Yesterday, the CMS published the proposed rule for the Medicare and Medicaid Electronic Health Record Incentives Program Stage 2: [bit.ly]
This is my first blog and I would like to talk about the HITECH Act and how dentists may qualify to receive incentives for demonstrating meaningful use of electronic health records. In February 2009, the Health Information Technology for Economic and Clinical Health (HITECH) Act set aside up to $29 billion over 10 years to promote the adoption and meaningful use of electronic health records. The Act was enacted on the belief that the HIT has potential to improve the quality, safety, efficiency of the patient care, and the major barriers to HIT adoption could be overcome with federal government assistance. More than two years have passed since the enactment of this historic program and it is reported that the percentage of US primary care physicians with at least a basic Electronic Health Records (EHR) increased from 20 to 39 percent between 2009 and 2011. In addition, 3880 providers have attested to meaningful use of EHRs under Medicare and received about $357 million as incentives. Another 6767 providers received more than $514 million from the state Medicaid programs, which do not require attesting to meaningful use in the first year. These reports illustrate the early successes of the HITECH Act and its potential to reshape the US healthcare system.
Now, how about dentists? Yes, dentists are considered eligible professionals to receive incentives up to $63,750 for the adoption and meaningful use of EHRs if they meet certain requirements. At least 30 percent of their patient volume should have received Medicaid assistance in a 90-day continuous period and they should start using a certified Electronic Health Record. The list of certified dental Electronic Health Records are available at http://onc-chpl.force.com/ehrcert. While most certified EHRs are for physicians, there are a few certified dental EHRs such as axiUm CE (version 5.10) and MacPracticeDDS (version 4.1). Once you have the certified EHR, you must demonstrate and report meaningful use of the EHR.
There are 25 defined meaningful use objectives. An eligible dentist will be required to meet 15 core objectives and at least five other measures from a list of 10. The complete list and explanations are available on the CMS website. While these objectives may look exhaustive, the CMS and ONC have taken steps to ensure the dentists are also able to meet these objectives. Keep in mind that these are only Stage 1 measures and there will be additional Stages 2 and 3 measures in 2013. If all these requirements are met, dentists will receive up to $ 63,750 over a period of six years with the first installment being $21,250. Stage 1 of meaningful use lasts through 2012 and the program as a whole extends through 2018 for Medicare and through 2021 for Medicaid.
Looking forward to your comments and thoughts,
Thankam Thyvalikakath DMD, MDS, MS
Assistant Professor, Center for Dental Informatics
I will like to share with you this novel idea about digital logbook which I called: Blog+Twitter=Digital Logbook for short BT Digital logbook. I am still working on this idea and I will like you all to see the following links where you can read about my writings on this novel idea.
Please feel free to try this in any way you can at work and kindly let me have your comments. Your suggestions will be most appreciated as well. I will also post my final work on it here whenever is ready.
This question is a perennial favorite of mine. I get it a lot when I give talks to dentists or in response to papers we write. It reminds me of a question that many people asked in 1910: “Should I get another horse and buggy, or should I get an automobile?” (Disclaimer: I wasn’t there personally.) The early 1900s were a period of transitions in many ways, but few were as significant as the change in how we got around town. Around 1910, the number of automobiles was surpassing the number of buggies. Thus, we started to give up on a way of transport that had been with us for thousands of years. Horses and buggies were relatively cheap, required little training to use and had a (relatively) predictable standard of performance. Consider what we got in return at the time: The term “automobile” comprised a number of technological contraptions whose variety was only exceeded by the number of ways they could break down. Early automobiles were unreliable, non-standardized and had a variety of not-so-intuitive user interfaces.
Sound familiar? I thought so. We are currently in the process of phasing out the tried-and-true method of documenting patient care in favor of electronic dental records (EDR). This is simply a statement of fact, not a value judgment about which medium is better. In 2006 we conducted a study that found that about 1.8% of all general dentists in the US were paperless. In a recent study, which we just submitted for publication, the figure is about 15%. We are not very close to the moment when more dental practices are completely paperless than those who are not. But, we are heading there. The dental profession is voting with their feet.
Whether to go paperless or not is not only a significant, but also a very personal, decision for dental practices. Not only is “going paperless” it a fairly involved process. It also consumes a non-trivial amount of time, money and resources. (We discussed this transition recently in “Transitioning from Paper to Electronic Records: A Process Guide.”)
In my experience, there are at least three factors that play a big role in the decision to go paperless:
- Do you believe that you are better off using electronic than paper records? There are some areas where the computer clearly beats paper – anytime. Just ask any dental office that has lost its records during hurricane Katrina. But, the inverse is also true. Have you ever tried documenting Diagnodent values in an EDR in a systematic fashion? Most EDRs don’t provide structured fields for such diagnostic tests, so you are pretty much left putting them into progress notes. Not a great method for systematic review of these numbers later.
- Do you have the knowledge, skill and energy to take on a major computerization project? Many dentists who have made EDRs work in their office are not just geeks, they are computer geeks. They invest the countless hours needed to learn about their EDR, how to configure it optimally in their practice, train their staff and keep it running.
- Do you take the long-term view with regard to EDRs? EDRs are an emerging, immature technology. Several studies, including ours (see heuristic evaluation and usability of EDRs), have shown that. Cars weren’t perfect in 1910, and neither are EDRs in 2012. Better EDRs are a matter of time, ingenuity and perseverance.
Clearly, there are many other factors influencing whether to go paperless or not. But, one thing is certain: EDRs are here to stay, and will, sooner or later, replace paper. It is up to all of us to make them into a more useful tool for dental practice than they are now.
What do you think about this?
Titus Schleyer, DMD, PhD
Assoc. Professor and Director, Center for Dental Informatics
I am planning to periodically post topics related to the use (and misuse) of instructional technology in dental education. Here the first installment:
I just read a thought-provoking article “Hyper and Deep Attention: The Generational Divide in Cognitive Modes” by Katherine Hayles which discusses the generational shift in cognitive styles that poses challenges to education at all levels (published here, full text available here).
Dr. Hayles discusses the dichotomy between deep attention, concentrating on a single object for long periods ignoring outside stimuli, and hyper attention, switching focus rapidly among different tasks. The latter is characterized by preferring multiple information streams, seeking a high level of stimulation, and having a low tolerance for boredom.
While many people, in my age group anyway, would immediately argue that deep attention is better, “it comes at the price of environmental alertness and flexibility of response.” Dr. Hayles argues that “Hyper attention excels at negotiating rapidly changing environments in which multiple foci compete for attention, …” However, in our traditional educational environment “hyper attention [is] regarded as defective behavior.” The problem we are facing is, according to Hayles, the clash between the “expectations of educators, who are trained in deep attention […] and the preferred cognitive mode of young people.”
Her research also shows that while the “mean [of the population] moves toward hyper attention rather than deep attention, compensatory tactics are employed to retain the benefits of deep attention through the artificial means of chemical intervention in cortical functioning,” such as through cortical stimulants (e.g. Ritalin). Her article elaborates on research about synaptogenesis which is altered when children grow up in media-rich environment–reminding me of The Shallows by Nicholas Carr.
One of her key arguments is that “A case can be made that hyper attention is more adaptive than deep attention for many situations in contemporary developed societies.” However, I would note that the public thinks differently when it comes to the work of health care providers, see: New York Times: As Doctors Use More Devices, Potential for Distraction Grows, and AHRQ recently reported about a “multitasking mishap” in their Morbidity & Mortality Rounds on the Web.
CODA, the accrediting body for all US dental schools, states in its standards that the “[u]se of technology in dental education programs can support learning in different ways, including self-directed, distance and asynchronous learning.”
What challenges are we facing when these students enter our dental schools? Do we want to foster hyper attention, building on their acquired predisposition, or do we want to change their cognitive style to adopt a style of deep attention which is more suitable for a health care provider? Actually, is deep attention really more suitable for health care providers who must interact with often multiple computers and devices as well as need to adjust to the rapid pace of many patient encounters per day?
Do we need to prepare our dental educators for these hyper-attention learners? At the University of Southern California, researchers “explore new pedagogical models that provide greater stimulation than the typical classroom […] 14 large screens span the walls, providing display space for […] participants [who] search the Web for appropriate content to display on the screens while a speaker is making a presentation.” Think about dental educators: do you think they would enjoy teaching under such circumstances?
Or, maybe the solution can be found in what Atul Gawande recently wrote in The New Yorker regarding the promises of technology: “What ultimately makes the difference is how well people use technology. We have devoted disastrously little attention to fostering those abilities.”
Heiko, looking forward to your comments and thoughts
Associate Dean, Office of Faculty Development and Information Management
Associate Professor, Dental Public Health, Center for Dental Informatics
School of Dental Medicine, University of Pittsburgh