Fall 24 www.nvda.org 3 Editor’s Message SDM invited Dr. Paul Bornstein, who wrote a book on coding, to get the faculty up to speed on correct coding. His talk included the opinion that all (100%, including himself) dentists have committed insurance fraud. That actually makes sense after the passage of Obamacare in 2010. Obama and the HHS adopted the unconstitutional burden of proof posture that accused doctor coders of being guilty until they can prove themselves innocent, just like the IRS does. The accusation often metastasizes to doctor bios and CVs (i.e., Have you been investigated in the last two years?— a common recredentialing query). Some states require that if one is accused, entities are required by law to report the alleged rascally health professionals to sister agencies. For instance, a civil court would be required to report the doctor to the AG for possible criminal prosecution and also to the State Board for an administrative evaluation. A current case in another state involves administrative allegations and proposed penalties directly stemming from an EHR. A civil suit soon followed. The dentist’s staff mistakenly checked an incorrect box on the EHR, for which the doctor is, of course, responsible. The doctor actually developed a contemporaneous paper record that is correct, but the state apparatchiks want to simply dismiss the correct document out-of-hand. One bit of good news for dentists is that our CDTs are composed of only about 650 codes, while our medical colleagues must dance with 140,000 plus. It’s almost as if someone wants our physician colleague to make coding errors—go figure. That brings us to other not responsible for anything beneficiaries of EHRs, both plaintiff and defense attorneys. Depending on the way things fall out, they either view EHRs as scripture or as misinformation emitted from a vomitorium. EHRs are not true scripture, ever. They are in fact massive laundry lists that doctors must sort correctly, or face the consequences. Laundry lists never work either.2,3 If one does a search for problems with EHRs, literally thousands of articles will be revealed. One thing all these submissions have in common is that the doctor whose name is on the EHR is virtually always the one left holding the bag, absent proven criminality of another. Some of the problems often listed are: 1.They Are a Waste of Valuable Time: Perhaps this is a blessing if one works in time frames, rather than with patients. It took a couple of hours to complete the EHR for the two minute surgery mentioned above. Those hours happily represent less time to spend on other EHRs, but sadly, also less time left for actual patients. 2.Data Entry (coding): See 1. in part. 3.Alerting is Absent: Incorrect, or ambiguous, as in obscure allergies. 4. Inoperability: Routinely. 5.Visual Display: Chaotic. 6.Availability of Information: In reality, there is too much useless information to sort through. The doctor may be held responsible for everything in the chart, even the data of others. 7.System Automation and Defaults: There are always glitches. 8.Improved Versions Never End and Always Contain New Errors. 9. Workflow Support: Hospitals have assigned charting rooms with EHR computer babysitters for doctors attempting to use EHRs-surgery is much more straightforward. 10.Patient Harm: Generally, directly related to the EHR chaos. So, what is a doctor to do? Well, it is difficult to refuse to use an EHR when one’s employer requires it. As a courtesy to Nevada Dental Association Journal (NDAJ) readers, the following statement is something I try to attach to each EHR I am compelled to interact with. This is not legal advice nor an NDA-sanctioned treatment plan by any means, just a thought to consider: “The Electronic Record Developed by Dr. __________ for __________ is an Accommodation Only. Attestation Of Dr. __________’s Electronic Record Accuracy Is Perfected Via Dr. __________’s Notarized Physical Signature Only. Dr. __________’s Authorized Patient Record Will Be Maintained By Dr. __________.” Of course, dentists who unilaterally choose to use this or that software can’t attempt to assign blame to another. Good Luck! 0 References 1. Acenas R, 2.9 Billion Records Stolen in Hack, Including Social Security Numbers, Lawsuit Alleges, Epoch Times U.S. News, https:// www.theepochtimes.com/us/2-9-billion-records-stolen-in-hackincluding-social-security-numbers-lawsuit-alleges-5706444?utm_ source=morningbriefnoe&src_src=morningbriefnoe&utm_ campaign=mb-2024-08-16&src_cmp=mb-2024-08-16&utm_ medium=email&est=AAAAAAAAAAAAAAAAZeMlfBYAh87a% 2FpMbsGlPRbF%2B3g8R%2F5hN4kB%2FtGCswZ88%2BZ8%3D, accessed August 15, 2024. 2. Ismail J. Letter to the Editor. NDAJ. 2011;13(1):11. 3. Orr D. Dentistry Is? … NDAJ. 2009;10(4):5–6. 4. Pew Foundation (as reported by the AMA), https://www.ama-assn.org/ practice-management/digital/7-ehr-usability-safety-challenges-and- how-overcome-them, accessed July 17, 2024. A huge problem for doctors who use electronic health records (EHRs) is that they are generally the only ones held accountable for data breeches.
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