Ready for the transition to EHRs?

Information technology training spreads into dentistry

by Peggy M. Cotter, RDH, BS, CHTS-TR

To dental industry observers, it has been no secret that during the past decade there has been a profound shift away from old-style paper charts and files to various forms of digital record keeping. Even as early as 2006, the ADA Survey of Dental Practice revealed that some type of electronic record support was utilized by 90% of dental practices. Yet even today, the main focus of many practice management systems is merely scheduling, insurance claims processing, and patient billing. Practice management systems can vary between traditional systems to forward-looking systems that emphasize clinical data collection capabilities and interoperability. The capability for the electronic dental records (EDRs) to be interoperable with the more encompassing electronic health records (EHRs) is a key component of the federal government's Affordable Care Act initiatives.

One compelling reason to make the transition now toward systems that support EHR integration is the financial assistance that is available from the Center for Medicare and Medicaid Services (CMS) incentive program. This is funded through provisions in the Health Information Technology for Economic and Clinical Health (HITECH) Act. The CMS program provides financial incentives to help providers whose practices include at least 30% Medicaid visits. This does not include Children's Health Insurance Program (CHIP) patients or those covered by any other programs. The key to qualifying for these benefits is meeting "meaningful use" criteria.

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Dentists can qualify for incentives at any of the three stages of meaningful use. Stage one is "attestation," and eligible dentists can receive one third of the $63,750 incentive per eligible dentist in the practice. To qualify, dentists must meet the Stage One criteria of having a certified EHR, being able to report, and attesting to the fact they can report. Meeting Stage Two meaningful use requirements allows for another third of the incentive payment. The Stage 3 meaningful use criteria include two specific standards for preventive dentistry. In 2014, all providers, regardless of their stage of meaningful use, are only required to demonstrate meaningful use for a three-month EHR reporting period (links to more information are provided at the end of this article).

Dentists benefit from information such as a patient's documented drug interactions, and general health status when making their dental treatment decisions (see related article on decision support functionality). Likewise, the ability of other health-care professionals to view a patient's complete dental history enhances their ability to provide more effective diagnosis and treatment. This provides a continuum of care and promotes consideration of the impact of oral health on overall health and vice versa.

Patients love this "whole picture" approach to personalizing their health care and improving their health in a comprehensive manner across both the medical and dental spectrums. You many even find that they will demand it, or choose a different provider that can provide that level of care.

Knowing Your Patient

Current meaningful use requirements focus on consumer engagement though a patient portal. Such portals will provide benefits for the patient and the practice. Consider the convenience of the patient adding health history updates in advance of their appointment.

How many of you have had to turn a patient away because you were unaware of their need for premedication? Dr. Mark Jurkovich, a practicing dentist in Minnesota, shared that a patient recently arrived for treatment from a long-term care facility, feeling confused and agitated. Once the need for premedication was discovered, Dr. Jurkovich had no choice but to reschedule the patient. Due to other health issues in the interim, it was two weeks before the patient could return. Using a portal would eliminate this type of costly inefficiency.

Knowing Your Practice

Certified EHR compatible systems provide enhanced opportunities to employ data analytics to evaluate treatment plans and procedures. Through analyzing practice data, Dr. Jurkovich determined that his practice had two specialty areas where patients frequently were not completing recommended treatment plans. The data indicated the areas were periodontics and occlusal adjustments.

This knowledge allowed Dr. Jurkovich to review and revise the way that he presented the treatment plans for these specific procedures. He decided to incorporate visual examples and changed his explanation to better describe the benefits of moving forward with treatment.

The result was that more patients scheduled periodontal and occlusal procedures, resulting in higher revenue for the practice and better patient outcomes -- a true win-win!

Such discoveries related to using data to shape best practices in dentistry inspired Dr. Jurkovich to return to the University of Minnesota to complete a master's degree in health informatics. As the adoption of EHRs for the dentistry accelerates in the coming years, there will be a growing need for professionals knowledgeable in both dental and information technology (IT) concepts.

What are the first steps to moving toward adopting EHRs?

The key to discerning which EHR compatible system will work well in your dental practice is to observe and understand your practice workflow. The term workflow refers to a sequence of connected steps to complete a process or procedure. For these purposes, the workflow analysis should include in detail:

  • How tasks are structured and sequenced
  • Who performs them
  • What equipment is needed to perform the tasks
  • Where the decision points are
  • How information related to the task or procedure is tracked, including which data is critical to capture

A good first step in understanding workflow is to identify six to eight common clinical procedures to examine in detail. At staff meetings, ask for staff input to capture the most efficient way that you can complete each procedures, while capturing the relevant data required. Repeat this workflow analysis with six to eight administrative procedures.

This detailed description of your clinical and administrative practice workflows will allow you to choose an EHR system that closely matches your workflow. If you take the time to do this, the changes and growing pains involved in adopting EHR technology won't need to include a fundamental change in the way your staff currently works. This foundational information will also assist you when you collaborate with an EHR vendor to customize the EHR to be a good fit for your practice.

The goal of an effective EHR is obtaining the right information, in the right place, at the right time, so look at what information you need, where you need it and when you need it. Once you are comfortable that you know the kind of functionality your workflow demands, you can schedule vendor demonstrations to compare and contrast various EHR compatible systems and ultimately choose a certified EHR that closely matches your practice workflow.

Why is Health Information Technology (HIT) training critical?

The U.S. Bureau of Labor Statistics, the U.S. Department of Education, and independent studies estimate a national shortfall over the next five years of approximately 50,000 qualified health IT workers (see related article: Health-care workers embrace IT training) required to meet the needs of hospitals, physicians, IT vendors, and others in the health-care field as electronic health records systems are adopted. Virtually every aspect of health care will be affected by the integration of information technology and data systems.

Dr. Jurkovich, who is a dental informatics scientist, said, "This conversion to EHRs is about improving outcomes and reducing costs. Going forward, those who use the technology properly will thrive, and those who do not may merely survive."

To thrive in the dental IT environment of the future, begin by involving your staff in a detailed analysis of your workflow. Then carefully choose a certified EHR product and vendor to customize a system to your practice needs. Finally, seek training for members of the dental office staff to ease the transition and provide affordable ongoing IT support. Successfully completing these steps will pay huge dividends for your patients as well as your practice! RDH

Peggy M. Cotter, RDH, BS, CHTS-TR, is a Minnesota Health Information Technology Program Specialist at Normandale Community College in Bloomington, Minn. She provides continuing education and customized training in Health IT. She can be contacted at Peggy.Cotter@normandale.edu.

References and resources

1. CMS Participation data:

http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/Downloads/August2013_PaymentandRegistrationSummaryOverview.pdf

http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/Downloads/August2013_MedicaidEHRIncentivePayments.pdf

http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/DataAndReports.html

Meaningful Use Criteria:

http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/index.html?redirect=/ehrincentiveprograms/

http://www.healthit.gov/providers-professionals/ehr-incentive-programs

Access this link for an updated list of certified EHRs: http://oncchpl.force.com/ehrcert

Decision Support Functionality

While some estimates1 suggest that only 7% to 9% of dental practices may be eligible to take advantage of the CMS incentives, even those dentists who are not eligible may be convinced to embark on the journey towards implementing certified EHR compatible systems. EHR compatible technology can greatly improve the efficiency and efficacy of dental visits.

The decision support functionality found in many EHR compatible systems enhances patient care outcomes and safety. Some features include:

  • Displaying prompts and alerts, such as notifying practitioners of patient allergies or when it is time to recall patients
  • Warnings to prevent dangerous or undesirable drug reactions
  • Suggesting evidence-based treatment options.

When clinical observations are entered, a suggested diagnosis and treatment procedures can be chosen based on those observations.

In addition, the interoperability of EHR systems allow dentists to have access to a patient's entire longitudinal medical history. The American Dental Association concurs with the benefits of interoperability and states:

"Perhaps the most important feature of such systems is the ability to quickly share health information with authorized providers across more than one health care organization or even across multiple health care settings."

Health-care workers embrace IT training

It is increasingly important that members of the dental office staff be IT savvy. Training to meet these needs has been developed and delivered through funding from the HITECH Act. Sponsored by the Office of the National Coordinator for Health IT, curriculum was developed by five leading universities and is being delivered by 17 community colleges nationwide.

Normandale Community College is one of these trainers, offering the Minnesota Health Information Technology (MNHIT) program (www.mnhealthit.com). MNHIT is a fully online program that can be completed in just six months, making it ideal for distance learners or employees.

A dental staff member with this IT training could then become a liaison with the EHR vendor and could also be responsible for staff training related to EHR implementation, through the "go-live" period, and beyond. When a staff member adds value in this way, not only is it more economical than hiring an IT consultant, but the career growth opportunity within the dental practice enhances employee retention.

Workforce training in health IT is designed to leverage the clinical knowledge of a health-care professional by delivering curriculum involving IT concepts relevant to EHR adoption. In the MNHIT program, those with a health-care background embark on a course of study to become a clinical systems specialist. Professionals in this role will lead or assist in planning, developing, and reorganization of the work of a provider to take full advantage of the features of health IT in pursuit of meaningful use, improved quality, lower costs, and optimal care. This individual/role will provide insight and translation of the technologies to the provision of care.

Conversely, candidates with an IT background can be cross-trained in health-care concepts in the healthcare technology specialist training. Professionals in this role may provide onsite user support before and during implementation of health IT systems in clinical and public health settings. Providing support services above and beyond what is provided by the vendor, they assure that the technology functions properly and are configured to meet the needs of the redesigned practice workflow.

All individuals enrolled in the program begin their studies with the "Fundamentals of Health IT," which provides the core understanding essential to working in the health IT industry. Some topics are collaboration, critical thinking, time management, problem solving, decision-making, the culture of health care, introduction to computer science and health information management systems.

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