Health Care Politics Telemedicine

ADA updates teledentistry policy

This is very disappointing.

Dentists who deliver, direct or supervise teledentistry services should be licensed in the state where the patient receives services unless otherwise authorized by a state’s dental board, according to the policy. Patients have the right to know the identity and qualifications of oral health practitioners involved in the teledental encounter, costs they are responsible for in advance of the delivery of services, and be actively involved in treatment decisions, according to the policy.

Source: ADA updates teledentistry policy

I am happy that the ADA is addressing the issue however it is upsetting that they have fallen back on old ways of thinking that limit the application of new technology. I am afraid there is more politics here than patient care.

Does the ADA really believe that my friend Dale Miles, one of the best dental pathology and radiology specialists in the country cannot diagnose a CBCT that was sent to him via the Internet from a dentist in a state that Dale is not licensed in?

Future Tech General Management Software

Deleting your Facebook account permanently deletes your entire paid Oculus VR library

From CNET:

If you delete Facebook and have an Oculus VR headset, you’ll lose your entire paid gaming library. And you won’t be able to get your Oculus VR games back if you make a new account,

Source: Deleting your Facebook account permanently deletes your entire paid Oculus VR library – CNET

Another instance of the capricious nature of digital ownership and of the primary issue, “Who owns the data?

When you “purchase” a high tech device you never actually own the software you merely have a license to use it. What happens if you do not maintain the license? What happens if the vendor goes out of business?

You could end up not having access to all your patient and financial data stored on the cloud based system. Would it be OK if the software developer refunded a portion of your fee yet did not allow you access to the data?

You could end up having a useless $100,000 CAD CAM system.

The wonders of the digital age are manifest. However we do not yet have adequate legal and ethical standards to guide us.


Teledentistry App – Grin

Dvora Brandstatter used to drive her son Elchanan half an hour to the orthodontist and back every month to make sure his braces were working properly. Now, from the comfort of her home in Bergenfield, New Jersey, she attaches a special scope to her smartphone camera, opens an app and inserts the contraption into the 11 year-old’s mouth. A video of the boy’s choppers is sent to his dentist who checks progress, diagnoses any issues…

…The app and the scope were created last year by New Jersey-based startup Grin. After the pandemic hit, Chief Executive Officer and dentist Adam Schulhof said the company sped up development of the technology and partnered with manufacturer 3M Co. to quickly distribute it to as many orthodontists as possible. About 5,000 units have shipped out and roughly 1,000 patients have used the system so far, according to Grin.

Source: Dentist visits go remote during the covid-19 pandemic

Another promising teledentistry app. The next step will be to incorporate AI into the app to assist in diagnosis.

Future Tech

Dental Implant Surgery with Yomi’s advanced robotic assistance

Surgical robotics have transformed multiple medical disciplines, and enabled early adopters to differentiate their practices and become the recognized leaders in their fields.Yomi is the first and only dental robotic system for implant surgery. Nothing is more accurate or precise than Yomi when it comes to placing implants.

Source: Dental Implant Surgery with Yomi’s advanced robotic assistance | Yomi By Neocis

FDA 510(k) clearance

Future Tech Telemedicine

Boston Dynamics Is Putting Legged Robots in Hospitals

From  IEEE Spectrum:

For the past eight months, Boston Dynamics has been trying to find ways in which their friendly yellow quadruped, Spot, can provide some kind of useful response to COVID-19. The company has been working with researchers from MIT and Brigham and Women’s Hospital in Massachusetts to use Spot as a telepresence-based extension for healthcare workers in suitable contexts, with the goal of minimizing exposure and preserving supplies of PPE.

Source: Why Boston Dynamics Is Putting Legged Robots in Hospitals – IEEE Spectrum

I love the concept…but…It is more than a little creepy. Follow the link for a video.

Artificial Intelligence

Dental AI Council

Leaders from across the dental industry announced the formation of the Dental AI Council (DAIC), an organization devoted to helping define the future of artificial intelligence (AI) in dentistry through research and education. DAIC members represent all major industry constituencies, including practitioners, dental service organizations, equipment manufacturers, practice management software providers, insurance carriers, laboratories and universities. As AI begins to yield increased efficiency, accuracy, consistency and insight in a variety of dental applications, the DAIC will seek to stimulate greater industry-wide understanding of the technology.

The primary mission of the Dental AI Council is to help define the future of AI in dentistry and educate the larger dental community.

Source: Dental AI Council

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Making healthcare more affordable through scalable automation

From McKinsey:

As more healthcare companies start to implement automation technologies, the ability to coordinate across the organization in achieving scale will be a major determinant of success.

Source: Making healthcare more affordable through scalable automation | McKinsey

Another thoughtful analysis from McKinsey. The linked article looks at many business sectors, not just medicine/dentistry and analyses how much of each business is liable to become automated. Healthcare is not high on the list, nevertheless there are a great many tasks we do in the dental office which can be automated and or done from home via telecommuting.

As I have said many times the health care crisis is not really a crisis in care it is a crisis in affordability. Anything which reducers costs while maintaining or even improving the quality of care will help relieve the crisis.

Future Tech Management Office Design Paperless

Too Many Goals = No Goals at All

From Marcus Buckingham:

If you overwhelm your people with tons of goals, or many sub-goals, you run the risk of them trying to do everything in a superficial or inadequate way. Instead, try to create total clarity around a few — probably 4-6 a quarter is about right.

What is true about goals in general is also true about implementing technology in particular. If you try and do everything all at once you are likely to be frustrated and discouraged.

Let’s say you want to add a digital pan, launch a practice web page, convert to paperless charts, add photos to every patient exam and install CAD CAM. All of those things will benefit your practice but you are doomed if you try and do them all at once.

People can only cope with so much change at one time. If suddenly everything is different then people simply slow down and quit. People, that is both the team and the dentist, will be frustrated and burn out preferring to slip back to the old way of doing things and your new technology never gets implemented properly.

For example; switching to paperless records is not an event – you don’t do it in a weekend – it is a process that will take from three to twelve months. First you create a system to digitize everything in the paper chart, and then you stop making paper. However you will still refer to the old paper records as needed to review last year’s x-rays or see when some treatment was done. By the way we refer back to these old records far less often then we imagine.

NOTE: Do not try and scan all your old records in order to go paperless it is a big waste of time and money,

3D Printing CAD CAM Theraputics

XJet and Straumann partner to scale up ceramic Additive Manufacturing for dentistry

From 3D Printing Industry:

Material jetting specialist XJet has announced a global partnership with dentistry leader Straumann to advance the capabilities of its AM technology for dentistry applications. The duo intends to develop the XJet Carmel 1400 system currently used at the Straumann headquarters in Basel, Switzerland to begin producing end-use ceramic parts.

Source: XJet and Straumann partner to scale up ceramic Additive Manufacturing for dentistry – 3D Printing Industry

A step toward 3D printed ceramic restorations.

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Could your Fitbit or Apple Watch detect early COVID-19 symptoms?

From  Reuters:

Fitbit and other wearable devices typically linked to exercise are being studied as ways to identify people who are potentially infected with COVID-19 before symptoms appear, when they can unknowingly spread the disease.

Source: Could your Fitbit or Apple Watch detect early COVID-19 symptoms? – Reuters

The linked article hits many of my hot buttons regarding future tech in medicine and dentistry. It is also up to the second relevant as it provides a potential break through in Covid 19 diagnosis.

it seems that researches could identify people who had contracted Covid 19 based on changes in heart rate before any of the overt symptoms were apparent. Click the link for the details.

Reportedly researches could detect 80% of users who had Covid 19 based on wearable data. What the article does not state is how many false positives were detected. In other words did Fitbit data suggest a person had Covid who in fact did not? In many ways a large percentage of false positives is a bigger problem than the 20% who had it who did not receive the early warning diagnosis from their wearable.

The potential to improve the human condition with this type of technology is awesome. Would it not be fantastic if our health could be constantly monitored by that big data AI in the cloud and potential diseases detected and treated early? Wouldn’t it be wonderful if we knew we had early asymptomatic Covid and we could avoid infecting the rest of the family? Would it not be great if the doctor in sky knew everything about us and could remind (not nag…remind) us to get more sleep, loose a few pounds and skip that extra six pack of Bud?

Okay you see the problem. Who has access to all that extremely personal health information? Is it safe?

RELATED: Garmin a major supplier of GPS and other wearable devices has suffered a MAJOR cyber attack.


Management Telemedicine

How business leaders (and dentists) can plan for the next normal

From McKinsey:

The figures for telemedicine and virtual health are just as striking. Teladoc Health, the largest US stand-alone telemedicine service, reported a 50 percent increase in service in the week ending March 20, and is adding thousands of doctors to its network. The Federal Communications Commission is spending $200 million to improve connectivity between patients and virtual-healthcare providers, and the US Department of Health and Human Services has increased reimbursements for telemedicine and enabled cross-state provision of virtual care.

Source: How business leaders can plan for the next normal | McKinsey

More evidence that telemedicine (and teledentistry) will be a huge part of the future of health care. There are many reasons for this and the Covic pandemic has accelerated the change and eliminated many of the barriers to change.

Dentistry will continue to be a hands on profession however there are many tasks we could perform remotely. Following is an article I wrote a couple of years ago written as “News of the Future” that presents how we could be using teledentistry a few years from now. All the technology presented in the article is already available.

May 21, 2022: Arnold Zimmer , a San Jose dentist, prepped a tooth on a patient in Fargo North Dakota. By means of tele-dentistry techniques Dr. Zimmer used 3D images of the patient, including bones, teeth and soft tissue integrated into a virtual patient simulation transmitted to his office in California over the Internet. He transmitted his telepresence image back to the clinic in Fargo to talk with the patient and inevitably to ask him to open his mouth.

With Augmented Reality Glasses to guide him Dr. Zimmer slipped his hands into a pair of cyber gloves in San Jose to guide the digital laser handpiece connected to a surgical robot at the other end in Fargo. He used real time 3D images of the tooth prep including patient vitals off to the side and a shadow image of the pulp below the surface to help guide the prep.

The image of the prepped tooth was than transmitted to an artificial intelligence driven online system to design the restoration. The design process took 12 minutes. A master technician in Bern Switzerland then reviewed the design and checked it off in one minute. The design was whisked back to a 3D printer in Fargo to create the restoration.

Dentists and lab techs in Fargo could not be reached for comment.

3D images, virtual patient integration, telepresence robots, 3D goggles, surgical robots, augmented reality, digital impressions and 3D printers all exist right now. 

Management Telemedicine

Telehealth: A post-COVID-19 reality?

From McKinsey:

COVID-19 has caused a massive acceleration in the use of telehealth. Consumer adoption has skyrocketed, from 11 percent of US consumers using telehealth in 2019 to 46 percent of consumers now using telehealth to replace cancelled healthcare visits.1 Providers have rapidly scaled offerings and are seeing 50 to 175 times2 3 4 the number of patients via telehealth than they did before.

Source: Telehealth: A post-COVID-19 reality? | McKinsey

Right now most telemedicine is little more than Facetime or Skype. However as DIY digital diagnostics become more accepted future telemedicine will become even more significant. The two biggest factors holding back telemedicine are payers and regulators. For example Medicare refused to pay for telemedicine until the Covid crisis forced them to.

Be creative, how can dentistry use telemedicine?

Diagnostics Digital Impressions Future Tech Management Paperless Radiography

Digital dentistry: The new state of the art — Is it disruptive or destructive?

From  ScienceDirect: Following is the summary of this scientific article by E. Dianne Rekow, King’s College, London.

Digital innovations have unquestionably disrupted dentistry. With these innovations, patient experience has improved. More restoration options are available delivering longer lifetimes, and better esthetics. Fresh approaches are bringing greater efficiency and accuracy, capitalizing on the interest, capabilities, and skills of those involved. New ways for effective and efficient interprofessional and clinician-patient interactions have evolved. Data can be more efficiently mined for forensic and epidemiological uses. Students have fresh ways of learning. New, often unexpected, partnerships have formed bringing further disruption — and novel advantages.

Is digital dentistry disruptive? Absolutely. Is it destructive? Absolutely not!

Source: Digital dentistry: The new state of the art — Is it disruptive or destructive? – ScienceDirect

I have been saying the same thing for many years. It is nice to see some research backing me up.

Future Tech Internet Security

The Internet of Things Has a Consent Problem

The Internet of Things (IOT) has a consistent problem with security.

From  IEEE Spectrum:

IoT companies should tell users what information their devices are gathering and how they’re using it

Source: The Internet of Things Has a Consent Problem – IEEE Spectrum

Read the whole thing.

Most people would be shocked to discover all the information that their devices are sending back about them and even more shocked to find out how companies manipulate that data to determine personal details about you.

In addition to these privacy issues IOT devices are notoriously insecure providing a backdoor for hackers to get into your systems.

Corona Pandemic Telemedicine

Virtual health: The next frontier of care delivery

From  McKinsey:

For the past 10 to 15 years, virtual health has been heralded as the next disrupter in the delivery of care, but there has been minimal uptick in adoption. The COVID-19 pandemic is pushing against structural barriers that had previously slowed health system investment in integrated virtual health applications.

Source: Virtual health: The next frontier of care delivery | McKinsey

A nice overview on the current state and expected development of telemedicine. The article is focused on medicine but never the less as many good insights dentists should be aware of. As the article states the Covid pandemic has made people in general much more open to telemedicine. It has also reduced some of the structural barriers such as government regulations and insurance limitations.

Corona Pandemic Telemedicine

OralEye teledentistry Network 

Provide Virtual Checkups For Patients Using Your Computer

Source: OralEye Network | Join Today and start using teledentistry

Another teledentistry resource.

Corona Pandemic Management Telemedicine

Work From Home (WFH) Guidelines

The following guidelines are from Jeff Broudy, the CEO of PCIHIPAA

Unlike Telehealth, where OCR has announced softening of the HIPAA Rules, when working from home, healthcare providers face cyber-security and HIPAA challenges.  Below are tips to consider to help keep patient data private and secure while working from home.

  1. Review your Company’s Workstation Use Policy, specifically as it relates to remote use. If you don’t have one, establish guidelines.
  2. Determine if employees will use their own device or company devices.
  3. Document and inventory all employee devices and their access rights to sensitive information.
  4. Establish a daily communication plan between managers and staff.
  5. Do your HIPAA training and review what constitutes a data breach.
  6. Use encrypted e-mail and review all data backup procedures.
  7. Review with staff phishing email examples, and specifically Coronavirus examples.
  8. Don’t share hardware or software login and passwords.
  9. Use a Virtual Private Network (VPN) when accessing the company network remotely.
  10. For home wi-fi make sure manufacturer passwords are changed and firewalls are installed.
  11. Don’t use a public wi-fi from a laptop to access company information.
  12. Don’t save information on thumb drives or public Google Drives.
  13. Update all home computer software, operating systems, and anti-virus software.
  14. Establish IT escalation paths to assist employees and discuss home use of devices.
  15. Disallow printing of patient records at home. If absolutely necessary, obtain a HIPAA compliant shredder.
  16. Track all company mobile devices and enable wiping in case they are lost.

It’s critical when employees work from home that they understand the inherent risks and rules.  You can also have everyone review PCIHIPAA’s Fight Ransomware Page.

For more cyber security and HIPAA compliance  help click here.

Future Tech General

How Negative News Distorts Our Thinking

From Psychology Today:

Exposure to consistent, sensationalized pessimism and negativity has become the norm for those keeping up with the news.

This matters, because research shows us that what we see on the news can significantly impact our mental health.

Source: How Negative News Distorts Our Thinking | Psychology Today

The media thrives on negativity. The current pandemic is a wonderful excuse to predict the worst – the end of the world. One reason they do this is that we reward them with attention, clicks and likes. The linked article explains why this happens and gives some advice on how to mitigate this negative bias.

It also supports a long held thesis of mine. We live in remarkable times and everything is better, much better, than it has ever been in history. (Here.) Yet people insist on believing times are bad, Certainly the Corona pandemic has been and continues to be a major concern. However this too shall pass and we will still be living in the age of miracles.


Teledentistry by PBHS | Virtual, Online Dental Consultation

Another Tele-dentistry option from PBHS. They are primarily a web site and marketing company offering this as an added service.

PBHS SecureVideo provides unlimited encrypted, HIPAA-compliant teledentistry consultations right through your desktop, iOS and android devices. It includes secure two-way clinical chat, screen sharing and file transfers.

Source: Teledentistry by PBHS | Virtual, Online Dental Consultation | Online Dentist Consult

Tele-dentistry is a great way to triage patients for emergency care, take care of non emergencies and generate a bit of cash flow during the pandemic shutdown.

Corona Pandemic Health Care Politics Internet Telemedicine

Physicians Should Be Allowed To Practice Across State Lines—and Not Just During a Pandemic


The COVID-19 pandemic is straining all the country’s health care resources right now—including the supply of physicians. In response, nearly all 50 states are temporarily suspending regulations to allow physicians to practice across state lines and to encourage the use of telemedicine, which lets patients interact with doctors remotely via audio or video…

…Medical professionals are typically licensed on a state-by-state basis, so a doctor licensed in one state can’t practice in another without receiving an additional license. The patchwork of licensing requirements across states is a major obstacle to the use of telemedicine because physicians are generally only permitted to provide telemedicine services to patients in states where they are licensed.

Source: Physicians Should Be Allowed To Practice Across State Lines—and Not Just During a Pandemic –

State licensing restrictions and limited insurance reimbursement are two primary obstacles restricting the growth of tele-medicine and tele-dentistry. Both obstacles have been reduced in response to the pandemic shutdown. This may be the silver lining in the pandemic. It seems we can do just fine in fact do better with fewer restrictions and regulations.