I Feel Fine

Sept. 1, 2010
This year, practice-management systems are rolling out new updates that will surely include easier implementation of the electronic health record (EHR).

For more on this topic, go to www.dentaleconomics.com and search using the following key words: patient medical history, practice management, EHR, PHR, Dr. Paul Feuerstein.

This year, practice-management systems are rolling out new updates that will surely include easier implementation of the electronic health record (EHR). One of the improvements will be the patient medical history forms. There are programs within PM systems, as well as third party programs, that allow a patient to complete these forms electronically and embed them in his or her record. Of course, this has to be HIPAA compliant, and as I have stated in earlier columns, it has been a source of controversy.

But while the dental industry is readily introducing these tools, a few of our friends have been marketing directly to consumers. Industry giant Microsoft has debuted HealthVault (healthvault.com). Google has Google Health (google.com/health). Two others are Web MD, which has started Personal Health Record (webmd.com/phr), as well as a service called Dossia (dossia.org). This service is sponsored by Intel, Walmart, AT&T, Vanguard Health, and other entities.

Microsoft HealthVault allows consumers to store and control an array of health information, including prescription medication lists, health histories, hospital records, lab results, and fitness data. You can add information from electronic blood pressure cuffs, heart rate monitors, blood glucose monitors, lung peak flow meters, and weight scales.

Microsoft has a certification and a logo found on certain devices that can communicate directly with this service. This can be shared with physicians and health-care providers, and as we will see, insurance carriers. Microsoft states that the platform is offered free of charge for consumers, but connectors may charge a fee for using its services.

Of course, one large base of data users will be the insurance industry. A claim on Microsoft’s Web site states (without my comment), "Your health plan can help reduce costs and provide better service by helping members find tools they can use to stay healthier with Microsoft HealthVault.... Giving plan members access to more health information and increasing the effectiveness of existing care management programs can help reduce claims costs."

Microsoft states that the company has tight security managing the data.

This was in a Cnet.com report by Lance Whitney, in which he also expressed some concern about security of information "in the cloud" of the Internet. He stated that the access is your gmail password, which is only as secure as any password.

Like Microsoft’s offering, Google Health can import information from certified devices, insurance companies, pharmacies, prescription companies such as All Scripts, and more. It is also available to health-care providers, insurers, and "partners."

So what about HIPAA?

Since these companies are not health-care providers, they do not fall under this rule. So we have to learn a new acronym – PHR (personal health record). PHRs are exempt from HIPAA.

One problem is that patients are reporting their medical conditions in their PHRs while electronic medical records (EMRs) are recorded by medical providers. This could lead to confusion, and could have an impact on outcomes such as status for insurance rates.

Perhaps instead of asking patients to complete these history forms on clipboards in the waiting room, or asking patients to fill out online forms, we might want to ask them to just send us the password to their personal information.

Of course, this could be at a cost to the practitioner since the office would then become a "partner." Do you think this might be food for some debate? For more on this debate, I urge you to check online forums, including those at DentistryIQ.com.

As an aside, while we are all adding technologies to the practices, many people look for companies that can do that integration. There are many local independents as well as national companies, but how do you know, other than a referral, if the local company has any knowledge of integrating, for example, digital radiography with the office practice management system? There is a new initiative behind the scenes of a group, Dental Integrators Association, trying to set basic standards for these companies and give them a "seal of approval." The information can all be found at www.dentalintegrators.org.

Dr. Paul Feuerstein installed one of dentistry’s first computers in 1978. For more than 20 years, he has taught technology courses. He was named "Clinician of the Year" at the 2010 Yankee Dental Congress. 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 protected].

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