As a hygienist, how beneficial would it be from both a patient care and liability standpoint if you could actually know a patient's most recent medical conditions, procedures, medications, and other health-related information real time? How about the ability to communicate with your referral partners, such as periodontists and oral surgeons electronically … and know everything that was happening with your patients? Or, even taking it a step further, sharing your patient's records with their medical primary care and medical specialty providers?
As a hygienist, how beneficial would it be from both a patient care and liability standpoint if you could actually know a patient's most recent medical conditions, procedures, medications, and other health-related information real time? How about the ability to communicate with your referral partners, such as periodontists and oral surgeons electronically … and know everything that was happening with your patients? Or, even taking it a step further, sharing your patient's records with their medical primary care and medical specialty providers? Do you see a day when dental treatments will be diagnosis-driven using best practices as a standard?
You, the hygienist, are smack in the middle of an expanding Oral Systemic Health Revolution and, along with that, a revolution in next-generation dental electronic health records (EHRs) that support it. And recognize that you have a unique perspective into the requirements necessary for this new software to support better patient care, especially regarding your patient's oral health. Most hygienists don't have a clue as to the power they can acquire with a properly designed and implemented EHR system.
Note that even if you have a present practice management software vendor, there is a possibility that your vendor might not keep up with the innovations necessary to produce next-generation EHR features and functionality. So, you are doing yourself a disservice if you keep your head in the sand and don't look at what's happening in the dental software industry around you and associated options.
And don't be satisfied if you presently have what's commonly referred to as a "paperless office." Dental EHRs offer hygienists tools to do their jobs safely and efficiently above what is commonly offered with just getting rid of the paper chart.
So let's explore some of the powerful features that this technology offers for hygienists so you are better prepared to be involved in the decision-making process when it comes time for your practice to acquire dental EHRs.
Your patient’s medical profile
How many times have you had a medically compromised patient (for example, a patient with heart problems) sitting your chair while you were performing various exams and procedures and wondered to yourself what their recent medical history or issues were? Or have you had some angst about what procedures their specialists had performed on them over the past few weeks? Do you count on your patient to give you accurate medical information, or would you be better served to have real-time, accurate, reliable information served up to you by the computer system? Well, that's one of the major benefits of a true EHR system. All the medical information about your patient can be captured and displayed in a useful organized fashion. There are no more gray areas as to that patient’s medical history. Imagine … there's no longer a need to try to contact any of the patient's medical or dental providers for background information or to fill medical history information gaps during the visit.
Taking this one step further, it is very typical in the medical world to have patient records electronically passed between different systems. And we are about to embark on this technology in the dental world. Histories, exams, and procedures that were done at the patient's medical provider office can electronically make their way into your dental EHR system so you always have a complete medical history at your fingertips prior to performing any exams or procedures. This is happening via interoperability and health information exchanges (HIEs), which are like big routing systems through which information from various systems, general providers, and specialists passes. Already, standards are being adopted by EHR systems to facilitate this.
Supporting oral-systemic health
With more and more research linking oral health with systemic health and the simultaneous burgeoning growth of interoperability and health information exchange, dental and medical providers should be able to easily share information of patients they have in common. Thus, EHR helps facilitate this collaboration and team approach. There is a term "The Medical Home" that is getting more popular and describes this multidisciplinary approach to managing a patient's health and wellness. This type of collaboration would be much more difficult and perhaps more error-prone if not for EHR technology.
Let's talk for a minute about a topic that is very near and dear to my heart … that of federal money that is being given to dentists for using qualified EHR systems in their practices. There are regulations on the books that specify if a dental practice takes a certain percentage of Medicaid patients, then so long as they use a "qualified" HER, they can receive up to $63,750 of incentive money. The thing about it that bothers me is that you, the hygienist, who deals with much of that patient's oral systemic health, isn't eligible to receive the incentive money. In fact, there is much controversy regarding hygienists who have gone on their own to become dental therapists, especially in underserved areas and should be on an even playing field with their counterparts in medicine, such as nurse practitioners who are eligible to receive the federal incentive money. My hope is that there will be a day in the near future when you are able to receive incentive money for use of an EHR system. Hygienists are flying under the radar on this program and is unfair.
Tracking medications … less liability, better patient care
It is definitely worthwhile from both a patient care and liability standpoint to understand your patient’s present medications and medication history. I've heard the story over and over again. The hygienist has an older medically compromised patient sitting in his or her chair and when asked what medications the patient was on, the patient either doesn't really know or refuses to answer because he or she is “just in for a cleaning.” What do you do when this happens? All you can do is just try to get as much accurate information as you can.
How comfortable would it make you feel in these scenarios if you could push a button and magically get a real-time list of medications for patients based on their trips to their physician, specialist, hospital, or other dental providers? This is what electronic prescribing is all about. And, although it has become very standard in the medical world, not all dental software companies have embraced it up to this point. However, the more advanced EHRs incorporate this feature that not only allows you to increase your patient care is a release medications, but also reduces your liability by having accurate medication information at your fingertips. Basically all the prescriptions a patient is given, no matter what the source, go through a clearinghouse to the pharmacy and, in turn, these lists can be shared almost real time with a practice’s EHR when the patient’s chart is opened.
With electronic prescribing and electronic medications capability, you also get a bonus … that of checking drug and allergy interactions and, in some cases, even checking potential interactions between medications and treatments you are proposing. In terms of actually prescribing medications, the system can automatically check for any interactions with prescriptions that you are contemplating and update the overall medication list with your prescription. On the horizon is the capability to check for compliance (has the patient actually picked up his or her meds at the pharmacy?). What powerful information these prescribing systems will give you!
Diagnosis-based treatments … a novel concept?
More and more, you as a hygienist are put in the position of diagnosing issues. Your training affords you the ability to understand the connection between proper diagnosis and associated treatments and procedures. So with the tools EHR systems provide, you have the ability to provide templates for various exams and evaluations so that pertinent information is not missed. The better systems have libraries of evidence-based templates that have been put together by clinicians with the ability to customize the template depending on the needs of the hygienist. For example, in the case of periodontal disease, the EHR could incorporate a checklist that corresponds with the “Comprehensive Periodontal Therapy Statement” from the American Academy of Periodontology.
With EHRs, patient education is being kicked up on steroids. It is possible, based on a diagnosis and treatment, to have the system automatically present patient education materials (videos, charts, graphs, images, etc.) to the patient during the hygienist encounter. In addition to presenting this information at point-of-care, the system should be able to print these materials out upon checkout. The golden grail for all this patient education comes in the form of patient web portals, where the patient can log into a browser, sign on to the EHR system, and receive patient education materials that have been specifically loaded into their account. This is especially helpful when patients forget the educational material they received in the office.
I could go on and on with additional features that will make your life much easier with the integration of next generation dental EHRs. However, I will save this for another article. Needless to say, it is important you understand and embrace this new technology and, in fact, demand that you are an active participant in a dental EHR evaluation and selection for your practice or group. Only you, as a hygienist, know how technology can best help your particular situation and you need to be engaged in the process so you can get the best system for your needs.
About Mike Uretz
Mike Uretz is a nationally-recognized dental software and Electronic Health Records (EHR) expert. He is the founder of DentalSoftwareAdvisor.com, as well as the EHR Editor for Dental Products Report.
As an industry consultant and educator, Mike has helped individual practices and multi-clinic groups properly evaluate and select dental software and EHR vendors and solutions, structure and negotiate pricing and contracts , and provide implementation oversight and vendor management.
For questions regarding this article or EHRs in general, Mike can be reached at firstname.lastname@example.org.