PROACTIVE PRACTICE MANAGEMENT
 

Our operating system crashed and we lost about a third of our patients' radiographs. To make things worse, our backup files were corrupted as well.  While we are not planning on ever being faced with a patient complaint and subsequent subpoena by BODEX, we are wondering what would happen in that instance if we were unable to produce an x-ray. Would that be considered non-compliance? What proof would I have that the appropriate x-rays had ever been taken? What are the possible ramifications of having lost these radiographs?

There are two issues involved in these questions. One aspect is the information technology, or computer issues. The other is the compliance issue regarding maintenance of records.

First, let’s discuss the computer issue. Unfortunately, computers are extremely complex machines built by people with engineering and technology related degrees. The majority of employees in the dental work force don’t possess the formal education necessary to understand how they are built or how the machines operate, but they are required to use them in their day-to-day activities.

To battle this dilemma, computer manufacturers and software companies have been successful in constructing a “User Friendly” environment. That is to say, the end user of personal computers doesn’t have to posses an engineering degree or have the technological prowess to operate a computer because of GUI (pronounced, “gooey”), short for Graphical User Interface. This is the mainstay of Apple and Windows based systems that make it simple to orchestrate daily operating tasks with such a complex integration of silicon and metal. I still marvel at how something as simple as using the mouse to move the cursor arrow and double-clicking the 8:30 a.m. appointment slot in the Dentrix Appointment Book pops up a box that helps me schedule an appointment for a patient. What’s going on behind the scenes that make this stuff happen?!

Doesn’t matter, does it? It works! And it makes our jobs easier; we’re more productive; and it looks cool!

Using the computer makes our job easier, until the computer doesn’t respond to the nice commands we’ve become so accustomed to typing, the screen is black, and we realize we are witnessing a disaster in the making…our hard disk is crashing! Now, all of a sudden, our whole attitude and demeanor changes about computers. Four letter words that are outside of dental terminology and completely out of the editorial capacity of this article echo through the confines of the workspace like the roar of an avalanche in the Alps during the dead of winter.

Then, we realize we have a backup. Oh, thank goodness! All is not lost; we’ve been safeguarding our data! As your initial question states, you checked your backup and the data was corrupted. My daughter who is a sophomore in high school would probably respond with, “Bummer”. So would I.

How sad would it be if you reached down to the slot where your tape backup is placed, pull it out, and find that the tape is stuck?! You tug and pull, and it finally releases, only the tape is caught in the drive and the spool of tape is unwinding from the cassette with every inch you pull away from the box.

Okay, all kidding aside, these are big problems. For more on safeguarding computer data and dealing with computer crashes, you can go to my website, www.FredHeppner.com and click on “Articles by Fred Heppner”. Read the one titled, “How Sound Is Your Practice’s Data?”

Now, on to the maintenance of records issue. For this I have contacted known expert on dental law in Arizona, Jeff Tonner. According to Mr. Tonner, recent information from the Arizona State Board of Dental Examiners, or BODEX, indicates a new statute is now in effect, (ARS §32-1264e) that covers Maintenance of Records. Essentially, this statute now states that dental records must be kept for six years from the last date of service for adults; and three years after a juveniles 18th birthday, or six years from the juvenile’s last date of service whichever is later.

When asked about the dilemma regarding losing patient data from a computer crash and the legal issues in our original question, Jeff was very helpful and informative with his responses. Here are answers to the records questions that I trust will be helpful and useful to you.

The Board might find a person in violation if a requested record cannot be reproduced. If one can’t produce the record, x-ray or otherwise, even if the progress notes indicate the record was taken, one may be in violation due to the fact that the record can’t be produced. It’s also a matter of degree. If one can produce most of the records, but can’t produce all of it (request for records), then one may stand a better chance of being exonerated. For example, from a full set of x-rays, one is missing and the missing x-ray is the one needed for the case, then perhaps one may experience some leniency from the licensing board.

Essentially, if everything crashed, and a person had taken proper precautions, and it was a fluke that nothing was recoverable, perhaps there may be some leniency. The more comprehensive the backup plans one has, the better chance one would have to avoid possible legal entanglements if required to produce a record.

Another example would be if the backup routines were sound and reasonable. That is, the routine called for daily backups at the end of the working day, perhaps even at night before the next day, and they were done appropriately. Someone breaks and enters the dental office in the middle of the night and steals the computer and all the data. In this case, the board might be more lenient due to the fact that reasonable precautions were taken and one day’s worth of data was the only information lost.

If one requires proof that an x-ray had ever been taken, then inspect the office for the X-ray itself, a notation made in the progress notes, the ledger for a billing entry charging out for the service, an insurance claim form, or a billing statement.

The ramifications of not being able to produce a record subpoenaed by a licensing board could be Unprofessional Conduct: Failure to Maintain Records. Or, one may be in violation when the patient requests the records and one is unable to produce them. Again, the board may find that person in violation.

Another event that happens occasionally is a patient arrives at an office and brings their own records, in particular their own x-rays. When the patient leaves and requests their original x-rays, oftentimes the office gives them back to the patient without obtaining a copy of the records for their files. True, the patient owns records brought by the patient. But without records, the office may put themselves in an embarrassing situation in the future, or in a legal entanglement if a complaint is filed. To guard against this, make a duplicate immediately, and make a note in the record: “Patient brought full mouth series from Dr. Simpleton on 10/10/06. Copy made for our records”. If a copy was not made, Dr. Simpleton’s records could be subpoenaed and therefore could help in supporting the diagnosis.

It’s a tragedy when hard work is lost when a computer crashes. The uneasiness that comes along when the records are required for potential legal entanglements compounds the frustration. Be Proactive and safeguard your data, and work hard to maintain your records so that you will be prepared, just in case something happens.