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Thursday, 15 August 2013 07:47

Health Information Exchange (HIE) in Dentistry Featured

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post 56 picI have been following the developments around the government’s promotion of exchanging a patient’s health information between healthcare stakeholders. 

I blogged about this a year ago in my post entitled Connected Dentistry and then more recently in my post entitled Can Dentists Hide from Electronic Health Records

The Office of the National Coordinator (ONC) made a very interesting announcement last week with the publishing of “Principles and Strategy for Accelerating Health Information Exchange (HIE)” and I’d like to share with you some of the salient points of this strategy along with an attempt to make it more meaningful to the dental practice.

According to the ONC, “the ultimate goal of a transformed health care system is real-time interoperable HIE among a variety of health care stakeholders”.  This allows all of the health care providers involved in a patient’s care to securely share health information concerning that patient with each other. 

The reasoning behind this sharing is to improve quality, efficiency and the safety of health care delivery.  A key word in this goal is “interoperable”.  The state of Minnesota used this word extensively when they described the nature of their mandated Electronic Health Record.  

All practice software (medical, dental, mental health…) captures and stores health information about patients.  Each system has been customized for the particular care setting in which it operates, so each may be interested in different pieces of health data. 

For several years efforts have been made to unify this information across care settings through the introduction of certified Electronic Health Records.  These efforts have had success through the financial incentives offered by Medicare and state Medicaid offices.  

The ONC now feels that it is time to leverage that EHR progress by pushing to make that information shareable.  The “Principles” document defines two steps to interoperability:

  1.     The ability to exchange information
  2.     The ability to use the information that has been exchanged

Dentistry is expected to fully participate in these efforts.  After all, they probably are the health care setting that patients visit most frequently and the dentist’s contribution to the patient’s overall health cannot be minimized.

How is it exchanged?

All of the policies stress the secure exchange of information.  This does not mean open Internet email.  Efforts are happening all over the U.S. to promote mechanisms for secure exchange in Healthcare.  I blogged about the Oregon effort in my post entitled “Secure Email for Oregon Dentists and Beyond”.  This is as simple as email where attachments can consist of treatment plans, x-rays, intraoral pictures or anything relevant to the patient’s health.

What is exchanged?

CMS has defined a Summary of Care Record that they encourage be exchanged by each care setting transition or referral.  Rather than a specific format, CMS simply provides the descriptions of the data this record should contain.  You have the typical demographic information identifying the patient with various health history facts along with a care plan.

What does it mean to dentistry?

When I read about requirements, such as these, my mind immediately goes to;  how will it be used in the dental setting or to use a little more geeky term, what is the “use case”?
When a dentist receives a Summary of Care Record from a patient’s physician, what might they receive that would influence the services that they are about to render?

  •     A patient has had a hip or knee replacement and must pre-medicate with an antibiotic before certain dental procedures.
  •     The patient takes blood-thinners and this needs to be taken into consideration for oral surgery procedures.
  •     Patients often can’t recall which meds they are on, a complete list from their other prescribers can reduce potential complications from dental treatment.
  •     Recent hospitalizations or surgeries – as strange as this sounds, patients can often forget when updating their health history.

When a physician receives a Summary of Care Record from a patient’s dentist, what might they receive that would influence the services that they are about to render?    

  •    The medications that have been prescribed by the dentist, particularly opiates.
  •     Biopsy results for certain mouth conditions.
  •     Odontogenic infections.
  •     Any vital signs captured during the dental visit.

Expect Medicare and state Medicaid agencies to begin to incentivize the exchange of Summary of Care Records between patient care settings. 

Also expect this “carrot” to be followed by the stick of penalties for those who don’t comply.  The ONC strategy document closes with eleven recent actions the federal government has taken to accelerate HIE. 

Make no mistake; they are serious about this effort.  Planning now for these kinds of exchanges in your dental practice would be a right click.

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