Many have posed the question, is the transition to Electronic Medical Records federally mandatory for dental practices, and if not, when will it be?  According to the American Dental Association, for the majority of dental practices, there is currently no deadline to switch to EMRs. However this year, Medicare eligible dentists who have not successfully switched over to electronic records and demonstrated meaningful use will be subject to a payment adjustment. The payment reduction starts at 1% and increases each year that a Medicare eligible professional does not demonstrate meaningful use, to a maximum of 5%. Dentists are encouraged to check with their State Medicaid Agency for applicable state law requirements. 

Minnesota was the first state to add dentists, oral surgeons, and orthodontists to their EHR requirement by 2015. What impact the mandate will have has not yet been determined, as the law did not include fines or any other enforcement. However, as the healthcare industry is steadily moving ahead with EHR adoption, many believe other states will follow Minnesota’s lead. 

Why have EMR adoption rates so low within the dental industry? 

As of 2014, 83% of office-based physicians and 97% of hospitals have adopted EHRs. While this number may seem encouraging for healthcare, there is a large gap when it comes to the dental industry. Many believe this is because the meaningful use incentive programs aimed at increasing adoption were not very favorable to dentists from the beginning. 

Dentists are eligible to qualify for the meaningful use incentive program, but few participated due to how difficult it is to qualify. Data from CMS indicates that as of October 2013, there were 286,771 total registrants for the meaningful use incentive program; dentists accounted for 346 of that total, and 194 dentists had received incentive payments. 

Challenges and barriers of EMR adoption for dental providers

The EHR adoption among dentists has mostly been limited to large dental practices; however, the majority of dental providers are small independent practices. There have been many challenges and barriers facing the adoption of EHR for these dental practices including: 

• Lack of financial incentive to invest in EHR technology
• Cost to implement EHR’s
• The lack of EHRs with applications appropriate for dentists
• Lack of software for oral health that meets certification criteria
• Lack of training on oral health IT in pre-doctoral and residency programs

Benefits of EMR adoption and implementation

The American Dental Association has been involved in the improvement of EHR’s for the dental industry. While, there are still many barriers and challenges to implementing EMR that continue to exist for dental health providers, there are also a host of benefits to be considered. 

• Improved quality and patient safety 
• Increased security
• Reduced paperwork and storage issues
• Increased efficiency and productivity
• Reduced operational costs such as transcription services and overtime labor
• E-prescribing and clinical documentation capabilities
• More efficient patient billing process
• Increased accuracy. Fewer errors found within personal health records.

As the US healthcare system continues to transition into the digital age, it is apparent that Electronic Health Records are here to stay. The dental industry is a segment of the overall healthcare system, and providers cannot ignore being a part of that system. Whether the industries transition is eventually mandated through state or federal regulations or it is made due to the promising benefits of improved patient care, many experts believe it is no longer a matter of whether the transition will take place, only when.

References:

American Dental Association, Meaningful Use Faqs and General EHR requirements. Retrieved from http://www.ada.org/en/member-center/member-benefits/practice-resources/dental-informatics/electronic-health-records/ehr-faq-index/medicaid-and-medicare-ehr-incentive-program-faq-not-in-matrix/program-eligibility-not-in-matrix

What Certified Products are Available for Dentistry? (n.d.). Retrieved from http://www.hrsa.gov/healthit/toolbox/oralhealthittoolbox/meaningfuluse

Why Are EHR Adoption Rates so Low for Dentists? | HealthBiz… (n.d.). Retrieved from http://www.healthbizdecoded.com/2013/12/why-are-ehr-adoption-rates-so-low-for-de

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In 2009, emergency rooms received 830,590 visits nationwide for dental conditions – a 16 percent increase from 2006. California had 83,000 emergency room visits for dental problems in 2007, North Carolina had 69,000 visits in 2009, Florida had more than 115,000 dental-related ER cases in 2010, and New York has experienced a 32 increase in emergency treatments for young children.

The financial burden associated with these visits is staggering. A study of decay-related ER visits in 2006 found that treating about 330,000 cases cost nearly $110 million. Taxpayers bear the major portion of these costs, since close to 50% of the visits are paid by Medicaid and other public programs.

In addition to being an expensive source for treatment, hospitals generally are unable to treat toothaches and dental abscesses effectively. Most emergency rooms are not staffed with dentists, and physicians and other staff are not trained to treat underlying oral health problems. Generally, they can only provide short-term relief, such as medication, to treat an infection or temporarily relieve pain. Because treatment only addresses pain or infection, most patients require subsequent care from a dentist, and a large percentage of people seeking dental care in emergency rooms have a high rate of repeat visits.

There are two primary reasons people turn to emergency rooms for dental care. The first is cost. In today’s troubled economy, with high unemployment and families struggling to pay for rent, heat, and groceries, preventive dental care is low on the list of priorities. A study in Washington state revealed that a trip to the ER was the first “dental visit” for one in four children overall, and for roughly half the children younger than 3 and one-half years. In 2009, 56 percent of Medicaid-enrolled children did not receive dental care – not even a routine exam. Also, because of low fees, many dentists do not participate in the Medicaid program. In Florida, only 10 percent of dentists participate, and a 2009 survey revealed that in nearly two-thirds of the 39 states reporting data, most dentists treated no Medicaid patients during the previous year.

The second primary reason contributing to ER visits for dental care is the growing shortage of dentists. One study projects that by 2019, there could be 7,000 fewer dentists practicing in the United States compared with the number working in 2009. But even in states with a less severe shortage, many people live far from the nearest dentist. Roughly 47 million Americans live in areas that are federally designated as having a shortage of dentists.

The tragedy is that most of these visits to the ER could be completely eliminated with preventive dental care. A routine teeth cleaning costs between $50 to $100, and the problems associated with neglect of oral health can be severe, especially in young children, who may develop fevers and dehydration from preventable dental conditions. In Florida, for example, 200 children were hospitalized in 2006 for those types of infections.

The cost to taxpayers for untreated preventable dental problems is hefty. By investing in preventive care, insuring access to treatment, expanding the number of dental practitioners, and paying reasonable Medicaid rates for dental services, both states and patients can benefit.

To read the Pew Center study, click on http://www.pewcenteronthestates.org/uploadedFiles/A%20Costly%20Dental%20Destination.pdf.

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