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As the impact of COVID-19 drags on and digital healthcare ramps up, dentists are being urged to focus on the digital health of their practices. By Cameron Cooper
At his Darlinghurst Dental practice in Sydney, Dr Frank Farrelly is taking no chances with patient data and potential privacy breaches.
Instead of using a general Gmail account for online communication with patients, his team accesses a commercial-grade Gmail service that meets strict American legislative requirements around healthcare confidentiality. Why is Dr Farrelly, the principal dentist at the practice, so vigilant?
“We find that a lot of practices still have a generic Gmail or Hotmail account and that doesn’t meet privacy standards,” he says. “And patient privacy is going to be the next big problem that we face as an industry. It’s becoming more and more commercially viable for cybercrime actors to misuse data—and data is the new currency.”
Conscious of possible brand damage and simply wanting to safeguard patients, Dr Farrelly says it is incumbent on dental practices to have robust cybersecurity protocols in place.
A dramatic uptake in digital healthcare in Australia during COVID-19 and greater comfort among many patients with having mobile access to their health information underscores Dr Farrelly’s assertion. The Australian Digital Health Agency reports that since March 2020, 87 million telehealth services have been delivered to 16.2 million patients. In October 2021 alone, consumers and their healthcare providers viewed almost 1.7 million pathology reports, up 500 per cent in a year.
In this environment, the Australian Dental Association recognises that many dental clinics are not using approved secure messaging for the transfer of patient information such as clinical notes, radiographs and referrals. Many practices also find it difficult to integrate their systems with My Health Record.
“Most dental practices are using email and fax to transfer patient information, which are not secure methods of communication,” says Dr Michelle Mun, chair of the ADA’s Dental Informatics & Digital Health Committee.
She adds that health service providers, including dentists, consistently report the most data breaches among all sectors, despite the availability of messaging systems that can encrypt and safely transfer data. “The risks of this can include financial damage to the practice—for example, through ransomware—and reputational damage to the practice or patients, including through leaks of sensitive health information.”
Preparing for the digital age
Professor Heiko Spallek, head of School and dean at The University of Sydney School of Dentistry, wants to see the profession become more digitally enabled. For example, Professor Spallek believes dentists should never have to ask patients about their general medical history or medications—just confirming what they see on their screen, such information should already be at their disposal via connected systems, such as information from medical GPs through My Health Record. He adds that true healthcare interoperability, whereby information is exchanged and used quickly and safely, should be the norm.
“I’m almost militant about that because everything needs to be interoperable,” Professor Spallek says. “Of course, the patient should have the choice to allow access to their records. Privacy and confidentiality are at the top of the list, but that information should be available. New systems like Wisdom (Epic) allow this and are used, for instance, at HealthPartners in Minnesota and Kaiser Permanente in the northwest of the United States.”
Such interoperability is especially crucial for dental research given most patient data is locked up in smaller practices, according to Professor Spallek, whereas general medicine has the advantage of accessing large datasets from tens of thousands of patients through the hospital system, which has led to major discoveries.
With COVID-19 prompting more patients to share and access data over digital devices, he believes dentistry has a rare opportunity to upgrade its digital health status. “It’s a question of balancing privacy and confidentiality with the benefit of having access to data. You cannot have perfect privacy and confidentiality, as well as shared data and personalised medicine, at the same time.”
Room for greater take-up
In its National Digital Health Strategy 2022 submission, the ADA states that in the Australian dental sector, treatment delivery and health information exchange occurs mostly within and between dental practices. It adds that innovations such as secure messaging, teledentistry and virtual care, and computer-printable prescriptions are in the early stages of adoption.
“We encourage dental providers to reinforce their knowledge of secure messaging and teledentistry to understand how they can be used to increase quality and safety of patient care in their practice,” Dr Mun says.
With regard to other digital opportunities, she expects that when easy-to-implement solutions for fully computerised ePrescriptions are available, these will be adopted very quickly. Dr Mun says the ADA supports secure system integration that may allow patients to access their dental information. It also backs digital health innovation in dentistry that improves access to patient care and is clinically validated for patient safety.
Professor Spallek is committed to preparing dental graduates for the future by ensuring that digital health education and training is embedded in all health programs, not just in dentisty. Such education has two key roles. First, it can help prepare students, in collaboration with other faculties such as science, with the foundational knowledge in data science and digital health. Second, it can ensure that medical professionals possess both a health understanding and technical knowledge. “I cannot stress enough that it’s very dangerous when physicians and dentists dabble in that field without having the proper knowledge, and it’s equally dangerous when computer scientists go into these fields without having the clinical connection and the understanding of what problems exist. An educated team of clinicians and technical experts is needed to create successful and secure digital health applications that benefit our patients.”
Play it cyber-safe
On the cybersecurity front, the ADA is recommending that dental practices establish robust protocols, including how to prevent data breaches and how to act if a cyber attack occurs. It is working on cybersecurity resources for its members. “We strongly recommend dental professionals and practice staff increase their cybersecurity awareness through education and consultation with qualified IT professionals,” Dr Mun says.
At a practice level, Dr Farrelly says the use of 3D printing, CAD/CAM and virtual solutions such as DentalMonitoring are clearly on the rise. For privacy and security reasons, he prefers to keep data in the cloud, where providers typically offer sophisticated backup services and bank-like data security. “Data in the cloud is just a lot more secure,” he says.
Dr Farrelly believes running a digitally progressive dental practice also gives him a business edge. “Patients in our demographic are young, time-poor professionals and for them it makes sense to go somewhere that is going to respect their time and improve their dental outcomes and accessibility to treatments through the latest technology.”
The ADA welcomes feedback from members about their digital health needs by emailing firstname.lastname@example.org.