Disaster Recovery Solution? CDP

Continuing with the last blog, disaster could hit us at any time. The question that seems to arise:

What are some solution to protecting your asset?

One of the growing trend is: Continuous Data Protection

How to Use Continuous Data Protection to Improve Backup, Disaster Recovery

http://www.eweek.com/c/a/Data-Storage/How-to-Use-Continuous-Data-Protection-to-Improve-Backup-Disaster-Recovery/

As Wikipedia defines:
Continuous data protection (CDP), also called continuous backup or real-time backup, refers to backup of computer data by automatically saving a copy of every change made to that data, essentially capturing every version of the data that the user saves. ...

In laments term, it is a CDP software or appliance that detects a change in the data, run and "capture" the data, and back up the data.

What is impressive is that CDP is chronologically "documenting" all the changes in your data. It is better than an image snapshot because it is able to continuously take snapshot of each individual data. You could edit your disaster recovery with some data at one point in time and another data set on another date.

It allows the optimal solution in backing your data and recovering your data. As the article points out:

"When used properly, CDP technology can unify local and remote data protection processes, combining replication and backup into a comprehensive solution that minimizes data loss, speeds recovery, and reduces or eliminates the need for tape-based data protection"

One the amazing application of CDP is that, it could do what they call a "bare metal recovery", you could run the CDP and create a recovery disk for a computer. Have the CDP running to save backing up the whole computer. If a computer hard drive fails, you could run the recovery disk to get it back and the use the CDP to bring the unit up to date with its data.

Some units have the capability to transfer the hard drive information from one unit to another by removing drivers with adding generic drivers onto the new unit. It is not always simple but the capability to image your hard drive to a completely different unit is amazing.

Are you Ready? For a Disaster?

I am sidetracking from the normal blog of Cloud Computing and Centralized Data Storage in Health IT to go back to a basic fundamental. After the news of Hurricane Irene coming into the NYC area, many people were panicking and various government officials urged people to follow a disaster plan. Why? To ensure safety for many residents, communication and update, and prompt performance in case there was a major disaster. Though nothing but minor issues occurred in NYC, I ask the same question to many clients and peers about understanding disaster. Natural or artificial (by lack of proper policy as an example), how ready are you if a disaster happens to occur?

Many peers and companies have to realize and determine the value and cost to lost and/delayed data needed for "normal" operation. I know we do not have bottomless money resources to make a "complete" disaster recovery (DR) but time, effort, and money are needed in case something bad happens.

Computer World: Ready for Trouble
http://www.computerworld.com/s/article/101249/Ready_for_Trouble_

Though the article is old, I chuckle on how the article is still relevant today as it did in the past.

The article takes about a scenario and how do you manage disaster in your own home, your client, your employer, etc. As the article points out, there general guidelines to making an effective and successful disaster recovery:

1) Planning for the Unplanned: You have to know your scenarios of disasters and how to properly communicate and document your plan. How could you plan something that is not in writing, easily accessible for many, and known with compliance by the employees? Also, I am not looking for all doomsday scenarios (scope creep and this plan will never be complete and costly) but start with the most common known issues that would impact the stakeholders.

As Glenmede (a company) states: "If the building's power goes out, the critical systems can be brought up within four hours at a "hot site" across town owned by business continuity services and outsourcing provider SunGard Availability Services Inc., a unit of SunGard Data Systems Inc." Meaning, they define how critical certain business processes and understood the cost and value if their own infrastructure went down. Also, they utilize a plan that deemed appropriate so that their business operation could function while they work on restoration on the primary site.

2) State of the Art Technology: Though it could be costly depending upon your current infrastructure, the important part is knowing the existing technologies out there. being familiar with the technology, and implementing that is best for you. your company, etc.

3) Testing Times: This is a no-brainer. Run a disaster recovery to obtain actual real data as well as verify your disaster recovery's success! Why do we believe professors with real world experience? Because they actually do what they preach! Just like that a disaster recovery plan is only as real as actually testing (to expose shortfalls as well as strength). The whole point of testing to ensure you have the right resources, planning/documentations, and know-how for a successful disaster recovery. So when it does happen, we do not encounter an actual disaster without any recovery!!!!

With the old article presented, I come back to the present with cloud computing and how it could be a cost-effective means to disaster recovery. Why? The information is safe in an off-site location and most cloud centers are data centers that have high standard of fault tolerance and redundancy in security, data protection, and service. Again, that is the assumptions

http://www.drj.com/2011-articles/online-exclusive/the-cloud-is-a-cost-effective-option-for-disaster-recovery.html

Cloud Computing could be a good solution to certain users BUT it all depends!! It depends upon you and understanding the strength and weakness of the technology (back to #2)

How does this apply to me and you? We need to really understand what is important to the business. I have seen offices have safe for certain equipment but how much important is your data that keeps your business running? What I address a lot of time with doctors are:
1) How are you backing up your data? That could be easily answered (though the answer might not be correct at times)
2) Do you actually test the data backed up? That could be answered but rather vague
3) How long does it take to bring your data back (DR)? They do not know and didn't really think about...

It is important to understand that backing up your data is good but verifying and replicating your backed up data in a timely manner is CRITICAL!!!!! I hear doctors complain how the back up takes so long. I told them, do you care more about how long the back up takes or how fast you get your data back? The answer is obvious.... But doctors pay significant amount of money backing up with an off-site, Internet-based solution (in Kansas just say) and never tested to see how long it takes for the data to come back from there to here (consider they have image files).. They do not have fiber line channels for high throughput (just high speed Internet) and the data do not dedicate all the bandwidth to them... What we found out was 20GB of Data took anywhere from 8-16hours to just download the data they backed up. What happens if Internet is down? You see the picture about how TIME IS THE ESSENCE of recovery... You have to consider the cost on how it cost You to be DOWN...



Now, with Irene gone.... Are you ready?

Need for Nationalized Medical Records

With my last blog and post on Cloud Technology, I thought about the implications in our health records. Could this provide a means to a standardized or "nationalized" health records in the United States?

I know many people have different views on nationalized systems. I happen to be one that does support it due to the facts and data in Europe, South Korea, and various countries in mandating it. I know some will beg to differ, especially those who worry about "Big Brother".

Again, Peter Parker's quote comes back again. Before we talk about why it is bad. We have to understand why Nationalized Medical Records could be good, we need to see its strength. I hope on my next blog, we talk about what is bad about it.

My previous blog, "History of eXRs", hints toward a nationalized patient records. I will be honest that it does but the scope of nationalization varies (by the adopted vendors and health institutions/self-governing, state mandate, and/or national mandate).

Again, why centralized medical records (not nationalistic speaking)?

The Need for Centralized Medical Records
http://www.pinnaclecare.com/about_pinnaclecare/resource_center/white_papers/the_need_for_centralized_medical_records

Note: This is an open-ed and marketing for this group. But it does hit some main points. I will add another article on the same matter of centralized storage.

It starts out with how are patient records are currently documented and saved:

"If you're like most people, you receive your healthcare from more than one doctor—a family medicine specialist, an OB/GYN if you’re a woman, perhaps a dermatologist, an orthopedist, or a cardiologist. That means the records each physician gathers on your health and treatment are scattered across offices all over town, perhaps even all over the region. Of course, you do your best to inform each doctor of all of your conditions, tests, and treatments, but it's hard to remember everything during an appointment and sometimes you may not know what information is germane"

Remember, the biggest concern and growing aspect of most doctors' and dentists' practices are the LIABILITY of taking on patients (when their focus should be in treating the patient).

Without a full picture of the patient, they:
1) can improperly diagnose or duplicate multiple of tests for the patient
2) mistreat and not optimally treat a patient (second paragraph states my concern: "potentially life threatening")
3) collaboratively work with other doctors to provide the best treatment since issue of the patient could hit a different part of health care (Dentistry, it happens a lot like head trauma due to injury that affects jaw, teeth, and neck/backbone)

What comes down to it is:
1) Improved Health Care and Service as well as reducing waste or repetitive diagnosis (cost of healthcare is reduced)
2) Better and Clearer picture of the patient health
3) Easier Transfer and Means of Patient Records Access (This is a big point that I see first hand when a patient relocate, does not like the doctor)

As the article address, Markle Foundation (private foundation) did a study. "The study found over 70% of those questioned believe these records would improve the quality of care they receive."

Also, this clearer picture of yourself (including your family) could show better diagnosis. This is good for you as a patient of immediate care. (The negative I feel is the concern with all this health records and the risks of you being patient.. Meaning pre-existing conditions and family history of say, cancer... Your cost to insurance.. Address on the next blog).

Though the article hits the point of medical records, a nationalized medical records are still away (though the mandate should be by 2014). What is truly important is that your medical records (like your credit report) are accessible via Internet. It is possible to reach the information if you were traveling oversea.

"Because the information is in a compact digital format, it can easily be transferred at any time to any location around the globe if the need arises. There is also a highly secure online site that allows access to a members' complete health record anywhere there’s Internet access."

That is the intention of electronic Patient Records. The biggest concern and issues for centralization are:

1) Standards and guidelines
2) Who dictate the standards and guidelines
3) Security (since this data is so valuable to marketers and hackers)
4) Who holds the data for access?

Centralized, Electronic Storage of Medical Records
http://it.toolbox.com/blogs/adventuresinsecurity/centralized-electronic-storage-of-medical-records-22748

Again, the same arguments of benefits are addresses as well as some of the minor concerns of that benefits (I hit #2 and #3 which is the biggest no from many who oppose this as well as cost).

As Google (a big, cloud data center) will work on a pilot with Cleveland Clinic to provide medical records over the Internet:

"The test program will allow 1,500 to 10,000 patient volunteers at the Cleveland Clinic to store certain records - on prescriptions, allergies and laboratory test results - in a secure Google account. Patients will have passwords, and only they will be able to access the medical records"

With this technology, the speed of obtaining medical records is instantaneous. Added with the right security, the right people will access the right files. That information could be provided to your doctor/dentists. Have you ever dealt with patient records transfer from one office to another (relocation as an example). It could take days to send, verify, and entered (into the system). What if the patient has major surgery and time is an essence? Also, the handling of information could be very diverse (US Mail, UPS, FedEx, email, encrypted email, etc.) Since software do not necessarily work the same way, the data you get might not be usable to your current practitioner (I dealt with a Veterans Hospital eDR sent to a private dental practice via CD. Checking the CD, we could not read anything except file names. Why? Because the Image Format was proprietary and only readable in their software.. There's HIPAA for you.. =P )

With electronic services becoming the norm in dentistry. Paying your bill online, confirm and cancelling appointments, etc., standardization becomes a bigger variable on how the information displayed, accessed, and modified (as well as format for sharing between health organization like your private practitioner to hospital).

As for technology impacting my career?
I hits all angles. I have to be proficient in various governing laws (Like HIPAA, Red Flag, etc.) and state laws and regulations (NY is different from NJ and CT). I can't just be focus on the technology and understands the politic and stakeholders in the industries. Technology is forcing myself to be more of the instigator of technology as well as the ambassador to standardization.

Lastly, this argument is not only Patient Health Care Records. Like this webpage, it talks about the strength and weakness of centralized vs.decentralized filing (in this case, just records.. Who is to say that it could health records if EPA was not written on it).

http://www.epa.gov/records/tools/central.htm

Patient Records into the Clouds?

I know many people have heard of "The Cloud". This is an emerging technology that seems to be the "way" of doing business. I was wondering if practice management software or imaging software could embrace "cloud" technology. Looking into DentistryIQ.com , I came across such software.

New Web-based digital imaging technology allows dentists to capture images directly to the cloud

http://www.dentistryiq.com/index/display/article-display/3380096759/articles/dentisryiq/products/technology/2011/08/curve-digital_imaging.html



What is cloud technology?
As Wikipedia (http://en.wikipedia.org/wiki/Cloud_computing) writes :
"Cloud computing provides computation, software, data access, and storage services that do not require end-user knowledge of the physical location and configuration of the system that delivers the services. Parallels to this concept can be drawn with the electricity grid, wherein end-users consume power without needing to understand the component devices or infrastructure required to provide the service"

(Image Courtesy from Wikipedia's webpage on Cloud Computing)

In laments term, you do not need to worry about the investment and cost of physical assets as well as maintenance. All you need to know is how to access and utilize your data. Cloud computing is over the Internet. I think of those old mainframe computers as cloud computing in that the clients are nothing but dummy terminals (except that it is over the Internet and resources do not necessarily need to be mainframe computers).

Why is this significant?
Dentists are mostly K.I.S.S. type of people. The acronym stands for Keep it Simple Silly (the last S could be different with varying people). Dentists like to keep their operation smooth and clean. Taking the responsibilities of hardware and software purchase and maintenance off their plates, they would focus on their operations (business practices) and minimize cost.

As Curve Dental emphasizes:
"Using the cloud to capture and store patient images helps eliminate the need for a server, affords unlimited storage and a proven backup and business continuity solution, and provides the dentist with access to the data from any computer with Internet access."

As the article points out, the imaging software allows the office to acquire image acquisition with digital x-ray sensors, intraoral cameras, and panoramic/cephalometric equipments. As they stated:

"Switching to our software shouldn’t require the dentist to invest in new digital devices; that is our goal."

With the software being upgraded, maintained, and supplied by the Curve Dental, you would think it is a "no brainer" right?

Peter Parker's quote comes back again to our conversation. We have to consider the cost of technology:
1) Benefits and rewards
2) Responsibilities (including Disaster Plan and Politics)
3) Process

Benefits and Rewards:
I do not see any issue since it eliminates the need to purchase, maintain, and upgrade software. Also, if the cloud provider does what is expected, your data should be protected in case of disaster. There is a lot of pluses there

Responsibilities:
1) Various State, Federal, and International Laws:
Why I address this dictates how compliance are being met by Curve Dental (or their subcontractors). Since clouds are to meet compliance laws depending upon operation location and use. How are prevailing compliance laws implemented and mandated. Like I stated, is the data stored outside the USA? How are the data being backed up and security compliance in who has access to your data?

2) How does the Imaging Software works in correspondence to Practice Management Software (PMS)?

There is a terminology in the dental world called "Seamless Technology". This means does the PMS work bi-directional with the Imaging Software. Both software utilize the database(s) to perform various functions that otherwise would not when they bridge database or are standalone. Meaning, the patient name and their corresponding relations could work from PMS to Imaging or Imaging to PMS (Compare to Standalone, you need to have to separate databases that has no relations. Bridge has few relations and usually one directional; from PMS to Imaging.)

As Curve Dental stated:
"Because our imaging software is ‘native’ to our practice management software, it is more efficient and more stable than an integrated or bridged solution,” said Dorey. “‘Integrated’ or ‘bridged’ solutions equate to separate databases, separate sources for technical support and two applications that may work and look differently from each other.”

Meaning:
To have seamless integration, you need to switch out your PMS to their software. There is a cost in data conversion (let alone training and process changes to practice operations). This is a hidden cost to working the way you want it to work. Note, this has the same question and concern in terms of process

3) (Since we are talking about Imaging Software,) What Equipments will work?
They state they are compatible with many digital equipments but they do not list all equipments. When switching, we have to truly see and verify your digital equipments will work (and work the way the equipments are suppose to work.. This is a big emphasis on intraoral cameras and their buttons to capture/retake/save). TWAIN drivers are a solution but not all equipments are TWAIN capable. Again, with the industry taking sides, what type of relationships does Curve Dental have with the various vendors (and will they be willing to work with them in the future).

Emerging in the Dental Industry is the acquisition of 3-D Images (especially for oral surgeons) which utilizes manufacturers' software and drivers (in some case, their own acquisition machine and their own proprietary image format). How does the software handle these acquisition brings the question of going to the cloud completely or not. Note, we address the size of data later.


3-D Image Acquisition of Patient (Courtesy of Imaging Science iCAT)


Software Analysis 3-D of Patient Face (Courtesy of Imaging Science iCAT)


4) Security and Standards including Internet Data Transfer & Data Size
The important question is how are they are compliant to various health standards (HIPAA, Red Flag) and how are data secured over the Internet (Encryption, VPN, etc). That is a big and obvious question. Even if they answered the question, how are they managing user rights and security for each employee in an employer as well as guidelines when Internet goes down. When you take an x-ray, does it get saved on the machine locally and then to the Internet (process of the software)? Or if you lose connection, you lose the data image and have to retake? How much data compression do you have especially when 3-D Image (if possible to send) could be anywhere between 50MB to 100MB?

To Hit the point: How does the office function when the Internet is down? What is the contingency plan?

5) Cost of the Software
Since it is a subscription based, you are going to pay monthly. How much do you save (short and long term) in comparison to owning your own equipment and data? Subscription based on data size (images will add up and accumulate over time)? Data Conversion (what part of the data stays the same? Primarily accounting and ledger in correspondence to transactions) and its price? Support Cost included with the subscription?

The main point here is to look at the Doctor's vision and see if Cloud is really advantageous (especially if their Internet connection is sporadic or down.. T1 Lines needed and how much more for guarantee High-Availability)? Does owning the equipments consider cheaper comparing to "renting" the equipments?

Process:
How does your office function with the changes are involved. There are no distinct things to look at but general points to consider:

Is the learning curve and training easier?
What does the software allow me to take care (than the previous software did not) and not take care? (This deals with software interaction with the staff)
How are updates notified to the office?
Does the software work with other 3rd party vendor software (like electronic claims)


At the end, patient records are the dentists' livelihood. As a consultant, I want the doctor weigh the good and bad. Technology has many promises but it all deals with my sense of trust with the vendor and how the vendor deliver disaster recovery successfully and promptly. Also, I let it become more standardized and jump on board when all questions are answered to the expectations that my doctor and I desire (Never believe in the promises but the delivery)

How does this technology affect me? It gives another flavor of how to do business for the dentists. Practically, off-site data backup to the cloud seems very logical in terms of service. Also, cloud shows my company a directive to approaching our clients with value add and expertise in looking at the return of investment. Technology has grown in this industry faster than most people think. But technology is allowing the work of dentist (as well as my livelihood) to go faster to the speed of life..

Emerging Technology - Concerns

With some basic understanding of Digitization of Patient Records becoming the "norm" like CD was to Tape (like DVD to CD), there are many implications and "growing pain". The biggest being privacy and security

Security Gaps Leave Patient Records Exposed by health MSNBC.com
http://www.msnbc.msn.com/id/43054034/ns/health/t/security-gaps-leave-patient-records-exposed/#.TlUVC6iNsf4

The article see the centralization of patient records have many concerns but not limited to:
1) Privacy failure
2) Security Parameter and Requirements
3) Implication and Application of the Health information and records

As my career in the health industry grows, my responsibilities became more and more on the liability of the patient information (anything from lost information by user error/failure, hardware failure, or security breaches). It is imperative in our careers, we need to address setting up an optimal security. This is followed by clear and defined rules and guidelines to implement the security. Application (be it by pilot testing or fake sampling) to ensure our implementation meets and exceeds requirements.

Lastly, technology is not always a start and end procedure but a cyclical process. I understand as a project manager the importance of milestone and close date but technology does not stay stagnant and our roles has to adapt to newer technology (including ones that could compromise the data) as well as process improvements (metric measurement). The word I always state is we need to have all the stakeholders involved, held accountable to the define responsibilities, and ensure the resources are there for stakeholders' success (training, changing the procedural/process flow).

The implications here with the digitization are there will be needs for more project and data managers in the health industry. HIT (health information technology) is a growing segment and with the changing technology, everyone involved has to see the payout as the responsibilities (Remember my 1st quote of Peter Parker in the Spiderman movie).

This is why people need to audit (like the article, one hospital store radiology data in a backdoor room that was lock by tape.. Not even locked). They need to understand the implication of this memory lapse of security. Remember how it feels when someone knows your password to your email. Now, imagine it is 1000 patients. How about a research hospital server was used as a gaming server for hackers (SonicWall Case Study - Southwest Family Medicine- http://www.sonicwall.com/downloads/F204_Southwest_v4.pdf ) because they did not have:
1) Right plan and personnel
2) Understand the severity of access
3) Cost and Liability of this breach

With the rise of Identity theft, the emphasis of security is greatly enhanced in the health industry. What is the biggest and my greatest concern is with globalization, how do we protect our patient records when our information is transmitted overseas? Remember, HIPAA does not apply just say India. How are the technology going to protect us there.

An Article that published indicates how our information reaches global proportion and ramification. Again, there is no HIPAA laws in India (but they state they comply with the laws). What security protocols are there and the emphasis of protecting your information is the heart of all issues.

http://www.workplaceprivacyreport.com/2009/10/articles/hipaa-1/hipaa-data-breaches-in-india-threaten-outsourcing-industry-require-greater-vigilance-at-home/

How does technology impact me? Everywhere from my patient records, my credit card, banking statements, my student loans. What health technology transformation shows are that people can't just be "doers". We have to think outside the box (without project scope creep) and knowing how to add the human element to technology. My success in the industry is to emphasize and understand the implication of the office and making it happen by phases/projects and showing the rewards (Return of Investments) and value in approaching our goals. So HIT professionals have to understand the value of technology, disaster plan for technology, implementations (with cost in mind), and understand the human side (changes in process, etc) to making this change a reality and success.

Lastly, you see the change in technology when you go into a dental office. See your x-rays on a computer screen instead to lighting station for your old x-ray film. That is technology change in how dentists do business and getting quicker impact to the patient (films take a longer time to develop but a digital x-ray take less than a minute)

Understanding Government Mandates and Industry Trend

Government Mandates

1) HIPAA

Mandated and signed by Pres. Clinton in 1996 with complete compliance by 4/13/2003. This was mandated to all health profession and included the dental industry (though health plans might be separate from dental and vision coverage). Though exemptions existed like long-term health plans and limited-scope plans, most dental office were required to comply. Also, the development NPI were created

2) Red Flag

Mandated by Federal Trade Commission (FTC), businesses were to safeguard against identity fraud and theft. All business had to comply by Nov 1, 2008 but did not clearly define dental industry as one of the industry for compliance. With the work of ADA, the dental industry was given an extension to 5/1/2009 for compliance.

Emergence of Practice Management Software

Practice Management Software (PMS) started in the Medical Industry in Late 70s to early 80s (with the advent of computers and software development). With medical and dental field going hand in hand, dental industry developed PMS. With the progression and computing power of the PC, PMS expanded its roles from scheduling in the front side to the “chairside” and clinical part of the practice. Since data are entered into the PMS, it laid the backbone to the emergence of eDRs by being the central depository of data of patient from insurance info, finances, treatment plan, clinical notes, and family history.

Emergence of Digital Radiography

Like PMS, digital radiography focuses on the procedure and diagnosis of patients’ x-rays and “cosmetic” images (from digital camera and intraoral cameras). The physical equipment of digital radiography are reusable (compare to film being an one-time usage item) and require a means to store data in a central depository (imaging software). This provides the same foundation for the emergence of eDRs.

Conclusions:

With my deduction from Pres. Bush integrating oral health as part of the overall health (and CPRs/eHRs) and 10 year mandate of Executive Order 13335, I believe the expectation of eDRs will be mandated with the compliance date of 2014 (unless the ADA steps in to delay the implementation). Added with the increasing usage of PMS and digital radiography (with imaging software), as the means of communicating electronically, eDRs are the de facto vehicle for patient information (in particular HIPAA compliance when a patient goes to another practice as well as e-claim services by insurance).

Also, PMS and Imaging software vendors are implementing eDRs directly into the software (and it’s a logical implementation) without any concerns for most practices who are already utilizing the one or both software. That is an intrinsic cost and value already covered by your support/upgrade package you pay to the software vendor (usually annually).

At the end of the conversation, it is not a question of if but when?

History of eXRs

With technological development and advancement, the way we live and do business change and evolve each and every moment. With these changes, there are many consequences.. Good or bad. As Peter Parker said in Spiderman:

“With great power comes great responsibility..”

Being a HIT (healthcare information technology) advisor, I emphasize that all changes are beneficial, ineffective, necessary, and/or inevitable. Meaning not all changes are necessarily the best for your practice but could be for the overall progress of the industry. One of these changes that are being discussed is Electronic Dental Records (eDRs).

To provide an overall of how eDRs are the current progression of the dental industry, we have to see where it all started: Medical field and eMR (electronic medical records). There is no difference in the concept of eXRs (where X= M or D) except in content and industry (Dental is the lower 3^rd of the head and Medical could be the whole body). This analogy is like looking at cable signal seeing ESPN as being Dental records and HBO as being Medical records. How the data is delivered is conceptual the same but not the content necessarily.

Federal mandates started the initiative of eXRs:

1996 - HIPAA (Health Insurance Portability and Accountability Act)

With an efficient and safe mean of patients’ Information to be transferred, eXRs developed as vehicle and means with the rise of Internet and e-services (like e-mails, electronic claims)

2003 - Medical Prescription Drug Improvement and Modernization Act (MMA)

Medicare’s prescription drug overhaul (with Medicare Part D plans to support electronic prescription with planned implementation date of April 2009)

2004 – Executive Order 13335

Calls for complete computerization of health care of CPRs, computer-based patient records through NHII (National Heath Information Infrastructure), for health records, transparency, cost savings, and bioterrorism defense by 10 years – 2014

Note: NHII is not a government plan to establish a central repository for all medical records

George W. Bush quoted:

“By computerizing health records, we can avoid dangerous medical mistakes, reduce costs and improve care” State of Union Address 1/20/2004

“We need to apply 21^st-century information technology to the health care field. We need to have our medical records put on the I.T.” Collinsville, Ill.1/5/2005

Additional Reasons for eXRs:

2002 – Pres. G.W. Bush First Health Center Initiative (under Federal Consolidated Health Centers Program under Section 330) mandates that oral health be included as an integral component of the process (hence the development of NHII)

2008 – 70% Voters wanted President who would back a Health IT Network (survey by Computer Sciences, Government Technology Reports)

2008 (12/8) –U.S. President-elect Barack Obama has outlined an ambitious plan to give every child in the U.S. access to the Internet and to connect the nation's hospitals with "cutting edge technology.

"We will make sure that every doctor's office and hospital in this country is using cutting edge technology and electronic medical records so that we can cut red tape, prevent medical mistakes, and help save billions of dollars each year," he said.

The Federal initiatives and funding combines the theoretical and ideal concept (even if I agree with it or not), the development of eXRs into the platform and development of CPRs. Added with the importance of oral health as part of the patients’ complete health, eDR + eMR = CPR (or eHR – electronic health record).

Is eXRs Mandate and Reasons?

Technically speaking, there is no clear define mandate on eDRs in all dental office (my lament term was the Patient Digital Act which is the Executive Order). Checking all government mandates in reference to eXRs are primarily all related to the medical field. Date for mandate (if any) has be discussed as early as 2012 and as late as 2015 by dentists, HIT experts, and various HIT vendors. So why would I address this as a mandate for the dental industry?

As quoted:

“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.” - Dr. John Findley, ADA President-elect, September, 2008.

I believe the reason and thought behind the eDR mandate are based on pre-existing government mandate that did applied (and funnel) to the dental industry, emergence of practice management software, and digital radiography