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It is obvious that World Health Care Blog represents healthcare stakeholders other than doctors with small private practices, like mine. I am a dentist. Dentistry continues to be overlooked in the struggle for interoperable Electronic Medical Records. We are years behind physicians who also own small practices. If 10% of them have EMRs, I would guess that less than 0.5% of dentists have them, and there is no interoperability with anyone, unless you count the insurers.

If the incredible danger of privacy breaches is not mentioned, and it was not, it is understandable that at least half of all consumers want doctors to go ahead and change their paper records to electronic medical records. Why not? It is obvious that if a survey is worded just right, statistics can be strategically applied to the data to show that some consumers “…would be willing to pay a reasonable extra amount to cover the costs of such a system.” One could also show that between 8 and 12% of a given group of people would say that they like the way that athlete’s foot makes socks smell.

Yea. Patients say that they will pay a “reasonable” amount now, but what if doctors and dentists like me take the bait and things just do not work out as planned? Is that possible in this country?

Let us say that I risk the expense and significant danger to my patients to convert my thousands of paper records to electronic form. Let us assume that after I borrow 50 thousand dollars to “invest” in an EMR system, my finicky patients, who were all for the goodie stuff you mention, reveal that when they actually volunteered to pay me more for my services, they (wrongly) assumed that their insurance would pick up the additional cost. This happens, you know. And what happens when my patients hear about another 10,000 EMRs fumbled — patient records in a computer, stolen from a doctor’s office?

With the added expense to my overhead to pay off the note, and even fewer patients to treat, how will my increased fees compete with the dentist down the street who wisely did not take the electronic risk you are pushing?

Can he be somehow taxed heavily and, like HIPAA covered entities, be threatened with jail-time? That would level the playing field and the tax revenue could even be used to pay for the EMR promotion that is desperately needed to overcome common business sense.

Doctors with small practices are not adopting EMR systems because even with cheer-leading from government, IT industry, insurers, big business, and many other business entities who stand to gain from the new and expensive cottage industries, EMRs simply do not yet make sense for small practices. Physicians are indeed moving towards adoption all the time, although very, very slowly. For dentists, information technology is stalled and beginning to roll backwards.

Face it, your selling points are very weak: Employers refer employees only to physicians and dentists who have bought into the EMRs. From what I understand, this could be called employer-managed care. Employees will pick their doctors from an employer-approved list of doctors and dentists. How good is that? Whoever thought up this idea has never shaken hands with either and employee or a consumer. Employees will hate this arrangement even before they are told about EMR “health management.” Its description is vague, but I think the system allows bosses to keep tabs on employees’ weight and exercising habits.

And what is this about employers using EMRs to help their employees choose doctors? Let me get this straight: On top of risking my 50 to 60 thousand dollars, I am expected to allow insurers, who profit by paying me less, to not only grade my quality of care, but to offer their opinion to employers in my neighborhood? Nasty class actions suits begin here. I hope the AMA and the ADA are not supporting this unfair business practice. Those organizations could be named as co-defendants along with the insurers.

As “just one more reason” for doctors to invest in… fantasy, the author mentions the portability of electronic health records in the event of emergencies like hurricane Katrina. My practice, like the majority of practices in the US, is located hundreds of miles inland. A hurricane is less of a risk than a nuclear blast. How well do Electronic Medical Records endure incredibly strong electromagnetic pulses that have no effect on paper records? Maybe practices close to the shore should keep both computers and filing cabinets.

Darrell Pruitt DDS

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