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Did the NSA End Obamacare?

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Did ambitious NSA officials unintentionally end Obamacare years ago?

[By D. Kellus Pruitt DDS]

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

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

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

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

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

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

My POV 

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

National Obamacare Hangs in the Balance

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

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

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

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

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

More on Health Information Exchanges

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

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

Obamacare

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

The RAND Study

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

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

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

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

Assessment

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

Conclusion

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The Healthcare Industry’s Unrecognized Cancer

The Untreated Cancer of Health Informatics Leads to Painful and Unrestrained Growth

By D. Kellus Pruitt DDS

A few days ago, Daniel Palestrant MD, Founder of par8o & SERMO, compared the American healthcare system to a patient with cancer.

The clinically blunt article includes a graphic photo of a fresh tumor the size of a cantaloupe, labeled “AMA.” It is appropriately titled, “I Know Cancer When I See It.”

I believe him. What’s more, Dr. Palestrant shows no respect for cancerous growth in healthcare. That’s Hippocratic cool.

http://par8o.com/wordpress/i-know-cancer-when-i-see-it/

I think we all know which presidential candidate’s think tank is to blame for selfishly stimulating metastasis of their harmful information. Like the American Medical Association, the ADA unwittingly developed informatics cancer years ago. Now, a similar, energy-sapping tumor is becoming increasingly difficult for stoic ADA officials to quietly schlepp around.

My Dental Analogy

If one replaces every mention of “AMA” in Dr. Palestrant’s excerpt below with “ADA,” every “CPT® code” with “CDT® code” and every “physician” with “dentist,” his analogy becomes strikingly similar to one I wore out long ago, but without an ugly photo (My apology to Dr. Palestrant):

1. Divert resources – The ADA’s CDT system creates a maze of payment infrastructure and rules that diverts resources to administration and makes transparency impossible.

2. Fool the immune system – The ADA has fooled the American public into believing they represent the opinion of America’s dentists.

3. Self perpetuate – Like a cancer, the ADA perpetuates itself through special interest lobbying, and most importantly, by updating the CDT codes as frequently as possible and forcing the entire dentalcare system to use them.

Assessment

If it weren’t for CDT® copyright royalties, ADA members’ dues would double – undoubtedly causing members to naturally demand better accountability to their patients’ welfare instead of HIT goals even Newt Gingrich abandoned a few months ago.

He’s a smart politician – arguably smarter than dentistry’s embarrassed leaders who own autographed photos of him.

Conclusion

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Newt Gingrich has his Way with the ADA

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 

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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.

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OWS versus Tea Party Movement

Understanding Two Poplar Political Movements

By Staff Reporters

This infographic compares the two most popular political movements in the United States: Occupy Wall Street and the Tea Party Movement.

It debunks several misconceptions surrounding both movements, including the stereotype that OWS protesters are largely lazy, liberal, and jobless -OR- does it?

Assessment

Is this a matter of conservative [republican] medical professionals versus liberal [democratic] laymen – or something else?

More:

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[Do] eHRs Fail to Improve Healthcare Quality?

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.

http://blogs.wsj.com/health/2011/01/21/study-looks-for-cant-find-much-evidence-of-e-healths-benefits/

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).

http://health.usnews.com/health-news/managing-your-healthcare/policy/articles/2011/01/25/electronic-record-keeping-alone-may-not-boost-health-care

“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.

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Are You Prepared for a HIPAA Dental Audit?

Why – or Why Not?

By D. Kellus Pruitt; DDS

If you are a dentist and pay ADA dues year after year to be kept better informed about protecting your patients as well as your practice, your ignorance of HIPAA is not entirely your fault. The ADA clearly dropped the ball. Nevertheless, you could still suffer fines as high as $1.5 million for what our leaders failed to emphasize.

It’s time members accept the shameful truth about the ADA Department of Dental Informatics, headed by Ms. Jean Narcisi. Narcisi, working under the direction of ADA Sr. Vice President Dr. John Luther, has been abysmally negligent in preparing members for HITECH HIPAA, and now the compliance deadline is only days away. It’s been months since any information about HIPAA has been published in any ADA publications. Why?

HIPAA Avoidance 

Why do ADA leaders avoid discussing HIPAA? They are ashamed, not unlike embarrassed scam victims. About six years ago, Newt Gingrich visited ADA Headquarters and “lied” to ADA Delegates about the future of eHRs in the US. Then he bribed the ambitious career bureaucrats in the crowd with millions of dollars in federal grants to play along with the scam. I can only imagine that the Delegates must have been star-struck by the former Speaker of the House, because nobody dared asked the tough questions.

Newt’s Slick

So here I am, Ms. Jean Narcisi. I’m again doing your job because your mistakes I pointed out years ago now have you frozen in shame. If you disagree, and consider self-respect as something worth defending, let’s discuss your innocence in front of everyone – including the ADA members who pay your salary. Or, you can continue to hide from your responsibilities. This crap will catch up with you soon enough, Ms. Narcisi, and Dr. Luther no longer has the courage to stick his neck out to protect you. He’s also scared of me. You are alone.

Newsletters 

Dom Nicastro, senior managing editor at HCPro, edits the Briefings on HIPAA and Health Information Compliance Insider newsletters. He posted an informative article on HealthLeadersMedia.com today titled “HIPAA Compliance Questions to Ask as HITECH Date Nears.”

http://www.healthleadersmedia.com/page-1/TEC-246514/HIPAA-Compliance-Questions-to-Ask-as-HITECH-Date-Nears

The article features Chris Apgar, CISSP, president, Apgar & Associates, LLC, in Portland, Oregon. Mr. Apgar notes that “many covered entities and business associates have consistently failed to comply with the HIPAA Security Rule.” Apgar adds, “I find this over and over when conducting compliance audits.”

The lack of compliance described by Apgar is consistent with the results from my study in 2008, “HIPAA Rules and Dentistry.”

https://healthcarefinancials.files.wordpress.com/2008/08/hipaa-survey-dentists4.pdf

Study Abstract

A survey of 18 dentists was performed using the Internet as a platform. The volunteer dentists’ anonymity was guaranteed. The dentists were presented with ten HIPAA compliancy requirements followed by a series of questions concerning their compliancy as well as the importance of the requirements in dental practices.

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.

Frustrated at Mandates

Frustration with the tenets of the mandate, as well as open defiance is evident by the written responses. In addition, it appears that a dentist’s likelihood of satisfying a requirement is related to the dentist’s perceived importance of the requirement. Even though this is a limited pilot study, there is convincing evidence that more thorough investigation concerning the cost and benefits of the requirements need to be performed before enforcement of the HIPAA mandate is considered for the nation’s dental practices. 

HIPAA

Questions to Consider

Apgar says that the security rule requires covered entities to consider these questions:

  • Has a risk analysis been conducted lately? Was it properly documented? Were damages mitigated and were the risks acceptable?
  • Is privacy/security training current? Have new workforce members who will have access to personal health information (PHI) been adequately trained? Has refresher training for all staff been accomplished? Have security reminders been provided?
  • Are the office policies and procedures complete, current and enforceable? Are workforce members trained on the policies and procedures they are required to respect?
  • Has a comprehensive audit program been implemented? (The security rule requires three periodic audits and an “evaluation” or compliance audit). Are evaluations current? Have audit findings been addressed and documented?
  • Have up to date disaster recovery and emergency mode operations plans been communicated and recently tested?
  • Are CMS’ remote access guidelines being followed? (These are not part of the rule, but CMS earlier indicated remote access management would be included as audit criteria).
  • Are data in transit and data at rest encrypted? Are non-electronic PHI being protected?

Office of Civil Rights

Mr. Apgar adds that even though the Office of Civil Rights isn’t saying when audits will start, if a complaint is filed with OCR alleging ”willful neglect,” OCR is mandated by statute to investigate. The fines for “willful neglect” are much more devastating than fines for simple carelessness. And “willful neglect” is a subjective judgment call made by inspectors … who work on commission.

Assessment

Unfortunately for the nation’s dentists, the statute invites disgruntled patients and employees to celebrate revenge via federal inspectors. And, the more dentists are fined, the more the inspectors make. That can’t end well. Where are you hiding, Jean Narcisi? You’ve been silent far too long. Let’s talk. Don’t make me come get you.

Editor’s Note: The applicability of this post to all medical specialties is obvious.

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Encrypt or De-identify PHI

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Which One Just Might Work?

[By Darrell K. Pruitt; DDS]pruitt

The United States’ advancement in Healthcare Information Technology, which has the potential to lead to wonderful money-saving cures through research using trustworthy interoperable health records, is currently stopped cold by patient security problems that are only getting worse. Our lawmakers cannot get around the security obstacle without resorting to authoritarian means using CMS’s power to withhold providers’ discounted payments and threats of obscene fines from the HHS and the FTC. History shows that tyranny is not tolerated well in this part of the world. Lawmakers can get their butts voted smooth out of office in my neighborhood.

HITECH  

Here is something nobody mentions: Despite the current hope in a thick, political fantasy called HITECH, encryption of patients’ Protected Health Information [PHI] is a non-starter in the land of the free. Everyone knows that resourceful, cynical Americans will simply never trust encryption to protect their secrets, and will reliably withhold important information from their eMRs – one way or another. Doctors as well as patients can be expected to go out of their way to sabotage technology they fear. We all intuitively know this is true, don’t we? We aren’t so naïve to think all the players will happily play by the rules, are we? And I think we can all agree that an untrustworthy digital health record in an emergency room is worse than no patient information at all. Security is a grand problem with eMRs that started with HIPAA changes in 2003 that made eHRs so slippery. And the problem is clearly not being resolved. Not yet.

Public Lacks Trust 

Regardless of the campaign donations which follow him, there is nothing Newt Gingrich and his entrepreneurial friends in high places can do about the public’s lack of trust in encryption. It gets worse: Encryption hasn’t a chance of isolating PHI from dishonest employees in doctors’ offices, and slippery digital patient data can be moved soo easily. Everyone knows that as well, don’t they? It is estimated that two-thirds of the identities stolen in the nation are lifted from doctors’ offices. That’s us, Doc. HIPAA is not only irrelevant, it is an expensive distraction – it gives future ID theft victims a false sense of security.

HIPAA Approved 

De-identifying digital records is not mentioned in HITECH as a HIPAA-approved method of security. Yet it is the ONLY solution that promises to be even more secure than paper records. Because of heavy stakeholder stakes in hospital care, it will take longer for CEO-types to embrace patient-friendly de-identification. Other than identifiers such as names, social security numbers, birthdates, addresses and other items that have street value, NOBODY cares what is in a dental record. I actually think this opens a tremendous opportunity for someone courageous in the Texas Dental Association to discuss the feasibility of de-identification of dental records. Otherwise, instead of leading the nation in solving security problems, the TDA will look just as stupid as the ADA.

Encryption would also provide a dangerous false sense of security in eMRs – that is if it had a chance in the marketplace. But encryption will never go far because consumers simply won’t buy it. That is a marketplace fact that stoically optimistic HIT stakeholders are trying hard to avoid. They also know they are running out of time. Deadlines are quickly approaching for both HIPAA and the Red Flags Rule that providers are far from prepared for.

Former Attorney Speaks 

Bill Lappen, a former attorney and author of the ad I copied below, as well as a partner with his brother David in the de-identified health record venture says: “Since no identifying information is ever entered, a hacker can’t determine whose information is shown.”

So in addition to protecting one’s practice against dishonest or vindictive employees, de-identification of dental records would make hacking a dentist’s computer a complete waste of time, and hackers wouldn’t endanger dental patients and bankrupt dentists.

My Confidence 

I confidently tell you that soon, someone smart will come upon the unprecedented idea that the ultimate answer to our security problem in healthcare will be de-identification of medical records, not encryption. De-identification allows a compromise of privacy for only a miniscule percentage of physicians’ patients. We cannot allow that to stand in the way of better health for everyone else. Those special cases are so few that I am confident that they can be dealt with individually. We simply must move forward. I’ll have to retire some day. I may need help from Medicare.

Encryption gives us only danger and protects nobody but a thief with a key.

Assessment 

We’ve wasted enough time on HITECH and HIPAA, as well as CCHIT. It’s time to say no to stakeholders and pay attention to patients’ needs instead of those who would needlessly increase the cost of their care. Stimulus money attracts cockroaches.

In the name of Hippocrates, disregard the tainted HIPAA mandate. It is dangerous, and especially absurd in dentistry.

Link: http://www.theopenpress.com/index.php?a=press&id=58568

Life-Saving Patient Information can be Online, Anonymous and Usable

Published on: September 26th, 2009 12:19am

By: blappen

Los Angeles, CA (OPENPRESS) September 26, 2009 — Hospital Emergency Rooms need instant access to patient medical information. Allergic reactions and dangerous drug interactions can be deadly. Time is critical. Until now, privacy was a large concern. Two brothers, who have developed medical software over the past 15 years, think they have a simple first step towards moving patient information on to the internet.

“The ER doesn’t need to look up the information by patient name” said Bill Lappen, a former attorney. “We have implemented secure systems in the past, but no matter how secure we make the site, we have to assume that it will be hacked” added David Lappen, a computer design engineer from Stanford. “But providing instant access to life-saving information is too important to ignore”, he added. To protect patient privacy, their system does not know to whom the medical information belongs. Since the person’s identifying information is never on the system, it can’t be stolen. “By enabling anonymous entry, we have protected people’s privacy while allowing them to put their life-saving information in a place where it can be instantly accessed when needed”, added Bill Lappen.

www.AMCC.me is the public service website they created. It allows anyone to enter medical information anonymously. The site provides a random ID which the user carries in his/her wallet. For someone to see that user’s medical information, they merely enter the ID into the site. Unless the user has given them their ID, the information shown is meaningless. That same information, when associated with a patient, can save their life.

Since no identifying information is ever entered, a hacker can’t determine whose information is shown. “Secure patient-controlled Electronic Medical Records are now available on the internet” said David Lappen. A sample ID has been set up on the site to allow users to evaluate the concept before setting up their own free ID.

Contact:

Bill Lappen

Bill@AMCC.me

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Reflections on Evidence Based Dentistry

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My Search for Truth – 2009

[By Darrell Kellus Pruitt; DDS]pruitt4

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.

***

dental

***

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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Avi Baumstein and HIPAA Compliancy

A Ten-Step Process

By Darrell K. Pruitt; DDSpruitt

HIPAA inspections are coming. Are you still computerized? If so, are you prepared? The fines are steep if a dentist’s [optometrist, podiatrist, allopath or osteopath’s] computer is hacked and he or she is found to be not in compliance.

About Avi Baumstein

Avi Baumstein is an information security analyst at the University of Florida’s Health Science Center in Gainesville. He posted an article recently; on InformationWeek titled “Time to Get Serious about HIPAA.” Baumstein is one expert who should know.

Link: Ten Step Process

http://www.informationweek.com/news/industry/health-care/showArticle.jhtml?articleID=214600332&pgno=1&queryText=&isPrev=

Mr. Baumstein notes that in October, the HHS inspector general issued a report that was sharply critical of CMS (Medicare and Medicaid) for not enforcing HIPAA security. The embarrassing dope-slap of CMS leadership causes Baumstein and other experts in the security industry to anticipate more “proactive enforcement” (unannounced inspections) in the next year. 

From his article, I am led to believe that the last prerequisite for meaningful action to enforce security is a tax-paying and otherwise acceptable nominee for Secretary of Health and Human Services. Whoever Obama finally digs up [Kathy Sibelius] I think providers are in for significant changes. 

For example, it will be the Secretary who will ultimately decide if HIPAA inspections will be performed by new federal employees or PriceWaterhouseCoopers personnel – which was the former President’s administration’s “market approach” to helping the GDP by outsourcing policing duties, as well as accountability, to favored big businesses. (For those who are sensitive about political affiliations and become upset with me for saying unflattering things about your heroes, please don’t feel too hurt.  I’m a bi-partisan critic for natural reasons).

The ADA’s imaginary playing field and toy soldiers

“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.”

ADA President-Elect Dr. John S. Findley,

In-house interview ADA News

October 7, 2008

In spite of President Findley’s manicured and traditional cause-I-say-so sound bite, the actual invisibility of ADA leadership in healthcare IT matters clearly hints that whatever happens in Obama’s healthcare reform, dentists’ and patients’ concerns stand little hope of being adequately represented by ADA representatives. 

For example, when I recently contacted CCHIT to ask about EHRs in dentistry, I was told that I was one of the first to even mention dentistry to the private and reclusive non-profit EHR certification club. I think that chunk of unexpected news blows a huge hole in President Findley’s boat. Want to see something hilariously scary in a darkly humorous way? The President’s campaign motto this time last year was “Findley for the future.” Get it?

In spite of the silent neglect of dentists’ interests by dental leaders from the top down, I would like to proclaim that there is accidental hope that future HIPAA inspectors will know more about dentistry than the jobless OSHA hired in the late 1980s during the HIV panic. I heard a rumor back then that OSHA sent an inspector to a dental office who didn’t know the difference between a microwave and an autoclave.

Panic and Urgency

Panic, a favored US government bureaucratic response, occurred when OSHA leaders found themselves suddenly under pressure from Congress over a mysterious disease that was raging out of control. Since immediate action was demanded, even if it was irrelevant and wasteful, OSHA leadership was so busy chasing shadows that it was hiring almost anyone just to cover their lower backs. Eventually, the panic subsided and yielded to a low level of common sense, thanks in large part to the intervention of the late Rep. Dr. Charlie Norwood of Georgia – a dentist and a courageous statesman. Nevertheless, because of the momentum of institutional panic, millions of healthcare dollars have been wasted on 99% superstition; incredible? Consider this.

In the last two decades, how many lives have been saved by covering dental chairs with plastic between patients? Now, how much does the effort raise dentists’ fees – thereby lowering accessibility and increasing disease and suffering among Americans? Furthermore, after each dental patient is released, the “contaminated” sheet of petroleum-based polyethylene is thrown away. I ask this: Are the reasons for inevitable environmental problems caused by regularly adding non-biodegradable plastic to the city dump based on evidence-based science? 

Of course not! This and other related acts of foolishness are nothing but lingering, costly superstition – now accepted as standard of care without proof of effectiveness. Here is how such absurdity happens: Some of those weekend miracles quickly hired by OSHA in the ‘80s went on to become prosperous and influential consultants with lots of ideas.

Since the US government is prone to panic followed much too quickly by careless and expensive overkill, national responses to adversity often stimulate lots of employment – evidence of need be damned. The OSHA surge of the 80s followed the AIDS scare. More recently, coming on the heels of the banking collapse, auditing has become one of the fastest growing fields in the industry. The feds cannot hire people with accounting skills fast enough. I contend that one should expect that for reasons and attitudes similar to those surrounding the increased funding for OSHA, it follows that news of frightening breaches of EHRs by the hundreds of thousands at a time has created a new nidus of power in a fresh, enthusiastic administration, as well as an enormous employment opportunity for anyone with knowledge of dentistry – like super-hygienists.

A hazy glimpse of the future and a promise to tie all this together soon

This brings us to a fanciful peek over the edge of the event horizon in dentistry. At the same time that HIPAA inspections of dental offices appear unavoidable, there is currently a turf war between fully licensed dentists and expanded duty “super-hygienists” who wish to be able to practice independently – limiting their invasive work to only easy fillings and simple extractions that in their assessment will not turn complicated.

Link: www.HealthcareFinancials.com

Turf Wars

This kind of war has been fought before, and physicians lost. Nurse-practitioners annexed physician turf like Sudetenland, and they are still grabbing lebensraum. CMS loves it. 

However, dentistry is different. It is my opinion that because of dental patients’ very personal reasons that include under-rated motivation from primal fear and terror, they will shun almost-dentists almost immediately – leaving graduates with huge student loan payments and lots of unused knowledge about dentistry.

Furthermore, I predict that when super-hygienists consider the expense of finishing out and leasing space at a shopping mall or department store, in addition to monthly loan payments to cover the price of dental equipment, or perhaps even the buy-in price to an insurance-sponsored dental franchise, a few will be discouraged from their initial intention to increase accessibility to dental care by lowering cost and quality.  

I think reality will cause a few super-hygienists to be readily lured from their initial goals upon entering two-year junior college programs that taught them nomenclature and the easy parts of doing dentistry. Unless they agreed to work in underserved areas in exchange for paid tuition, some will consider the benefits of working for commission for the US government as HIPAA inspectors. And later, the most successful of these will have the opportunity to continue their careers as HIPAA consultants with lots of ideas.

Are you following me so far? In conclusion, within two years, instead of real-dentists and almost-dentists being faced with uninformed HIPAA inspectors like OSHA’s shock-and-awe weekend miracle crews of the ‘80s, there will accidentally be thousands of nomenclature-savvy super-hygienists graduating across the nation looking for work about the time an acceptable HHS nominee finds his or her stride. What a story! 

Did I ever tell you that I once did a short stint as a screenplay writer? 

I guess I am being a little bit silly concerning super-hygienists, but do you see how all these pieces of history can conceivably come together at a time when the nation couldn’t be more vulnerable to wasting money on foolishness? Common sense about patients’ security is just not that common in Washington DC, and the absurdity of HIPAA is so great that the stunned silence it evokes actually causes the enforcement of folly to fit in well with the traditional Democratic tendencies of using big government to handle all possible contingencies caused by human frailties – even if that means micromanaging everyone. Who needs that? 

Every day, I am increasingly thankful that my office is not computerized. The sheet-metal box that contains my patients’ ledger cards does not have a USB port. Preparation for inspection is tricky by design.

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Assessment

Baumstein concedes that preparing for a HIPAA inspection is difficult because the law is intentionally vague:

“One goal of HIPAA was to be a one-size-fits-all, technology-neutral regulation.” 

Incredible; when you read the ten obligations Baumstein says a dentist must complete to be compliant with a vague mandate, you too may want to go back to a pegboard system – carbon paper and all.  

It seems to me that in 2003 or so, someone in the ADA Department of Dental Informatics should have warned ADA leadership about the obvious fact that as long as there is a dependable supply of cheap carbon paper in the nation, HIPAA enforcement has the potential to drive computers smoothly out of dentistry. Instead, there was silence followed by increased funding for the department’s budget, and the game was on. By 2005, at the urging of the former administration and healthcare IT stakeholder Newt Gingrich, the ADA News was posting articles pushing ADA members to quickly volunteer for irreversible NPI numbers for no good reason.  A trusting majority of members dutifully followed the tainted command. I am saddened by the loss few yet comprehend.

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Conclusion

And so, your thoughts and comments on this Medical Executive-Post are appreciated. In bringing a close to this contiguous, here is something some may find interesting about the University of Florida, where Avi Baumstein works. Do you remember the 330,000 dental patient records that were hacked this fall from the Dental School located in Gainesville, Florida?  You guessed it; same college town – same health science center

And, as of last week that the dental school was still hemorrhaging patient data to who knows where. I bet by now, Baumstein knows more about HIPAA and dentistry than anyone in the nation How about you? 

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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