The Health Insurance Portability & Accountability Act and the practice of dentistry in the United States: system security.

This article reviews the issues related to the Health Insurance Portability & Accountability Act (HIPAA) security rule that apply to dental practice. The security rule specifically addresses individually identifiable health information that is transmitted or maintained in electronic media. System security must be applied to the entire technical infrastructure for the practice environment as well as to the work culture on a daily basis and must be thought of as an enterprise asset. Security refers to all of the policies, procedures, tools, and techniques used to assure that privacy and confidentiality are adequately addressed in a healthcare system. HIPAA requires all covered entities that transmit or maintain electronic health information perform, and document, a risk assessment for security and develop a security plan to address major areas of concern. A self-assessment tool is provided in this article.

The Health Insurance Portability and Accountability Act and the practice of dentistry in the United States: electronic transactions.

This article reviews the kinds of electronic transactions required under the Health Insurance Portability & Accountability Act (HIPAA) and relates them to relevant data contained in an electronic oral health record (EOHR). It also outlines the structure of HIPAA transactions using the claim transaction as an example. The relationship of the HIPAA resource management function to those of patient care are discussed. The discussion points out potential future uses of other existing resource management transactions to realize the maximum potential of linking the primary patient care functions to those functions related to managing resources in support of that care. This is needed in all aspects of oral health using the informatics standards activities in which the American Dental Association (ADA) actively participates. The article concludes by providing the dentist a perspective on how to relate these capabilities to his/her individual practice setting.

LOINC, a universal standard for identifying laboratory observations: a 5-year update.

The Logical Observation Identifier Names and Codes (LOINC) database provides a universal code system for reporting laboratory and other clinical observations. Its purpose is to identify observations in electronic messages such as Health Level Seven (HL7) observation messages, so that when hospitals, health maintenance organizations, pharmaceutical manufacturers, researchers, and public health departments receive such messages from multiple sources, they can automatically file the results in the right slots of their medical records, research, and/or public health systems. For each observation, the database includes a code (of which 25 000 are laboratory test observations), a long formal name, a "short" 30-character name, and synonyms. The database comes with a mapping program called Regenstrief LOINC Mapping Assistant (RELMA(TM)) to assist the mapping of local test codes to LOINC codes and to facilitate browsing of the LOINC results. Both LOINC and RELMA are available at no cost from http://www.regenstrief.org/loinc/. The LOINC medical database carries records for >30 000 different observations. LOINC codes are being used by large reference laboratories and federal agencies, e.g., the CDC and the Department of Veterans Affairs, and are part of the Health Insurance Portability and Accountability Act (HIPAA) attachment proposal. Internationally, they have been adopted in Switzerland, Hong Kong, Australia, and Canada, and by the German national standards organization, the Deutsches Instituts für Normung. Laboratories should include LOINC codes in their outbound HL7 messages so that clinical and research clients can easily integrate these results into their clinical and research repositories. Laboratories should also encourage instrument vendors to deliver LOINC codes in their instrument outputs and demand LOINC codes in HL7 messages they get from reference laboratories to avoid the need to lump so many referral tests under the "send out lab" code.

The Health Insurance Portability and Accountability Act: practice of dentistry in the United States: privacy and confidentiality.

This paper introduces the reader to the Health Insurance Portability and Accountability Act (HIPAA) of 1996 legislation in the context of its relationship to the Electronic Oral Health Record (EOHR). Privacy and confidentiality issues for administrative data are addressed in terms of the broader relationship of such data to the EOHR leaving the HIPAA-defined administrative transactions and security issues for the entire practice for a subsequent presentation. Educational requirements are presented that aid the dentist and the practice staff in understanding the broad and long-term implications of the HIPAA legislation.

The electronic oral health record.

This paper presents the history of the use of the computer for maintaining patient medical care information. An electronic record generated with a computer, which is non-specific for any healthcare specialty, is referred to as the electronic health record. The electronic health record was previously called the computer-based patient record. "Electronic" replaced the earlier term "computer-based" because "electronic" better describes the medium in which the patient record is managed. The electronic health record and its application to dentistry are discussed. The electronic health record is a "database" of patient information that has been entered by any healthcare provider; the electronic oral health record is an "electronic record" of oral health information that has been entered by an oral healthcare provider. The significant differences between the electronic health record and the electronic oral health record are outlined and highlighted. Included is a template describing a procedure to be used by dental personnel during the decision making process of purchasing an electronic oral health record. A brief description of a practice template is also provided. These completed templates can be shared with dental software vendors to clarify their understanding of and to clearly describe the needs of today's dental practice. The challenge of introducing information technology into educational institutions' curricula is identified. Finally, the potential benefit of using electronic technology for managing oral healthcare information is outlined.