean damn well anything one needs them to mean, and stakeholders with lots of influence have their fingerprints and drool all over the plans. For example, Dr. Robert Ahlstrom, a stakeholder and one of the speakers at last year’s conference uses HIPAA to support EBD and vice-versa according to closed-circuit, cause-I-said-so science that he evidently makes up as he goes. It is difficult for me to imagine that Ahlstrom’s eleven reasons that HIPAA benefit dentistry – which he presented as testimony for HHS Secretary Michael Leavitt over a year ago – were approved by a committee. I think Ahlstrom made up his reasons while waiting in the hall for the NCVHS meeting to begin. If the reasons were indeed approved by an ADA committee, I extend my sympathy. It must be difficult for challenged people like that to safely find their way home from work every day.
(See “HIPAA and Dentistry – About Ahlstrom’s Controversial HIPAA Testimony”)
https://healthcarefinancials.wordpress.com/2009/01/08/hipaa-and-dentistry/
Where is the Evidence?
A few hours before Dr. Ahlstrom, an ADA NHII (National Health Information Infrastructure) Task Force member, took the podium, Dr. Newman pleaded with dentists to always ask, “Where is the evidence?” I know Dr. Ahlstrom heard Dr. Newman’s words because Ahlstrom was sitting on the first row, next to ADA Senior VP Dr. John Luther, who is in charge of the ADA Department of Dental Informatics – a major beneficiary of EBD and HIPAA.
***
***
Buzzwords
I have come to the conclusion that EBD is a buzzword for a scheme supported by avaricious stakeholders who seek to regulate dentistry using healthcare IT. I assume it will be left to Dr. Robert Ahlstrom to present the plan to the next administration in his special, fanciful way. It is clear to me that the ADA is using Ahlstrom to lead American dentists down a computerized, cook-book path initially promoted several years ago at ADA Headquarters by none other than Newt Gingrich. The path ends with the NPI, NPPES and Ingenix-style Pay-for-Performance instead of free-market competition and consumers’ desires. Like Ahlstrom, EBD is little more than a tool.
Living with Rejection
I learned a couple of days ago that my application for this year’s conference was rejected. A PDF letter signed by Dr. Michael Newman, Editor and Chief of the Journal of Evidence-Based Dental Practice stated that the competition for seats was intense this year, and that I just didn’t have what the selection committee was looking for in a “champion” – even though one can see by their essay questions that the EBD stakeholders desire dentists who can draw audiences.
My Responses
Below are my responses to this year’s questions that I posted on September 23, even before I hooked up with PennWell, and the ME-P. I’m even more widely read now.
Q: Are you involved in the treatment of populations with limited access to care?
Counseling people who have big problems and little money is part of the job. Almost every day I help patients make hard decisions that affect their appearance as well as health. Compromises are always difficult, especially when it involves children. I do my best to provide my patients with the information they need concerning their specific problems in a personal manner. In that respect, I am no different than almost all other dentists I know.
Q: Given the opportunity, how do you plan to disseminate the information and knowledge of EBD?
For dentistry-related news, I am arguably the most popular commentator on the Internet. If I am convinced that EBD is in patients’ best interest, I can promote the concept to a wider audience than anyone else in dentistry and it will not cost a thing. I can use any number of websites in addition to a private network of colleagues that has been in place for almost three years.
If I leave the conference suspecting that stakeholders ambushed EBD to manipulate dentist-patient relationships for selfish reasons, I will work even more effectively to undermine it. Fair is fair.
Q: Are there any specific examples that demonstrate your ability to be a good disseminator?
Apart from having an increasingly popular column about healthcare matters on this ME-P https://healthcarefinancials.wordpress.com/?s=darrell+pruitt+dds ), I am always seeking new and innovative ways to attract attention to dentistry. I am very good at what I do.
Here is a simple demonstration of my talent: Googlesearch “Darrell Pruitt DDS.” You will discover that I’ve got what they call “googlejuice.” I create interesting content. People you need to reach read me.
The question is; does the ADA have the confidence to subject EBD to my critique? On the other hand, does the ADA have the courage not to?
Since I will not be allowed to keep colleagues in my neighborhood as informed in real-time and in detail as they should be, I invite one or more “EBD Champions” to describe what they learned following the Conference in May right here on this ME-P and PennWell forums. And as always, I invite Dr. Robert Ahlstrom to discuss what he plans to do with my dental practice.
Assessment
Tomorrow, as part of “Transparency and the ADA – a dissecting experiment,” I intend to post another question on the EBD link following my weekly report. I will ask if Dr. Robert H. Ahlstrom will be addressing the audience before having my name put on a short-call list to replace late-cancellations. Depending on the answer, I may go camping instead.
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Conclusion
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Filed under: "Doctors Only", Career Development, Ethics, Op-Editorials, Quality Initiatives, Research & Development | Tagged: ADA, Allscripts, American Dental Association, delta dental, Dr. John Luther, Dr. Michael G. Newman, Dr. Robert Ahlstrom, Dr. Ron Zentz, EBD, eDRs, evidence based dentistry, Evidence-Based Dentistry: 3rd International Conference, HIPAA, Ingenix, National Health Information Infrastructure, Newt Gingrich, NHII, NPI, NPPES, P&G, P4P, Pay-for-Performance, PennWell, Procter & Gamble, The Journal of Evidence-Based Dental Practice | 7 Comments »
The American Recovery and Reinvestment Act
By Staff Reporters
On February 17, 2009, President Obama signed into law the American Recovery and Reinvestment Act [ARRA]. According to some, the law provides an opportunity to transform healthcare in the United States.
HIT
The law also provides $19 billion in health information technology [HIT] funding to ensure widespread adoption and use of interoperable HIT systems like the electronic health records funding provision. But, as ME-P readers are aware; this is not apparently for electronic Dental Records [eDRs]; and CCHIT is no advocate of professional diversity.
HITECH
Obama’s signing of the Health Information Technology for Economic and Clinical Health (HITECH) Act [a portion of the stimulus package] recognized the importance of HIT as the foundation for health care reform and cost savings.
Assessment
Is this report correct? Read all 187 pages and decide.
Link: HITECH http://democrats.science.house.gov/Media/File/Commdocs/HealthIT%20Bill.pdf
Conclusion
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Filed under: Health Law & Policy, Information Technology | Tagged: ADA, American Recovery and Reinvestment Act, ARRA, CCHIT, Darrell Pruitt, dentistry, eDRs, EHRs, EMRs, Health I.T., Health Information Technology for Economic and Clinical Health, HIT, HITECH, obama | 6 Comments »
The Continuing eHR Saga
By Darrell K. Pruitt; DDS
If you were one of fifty governors who decide to jump off a cliff because flying looks so cool, would you proudly race to be the first to grab the air? Blissfully, Minnesota Governor Tim Pawlenty is way ahead of the pack. He’s so confident in healthcare information technology [IT] that he doesn’t even have to watch where he’s going – leaving him free to smile for the cameras. Now that’s cool.
Initial Ambitious Plans
Attention ME-P readers! Please gather around to watch a world-class belly-flop of a gutsy statewide eHR mandate. A few years ago, Governor Pawlenty had ambitious plans to lead the nation with an interoperable eHR system that was touted to include all providers – that means Minnesota dentists as well. Your landing could be vertical and abrupt, Pawlenty.
CCHIT Approved?
In fairness to a brick, back in 2005 Pawlenty could not have predicted the economic collapse that began three years later, nor could he have known about the subsequent $19 billion eHR money that would be made available to providers – but only if they purchase healthcare IT software that is approved by the Certification Commission for Healthcare Information Technology (CCHIT).
CCHIT Laggards
Even if the descending Pawlenty could have predicted the recent changes in the terrain, including the CCHIT qualification, he would have never guessed that to this day in March of 2009, the certifying commission would still be yet to certify even one single electronic dental record – thereby blocking Minnesota dentists from copious federal help in their efforts to become compliant in Pawlenty’s brave new state.
“The government is actually looking for places to spend the money where there is a strong likelihood of success stories”.
–Mike Ubl
Executive Director Minnesota Health Information Exchange
[Owned by Blue Cross Blue Shield of Minnesota, HealthPartners, Medica, Fairview Health Services, UCare and the Minnesota Department of Health].
Link: http://www.twincities.com/ci_11830085
“And that after this is accomplished, and the brave new world begins – When all men are paid for existing and no man must pay for his sins”.
-Rudyard Kipling
The CCHIT qualification was incredibly bad luck for Pawlenty’s nifty ideas of interoperability with all providers. When Minnesota dentists discover that they must pay $30 thousand for software they don’t want in order to practice in paradise, some may just swallow their pride, sell the portable ice-fishing house, and move to slow-moving Iowa.
Dentists, MDA and the ADA News
Why the surprisingly quick landing? If Pawlenty actually gave any consideration for dentistry at all, just like everyone else, he must have assumed that dentists’ concerns about digital records would be adequately attended to by the Minnesota Dental Association [MDA] and the American Dental Association. It was easy to make that mistake because of the enthusiasm for eDRs radiating from ADA Headquarters and expressed in confident terms in ADA News Online articles that have since stopped appearing. Most eDR enthusiasts naturally assumed that by now the majority of dentists in the nation would be saving money, lives and trees with paperless practices. However, the ADA has been nowhere to be found for a long time. As it turns out, the professional organization has still not yet even contacted the certifying commission. We know this, because when I personally contacted CCHIT a few weeks ago, it caught them off guard. I was told that I was one of the first to ever mention dentistry.
No Endorsements
To show how far the ADA has slipped, and as an example of its flagging influence on membership, I doubt that more than 5% of American dentists have made the ADA-endorsed leap from paper to digital. Why should they? It makes good business sense to wait, and most dentists are not techno-silly. Consider this; Even if a dentist is happy with a costly eDR system that demanded unanticipated time and effort to learn, in less than a year, CCHIT could determine that his or her favorite system is not worthy of certification because it does not integrate with physicians’ one-size-fits-all, CCHIT-certified eMRs. Tough luck, Minnesota dentists! Uncertified eDRs will be outlawed, while favored, large healthcare IT companies in Madison and Chicago will profit and pay more state taxes with Twin-Cities’ dollars. By then, all the stimulus money will be gone and lawmakers will no longer be giddy about eHRs due to the imminent explosion of data breaches everywhere caused by moving too fast. No return on investment [ROI] there.
Assessment
Still, Tim Pawlenty could have never known, yet away he sails with a stupid grin on his face.
Conclusion
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Filed under: Career Development, Health Insurance, Information Technology, Op-Editorials | Tagged: ADA, American Dental Association, Blue Cross, Blue Shield of Minnesota, CCHIT, Certification Commission for Healthcare Information Technology, Darrell Pruitt, david marcinko, DDS, DMS, eDRs, EHRs, EMRs, HealthPartners, HIPAA, HIT, IT, MDA, Medica, Mike Ubl, Minnesota Department of Health, ROI, Tim Pawlenty, UCare | 1 Comment »
Address Medical ID Theft
[By Darrell Pruitt; DDS]
Yesterday, an important message titled “Don’t Rush eHRs Without Addressing Medical ID Theft” was posted on ModernHealthcare.com by Martin Ethridgehill, a provider training specialist with Blue Cross and Blue Shield of New Mexico.
Link: http://www.modernhealthcare.com/apps/pbcs.dll/article?AID=/20090302/REG/303029965
Mr. Ethridgehill points out that if a patient’s electronic medical identity is stolen by someone for health insurance benefits, critical information about the patient can be imperceptibly altered, leading to accidental death in an emergency room for any number of reasons. Furthermore, he points out that even if the real patient is aware that his or her record is tainted by a false patient’s data, it is very difficult to get the comingled record cleared up.
I have also read elsewhere that HIPAA actually impedes resolution of the nightmare because the Rule also protects the privacy of the false patient – prohibiting the real patient from examining his or her own health record.
Reasons to Go Slow
Ethridgehill is particularly critical of the EHR industry which lately has downplayed the importance of patient privacy in order to sell dangerous products. He gives these reasons for the need to slow down in the rush for interoperability:
Conclusion
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Filed under: Health Law & Policy, Information Technology, Research & Development | Tagged: ADA, CCHIT, Darrell Pruitt, david marcinko, dentists, eDRs, EHRs, EMRs, HIPAA, HIT, IT, Martin Ethridgehill, ModernHealthcare | 20 Comments »
About Ahlstrom’s Controversial HIPAA Testimony
By Darrell K. Pruitt; DDS
Dr. Robert H. Ahlstrom, representing the ADA as well as all US dentists, testified in July 2007 before the standards and security subcommittee of the National Committee on Vital and Health Statistics (NCVHS) about the benefits of HIPAA in dentistry. His testimony is featured as an official HHS 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
The NCVHS Document
The document was presented by NCVHS to HHS Secretary Michael Leavitt as fact – a mistake that not only set back healthcare IT in dentistry, and miracles from trusted Evidence Based Dentistry [EBD] a decade or more – but seriously stained the reputation of the American Dental Association, crippling my profession’s influence in the nation’s capitol. Dr. Ahlstrom is a prosthodontist from Reno, Nevada and a tireless ADA volunteer. At one time, he was a respected proponent of paperless dental practices, and was rewarded with prominent appointments in the ADA, which he continues to silently cling to. However, at some point in his efforts, his enthusiasm for healthcare IT in dentistry caused him to lose perspective of who he was serving. When Dr. Ahlstrom chose to ignore the warnings of the danger from digitalized patient information, he abandoned the needs of dental patients and dentists.
Discussion Avoidance
For at least the last few years, Dr. Robert Ahlstrom has suspiciously avoided discussing the dangers of digital records with ADA members – including me – even in front of a crowd of a hundred or so witnesses in ADA Headquarters.
The Challenge
Even though I think it is unlikely that he will accept my open challenge, I emailed him an invitation to defend his testimony here, or on the PennWell forum. In my opinion, the time has come for Ahlstrom to either show courage or be terminally irrelevant. If he fails to respond, I personally call for his resignation from all ADA positions because of clear unaccountability to ADA membership.
Robert Ahlstrom is the only dentist left in the nation who applauds HIPAA, and I don’t expect any official from the ADA to come to his defense. It would be wonderfully entertaining, but that is just too much to ask of the shy good ol’ boys I have bumped heads with. My questions to the ADA about HIPAA have been evaded for years.
Ahlstrom’s Eleven Selling Points
Here are the 11 selling points Ahlstrom presented to our lawmakers in support of HIPAA – which I will contest individually and in depth:
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.
Pruitt’s Response
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. Just how important is that to dentists other than you and the insurers you repeatedly represent, Dr. Ahlstrom? Adequate communication with other healthcare professionals has never been an issue in my office, and the US Post Office is hard to beat for safety. Dentists’ offices are not emergency rooms. Even in the most urgent situation, I cannot imagine a general dentist needing anything faster than the telephone and fax machine. And if it is a life-threatening emergency, rather than going online, we simply dial 911 in my office.
Common forms of communication are much more convenient, inexpensive and dependable than computers. But most importantly, like the US mail, they do not endanger dental patients’ welfare like digital records do. In fact, because universally accepted communications are not covered by the HIPAA rule you support, they cannot draw inspections and fines from the HHS.
As far as aiding communication with insurers, that has always been an insurance problem – commonly used to delay and deny payments to dentists. Since dental insurance companies continue to avoid transparency with their own clients for strategic reasons, their greed must never again be officially declared as dentistry’s problem by representatives of the ADA. You are wrong to mislead the federal government. It has never been the mission of the ADA to protect the profits of dental insurance companies. In fact, those you assist compete with dentists for dental patients’ dollars. That means it is unethical as well as against the Hippocratic Oath for you to assist them, Dr. Ahlstrom.
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.
Supply solutions for what problems? How can a prosthodontist be so imprecise as to include vague words like “low-cost” in such important testimony to lawmakers on behalf of the nation’s dentists? Low-cost compared to what – no software? Just how expensive are the postage and telephone bills compared to the $40 thousand vendor problem you describe later in your testimony to the NCVHS?
“One dentist contacted the ADA recently and said that their current vendor was not going to update the current version in use today and instead the dental office would be forced to purchase a new system for $30,000-$40,000 dollars or return to submitting paper claims.” Dr. Ahlstrom, please leave baseless advertisements to healthcare IT vendors. They follow a code that forces them to maintain credibility.
3. All administrative tasks can be accomplished electronically. Dentists will have more time to devote to direct care.
As the best, if grossly exaggerated selling point for HIPAA that Dr. Ahlstrom highlights, this is still a blatant reach that is silly. I find it odd to read that any dentists sacrifice chair time for administrative tasks.
The business of dentistry is actually so simple that it was managed successfully for decades in even the busiest offices with pegboards and ledger cards. The bottleneck in dentistry has never been the front desk. It has always been the speed of the dentist. As a matter of fact, HIPAA forms have actually hurt efficiency. In addition, operatory turn-around is further delayed by another unfunded and unproductive mandate called OSHA, which also offers nothing to hold down the cost of compliancy.
What is the difference between the two? OSHA makes a little bit of sense, is hundreds of times cheaper and it does not harm patients other than increasing the cost of dental care. As for Ahlstrom’s incredible claim that “All administrative tasks can be accomplished electronically,” HIPAA compliance itself increasingly adds serious administrative tasks to covered entities’ overhead even before HIPAA inspections of dental offices begin. Let me provide a partial list of documents that are expected to be handy for HIPAA inspectors: In April 2005, long before Ahlstrom’s deceptive suggestion that HIPAA reduces non-productive tasks, Piedmont Hospital in Atlanta was inspected by HHS for HIPAA violations.
http://www.computerworld.com/action/article.do?command=viewArticleBasic&articleId=9024921
As a result, Piedmont officials were presented with a documented list of 42 items that the agency wanted information on “… including physical and logical access to systems and data, Internet usage, violations of security rules by employees, and logging and recording of system activities. The document also requested items such as IT and data security organizational charts and lists of the hospital’s systems, software and employees, including new hires and terminated workers.”
Has the ADA prepared members for HIPAA inspections? Not at all! They never mention it. Isn’t that odd?
I personally conducted a survey that I posted on the Executive-Post titled “HIPAA Rules and Dentistry.”
https://healthcarefinancials.wordpress.com/2008/09/01/hipaa-rules-and-dentistry/
The results show that the range of compliancy was found to be from 0% for the requirement of a written workstation policy to 88% for that of password security. The average was 49%, meaning that less than half of the requirements are being respected by the dentists in this sample. Once again, neither Ahlstrom nor the ADA has mentioned a word about HIPAA inspections to membership.
4. Dentists will have a more complete data set of the patient they are treating, enabling better care.
This is beyond reaching. This is absurd. If Ahlstrom had not obviously included this false testimony to placate members of the NCVHS who know nothing about dentistry, the intention of his misrepresentation would not make sense at all. What more do dentists need to successfully treat a patient’s oral problems than an uncomplicated, up-to-date and concise health history like the hundreds of millions of paper ones safely in use today in dental offices? Even if one pulls up an interoperable electronic health record, the dentist still must review it before initiating treatment. No time saved there. As more eHRs become imperceptibly altered by health insurance thieves who are not likely to be allergic to the same medications as the true owners of the records, I am determined that my patients’ health histories will always be paper – even if I am forced to pretend to have a paperless practice as mandated by an absurd law. It will cost my patients more to have two sets of records, but they will enjoy less risk of anaphylactic shock.
Let’s face it, dentistry is not heart surgery. Dentists don’t even need to know blood types. A health record complicated with superfluous and possibly tainted information clearly increases the chance for serious error without providing patients any benefit. One complaint already heard from physicians using eMRs is that there is simply too much information in digital records that complicate treatment rather than enhance healthcare.
In addition, unethical employers, bankers, ad executives and insurers find detailed electronic information about patients’ frailties of value and worth paying for, while eHRs are being breached millions at a time. Why should a dentist maintain any more medical information than necessary? There is no black market value for dental records. Why on Earth create one?
5. Patients seeking information on enrollment status or health care benefits will be given more accurate, complete and easier-to-understand information.
This should have never been mentioned by Dr. Ahlstrom. Incomprehensible dental insurance policies can no longer be defended by the ADA. Otherwise the insurance industry will continue to encourage complexity in order to take advantage of their clients. As healthcare providers for trusting patients, we cannot allow agents of the ADA to force the nation’s dentists to be enablers of deceit. Otherwise, like Ahlstrom, we are guilty of deceit as well.
Adequate communication between an insured and the insurer has always been an insurance problem and not a dental problem. ADA leaders must immediately stop encouraging members to assume insurers’ responsibilities of explaining their intentionally complicated dental plans to their clients. The ADA should never again spend a penny of members’ dues to assist insurance companies. Once again, performing work for insurance companies is outside the mission of the ADA. It always has been.
6. Consumer documents will be more uniform and easier to read.
This is pure fantasy. Computerization does not fix sloppy, it empowers sloppy.
7. Cost savings to providers and plans will translate in less costly health care for consumers. Premiums and charges will be lowered.
Although it is undeniable that electronic records benefit insurers more than anyone else, one has to pay close attention to Ahlstrom’s use of the words “cost savings.” If Ahlstrom had said that HIPAA will lower dentists’ overhead, like head ADA lobbyist Michael Graham claims on his ADA website, Ahlstrom’s statement would be just another lie from another ADA representative.
http://www.ada.org/prof/advocacy/agenda.asp
By calling it a “cost savings,” Ahlstrom technically concedes that HIPAA will indeed require an increase in overhead – which dental patients will ultimately have to pay to obtain dental care. Ahlstrom cleverly skirts the lie that Graham continues to post by promising “savings over what it could cost otherwise” – perhaps without the “low-cost” vendors he previously mentioned.
It can no longer be denied by employees of the ADA like Michael Graham. ADA members will have to raise fees to cover the purchase and maintenance of untried and expensive information technology that neither patients nor dentists want. It is also undeniable that because of their deceit, more children will go to bed with toothaches; So much for increasing access to care, ADA.
Will there be problems? You bet! Big expensive ones attached to very angry ADA members similar to the $40 thousand problem mentioned by Ahlstrom himself.
Here is another problem that the ADA has kept hidden from membership: In Subpart D, §160.426, of the HIPAA enforcement rule, there is a section titled “Notification of the public and other agencies” which gives HHS the right to inform virtually everyone if they find a violation in a dental office. When inspections begin, I expect HHS to publicly punish violators. For good reason, there is a growing bi-partisan push for accountability for data breaches which continue to occur copiously. There is no doubt that news about HIPAA violations will be made public on the Internet through the NPPES using dentists’ NPI numbers. Since dentists freely volunteered for the numbers, it makes this legal. Volunteering is legal consent to abide the laws of the revised 1966 Freedom of Information Act which in 1996 was turned 180 degrees away from government entities such as the HHS and directed against US citizens who happen to be dentists. The ADA has also failed to inform members that an investigator can show up unannounced in any covered entity’s office and demand everything digital immediately. This means that office computers can be instantly confiscated even before one is publicly labeled as a HIPAA violator on the Internet.
And to think that some rookie healthcare IT enthusiasts are still foolish enough to mention Hurricane Katrina as a swell reason for going paperless. One can see hurricanes coming.
8. Patients will save postage and telephone costs incurred in claims follow-up.
Once again, this problem will never be solved electronically. Insurers will merely save money for postage on denial letters – which will naturally encourage more denials – and an insurance executive will receive a bonus.
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.
My patients can drop by my office at any time to see their dental records. If they want copies, I can provide those as well. I can even mail them. Nobody has ever had access to my patients’ paper records without my patients’ permission. As for protection, a huge, clunky sheet-metal file cabinet stuffed with hundreds of pounds of paper records, including radiographs, is hard to slip down a flight of metal and concrete stairs quickly without making at least a little noise. On the other hand, hackers, or even dishonest or angry employees raise no alarm whatsoever, and they can be gone in a flash with thousands of IDs. How can Dr. Ahlstrom possibly promise that with HIPAA, electronic records will be adequately protected? What about the organizational policies he casually mentions? Does this mean more staff meetings? I should remind everyone that selling point number three was a decrease in administrative work. Did Ahlstrom change his mind in mid-testimony?
Lastly, effective technical security controls just do not exist. For example: If electronic health records show who has accessed them, can someone discover who has accessed the more than 160 million records that have been reported lost in the last few years? Impossible!
10. Visits to dentists and other health care providers will be shorter without the burden of filling out forms.
Does this mean fewer HIPAA “Notice of Privacy Practices (NPP)” forms? How much time would it take for new patients to actually read the NPP form they sign? How much more time would it take for dentists to disclose to the patients that the form does nothing to protect their rights to privacy? Quite the contrary; “Patients also may ask covered entities to restrict the use or disclosure of their information beyond the practices included in the notice, but the covered entities would not have to agree to the changes.” – abstracted from “Protecting the Privacy of Patients’ Health Information,” released in April 2003 from the HHS.
http://www.hhs.gov/news/facts/privacy.html
11. Consumer correspondence with insurers about problems with claims will be reduced.
Since I am never a legal party in my patients’ insurance decisions, and since very few dental insurance companies hold themselves accountable to anyone, including their own clients, why should I care about patients’ contractual agreements with their dental insurance companies? I do not want that responsibility and such earthly bad advice from an ADA leader is simply not consistent with the mission of the ADA.
Assessment
In closing, I have to ask why Dr. Robert Ahlstrom would invent the fantasy he told lawmakers. It is as if he told the NCVHS what he thought HHS wanted to hear. Why couldn’t he just tell the truth? HIPAA offers no benefit to dental patients. In fact, the mandate endangers their welfare, making it unethical for a dentist to become a covered entity, even if encouraged to do so by a representative of the American Dental Association.
If I am wrong about any part of this national disgrace, Dr. Robert Ahlstrom should immediately stand up and publicly defend HIPAA on this forum. It is failing in dentistry on a national scale and pulling the ADA down with it. If nobody can clear up the apparent absurdity, not only will it hurt my profession, but the Department of Health and Human Services as well as Obama’s administration will suffer embarrassment when the media discovers that HIPAA is in reality, a grand fraudulent scheme of historic proportions.
The Challenge
It is your turn now, Dr. Robert Ahlstrom. Meet the professionals whose interests you misrepresented in front of lawmakers. Otherwise, be forever silent. I will always hold you accountable for abetting fraud against my profession.
Conclusion
Your thoughts and comments on this polemic and Medical Executive-Post are appreciated; especially from dentists, attorneys and health policy wonks, and IT gurus. Does the dentist have a point; or not?
Note: Dr. Pruitt blogs at PenWell and others sites, where this post first appeared.
Speaker: If you need a moderator or speaker for an upcoming event, Dr. David E. Marcinko; MBA – Publisher-in-Chief of the Executive-Post – is available for seminar or speaking engagements. Contact: MarcinkoAdvisors@msn.com or Bio: www.stpub.com/pubs/authors/MARCINKO.htm
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Filed under: "Doctors Only", Health Law & Policy, Information Technology, Op-Editorials, Research & Development | Tagged: ADA, eDRs, EHRs, EMRs, HIPAA | 13 Comments »
Let the Conversation Begin
By Darrell Kellus Pruitt; DDS
If someone says computerization in dentistry is inevitable, remind them that the metric system is inevitable as well. Sometimes inevitable takes a long time though – even when it makes sense. Interoperable dental records don’t.
Contrary to what healthcare IT stakeholders promise to win financing from a newbie Obama administration, interoperable eDRs will increase my cost of providing care, increase my liability as a businessman and endanger my patients’ health and welfare. Those are just three of many reasons why I intend to firmly stand in the way of their adoption until security problems are resolved to my satisfaction. I dare not grow discouraged, for there are far too many depending on me.
If my grandchildren are to benefit from the miracles of trusted Open Source Evidence Based Dentistry, we must not allow today’s temporary collection of reckless stakeholders to burn consumers’ trust in eDRs even once.
It is for these reasons that I watch very closely for the mention of eHRs on the Internet. I am particularly alerted to danger when someone tells lawmakers that they have their own special plans for my patients’ dental records – without first discussing them with me. I’m funny that way about my Hippocratic obligations and I don’t care what anyone thinks.
The Professor and IT Advocate
Valerie Powell, PhD., a professor of informatics at Robert Morris University, began commenting about dentistry and eHRs on ModernHealthcare.com in April. She has posted five comments. Her most recent appeared on November 25, and it was in response to my counterpoint titled “Dentistry EHRs not necessarily inevitable.”
http://modernhealthcare.com/article/20081124/REG/311249951
I continued my point-by-point critique of her uninformed ideas right here on the Medical Executive-Post in an article titled “Dental eHR Controversy Continues.”
Valerie Powell never returned a response.
www.HealthDictionarySeries.com
Today, Powell’s name popped up on my google-alert. She was interviewed for an article posted on the Pittsburgh Tribune-Review, written by Allison M. Heinrichs and titled “Experts lobby to add key dental data to medical records.”
http://www.pittsburghlive.com/x/pittsburghtrib/s_603452.html
She and her lobby went over my head. That was wrong, as well as foolish.
I must say this in defense of her courage, however. In the last two years, Valerie Powell PhD., is the only person in the US who is publicly pushing for interoperable health records in dentistry. She continues to hopefully plod along even though there are no longer any dentists promoting them – from what I can tell. The ADA long ago gave up on unwittingly pushing dentists to go paperless. In fact, because of the palpable resentment among membership over being misled about the NPI number, the ADA Department of Dental Informatics [ADA-DDI] no longer even suggests that members sign up for them. Just ask the department for yourself at NPI@ada.org
Tell them I sent you. They know who I am.
Even the eHR debate that limped along on PennWell was seemingly unnoticed by not only representatives from the ADA Department of Dental Informatics [ADA-DDI] but also by software vendors whose very market awaited their responses. There still must be a dozen or so unanswered questions about eHRs in dentistry featured on this thread. Does it not seem strange to anyone else that dental software firms are not tripping all over each other to get the names of their products in front of thousands of dentists for virtually no cost? Transparency on the Internet certainly beats traditional advertisement if a business can tolerate the matching accountability.
Other than Dr. Powell, why do you think healthcare IT stakeholders are so shy? And when they do speak up, why do they continue to over-stretch worn out rationalizations rather than offer tangible reasons for eHR adoption in dentistry?
For example, the lame Hurricane Katrina excuse for digitalization of dental records was stupid even before it was approved by some committee as a talking point. For anyone here in west Texas, it sounds really, really silly. Here is another almost extinct slow-moving talking-point I like to lampoon, “Someone can steal paper charts just as easily as they can steal digital records.” Is there anyone in the nation who can argue that point successfully? Please step forward; Your audience awaits.
Recently, I heard a fresh, incredible reason why dentists should computerize – malpractice protection. Someone who really should have known better told me with a straight face that there are not only more negligence lawsuits filed in dentistry than digital privacy breaches, but that if a dentist has a paperless practice, almost all malpractice lawsuits could be prevented. I find it hard to believe that a dentist could be so naïve. Or worse, that a dentist would assume a colleague is so naïve.
Regardless of bald lies mixed in with irrelevant talking points, some rationalizations for connectivity are better than others. But that still does not mean dentists must computerize their practices to accomplish worthy goals. For example, one thing Dr. Powell understands on a professional level is the importance of dental health in overall health.
“The research shows that there is a close relationship between diabetes and periodontal disease, also with stroke, respiratory disease, and kidney disease. Some research shows that certain oral diseases are associated with conditions that lead to low birth weight. And yet dentists and physicians aren’t communicating. I really don’t believe we’re going to get an optimal improvement in clinical care until we take care of this problem.”
Valerie Powell, PhD [Piittsburgh Tribune-Review]
Dr. Powell’s goal is sound, and I cannot argue with her about the urgent need for better communications between all healthcare providers. In fact, with the sudden downturn in the economy, it so important that we quickly gain control of the expensive and preventable chronic illnesses she mentions, that the nation cannot afford to wait until dentists are paperless. That could be decades. The $25 billion bailout that the healthcare IT industry is requesting will be squandered in part for political favors by members of Dr. Powell’s lobby. I call that churning profits. That was the old, inefficient way of doing things in dentistry.
We need something now and we need something that will cost virtually nothing. We need a system for better communications that can be erected in less than six months and will allow taxpayers to keep their $25 billion. Above all, in order to make this work, we must avoid HIPAA as much as possible.
I’ve put some thought to the serious problem that Dr. Powell describes. I think I have found a hybrid solution that will not require dentists to become HIPAA-covered entities to communicate more effectively with physicians’ computers. In fact, physicians also don’t have to be covered entities. And no, it is not a person-to-person phone call – an increasingly underrated form of communication in my opinion that also does not require HIPAA’s involvement.
Do you know what the solution is yet?
Keep reading. There’s more. A solution?
My solution would allow e-prescribing to occur in dentistry, without the dentist having to “volunteer” for a dangerous NPI number. This would help Glen Tullman, the shy CEO of Allscripts – a monster stakeholder in e-prescriptions. Otherwise, poor Glen is fresh out of ideas.
Committees just do not creative thinkers make.
That’s not all! The hardware necessary already exists in most dental offices, and can be obtained for less than $200 at any electronics store. And just wait until my solution is combined with state-of-the-art voice-recognition capabilities. All communications with physicians and pharmacies could be done chair-side in the presence of the dental patient without having to store their identifying information digitally anywhere. All that is needed is a universally acceptable paper format and an acknowledgement that paper is going nowhere soon – thank goodness.
So what is the revolutionary idea? It is so simple it will knock you down.
(Drum roll)… Make eDRs and eMRs compatible with common fax machines as a requirement for ONCHIT accreditation.
Wow! Now how difficult was that?
Assessment
I invite Dr. Valerie Powell, Dr. Franklin Din, or anyone else interested in finding a solution rather than funding, to discuss with me problems with my idea. I happen to think it is a cheap, common sense solution that will give us all the benefits Powell promises without excessively endangering anyone other than dental software vendors looking for bailout money. Another difference is my plan has a chance in hell of working www.HealthcareFinancials.com
Conclusion
And so, your thoughts and comments on this Medical Executive-Post are appreciated. What do you think? What is your plan? Let the conversation begin.
Note: Dr. Pruitt blogs at PenWell and others sites, where this post first appeared.
Speaker: If you need a moderator or speaker for an upcoming event, Dr. David E. Marcinko; MBA – Publisher-in-Chief of the Executive-Post – is available for seminar or speaking engagements. Contact: MarcinkoAdvisors@msn.com or Bio: www.stpub.com/pubs/authors/MARCINKO.htm
Subscribe Now: Did you like this Medical Executive-Post, or find it helpful, interesting and informative? Want to get the latest E-Ps delivered to your email box each morning? Just subscribe using the link below. You can unsubscribe at any time. Security is assured.
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Filed under: Information Technology, Op-Editorials | Tagged: eDRs, EHRs, EMRs, HIT, IT, medical records | 8 Comments »
