When Does Andre Consider a Patient a Patient in Eaglesoft
I want to address a topic that was addressed in the Eaglesoft Field Guide. There is a bunch of misinformation floating and I wanted to make sure Fielders have the correct information.
“When is a ‘Person’ a ‘Patient’ of the Practice?”
The question has a deceptively simple answer and nuanced answer.
Simply, the dentist-patient relationship begins when the dentist accepts, agrees to accept, or undertakes to render care to the patient.
The nuanced response is in real life, the points at which those events actually take place are often not clear-cut.
According to MLMIC Insurance Company, a leader in the medical malpractice insurance industry for over 45 years for physicians, dentists, hospitals: “A dentist-patient relationship may be deemed to begin when an appointment has been made or specific advice is delivered before the patient is seen, or when there is some other interaction which creates a patient’s reasonable expectation of care.”
The Virginia Board of dentistry code § 54.1-2711 states: “A bona fide dentist-patient relationship shall exist if the dentist has (i) obtained or caused to be obtained a health and dental history of the patient.”
Courts and clinical boards have evaluated the situation in two ways – a Contract-Based approach and a Tort-Based approach.
The Contract-Based approach:
Typically courts and professional boards consider evidence of mutual consent as the basis of a Contract-Based approach to determine when a “patient became a patient”. On a first contact with an office, the Patient is demonstrating consent to a relationship with the practice by seeking treatment the doctor demonstrates consent to it by scheduling the treatment, diagnosing, treating, or otherwise providing care to the patient.
The Tort-Based approach:
Typically courts and professional boards consider the doctor-patient relationship as a “special” relationship arising out of doctor’s responsibility to act on behalf of and in the best interest of the patient.
Both Contract and Tort approaches are “consensual”. The patient authorizes the doctor to treat, and the doctor voluntarily assumes that responsibility. The question is: What act by the patient or the doctor conveys the agreement that forms the relationship.
Typically, the agreement is made by the patient when at the act of seeking care directly. The act of the doctor is a bit more complicated in each given case. Because courts and professional boards see the patient as inherently vulnerable, the relation is typically created at the time the doctor appoints the patient and collects Personal Identifiable Information (PII) (defined as “Any representation of information that permits the identity of an individual to whom the information applies to be reasonably inferred by either direct or indirect means.”)
The kind of patient information stored in Eaglesoft that would be considered “PII” under HIPAA is:
• Full name
• Maiden name or mother’s maiden name
• Alias
• Date of birth
• Street address
• Telephone number
• Email address
• Social security number
• Driver’s license number
• Financial records or information
• Account numbers
• Credit card or debit card numbers
• Medical records
• Full face photos
• Employment records
When just one of the above pieces of information is gathered while creating or reserving an appointment in Eaglesoft, the Patient is “identifiable”. Facts such as place of birth, place of death, first name, last name, first initial, and zip code can be PII if two or more are present. There are key differences between PHI and PII. PII encompasses any information that can be directly or indirectly linked to an individual’s identity. Protected Health Information (PHI) is a subset of PII, but it specifically refers to health information shared with HIPAA covered entities.
Once the practice collects PII/PHI and in the case of Eaglesoft, once you enter the PII into the Edit Patient Screen, into the schedule (even as notes in a Schedule Block), that doctor-patient relationship may have been established.
The legal basis for the doctor-patient relationship arises out of court decisions that create precedents and vary by state. In general, the duty is established when a practice affirmatively acts in a patient’s care by diagnosing or treating the patient or agreeing to do so. Does “agreeing to do so” mean that by creating an appointment you are agreeing to diagnose or treat?
Here is a scenario that can clarify why a General Dentist’s scheduled appointment differs from say, an Obstetrician: A man named “Pat” calls an Obstetrician and makes and appointment. The office accepts the appointment under the assumption it is made for someone else. It’s on their schedule. Saved. They then ask for more information about the patient, “Patricia”. He says: “No I’m Patrick. I’m the Patient I was calling about my stomach pain.” They informed him that this is not something they can treat, so no D/P relationship has been established.
In general, a general dental office accepts appointments with a direct path from appointment to diagnose and/or treat those who call. Not always does diagnosis end with treatment but as stated above: “established when a practice affirmatively acts in a patient’s care by diagnosing or treating the patient or agreeing to do so.”
DISCLAIMER:
This is a resource guide and all decisions on each dental office setup should remain the sole decision of the dentist/owner of the practice. Eaglesoft is a registered trademark of Patterson Dental Company. All other software or products mentioned are the property of their respective owners. Although Andre Shirdan was an employee of Patterson Dental, he is not associated with Eaglesoft or Patterson Dental Company or endorsed by Patterson or any other Company Mentioned in this blog. Although I have gone to great lengths to make sure the information is accurate and useful, I recommend you consult a lawyer if you are seeking legal advice.
In no event will the creator of this document be liable for loss of profits or special, indirect, or consequential damages. No action relating to obligations here under may be brought by the reader or author more than one year after the occurrence of the event giving rise to any cause of action. The writer accepts no legal responsibility for the correctness and completeness of this material and its application to specific factual situations.
