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Electronic Health Records: Is it time to make the transition? by Christine Queally Foisey

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Header: Scoring the Perfect Patient Handoff
by Christine Queally Foisey

Many dentists have asked: Is the transition to electronic health records (EHRs) federally mandatory for dental practices—and if not, when will it be?

According to the American Dental Association (ADA), most dental practices currently face no deadline to switch to EHRs. But this year, Medicare-eligible dentists who have not successfully switched to electronic records and demonstrated meaningful use will be subject to a payment adjustment. The payment reduction starts at one percent and increases each year to a maximum of five percent. Dentists should check with their state Medicaid agency for applicable state-law requirements.

Minnesota was the first state to add dentists, oral surgeons and orthodontists to its electronic health record requirement, mandating their inclusion by 2015. The mandate’s impact has not yet been determined because the law does not include fines or other enforcement. However, as the health care industry moves ahead with EHR adoption, other states will likely follow Minnesota’s lead.

Why are EHR adoption rates so low within the industry?
As of 2014, 83 percent of office-based physicians and 97 percent of hospitals had adopted EHRs. While this number may seem encouraging for health care, the numbers are less high for the dental industry, possibly because the meaningful use incentive programs aimed at increasing adoption were not very favorable to dentists from the beginning.

According to Lee Ostroff, DDS, who also works as a compliance consultant, "In my many years consulting with numerous dentists, I have learned that the main reasons they have not switched to an EHR system are cost (very few qualify for meaningful use) and lack of comfort with learning a new system—going from paper charts to computers and digital charts. However, it seems that those recently trained dentists who used EHR systems in their dental training are much more amenable to—and even are looking for—practices that will use such a system."

Dentists are eligible for the meaningful use incentive program, but few have participated because it is difficult to qualify. Data from Centers for Medicare & Medicaid Services indicates that as of October 2013 there were 286,771 total registrants for the meaningful use incentive program. Only 346 of those registrants were dentists, and just 194 of them received incentive payments.

Challenges of EHR adoption for dental providers
EHR adoption among dentists has mostly been limited to large dental practices. However, the majority of dental providers are small, independent practices. The challenges and barriers to EHR adoption for such practices include:
  • very few certified dental EHRs that offer modules and applications appropriate for dentists, such as diagnostic, therapeutic or decision support applications that provide the ability to capture, store, display and analyze digital images
  • the cost to implement EHRs—some studies estimate the cost of purchasing and installing an EHR system ranges from $15,000 to $70,000 per provider.
  • the lack of proven interoperability between medical and dental EHRs
  • the lack of financial incentive to invest in EHR technology (Meaningful use incentives have not been favorable for dentists.)
  • a lack of training on oral-health IT in predoctoral and residency programs.
Benefits of EHR adoption and implementation
The ADA has been involved in the EHR system improvement for the dental industry. While dental health providers still face many challenges to implementing EHRs, there are a host of benefits to be considered.
  • Improved quality and patient safety. EHRs improve the quality of documentation with built-in protocols and reminders that increase patient safety and quality of care. Some malpractice insurers have started to reduce premiums for practices that use EHRs.
  • Reduced paperwork and storage issues. EHRs reduce the labor of managing paper charts and reduce the costs required to support a paper-based system. In addition, using EHRs can help an office gain additional space once used for filing charts.
  • Increased efficiency and productivity. EHRs make chart signing more efficient because clinicians can sign from any workstation at the office or home.
  • Reduced operational costs such as transcription services and labor. EHRs enable physicians to enter all data directly into the electronic medical record.
  • E-prescribing. Provides a convenience to the patient and minimizes common inefficiencies experienced between office and pharmacy.
  • More efficient patient billing and improved reimbursement. EHRs decrease coding errors by using built-in alerts and required fields, which help eliminate human error and improve turnaround time for reimbursement. In addition, EHRs can provide cost savings because of the reduced use of paper, toner and labor, leading to an improvement in the bottom line.
  • Increased accuracy. EHRs help standardize chart quality by minimizing problems from poor handwriting or inconsistencies in documentation.
As the U.S. health care system continues to transition into the digital age, it is becoming increasingly apparent that EHRs are here to stay. Because the dental industry is an important segment of the overall health care system, dental providers cannot ignore the inevitability of electronic records.

EHRs have the ability to improve efficiency, increase revenue by improving scheduling and billing functions, lower costs and enhance quality of services. Whether the dental industry’s transition is eventually mandated through federal regulations or comes through the promising benefits of improved patient care, many experts believe it is no longer a matter of if the transition will take place—only when.



Christine Queally Foisey Christine Queally Foisey is president and CEO of MedSafe (medsafe.com). She has more than 20 years of experience leading health care organizations in fiscal and strategic operations and has been with MedSafe since 1991 in a variety of leadership roles. Prior to MedSafe, Foisey worked in administration and operations for ISO America and Air Machine Corporation. She has a strong background in cost analysis and management, strategic planning, collections and team building for health care organizations and is well versed in HIPAA, ICD-10, OSHA, coding and billing compliance.




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