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