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Integration of medical and dental care and data is totally neglected,
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This review is from: Reengineering Health Care: A Manifesto for Radically Rethinking Health Care Delivery (Hardcover)
This book is a disappointment as it lacks attention to the fundamental model of health care and to clinical data integration in health care. Jim Champy and Dr. Greenspun have missed an opportunity to focus attention on a model of health care that integrates the entire human body, including the mouth. Although veterinary medicine (and its electronic patient records) recognize that the mouth is part of the body, most private-sector EHR products in the U.S. do not. Note this comment in a U.S. I.O.M. report regarding "medically necessary" about dental care in Medicare: "Such a restrictive definition may suggest that periodontal or other tooth-related infections are somehow different from infections elsewhere and imply that the mouth can be isolated from the rest of the body, notions neither scientifically based nor constructive for individual or public health. " in Extending Medicare Coverage for Preventive and Other Services by Marilyn J. Field, Robert L. Lawrence, and Lee Zwanziger, Editors; Committee on Medicare Coverage Extensions, Division of Health Care Services, I.O.M., 2000. Medicare's model, which statutorily prohibits support for routine, preventive dental care, is seriously flawed and needs to be "reengineered."
See: Powell VJH and Din FM, "The Medical-Dental Home: Achieving Comprehensive Care for Chronic Illness through Integrating Medical-Dental Care and Data," Medical Home News 1, 3 (May, 2009): 1, 5-7. See: [...], HRSA. Advisory Committee on Training in Primary Care Medicine and Dentistry, Coming Home: The Patient-Centered Medical-Dental Home in Primary Care Training. Seventh Annual Report to the Secretary of the U.S. DHHS and to Congress, December 2008. From 1977 forward multiple studies in the U.S. and U.K. have documented that discrepancies between unsynchronized patient records for medical and dental care are a risk, such discrepancies being in some cases characterized as "life-threatening."
While U.S. Federal EHR technologies, like those of the U.S. Department of Veterans Affairs, the Indian Health Service, and the U.S. military, support communication among the medical and dental providers of a patient, most private-sector EHR products do not. With such products, integration is not routine, but requires extra funding to be added to the standard product, which will only increase costs to the U.S. taxpayer in acquiring EHR technology and will also delay integrated care for patients. In the case of pediatric care, a three-way integration of medical, dental, and orthodontic records is required. Where there are unforeseen technical challenges to integrating medical and dental records, costs will be even greater. We have two inadequately articulated streams of care, each prescribing and administering medications and doing surgery on shared patients. Given the mass of clinical literature on the interrelationships between diabetes and periodontal disease, it is startling that in the 21st Century physicians and hospitals are treating diabetes patients without adequate routine access to those patients' dental records. Chronic illnesses like diabetes account for more than 70% of U.S. healthcare costs, according to common sources. Our failure to integrate medical and dental records (paper or electronic) further impedes needed medical research. Every year of delay in recognizing the need to integrate medical and dental care and records adds to costs and suffering.
These views are strictly my own and should not be construed as viewpoints of any organization with which I may be associated by employment or appointment.