Procrastination. Many of you are putting off networking the office or “going digital” because it is not time, or you are just not ready. Some offices have a few computers in place and the beginnings of a network while others are fully networked and do nothing more than use the treatment rooms for occasional data access or searching on the Internet. Another group is using the network for appointments in the treatment rooms while others enter treatments and treatment plans at chairside. Those who have implemented intraoral cameras and digital cameras can add this information to a patient’s record. And, of course, digital radiography has been discussed ad nauseam to add to the electronic record. Each step is a bit closer to the chartless office, which again seems like a nice idea but “maybe now is not the time.” A chartless office, which would entail putting all of the treatment notes in the system, seems a bit overwhelming to many. After all, it isn’t necessary, is it?
Well, guess what? In 2004, President Bush dropped a big hint in his State of the Union address. He established the National Health Information Infrastructure, and appointed David Brailer, MD, to head it up. The initiative’s goal is to have all medical records in a digital and interoperable format by 2014. Dr. Brailer has listed several goals. Among them is a call to “interconnect clinicians” that would “allow the appropriate information to be portable and to move with consumers from one point of care to another. This requires an infrastructure that can help clinicians gain access to critical health information when treatment decisions are being made.”
After studying this initiative, the ADA has realized several issues about the current state of dental practices. Forgive me for quoting from the ADA report, but I feel it is important that I do not paraphrase too much from our organization. (By the way, I encourage you to visit the ADA headquarters in Chicago. It is an amazing collection of people and resources that all ADA members support. Not only are there staff members working with dental legislation, disasters, rehabilitation, meetings and CE, there are research labs and an amazing library where people are ready to enlighten you on any topic.)
The committee realizes that “only a fraction of all clinicians in the United States use Electronic Health Records today. Those who are using EHRs are considered pioneers among their peers. While EHR use has been slowly gaining acceptance among clinicians, many smaller practices maintain a strictly paper office. ... Patients’ information should be portable and move with them from one point of care to another. The current practice of using separate paper files for one patient in multiple clinical settings is limiting and can compromise the quality of health care received. The conversion to an EHR system is necessary but not sufficient to solve the portability problem. The reason is because each clinician may purchase an EHR system from different vendors, which may not be compatible with one another.” As I see it, this last point is one of the real stumbling blocks. Anyone who has tried to do a conversion from one practice-management system to another is well aware of the current differences in how data is managed.
Now for the interesting thought from the ADA. “Purchasing and deploying an EHR is a costly investment for a clinician’s office, particularly a smaller practice. Therefore, the cost must become an investment shared between clinicians and others in the health-care environment. This will allow many to not only play a role in making the transition possible but to profit as well, reducing the possibility that only certain players benefit from their purchase and use. The government is currently exploring both financial and non-financial incentives for investors.” In other words, if this becomes a mandate, funds may be available for practices to set up this conversion.
The report also points out some obvious but necessary points. For instance, a patient’s electronic record reduces errors since there are no poor handwriting issues. The record contains basic demographic information, birthdate, proper spelling of name, current address (which we know is NOT a permanent record) and more. The electronic record will contain the history of services, such as when the last full series of radiographs was taken, how old a denture is, etc. Compiling this information takes a lot of research in many practices. Referrals will be more complete - not just a few scribbles on a piece of paper along with a patient’s history. The report also explains in great detail about standardized coding, privacy compliance, rural dentistry, and more.
The clock is ticking. Start thinking about getting your office into a more digital format. The report is available at www.ada.org. Type in “NHII” in the search area and enter your ADA number for access.
Dr. Paul Feuerstein installed one of dentistry’s first computers in 1978. For more than 20 years, he has taught technology courses. He is a mainstay at technology sessions, including annual appearances at the Yankee Dental Congress, and he is an ADA seminar series speaker. A general practitioner in North Billerica, Mass., since 1973, Dr. Feuerstein maintains a Web site (www.computersindentistry.com) and can be reached by e-mail at email@example.com.