When I Need You

Paul Feuerstein, DMD


An image of a swelling that was taken by a patient with her smartphone and sent to me.
MouthWatch’s HIPAA-compliant TeleDent platform.

Most of us are guilty of sending x-rays, images, or other information via email, but if it is not a secure portal, you are in violation of Federal law and subject to extraordinary fines.

Telemedicine is here. You can contact an MD from an app on your smartphone and get medical advice 24/7. For fees as low as $39, you can have a medical consultation, get prescriptions, take a photo of your issue, and have a video chat and a remote diagnosis. There may also be insurance reimbursement for these “visits.” Here are a few of the apps that I have found online: Express Care Virtual, First Opinion, MyTeleMed, MDLIVE, and LiveHealth Online Mobile. Note that I have not tried any of these, but the online reviews are quite promising. There seem to be restrictions in many states, and the reviewers report some glitches, but overall satisfaction is good. The reason I’ve looked into this is because, over the past few years, many patients have contacted me via email, text messages, and other online services with photos of their current dental problems that they took on their smartphones. Images of anterior teeth fractures, facial swelling, and a lower third molar were of decent resolution. Even though the image quality was not stellar, I at least had a hint about what was going on. Was all of this HIPAA compliant? Of course not: although the information was coming to me from the patients, my unsecured responses were not compliant, even though the patients requested them. The legality of this is ultimately for the attorneys to decide.

A few years ago, the enterprising Brant Herman (founder and CEO of MouthWatch) had an idea about this, resulting in the MouthWatch Home Monitoring System. This platform focused on patient-to-provider communications, which required an affordable, high-quality intraoral camera and HIPAA-compliant communication. He introduced a low-cost intraoral camera a patient could buy or borrow from the dental office to communicate issues securely to the practice. His MouthWatch Intraoral Camera (mymouthwatch.com) is simple to use and an excellent method for a patient to monitor new or postoperative issues without having him or her run in for a 2-minute evaluation. It’s also an easy tool to use if a dental professional was seeing a patient in a remote clinic (eg, public health) and needed a consultation. The camera, priced less than $300, became a big hit with dentists. He never claimed for it to be a robust, HD diagnostic device, but it was fine for a simple initial screening. The cameras then expanded to work with existing dental-imaging software.

As things progressed, Brant saw this as the beginning of an opportunity, since he had developed this HIPAA-compliant remote pathway. The company evolved its product to provide a unique turnkey secure and cloud-based teledentistry solution for clinician-to-clinican consultation and collaboration called TeleDent. Of course, the dental office could easily communicate with the patient, but what if the situation required the opinion of a specialist or colleague? Most of us are guilty of sending x-rays, images, or other information via email, but if it is not a secure portal, you are in violation of Federal law and subject to extraordinary fines. With the TeleDent infrastructure, a virtual study club can be set up, allowing a patient’s information to be shared among several practitioners. The portal is not limited to use of the intraoral camera: live video images, screen sharing, and video conferencing can also be done. It is also possible to have laboratory consultations while the patient is in the chair, including sharing conebeam images, computer designs, and more, all in real time.

As far as referrals, this system can actually be a practice builder for a specialist. There is a subscription fee for the service, but an office can purchase a number of licenses to allow any of the referring dentists to use the system for collaboration at no cost to them. In addition, patients have also been impressed with this high-tech, virtually instant referral system and know their specialists are familiar with their situations even before they arrive for their appointments.

Compliant file sharing is not unique to TeleDent, but the entire portal encompasses features of many products. Brightsquid (brightsquid.com), for example, has been around for a while and allows HIPAA-compliant communications with patients and among multiple offices. Other companies, such as eDossea (edossea.com), Aspida (aspida.us), and RecordLinc (recordlinc.com), all have HIPAA-compliant email with some conferencing features.

In addition to these products, a new program has been announced by a true visionary in this arena. Dr. Arnie Rosen of Boston launched Transcend Dental more than 20 years ago, which used a secure internet portal. His problem was that it was so ahead of its time, as no one knew much about the internet back then. Transcend is still alive and well in the dental lab industry. He is currently launching Awrel (awrel.com), which is based on HIPAA-compliant texting. He also has a few more products on the horizon, and there are many more products in this category.

Check out these and similar companies to familiarize yourself with this type of secure communication.

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