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Why Are EHR Adoption Rates so Low for Dentists?

Despite all the efforts to move health IT forward across all health care spectrums, a large gap still exists: the dental industry.

Adoption of interoperable electronic health record (EHR) systems among dental professionals is dismally low. Many either use basic systems that are not capable of exchanging information outside the practice, or still rely on paper charts. Without interconnectivity, dentists operate inside their own information silos, relying on the patients to communicate important health information that could inform decisions on things such as medication ordering or care plans. And the patients’ general health providers do not have access to diagnostic information that originates at the dentist’s office, such as gum disease, that could impact that patient’s general health.

This digital divide between dentists and general health providers has worsened in recent years as EHR adoption among medical doctors has grown exponentially, thanks to the meaningful use incentive program. Meanwhile adoption among dentists has remained stagnant. But there is evidence those trends may be changing.

Mike Uretz describes what is happening as the “déjà vu of EHRs.” Dentists have faced the same barriers to EHR adoption that medical doctors faced about 10 years ago. But they are now experiencing the same drivers their M.D. counterparts experienced when the medical industry reached its health IT tipping point, said Uretz, executive director of, an online resource that tracks innovations in the dental software industry.

One of the biggest barriers to widespread adoption is a lack of incentives to invest in the technology. The majority of dental practices are small mom and pop shops operating on tight budgets without enough surplus for capital investments. And those that have the funding and the desire to go paperless are finding very few options when it comes to systems that meet the unique workflow needs of a dental practice.

EHR adoption among dentists has mostly been limited to large practices and dental service organization members, said Dr. Samson Liu, vice president of clinical affairs at Heartland Dental Care, one of the largest dental service organizations in the U.S.

Liu and colleagues from across the country launched Dentists for Oral Health Innovation in the fall of 2013. The organization’s goal is to expand access to high-quality, cost-effective oral health. A major focus of the organization’s mission is to expand the use of technology. The American Dental Association has also been working on the advancement of dental EHR technology. Its Standards Committee for Dental Informatics has developed a “wish list” of dental EHR functions that practices should look for in a system.

Uretz said he has seen momentum building across the country for dentists to adopt. He said part of that is due to the growing belief that oral health is an important part of overall health. It used to be rare for primary care doctors to exchange data with specialists. They later realized the need to communicate, and the rise of health information exchanges and EHR interoperability made it possible. Now, more medical professionals and dentists are realizing the importance of exchanging information with each other, and are seeking the technology to make those connections possible.

The federal government has also expressed an understanding of how important it is for dentists to be part of the overall health care continuum. But the programs aimed at increasing health IT adoption have not been very favorable to dentists.

Technically, dentists are eligible to qualify for the meaningful use incentive program, but few are participating due to the difficulty. The Dept. of Health and Human Services acknowledges how difficult it is for dentists to qualify. As of early 2011, there were no standalone dental EHRs certified for meaningful use, but a few general EHRs had dental modules. Besides the lack of certified systems, it’s difficult for many dental practices to meet the eligibility criteria.

To qualify, 30 percent of a dentist’s patients must be covered by Medicare. Since Medicare does not cover most dental procedures, very few dentists could qualify for the Medicare meaningful use program.

Data from The Centers for Medicare and Medicaid Services shows the minimal impact the meaningful use program has had on adoption at dental practices. As of October 2013, there were a total of 286,771 eligible professionals who registered for the meaningful use incentive program; dentists accounted for only 346 of total registrants. Only 194 dentists have actually received incentive money so far.

Industry insiders have their eyes on Minnesota, which earlier this year became the first state to adopt a mandate that dentists use EHRs. It’s not yet clear what impact the mandate will have, as the law did not include fines or any other enforcement teeth.

Uretz believes it will not solely be state and federal legislative mandates or incentive programs that promote EHR adoption. It will also be a combination of the accountable care concept moving in to dentistry, and the rising demand from patients, he said.

“The cork’s out of the bottle and there’s a big movement now,” Uretz said. “The dental profession is part of the overall organic health care system. You cannot ignore being part of that system.”

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