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The ADA released a fact sheet to help dentists understand provisions of the 21st Century Cares Act: Interoperability, Information Blocking and Health IT Certification Program Final Rule, which was issued to give patients better access to health records, promote interoperability and prohibit information blocking, ADA News reported. The Office of the National Coordinator for Health Information Technology told the ADA that the rule does not require dentists and other providers to adopt specific health information technology or use a portal or application programming interface to proactively make electronic health information available.

Full Story: ADA News (11/15) 

See ADA: Information Blocking and Interoperability.

See original article here:

In case link no longer works, here is a downloaded version:

Adding a Blue Button

So there is this Blue Button initiative, which pushes software vendors to add a blue button ( on the software, indicating that the patient or doctor can download the medical record for a patient. It is now being proposed for implementation Medicare patients. This seems particularly promising as it would be the first time the patient could download their data from different Medicare providers and import them all into one single personal health record.

According to RollCall Providers can start enrolling now, apparently, and the CMS will roll out data in August. It sounds like the CMS, administering the Medicare program has control over that data, so it would all come from them.

The idea is to Further Reduce Administrative, Regulatory Burden to Lower Healthcare Costs. This is a direct move towards reducing clinician burnout from too much useless data overhead.

CMS is Centers for Medicare & Medicaid Services. From wikipedia: 

The Centers for Medicare & Medicaid Services (CMS), previously known as the Health Care Financing Administration (HCFA), is a federal agency within the United States Department of Health and Human Services (HHS) that administers the Medicare program and works in partnership with state governments to administer Medicaid, the Children's Health Insurance Program(CHIP), and health insurance portability standards. In addition to these programs, CMS has other responsibilities, including the administrative simplification standards from the Health Insurance Portability and Accountability Act of 1996 (HIPAA), quality standards in long-term carefacilities (more commonly referred to as nursing homes) through its survey and certification process, clinical laboratory quality standards under the Clinical Laboratory Improvement Amendments, and oversight of

Full article here.

A good article by Atul Gawande the author of The Checklist Manifesto in the New Yorker, which also touches interoperability:

Dentacoin is the first Blockchain based informatics system to make its way into the dental community. Is it actually useful?

  • It's an Ethereum based system that allows patients to provide feedback to dental providers and vice versa.
  • Founded by a finance market expert, a law and economics and business expert and a developer. Prof. Dr. Dimitar Dimitrakiev, Philipp Grenzebach, Jeremias Grenzebach. Based out of Munich.
  • As stated in the whitepaper:
    • The basic idea is to provide and maintain a decentralized review platform based on Ethereum smart contracts.
    • This website rewards high quality "patient reviews” and “market research surveys” with Dentacoin.
    • The Dentacoin Foundation recognizes that the value of all user contributions (reviews, recommendations, rewards, payments, trusted feedback, etc.) is one of the most important assets to the foundation. A single review is worth next to nothing, but millions of trusted and impartial reviews are worth many millions (or possibly even billions) of euros. Individuals should be paid for everything they do that brings value notonly to Dentacoin but also to the dental industry.
  • Each review earns the reviewer credits.
  • A verified patient's review gains more credits than an anonymous review.
  • Why is there a need for this to be decentralized?
  • Had a successful ICO in July 2017.
  • No app available for download on App Store yet.

See Also

Meltdown and Sepctre are a codename for various vulnerabilities of basically every Intel processor, which allows a malicious attacker to gain unrestricted access to the computer's memory, so every copy/paste command, every keyboard stroke, etc.

Everyone is concerned about passwords, and medical data might be even worse!

Medical devices are known to be slow with updates, which means that such devices might be vulnerable for quite a while. A successful attack would allow the attacker to gain access to images or potentially any medical data that is being processed on a medical workstation. This exposes the medical institutions and other providers to the potential of huge fines and law suites.

See Also

Blockchain as Our Future

In case you still have not understood how much of a game changing technology blockchains can be, this article from the World Government Summit gives a pretty good picture.

why is this article cool?

It's super cool, because humanity now has a way to solve the big messy global transition from paper to electronics in an interoperable, functional and scalable way! And this article will give you example of exactly how this can become true and how game changing it will be from a technical, medical and governmental perspective.


I've personally struggled with this concept for a long time. When i thought about it, the options i would come up seemed to be only 3:

  1. Vendors: those who develop the systems that providers use to collect and store clinical data retrieved from patients.
  2. Providers: the doctors who provide medical care also by collecting and storing patient's data in systems developed by the vendors.
  3. Patients.
At the end, i came to the realization that, even though each one of these parties can have influence on the data itself, none of them are the actual owners of the data: clinical data is a human heritage and should be accessible to everyone.

And here's why none of the above options really convinced me.


I have heard some stories where a product vendor holds the doctor hostage of clinical data: the doctor might not pay for the vendor's services any longer and the vendor, instead of simply interrupting its actual services, it also decides not to allow access to the clinical data to the doctor any more. My initial reaction to that has always been "hey, that's not ethical: the vendor's don't own that data, it's the practice's (or doctor's) data!". Yes, i feel strongly against this behavior.


Maybe doctors own the data they collect. After all, they have put in the investment of purchasing the hardware and finding the patients and actually collecting the data. But even this never felt quite complete, because what happens when the provider retires and doesn't really do anything with the data they collected? Should all that data get lost with him or her? Decades of hard work gone to waste? That doesn't seem quite right either.


So if the patient owns the data, then they would have to be the ones ultimately responsible for it's integrity and safety. Certainly they could allow others to take care of it for them, however it could be hard to make sure that the entire medical record remains "in one piece". What if the patient accidentally or purposely deletes parts of the medical record?

So after a lot of struggle with this, i decided to tackle the problem starting from first principles. And i came up with this list:

  • Everyone wants to suffer less.
  • Illness, pain and death are most commonly associated with suffering.
  • Humanity is striving to reduce its diseases, physical pains and to elongate its lifetime.
  • Medicine has provided ways to fight diseases, reduce pains and increase life expectancy.
  • Improvements in the medical field require lots of scientific research.
  • Scientific research requires lots of clinical data.

If the above points hold true, then it follows that there is a direct correlation between human suffering and clinical data. Which means that

Lots of Clinical Data Help Humanity Suffer Less

So at this point it became pretty apparent to me that clinical data is a human's heritage and should be therefore available to anyone for research or patient's care purposes, provided the datum consumer is not ill-intended. 

Certainly patient and provider should have a say as to who should have access to which part's of the data, and if the data should be able to identify the patient or not. In some cases, it is best if the patient is not aware of some opinions, thoughts or discoveries of the medical provider yet. Similarly, a patient might not want to fully trust a specific medical provider or for some other reason want to just give access to a partial subset of his or her clinical data to a provider. However these configurable permissions should not stop the data from being anonymously, globally and forever available. Besides, isn't this what humanity has always wanted? The ability to just walk into any medical provider's office without anything more than an ID, and allow them to access our medical records in order to provide medical care for us? 

What remains now is figuring out a technology that can allow for all this to work. Up until 2008, the software we at our disposal was not able to provide a functional, reliable, secure, scalable solution to the problem. However, the invention of the Bitcoin has introduced the new concept of the blockchain, a technology which theoretically has all the physical capabilities to make the above concept become real. Now, just the fact that the technology is there, doesn't mean the problem has been solved: after all, we also currently have the technology to colonize Mars. That doesn't mean we can colonize Mars without putting in some serious work. And serious work is required in the medical field as well, before we can manage to make this technology become widespread.


ADEA Washington Update

ONC Issues Request for Information Related to Interoperability

HHS, Medicare and Medicaid Services, CHIP, EHR | Permanent link   All Posts


 The Office of the National Coordinator for Health Information Technology (ONC) has published a Request for Information (RFI) aimed at establishing the correct metrics to use when trying to assess whether the goal of widespread interoperability of electronic health care records has been met.

why is this cool?

It's exciting, because this means the government is serious about actual real interoperability: they want to define a way to measure how well medical software can communicate with each other.

more details

Under the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), Congress declared it a national objective to achieve interoperability by Dec. 31, 2018. The bill also says that by July 1, the Secretary of Health and Human Resources must set up metrics to make sure this is achieved.

The RFI, released on April 8, is designed to seek opinions from various stakeholders on three subjects: the major components of interoperability that need to be considered; possible metrics that could be used; and other sources of data that will work to craft a metric that will measure interoperability in the broadest sense.

The RFI also asks what it calls “overarching” questions that include such things as whether ONC should use just one data source for consistency or different data sources, what the most important measurements are and how it should define “widespread” in terms of the “widespread interoperability” it is trying to measure.

Interested parties may submit comments until 5 p.m. on Friday, June 3.


It's official: the AAO is now sponsoring the PANIO effort


Well, this is not really news: the AAO has been investing on projects like PANIO for quite a while. However, what just happened is that the American Association of Orthodontists is now hosting this server (and therefore the PANIO efforts), and is therefore paying for it's electricity and bandwidth. This is huge. Thanks.

The history

At the beginning, some years ago, i was hosting this wiki in a server which was already running all the time at my parents office. However, their Internet Service Provider was doing funny things, and i soon realized that while i had no problems at all accessing it, some users would not be able to access it at all (it was wierd).

So then i decided to host on Google Compute Engine. Except those server aren't free. So i was shelling out roughly $40/month to have a system which wasn't even powerful enough, and needed to reboot every night, and would still crash every few weeks or so.

After a few years of having to spend money for something that wasn't even that great, i expressed my frustration, and the American Association of Orthodontics came to rescue: The AAO has provided a virtual server with 4 times as much memory and 10 times as much disk space at no cost for us.

I completed the move over the weekend.

The IHE has had a profile for being able to test interoperability of healthcare provider directories. Just recently, IHE USA has started their own version, which should be compatible with the international IHE version, in addition to providing extra details to accommodate for US needs.

A Healthcare Provider Directory (HPD) is just what it sounds: it's a public directory of private health providers or of institution health providers. Or, as defined on the IHE document itself, HPD directory structure is a listing of the following two categories of healthcare providers that are classified by provider type, specialties, credentials, demographics and service locations.

  • Individual Provider – A person who provides healthcare services, such as a physician, nurse, or pharmacist.
  • Organizational Provider – Organization that provides or supports healthcare services, such as hospital, Healthcare Information Exchange (HIE), Managed Care, Integrated Delivery Network (IDN), and Association.

The goal is to have a standard for this directory, such that every group, individual, organization or institution who is maintaining one, could have the ability to share it, and make a more comprehensive and up to date version available. 

why is this cool?

Honestly, i'm not 100% sure. Here's my thinking: Healthcare often needs to find locate a group of providers for care for referring patients to other specialists, or finding other doctors quickly in an emergency situation. Having a list (or many lists) of healthcare providers which can all be queried with the same language has a huge advantage.

For example, with a standardized protocol for the healthcare provider directory, there could be organizations which maintain a central directory by providing a simple user interface to download or update the directory, allowing other institutions to make use of the latest and most up to date version available.

What i'm not clear about, is who would be maintaining these directories, and what would their incentive be to adhere to this standard.

See Also

Dr. John Grubb steps down

Dr. John Grubb has been of great help and an invaluable resource. He has most recently followed up to make work item ACT-6 A Digital Standard for Sharing Orthodontic Photographs progress steadily. We really hope he will still find time to volunteer work with us. His feedback is greatly appreciated and he will always be welcome to join us, physically or remotely.

Thanks John!

Email from John Grubb

It is time for me to step down as a representative of the American Association of Orthodontists and the American Board of Orthodontics to the Standards Committee on Dental Informatics (SCDI). The journey has been enjoyable working with so many talented and committed professionals; and, I will miss greatly the camaraderie.

I wish you and all of the people involved in the SCDI process the very best for the future success of this very important process!

Very respectfully,


John E. Grubb, DDS/MSD