Tag Archives: emr

Better diagnostic codes for better dentistry

About Mary Otto

Mary Otto, a Washington, D.C.-based freelancer, is AHCJ's topic leader on oral health and the author of "Teeth: The Story of Beauty, Inequality, and the Struggle for Oral Health in America." She can be reached at mary@healthjournalism.org.

Here’s a question to ask dental leaders in your state or community:

Does dentistry need a uniform, commonly accepted system of diagnostic codes?

I had the chance to listen in on a daylong conference that focused on the topic and to write about it for DrBicuspid.com, an online publication that serves the dental profession. The question is one more way to think about the gap between dentistry and medicine.

Photo by TheKarenD on Flickr.com.

Dentists have long used procedure or treatment codes for billing and for keeping patient records. But, in terms of diagnostic terminology, “we’re behind medicine by a lot,” said Joel White D.D.S., M.S., at the conference.

“Back in the days of the bubonic plague, medicine captured why people die. We don’t capture why teeth die. We’re centuries behind,” said White, a professor at the University of California, San Francisco, School of Dentistry and a member of an international academic workgroup focused upon developing a useful vocabulary of dental diagnostic terms.

To that end, the team has come up with the EZCodes Dental Diagnostic Terminology, a system of 1,358 terms organized into 91 subcategories under 15 major headings.

Team members said their system, being tested in 17 dental schools and institutions in America and in Europe, will help dentists in providing care for patients and in tracking clinical outcomes as well as assist in mapping disease patterns, monitoring community oral health status and identifying best practices.

Mary OttoMary Otto, AHCJ’s topic leader on oral health is writing blog posts, editing tip sheets and articles and gathering resources to help our members cover oral health care.

If you have questions or suggestions for future resources on the topic, please send them to mary@healthjournalism.org.

The use of diagnostic terms represents “a move from treatment-centric to diagnostic-centric,” dentistry according to EZCodes lead developer Elsbeth Kalenderian, D.D.S., M.P.H., chair of oral health policy and epidemiology at the Harvard School of Dental Medicine. With the growing importance of electronic health records (EHRs), diagnostic coding will become increasingly important, many at the conference pointed out. Developers of the EZCode system say they set to work on the diagnostic vocabulary because other efforts to standardize dental diagnostic terms have failed to gain wide usage. The World Health Organization’s International Classification of Disease coding system, or ICD, includes some oral and dental diagnoses, but lacks sufficient specificity in its dental terminology, they said. They criticized as too cumbersome a second system of more than 7,000 terms called SNODENT which is contained within the Systematized Nomenclature of Medicine Clinical Terms (SNOMED-CT.)

For its part, the American Dental Association, developer of SNODENT says EZCodes is an “interface terminology” that is useful for capturing health problems but which is not a replacement for SNODENT in terms of storing information in electronic health records.

The Nov. 28 conference at the Harvard School of Dental Medicine did not end the discussion, as Dental Informatics blogger Titus Schleyer, D.M.D., Ph.D., pointed out in ”Does Dentistry Need More than One Diagnostic Vocabulary?

Electronic records raise privacy concerns

About Andrew Van Dam

Andrew Van Dam of The Wall Street Journal previously worked at the AHCJ offices while earning his master’s degree at the Missouri School of Journalism.

On Bloomberg’s Tech Blog, Jordan Peterson has been regularly hammering away and exposing, piece by piece, the privacy concerns that could arise from widespread adoption of electronic medical records. His latest piece addresses medical identity theft, and opens with a simple explanation of just how serious it can be.

Webcast: The status of health IT in your community

Farzad Mostashari
Farzad
Mostashari

Join us online on Tuesday, Aug. 7, at noon ET for an exclusive on-the-record conversation with Farzad Mostashari, M.D., national coordinator for health information technology, and other officials with the HHS Office of National Coordinator for Health Information Technology.

View and learn how to use an updated “Health IT Dashboard” to find local-level information about where Federal Recovery Act dollars are being spent on health IT programs, the percentage of doctors and hospitals adopting electronic health records, and how many doctors and pharmacies are using electronic prescribing tools.

This is an AHCJ members-only opportunity to learn about health IT and its impact on providers and patients in their own communities.

If your credit card is stolen, it may take a few minutes on the phone with the bank to reverse the fraudulent charges.
But if your identity is stolen and used for medical treatment, it could take a year or longer to undo the damage, a new study released today found. Victims may also get dropped by their insurance provider and end up paying the imposter’s bills just to make the problem go away, potentially to the tune of $100,000 or more.

According to the study, which was commissioned by an identity theft protection outfit, 1.85 million people could be affected by medical ID theft, which is estimated to cost the U.S. economy $41.3 billion this year. According to the article, 41 percent of respondents lost their insurance as a result of the theft, and 45 percent said they simply paid the fraudulent bill in order to make the problem go away rather than commit to the yearlong process of properly resolving it.

And, most, remarkably, Robertson writes, “Thirty-one percent of the survey respondents said they let family members use their information to obtain medical care, up from 26 percent last year. Most said it was because their family members were uninsured, couldn’t afford care or were experiencing a medical emergency.”

Other relevant posts in the ongoing series include:

CPI investigation details health information technology sector’s lobbying efforts

About Andrew Van Dam

Andrew Van Dam of The Wall Street Journal previously worked at the AHCJ offices while earning his master’s degree at the Missouri School of Journalism.

Writing for The Center for Public Integrity’s iWatch News, Josh Israel reports that, with billions of stimulus dollars still at stake, the number of health information technology lobbyists taking advantage of the lucrative “revolving door” between Capitol Hill and the private sector is sky-high, even by D.C. standards.

The Obama administration is still working to iron out the details of the “meaningful use” mandate expressed in the recovery act, and the big players in health IT are pulling out all the stops to ensure the rules are written to their advantage.

Healthcare Informatics magazine publishes an annual ranking of the 100 largest health IT companies by annual revenue. According to the Senate Office of Public Records, 15 of the companies in the 2010 ranking — most of them ranked in the top third by revenue — reported health IT-related lobbying activity in the first quarter of 2011 or the last quarter of 2010. Of the 90 lobbyists listed as having done health IT lobbying for those firms, at least 63 were former Congressional and/or executive branch staffers, many of whom worked for health-related agencies or committees.

For those interested in additional details on HIT’s lobbying efforts, Israel also included two sidebars:

Report explains doctors’ reluctance to adopt EMRs

About Andrew Van Dam

Andrew Van Dam of The Wall Street Journal previously worked at the AHCJ offices while earning his master’s degree at the Missouri School of Journalism.

Writing for the Center for Public Integrity’s iWatch News, Susan Jaffe spent time in the trenches to better understand how government incentives toward the adoption of electronic medical records are (or aren’t) working. She spent time with Cleveland-area small practices and government agencies to understand the real obstacles faced by physicians on the ground. It offers a picture of the reality of EMR today. Some of my favorite tidbits:

  • “570 different electronic health systems certified by private organizations for non-hospital settings may be used to qualify for the bonus.”
  • “The systems are priced in a way that does not make comparison shopping ‘easy or necessarily valid,’ said Dottie Howe, a spokeswoman for the Ohio regional extension center. There is no basic price because each company offers different components, features, options, and level of technical support.”
  • EMR systems can include more than a thousand sometimes-customizeable details, and that’s not including the myriad warnings and cross-checks.
  • Compatibility with the systems in the area’s large hospitals is tough to guarantee, yet factors as a major concern for many small practices.
  • How early adopters in the field were burned and are wary of getting fooled again.
  • When practices adopt EMRs, they typically have to go through a “learning curve,” a period of weeks or months during which they can only see about half as many patients.
  • Many major HIT companies don’t guarantee that physicians who adopt their systems will meet the standards for a government HIT bonus.
  • The VA’s proven HIT system is available for free, but can’t handle billing and insurance.
  • To get the maximum bonus payment, practices must adopt EMRs this year or next.
  • Only certified systems can earn bonus payments, yet the second and third stages of certification haven’t even been finalized yet.

An accompanying piece by Emma Schwartz looks at one physician’s concerns.

Baby’s death illustrates how health IT can introduce complexity, error to system

About Andrew Van Dam

Andrew Van Dam of The Wall Street Journal previously worked at the AHCJ offices while earning his master’s degree at the Missouri School of Journalism.

Chicago Tribune reporters Judith Graham and Cynthia Dizikes explore the pitfalls of health information technology through the story of an infant boy who survived despite being born months early and weighing just 1.5 pounds, only to be killed by a sodium chloride overdose when a pharmacy tech entered information into the wrong field of his electronic medical record.

health-it

Photo by Christiana Care via Flickr

The tech’s fatal clerical error was compounded by disabled alarms on a compounding machine, incorrect labeling on an IV bag and an ignored lab test. The heart of the errors, the reporters write, seems to be that all the different systems involved don’t communicate.

Almost all medication requests at Advocate are transmitted by a doctor’s keystroke to the hospital pharmacy’s drug-dispensing system. But in this case, there was no electronic connection with the automated compounding system that prepared the IV bag for baby Burkett, a specialized device that handles low-volume, highly individualized orders.

So a technician transcribed the order by hand, and an error was introduced.

Electronic communication gaps are common at large hospitals, which typically use upward of 50 to 100 different information systems at their facilities, with different technologies used in emergency rooms, labs, pharmacies and other medical departments, said Ross Koppel, a sociologist at the University of Pennsylvania who studies health information technologies.

“To some degree these systems talk to each other, but mostly they don’t, so hospitals have to design custom-made software ‘bridges’ to make this happen,” Koppel said. With each jury-rigged software solution comes the potential for new software bugs, transcription errors and other problems.