In November of 2013 the president signed into law the Drug Quality and Security Act which many are calling “track-and-trace”.
Will it affect dentistry? Maybe.
What is track-and-trace?
The law calls for the FDA to set standards for tracking and tracing pharmaceuticals from manufacturing to dispensing.
The FDA will do this by requiring the drug manufacturers to create and maintain a transaction history and be able to report, by lot, the movement of their drugs through the supply chain by January, 2015.
Systems will be put in place to report suspect or illegitimate products by the same date. It also calls for the serialization of individual products by 2017.
This means that the bottle given to the patient must have a serial number that ties back to the manufacturing lot, thus end-to-end tracking of the drug.
Why do this?
I have worked in the healthcare technology field for over 30 years and this has given me a pretty good handle on knowing what goes on in a typical healthcare setting.
However, in early November I was afforded the opportunity to see the industry from a different perspective, that of a patient. I broke my right leg. I thought I’d use this blog post to give you my impressions of that experience.
For once I was in a doctor’s office and the technology being used was not my focus. Even my dental office got involved in the journey.
We’ll start with the emergency room visit. I’ve had the occasion to drop in on this slice of the hospital several times in the past year due to an aging mother in-law and on a Friday or Saturday night it is a bee hive of activity. Luckily my duties in those visits have been confined to sitting in the waiting room.
It was a Saturday morning when I was called on to be the leading man in my healthcare drama and the bee hive was only a quiet hum. After a couple of quick administrative questions I was ushered into an examining room for a few more questions, pokes and prods and then off to x-ray.
Whether your news source is the old- school newspaper, or online, you can’t dodge news that links your oral health to your overall health.
The latest article I read was titled, “Research Links Oral Bacteria to Colorectal Cancer.”
The article describes an anaerobic organism in the oral cavity that is implicated in periodontal disease and has been linked to the second leading cause of cancer-related deaths in the U.S, colorectal cancer.
The author states that more research is needed, but dental plaque is increasingly implicated in the pathogenesis of some systemic diseases including cardiovascular disease, pneumonia and even diabetes.
Add to that list colorectal cancer.
The Affordable Care Act mandate that requires businesses with 50 or more full-time equivalent employees to provide employee health insurance benefits has been waived for one year.
Beginning in 2015, employers who fall into this category will face penalties for not offering employee coverage that provides the required “minimum essential health benefits”.
Penalties will also be assessed if the coverage offered does not meet the definition of “affordable”.
In order to comply with the affordability rule, an employee’s portion of his health insurance premium cannot exceed 9.5% of his annual household income.
Beginning in 2014, businesses with 50 full-time equivalent employees or less are exempt from the mandate to provide coverage, and will not face any monetary penalties for not providing an employer-sponsored group health insurance plan.
The penalties for not offering coverage, however, may come in the form of reduced employee morale and it may become more difficult to recruit and retain quality employees in the future.
Healthy employees often make more productive employees.
Consumers anxious to browse for individual health insurance options and determine their eligibility for financial assistance to purchase health insurance, and those ready to initiate the application and enrollment process, have already experienced many bumps in the road.
Much of the frustration has stemmed from technology glitches associated with the on-line marketplaces.
Fortunately, the initial delays should not have much of an adverse impact on securing a Qualified Health Plan, since the earliest available coverage date for the new “Obamacare” plans is January 1, 2014.
On-line marketplaces have been created to provide consumers with a streamlined, one-stop shopping experience for health insurance.
Consumers will have the opportunity to compare all available health insurance options based on their preference for deductibles, co-insurance, monthly premium, carrier, quality ratings, and type of coverage desired.
They will then have the opportunity to enroll in the medical and dental coverage that fits their needs and budget.
I 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.
My company has been planning to link its dental practice management software to an ONC certified Electronic Health Record (EHR) and we are about to kick off that project.
It looks like this will be none too soon.
Minnesota has mandated that all hospitals and health care providers (i.e. dentists) have an interoperable electronic health record by January, 2015.
The guidance document for the mandate specifically calls out Dental Practices. “Includes general practice; oral surgery; and orthodontics.”
This document makes four points about what an EHR must be able to do. My dental interpretations are in italics below.
1. Provide clinical decision support;
In dentistry I envision a prescribing system that automatically checks a prescribed drug against patient allergies, drug/drug interactions and age/gender appropriateness and alerts the provider when something is contraindicated.
2. Support physician order entry;
Electronic prescribing integration, lab orders and results from tissue sample testing would be dental specific usage.
3. Capture and query information relevant to health care quality;
A robust reporting module associated with the patient’s medical and dental care.
4. Exchange electronic health information with and integrate such information from other sources.
This is the interoperable portion of the mandate. Examples include electronic prescribing, lab results, quality reporting and transfer and receipt of care and visit summaries.
Adoption of electronic prescribing has been extremely slow in dentistry. I speak from experience because my company incorporated this capability into our practice management software about a year ago and we have been able to sell it to only a handful of clients.
There is one primary reason for this slowness, the inability to prescribe controlled substances (narcotics).
I read a recent study that claimed that physicians prescribe narcotics about 12% of the time. A similar study indicated that this percentage is over 40% in dentistry.
Pain relief is a primary reason for a dentist to reach for their prescription pad and these drugs are often restricted. Practices just aren’t interested in a feature that will only provide its full value only a little more than half the time.
So, I’ve been closely watching the progress of e-prescribing narcotics and would like to provide you with an update.
It seems like the patients who are better at flossing and brushing continue to get better at it and they do it more consistently over time.
The patients who've historically slacked at it seem to do worse over time. There's little question that children inherit not only the genetic dental traits of their parents but the behavioral dental traits too.
If mom doesn't floss regularly it's very unlikely that the kids will either and the proof is in the mouths of the 79% of Americans who will have a filling before the age of 18.
There's no magic-bullet solution but there is a new product that's been gaining some traction in the last few years.
You've probably heard of cavity fighting lollipops and maybe even looked at the website cavityfightinglollipops.com.
It may sound too good to be true. It is not.
In a previous blog post (What are patients concerned about in Healthcare?), I encouraged readers to establish a dental practice website. I opined that the younger generation expect this from their providers and also expect certain interactive features to be a part of it. Recently, I have been reading about “Responsive Web Design” and would like to promote this to you as well.
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