The COVID-19 pandemic forced dental practices to ask themselves a simple but tough question: “How do we continue?” In a business built on face-to-face interactions, lockdowns and social distancing were particularly daunting hurdles to overcome. Even as restrictions slowly lifted, it became clear new approaches would have to be adopted to ensure patients receive the care they need while maintaining safety and infection control. One such approach was teledentistry.
Telehealth and Its Uses
Sometimes known by the broader term, telehealth, teledentistry refers to the practice of delivering dentalcare using information technology and telecommunications. Clinicians can provide a range of services and functions through any number of channels – phone, email, text or video call, for example. During the pandemic, dentists used teledentistry to conduct patient consultations remotely as part of a larger effort to curb infection transmission. As healthcare risk and compliance expert Linda Harvey, RDH, MS, LHRM, DFASHRM, explained, “At the time, telehealth filled a great need.”
Although recent events triggered teledentistry’s spike in popularity, its usefulness certainly isn’t limited to public health emergencies. Remote consultations offer practices an option for ensuring continuity of care for patients who can’t make the trip to the office (such as those who live in remote areas or have mobility issues), screen out those who may not require an in-person appointment and communicate critical care information between visits. Some research also indicates that younger generations (millennials and Gen Z) may prefer the convenience of virtual visits over in-person care, so telehealth can help practices meet the needs of these patient populations.
HIPAA & HITECH
As every dental professional knows, whenever technology is paired with sensitive patient information, regulatory compliance comes into play. Consequently, when providing teledentistry, practices must follow federal health information privacy, security and civil rights laws, namely, those issued under the Health Insurance Portability and Accountability Act (HIPAA) and the Health Information Technology for Economic and Clinical Health (HITECH) Act. So, whether you’ve been using teledentistry since the start of the pandemic or are just now considering it for your practice, you’ll want to review the steps you should take to ensure your business is protected.
Keep Up With the Changes
To ensure the privacy and security of protected health information (PHI), the U.S. Department of Health and Human Services (HHS), Office for Civil Rights (OCR) enforces certain regulations issued under HIPAA and the HITECH Act. This includes the Privacy, Security and Breach Notification Rules (collectively referred to as the HIPAA Rules).
During the pandemic, OCR issued several notifications that effectively allowed practices to use normally noncompliant technologies to provide teledentistry. This included popular applications such as Apple FaceTime, Facebook Messenger, Google Hangouts, Zoom and Skype. As Harvey told Advantage in 2022, “If a dental practice is making a good faith effort to follow all the HIPAA protocols properly and they’re staying within the guidelines of the bulletins, then OCR is going to use its enforcement discretion and not pursue them for noncompliance.” However, in May 2023, the COVID-19 public health emergency expired, and with it, the temporary leniency OCR gave dental practices. “A good faith effort is no longer sufficient,” Harvey explained. “Now, you must be compliant.”
What Works Now
With the days of responding to a patient’s emergency call using an impromptu FaceTime behind us, practices must be deliberate when it comes to selecting a telehealth solution. A good place to start is with a business associate agreement (BAA). Under HIPAA, dental care providers are considered “covered entities,” and any person or entity “who performs functions or activities on behalf of, or provides certain services to, a covered entity that involve access …to protected health information” is a “business associate.” When a business associate enters into a BAA with a covered entity that purchases or subscribes to their product or service, it assures the practice that the partnership will protect the privacy of its electronic PHI and, in turn, keep it in compliance with HIPAA Rules.
Some telehealth solutions are designed specifically for dentistry (such as OperaDDS, Solutionreach and RevenueWell), whereas others are simply more “healthcare-centric” versions of popular applications (such as Skype for Business, Microsoft Teams, Zoom for Healthcare and Google G Suite Hangouts Meet). Although all these solutions should meet the criteria for HIPAA compliance and offer a signed BAA, none has been reviewed or endorsed by OCR, so it’s vital to carefully read the fine print associated with each. In choosing a telehealth product, you also should look for end-to-end encryption (E2EE): “With E2EE, data are encrypted on the sender’s system and only the intended recipient can decrypt it,” Harvey explained. Experts consider E2EE one of the most secure forms of encryption because it protects both at-rest and in-transit data, so it’s undeniably a smart choice for practicing safe and compliant teledentistry.
A Seamless, Integrated Workflow
One final consideration for selecting a teledentistry solution is whether it features the functionality you need to provide quality clinical care. “You want it to streamline your workflow and capture certain nuances of the appointment,” Harvey said. “If a telehealth program requires too many workarounds to achieve this, not only are you wasting precious time, but these extra steps may not be HIPAA compliant.” Picture a platform that doesn’t make it easy to document details of a patient visit or transfer records to and from your practice management software. In this case, you could find yourself storing and sending PHI through unsecure channels such as text or email. These kinds of workarounds put your data at risk of being lost or, worse, intercepted by third parties. And both scenarios can set your practice up for costly HIPAA violations and potential legal troubles. An ideal teledentistry product, on the other hand, affords seamless, secure integration with practice systems and supports a simpler, safer workflow.
Advantages Ahead
For teledentistry, the future looks promising. Artificial intelligence and machine learning are on track to expand capabilities, which will help improve and automate processes from data entry and diagnosis through treatment planning. And with new business opportunities presented by the more than 70% of younger patients who prefer the convenience of teledentistry, plus countless individuals who are otherwise unable to access dental services, practices that offer virtual visits are positioned for genuine growth. In all, teledentistry is primed to add tangible value for any practice that adopts this service and takes a few, simple steps to ensure safe, compliant provision.
References
American Hospital Association. There may be a generation gap in telehealth’s future. aha.org/ahacenter-health-innovation-market-scan/2021-06-29-there-may-be-generation-gap-telehealths-future
Burger D. Teledentistry poised for vivid future. ADANews.2023;54(6):1,4.adanews.ada.org/media/4idl4icj/adanews_v54n6_digital_v3.pdf
HHS Office for Civil Rights. Notice of expiration of certain notifications of enforcement discretion issued in response to the COVID-19 nationwide public health emergency. Federal Register. April 13, 2023. federalregister.gov/documents/2023/04/13/2023-07824/notice-ofexpiration-of-certain-notifications-of-enforcementdiscretion-issued-in-response-to-the
U.S. Department of Health and Human Services. Notification of enforcement discretion for telehealth remote communications during the COVID-19 nationwide public health emergency. HHS website. January 20, 2021. hhs.gov/hipaa/for-professionals/special-topics/emergency-preparedness/notificationenforcement-discretion-telehealth/index.html
