Th 313200

Chartless Future

March 1, 2009
Very few offices are prepared for 2015 deadline
Click here to enlarge image

Very few offices are prepared for 2015 deadline

by Patti DiGangi, RDH, BS

Health care is scheduled to be chartless by 2015. As part of his plan to revive the U.S. economy, President Obama plans to invest billions of federal dollars on health information technology. This is not a new plan; it has been in progress for several years. The federal National Health Information Infrastructure (NHII) has been formulating the parameters for this future. Chartless electronic records are not a choice. The year 2015 is only six years away, which can seem far until one remembers 2000, when the Y2K bug was supposedly going to create computer failure. Most corporations, businesses, and governments are interconnected with computers. Yet adoption in health care has been slow. Hospitals, physicians' offices, and other health–care providers are moving in this direction, yet dentistry is moving much slower. Only about 25% of practices are using computers chairside, and only 1% are chartless. Those who set standards for electronic health records want to get as many health–care providers as possible using the technology and working out the kinks over time, while also investing in infrastructure to help share data. The American Dental Association (ADA) is taking a proactive role in NHII. Hygienists must also take part in the coming changes, or once again they will be victims to others' choices.

Miniaturization of electronics, wireless communication, and large data bases are changing the way we live. The digital world has removed barriers we thought immutable. Yet overall, the transformation in health care has been slow. The U.S. spent nearly $2.3 trillion (12 zeros) on health care in 2007, accounting for nearly 16% of our gross domestic product, three times what is was in 1980. If this trend is not reversed, it will severely compromise our country's ability to compete worldwide. Although nearly 47 million Americans are uninsured, the United States spends more on health care than any other industrialized nation. Any nation that devotes that much to health care will neglect education and all the other areas it takes to maintain economic leadership. It is estimated that 20% of health care costs are for duplication of tests. Medication errors conservatively cost $3.5 billion per year. Experts agree that our health–care system is riddled with inefficiencies, excessive administrative expenses, inflated prices, poor management, inappropriate care, waste, and fraud. With a rapidly aging population, the paperwork is overwhelming. U.S. health care has thrived on technology, yet the major challenge of interconnectivity/interoperability still faces us.

Dr. Charles Mayo of the Mayo Clinic said in an address to the ADA in 1928, “The practice of medicine includes dentistry, and dentistry is the practice of a special branch of medicine, as is ophthalmology. It may be going too far to say that all dentists should be doctors of medicine, but certainly all dentists should know much about the practice of medicine as a whole, and conversely, all physicians should know more about dentistry, its importance and possibilities.”

Over 80 years have passed since Dr. Mayo made that statement, yet dentistry and medicine are still practiced separately for the most part. Mayo Clinic was the birthplace of the paper medical record, which helped to put them on the map. “The biggest mistake is to do more of what one has always done because it has always worked,” says Janet Lapp, licensed clinical psychologist and internationally known speaker and author of “Planting Your Feet Firmly in Mid–Air.” Though leaders in the paper record, in 1993 the Mayo Clinic decided it was time to transform their millions of paper records to the electronic world. Mayo's groundbreaking paper records no longer served the current world. One cannot walk more than 30 feet in the clinic until there is another terminal with access to full records at the point of care. About 10% of medicine has achieved the electronic record, putting medicine about 9% ahead of dentistry. Those hospitals, practices, and practitioners, both medical and dental, are better poised for the next wave of change–interoperability.

Interoperability means records will travel from health–care provider to health–care provider on the NHII, a communications system described as a network of information highways. Patients' electronic health records (EHR) will include their entire medical histories, pharmacy, vision, laboratory tests, and all other clinical information. Dental records will also be part of EHR and will bring us much closer to Dr. Mayo's prophetic words.

The impetus moving our health–care system to this future has reached the tipping point. Malcolm Gladwell describes the tipping point as, “The level for which momentum of change is unstoppable.” The federal government, the single biggest payer of health–care benefits, has decided this will happen. Agencies have been created and systems are already being fashioned. NHII, under the Department of Health and Human Services (HHS), is leading the changes. NHII is not a government plan to establish a central repository for all health records. It is a communication highway for records, similar to what we have for cell phones. Each person can purchase whatever cell phone and provider they want. The structure is already in place for cell phone interoperability; in other words, no matter what vendor we purchase our phones and service through, we can all call and text each other. (For you texters, YTMTB. Translation: You are telling me this because?)

The stakeholders in the NHII process are federal, state, and local government, health–care plans and purchasers, standards development organizations, information technology industry, community organizations, academic and research organizations, consumer and patient advocacy groups, and health–care providers. The reasons for the NHII are listed in Box 1. An improved understanding of health–care costs can potentially lead to savings, but first it will take the investment of more funds. A 2005 study estimated the cost of NHII at $156 billion, the equivalent to 2% of annual health care spending for five years. The estimated costs seem staggering at first glance. Yet spending $2 trillion annually on health care is also staggering. If the trend continues, it is estimated that by 2016 the costs will double to $4 trillion.

Due to the dire economic times, you may think this will come to a halt. It may, but not for long. As the numbers show, we cannot afford to continue in the same model. Just as we are seeing a green revolution, this will happen in health care. Michael Levitt, secretary of HHS, said in regard to our chartless future important words for dental hygienists. “You can fight it and fail, you can accept it and survive, or you can lead it and prosper.” It's time for dental hygienists to step up and take an active role in forming the future. During tough economic times smart people and businesses take the opportunity, and even the risk, to do some hard work and make the changes required to improve and grow. If we don't, we will once again be the hapless victims of others.

Pretty heady economic information for a dental hygiene magazine? Not in the least. Did you see yourself in the list of stakeholders? Dental hygienists are health–care providers and the future of dentistry. In my article Living in the World of Yes (August 2008 RDH), I say that what most of us lack is not the courage to influence change, but the skills. One of the first skills is deciding, “Yes, I am a lifelong learner and I want to have input into the future.”


  1. Flucke J. “Get Ready for 2015 EHR (Electronic Health Record)” June 25, 2008. Dental Technology Blog. Available at:
  2. Gibilisco JA. The role of dentistry at Mayo Clinic. Minn Med [serial online]. 2005;88:39–41. Available at:
  3. Lapp J. “Planting Your Feet Firmly in Mid–Air: Guidance Through Turbulent Change” Del Mar, CA, USA Demeter Press. 1996.
  4. Leavitt M. “Remarks as Prepared to the American Dental Association,” October 19, 2006. Available at:
  5. “Preventing Medication Errors” July 2006. Institutes of Medicine of National Academies. Available at:
  6. Palmer C. “Seeds for the NHII are sown,” January 22, 2007. ADA News. Available at:
  7. “The ONC–Coordinated Federal Health IT Strategic Plan: 2008–2012” June 8, 2008. Department of Health a1nd Human Services. Available at:
  8. “FAQs about NHII” National Health Information Infrastructure. Available at:
  9. “Information for Health: A Strategy for Building the National Health Information Infrastructure,” 2004 U.S. Department of Health and Human Services. Available at:
  10. Gladwell M. The Tipping Point: How Little Things Can Make a Big Difference. 2002. Little, Brown & Company. NY:NY.
  11. 11. Jakush J. “Health standard setting: ‘If the DDSs don't do it, the MBAs will'” October 20, 2006 ADA News. Available at:

Why do we need a National Health Information Infrastructure?

  • To improve patient safety (alert for medication errors, drug allergies, etc.)
  • To improve health–care quality (includes having the complete medical records available, test results and X–rays at the point of care, integrating health information from multiple sources and providers, incorporating the use of decision support tools with guidelines and research results, etc.
  • For bioterrorism detection (NHII will enable real–time aggregation of health data to detect patterns)
  • To better inform and empower health–care consumers regarding their own personal health information
  • To better understand health–care costs