In this issue:

         Dental News  •  Patient Resources  •  Did You Know?  •  Practice Management Tips

Dental News

Gingival Enlargement in Children Administered Cyclosporine After Liver Transplantation
Cyclosporine, a potent immunosuppressant agent, has significantly reduced the morbidity and mortality rates associated with solid-organ transplantations. The major side effect of this drug in the oral cavity is gingival enlargement. Cyclosporine-induced gingival enlargement was reported by different transplant centers as varying from 7% to 80%.
Source: Journal of Periodontology Online

Good evidence for ketoprofen and dexketoprofen as effective and safe analgesics for acute postoperative pain
The review compared the analgesic effects of ketoprofen (11 studies, 968 participants) and placebo (542 participants) and dexketoprofen (seven studies, 681 participants) and placebo (289 participants). The majority of studies, which were of high quality, evaluated ketoprofen at 25- and 50- milligram doses. To achieve at least 50 percent pain reduction across four to six hours, the NNTs for ketoprofen were 2.4 to 3.3 at doses between 12.5 mg and 100 mg, with better values for dental-only studies (2.4 to 1.6).
Source: Journal of the American Dental Association

6 Responses to Angry Patients
An angry patient may be scared or embarrassed about having to visit a doctor in the first place. Or, they could be angry at someone or something completely unrelated to their health. Sometimes it is the processes in your office that trigger their ire: An overlong wait time, a rude receptionist, or even a harried physician can become the target of their frustrations. Whatever the reason, it is key to recognize their anger, acknowledge it, and if possible, resolve the problem.
Source: Physicians Practice

Patient Resources

Asthma and Cavities Both Common in Kids but Not Linked, Study Finds
The study examined the 27 separate studies which looked for a link between asthma and cavities that were reported in 29 papers published between 1976 and March 2010.
Source: ScienceDaily

Helpful Tips for Healthy Smiles at Halloween
To keep cavities away and protect your child’s smile this Halloween, the Canadian Dental Association (CDA) recommends taking these simple steps: Limit the number of times a day your child eats sugary treats or snacks between meals...
Source: Canadian Dental Association

Did You Know?

Impacted wisdom teeth have been associated with pathological changes...

Impacted wisdom teeth have been associated with pathological changes, such as inflammation of the gums around the tooth, root resorption, gums- and alveolar bone disease, damage of the adjacent teeth, the development of cysts and tumours. Several other reasons to justify prophylactic removal have also been given. Wisdom teeth do not always fulfill a functional role in the mouth. When surgical removal is carried out in older patients the risk of more postoperative complications, pain and discomfort increases. Nevertheless, in most developed countries the prophylactic removal of trouble-free wisdom teeth, either impacted or fully erupted, has long been considered as 'appropriate care'.
Source: The Cochrane Collaboration

Practice Management Tips

Online vs. Desktop EHR, Do You Really Have to Choose?

New clinics often start out by using paper only charts until they ramp up the patient base. When the move to an EHR is considered, there are many options. One of the first decisions to face is the choice between desktop programs and online applications (also known as SAAS or Software as a Service, or Cloud Computing, which is equivalent to online computing). With some vendors one choice excludes the other.

As you examine advantages and drawbacks, it is obvious that in the future, the cost of switching from one vendor to another would be high and the procedure cumbersome. The majority of electronic health management systems do not support the export of data to public formats, which prevents clinics from having an easy conversion. When converting to a new system, typically active patient charts are retyped manually into another EHR. This can be done in bulk, or gradually as recalls become active. It may also be necessary to continue to run the former application on one computer in tandem with the new installations. This happens until all remaining inactive patient files within the old system become legally outdated.

SAAS is great for collaboration and accessing the data from anywhere in the world. It can also be used to hook up computers directly to the Internet by sharing a database online, with an optimum number of users and minimal IT requirements and expertise when compared to building your own private network on site.

The desktop solution permits more speed, and you are sure to have no service interruptions, which are unavoidable when using third party services. You are, however, in charge of the physical safety, integrity and backup of your data. Furthermore, you have to buy your own storage devices such as RAID-s or a variety of hard drive types, as desired.

The SAAS solution must rely on several other companies: (1) the EHR vendor for renting the application in “service” mode (usually this means monthly or yearly); (2) the speed and continuity of your Internet Service; (3) the online data hosting company that accommodates your database online, creates backups and provides some sort of physically secured location. Each of these is a specialized domain, with separate terms and agreements, and most often are independent of each other.

For example, a quick price comparison reveals: 1TB external hard drive is usually priced under $200, while hosting a small number of Gigabytes of data with a SAS 70 Type II certified data center can range between $200 to $600 US monthly, depending on the exact volume of data contracted. With most, automatic backups are provided by default, but moving your data up, from one package to another that allows more volume, may require separate cost.

What Should a Well-Designed EHR Look Like?

A well-designed EHR will support both desktop and online operation, even if the licensing paradigm if different for each. Clinics can grow or split, and either must be able to swap between desktop and online access-models, and vice versa, with no effort and without any transition cost when using the same EHR vendor. The technologies used to run desktops on your private network are geared to support multiple users and computers. When done right, these lend themselves well to online setups, which are technically comparable.

Another hallmark for good software architecture is the use of databases per-se (such as MS SQL Server, Oracle, MySQL, etc.). There are many problems with so-called custom-databases, especially those that in reality are simply bundles of files. These custom solutions do not support multiple users easily and tend to set a cap on the maximum number of patients allowed.

A proper database can be moved around and backed up as one cohesive unit and downloads faster than individual files if you have to recover your data. It can also be optimized for a variety of operations and facilitates access by multiple users. Finding a certified (for example, SAS 70 Type II) data center to host your data using a well-known database is a straightforward process.

Encryption is another important aspect. With so many EHRs, you must carefully read the small print. The promise of encryption is almost always there and is usually compared to the security of online banking. However, you will notice that the data is only encrypted while in transit to its target, and not necessarily while it resides in the database. You have to remember that once the data transmission is over, the data is decrypted again and saved. You should not necessarily expect the location that is the data center, to be physically secured in the same manner as a bank, so that comparison comes to a halt right there. Such data is exposed to the maintenance crew of the hosting company. Certainly that is the case any time the data center backs up or restores the online data manually. It is necessary for the data center to create multiple backups as a failsafe, since hard drives and RAIDs are not immune to malfunction. However, second and third copies of the data are sometimes stored offshore, frequently in undisclosed locations to keep the price of backup low. The data can be breached easily if physical security is more relaxed than on the primarily advertised site. If the patient information is not encrypted while it resides in the backups, it can be viewed effortlessly with any number of tools, most of which are available free for download to all. Demanding data centers to encrypt huge amounts of data as part of their routine backup is not practical. The encryption will exponentially increase the size of files and the time it takes to back up any significant volume of data when compared to the regular copy method.

Patient data can continue to surface after an unfortunate breach event for many years, an end date is difficult to anticipate. For the clinic involved there can be serious legal repercussions, as court orders may be in effect to put a stop to the leaking data, which the clinic is completely helpless to bring to an end. When it is clear that some patients had their identities stolen, the cost of restoring credit is assigned to the clinic that was responsible for those records, not the hosting data center. This is so because of the specific types of privacy requirements to their respective clients as legislated by each business sector.

Your ability to switch your data from online to desktop can be crucial if the data hosting company provides notice that they are going out of business. If you only have 24 hours to download your data before servers are being repossessed, and one hundred other clients are hitting the same servers at the same time, it helps to have an EHR that has built-in features for detecting the latest changes rather than a full download to make best use of time.

Fields of Code EHR Management Systems

All Fields of Code EHR Management Systems can be used to access data locally and online with indistinguishable ease. While the licensing models for renting an online database vs. hosting on your own location differ, the actual associated transition cost is zero as the two modes use the same kind of database. The process is to upload the database file, and is proportional to the speed of your Internet Service. It is done with minimal interruption to the operation of your business.

Additionally, when the application is running live, users will not notice the difference whether they are working with remote data or if the information originates from their own local machines. The data can be moved back and forth by either copying the MS SQL Server database, or by using the EHR’s internal import/export utility to extract the entire database or individually selected patient and employee files. The Fields of Code EHR also provides an interface to filter exclusively documents that changed in the last given number of days, weeks or months. All data is encrypted inside the database, not only while in transit to the data center. To the staff of the data hosting company the data remains undecipherable even while directly viewing the raw contents of your files.

Fields of Code EHR systems were built to accommodate change. Moving from a desktop implementation to an inexpensive online data host, and again later to a more serious, certified data center, such as SAS 70 Type II, is done with nearly no interference to patient care within a number of hours. If you are unhappy with your data center, the speed or the Internet Service in general available for high quality performance, this EHR also allows you to backpedal and download data into a private intranet setting as needed.

While it is impossible to know what type of EHR you will prefer to use in the future, you cannot go wrong with positioning yourself to be able to adapt quickly to a changing patient base, and an influx of new regulations. You can now choose to have the best of both worlds and never worry about the risk and cost of transition down the line.

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