NDA Journal 2 Dr. Orr practices Anesthesiology and OMS in Las Vegas, is an Adjunct Professor (Surgery) at UNLV SM and Touro University SM (Jurisprudence), Professor Emeritus at UNLV SDM, and a member of the CA Bar and Ninth Circuit Court of Appeals. Editor’s Message Daniel L. Orr II, DDS, MS (anesth), PhD, JD, MD [email protected] NDAJ Exclusive EHR 101 Someone, sans ID, walked into a Las Vegas hospital charting area this week and walked out with four hospital computers. Reportedly, the culprit was asked who he was and what he was doing. The ID-less perpetrator offered that he was from Information Technology (IT) and was directed to retrieve four computers. He was allowed to do just that; so much for protected information security. The feckless employees will now attend a retraining session about the loss of at least tens of thousands of protected records. Now, if someone walked into a dental office, picked up some computers with protected information on them, and disappeared, guess who would be in trouble, to the tune of potentially hundreds of thousands of dollars in fines in addition to administrative, civil, and even criminal prosecution? Yes, the dentist with the license. A huge problem for doctors who use electronic health records (EHRs) is that they are generally the only ones held accountable for data breeches. National, state, and municipal governments, corporations and their employees, insurance companies, software manufacturers, and pretty much any other third-party that doesn’t have a health professional’s license generally is simply advised to be more careful.1 Nowadays, a significant consideration for such breeches is that records are often electronic. Thousands of patient files are much easier to steal if they’re digital as opposed to on paper. This is but one disadvantage of an EHR. Historically, many of us remember being taught how to develop a hard copy, handwritten document. What we actually wrote down is secondary to EHR issues discussed herein. What is important is the purpose of the record. Remember? The primary reason we created patient records was to optimize patient care. The records belonged to the doctor and were actually, as opposed to today, truly protected and confidential. Today, EHRs are neither protected nor confidential as seen with frequent huge data breeches of millions of citizens. And no individual is responsible for the breeches, except of course the gullible doctors. EHRs are kept for vastly different reasons than our paper records were. Those of us who are coerced to used EHRs by third-parties know the new priorities have little to do with optimizing patient care. When EHR advocates speak in public, for decades they aways tout the toogood-to-be-true evanescent benefits of efficiency and safety, which is never the reality of the EHR. What is true is that the primary purpose, as iterated more privately, is to facilitate coding, ideally by vulnerable doctors, for more efficient billing. And boy, do some billers bill. I accepted a case recently for which a third molar was removed from a veteran who had undergone significant head-and-neck cancer therapy. He had vascular clips throughout his neck, had undergone a laryngectomy, and the standard radiotherapy. The tooth was removed in the OR because of the co-morbidities, not the difficulty of the 1–2 minute odontectomy. The office fee for this procedure would have been exponentially less than hospital bill of more than $18,000. But, don’t worry, the vet didn’t have to pay for it—the taxpayers did. Another primary purpose of EHRs includes creating wealth for the conflicted software developers for endless programs that always, as in 100% of the time, do not perform as advertised. Often, EHRs also relieve third-party billing entities of the burden of retaining coders, as doctors are now assigned to code procedures. UNLV
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