Teledentistry

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Telemedicine in the United States is experiencing a surge in demand amid the coronavirus outbreak. In response, teledentistry is expected to explode in usage.

For patients, telemedicine provides faster care and helps patients avoid hospital emergency rooms. Virtual care can also reduce the strain of the healthcare system, and help track the spread of diseases across geographies. 
The growth of teledentistry in the future will no doubt expand. However, the modalities of usage are relatively unknown and untested. Teledentisrty in relation to patient care can include the following modalities:
  • Live video (synchronous): Live, two-way interaction between a person (patient, caregiver, or provider) and a provider using audiovisual telecommunications technology.
  • Store-and-forward (asynchronous): Transmission of recorded health information (for example, radiographs, photographs, video, digital impressions and photomicrographs of patients) through a secure electronic communications system to a dentist, who uses the information to evaluate a patient’s condition or render a service outside of a real-time or live interaction.
  • Remote patient monitoring (RPM): Personal health and medical data collection from an individual in one location via electronic communication technologies, which is transmitted to a dentist or the provider (sometimes via a data processing service) in a different location for use in care and related support of care.
  • Mobile health (mHealth): Health care supported by mobile communication devices such as cell phones, tablet computers, and personal digital assistants (PDA).
General Considerations: The treatment of patients who receive services via teledentistry must be properly documented, which should include providing the patient with a summary of services. Dentists who deliver services using teledentistry must establish compliance protocols, especially when a referral is necessary.
Patients’ Rights: Dental patients whose care is rendered or coordinated using teledentistry specified modalities have the right to expect:
  1. That any dentist delivering services using teledentistry technologies will be licensed in the state where the patient receives services, or be providing such services as otherwise authorized by that state’s dental board [which for many states is a work in progress].
  2. That the delivery of services using teledentistry technologies are performed in accordance with applicable laws and regulations addressing the privacy and security of patients’ private health care information. The strict implementation of HIPAA guidelines and protocols is an absolute must.
Quality of Care: The dentist is responsible for the health, safety, and welfare of the patient, as if the patient received such services in the practice. Services delivered via teledentistry should be consistent with in-person services. In addition, the delivery of services utilizing these modalities must abide by all state and federal laws that address the expectation of patient privacy. 
Reimbursement: Dental benefit plans and all other third-party payers, in both public (e.g. Medicaid) and private programs, may provide coverage for services using teledentistry (synchronous or asynchronous). However, it should be noted that the reimbursement model for teledentistry is unsettled.
Technical Considerations: Dentists must consider conformance with applicable data exchange standards to facilitate delivery of services via teledentistry modalities, including but are not limited to Digital Imaging and Communications in Medicine (DICOM) standards when selecting and using imaging systems, X12 and HC7 requirements for the exchange of information and 2019/2020 IC D-10 Standards for documentation consistency. Currently, teledentistry is in the early stages of implementation. But, it should be noted that COVID-19 had brought teledentistry and telehealth to the forefront.