Darrell Pruitt's concerns are important. As for liabilitywould a dental provider in private practice face liability under the Health Insurance Portability and Accountability Act if her/his electronic health-record data was stolen? Would the procedures for dealing with such a theft interfere with her/his practice? Although if we suddenly had EHRs in every dentist's office in the U.S., I doubt there would be a crime wave of EHR thefts across the country, clearly there is a risk. Any dental provider should take the same steps as any provider, namely, encrypt the hard disk.
The high cost is because of proprietary systems of great expense. The Veterans Affairs Department and the Indian Health Service have had integrated (medical-dental) systems in place for years. While the VA dental package is not open-source, the VistA system per se is open-source, and is available, sponsored by the CMS. The IHS dental package is open-source and can be used together with the VistA database. When it comes to loss of records, please note that not one veteran's EHR in VistA was lost during the Katrina disaster in Louisiana.
The reason for integral communication among medical and dental providers is to optimize and support chronic care, the source of over 70% of costs of healthcare in the U.S., to optimally support prenatal care affecting the unborn, to optimally support pediatric care and to address the urgent multidisciplinary needs of patients at risk of osteoradionecrosis.
Dental-provider concerns are important and must be addressed. It is reasonable that dentists are alarmed, reading about thefts of computers and hard drives and problems of HIPAA compliance. Pruitt suggested in a phone conversation that two-way fax relationships with an alternative method of IDing providers and patients might solve the HIPAA liability problem. I suspect the best solution is a best-practice approach to electronic data security and backups. Practical solutions must be found so that routine, appropriate and necessary communication between medical and dental providers can safeguard the health (oral and systemic) of individual patients. Patient safety and quality of care are foremost. It is neither safe nor supportive of quality of care to have two less-than-adequately coordinated "streams" of care administering and prescribing medications and performing surgeries on patients receiving care in both "streams."
Valerie Powell, Ph.D.ProfessorComputer/information systemsRobert Morris UniversityChairwomanEducation/trainingWorldVistAMoon Township, Pa.To submit a letter to YOUR VIEWS, click here. Please include your name, title, company and hometown.
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