#244 Updating Health Histories - What, When, and How?

The American Dental Association recently announced it’s first update to their widely used patient health history form in a number of years.  Learn what changes/additions have been made, what are key elements of a health history and how often it should be updated.

Resources:

• American Dental Association (ADA) Medical/Dental Health History https://bit.ly/4bPCnp5 
• American Dental Association – Documentation/Patient Records https://bit.ly/41efGEU 
• The Dental Record https://www.dentalrecord.com/ 

                                                 https://www.thecompliancedivas.com

Transcript

Copy Transcript Copied

SPEAKER_01 0:00

Welcome to the Compliance Divas podcast. I'm Mary Gavoni and I'm here today with our Diva Leslie Cannum. And our topic today is updating patient health histories. Recently, the American Dental Association updated their widely used patient health history form. And so we're going to talk about what those changes are, but we're also going to talk about what are the components of a health history, why are they so important, and other types of things that we need to consider that go into having an effective and legal document as the health history is. So, Leslie, will you start us off and just talk about why do we even need health history forms?

SPEAKER_00 0:48

Well, Mary, the health history form is both a clinical assessment tool and a legal document. And it should support safe dental care, meet the standard of care expectations, and align with documentation requirements under HIPAA and clinical guidelines from organizations like the American Dental Association and Centers for Disease Control and Prevention. The form requires the signature of the patient or guardian that attests to the accuracy of the information that they're giving us.

SPEAKER_01 1:20

Perfect, Leslie. And I know that our listeners have all experienced that, I guess, level of mistrust of the patients. Are they really being honest with us or not? Or are we really getting all of the information that we need? So it's really about risk management and making your best effort to get that information that we need. So we're going to take a look at some components of the health history form and why it's so important. And we start off with patient demographic information, which establishes the identity of the patient, supports communication with the healthcare provider, and is essential for coordinating care. So we need to know who this patient is and how to contact them and so forth. This information needs to include their full legal name. Perhaps we ask them about what is their preferred name or if they have a nickname, their date of birth, address, phone number, and email if they will share that with us, which is very important for communicating with them, emergency contact with the name and phone number of who is the person you can contact if there is an emergency, name of their primary care physician, and any specialists that might be applicable for treatment consultations. For example, if they see a cardiologist, if they have indicated that they have a history of heart disease, we may want to know who their cardiologist is. Next, we want to know about medical conditions. And this is really sort of the meat of the health history, which is usually structured in a checklist, and they answer yes or no to the, you know, do you have this particular disease? And then some open-ended questions which talk about things like have you been treated recently for cardiovascular disease? Have you been treated with an immunosuppressant in recent years and what for? Have you been treated for tuberculosis or hepatitis? Are you pregnant? Have you had any recent hospitalizations or surgery? All these things that help us to understand do they have some medical risks when we perform dental treatment for them? Another section is medications, and this is a really critical one, and one that I think is a challenge for many practices to really get a good overall picture of what kind of medications that patients may be on, especially if they have a lot of existing medical conditions, or perhaps if they're an older patient, because many of those patients are on a lot of different medications. We also want to know if they're taking over-the-counter meds, like maybe allergy medications. Are they taking supplements because there are some supplements that can affect bleeding time and so forth? So we need to know all of that information and about their prescription medications. For the prescription medications, we want to know what's the drug name, the dosage, and the frequency that they're taking that medication. And this is a difficult thing to get sometimes when the patient fills out their form in the office because they may not remember. I always would laugh about sometimes the elderly patients would come when we told them ahead of time if they were coming as a new patient, you need to let us know all the medications that you're on. And so they come in the office with a paper bag full of prescription bottles, and then we would go through them and write down on their health history what all their medications are. So we'll talk about a better alternative for that in a minute. But we need to know about any changes in medications, especially from one appointment to the next. Have they started taking a new medication that they weren't taking the last time they were there? And that's actually one of the key questions that I would do when I would do a health history update with a patient. If I ask them, have you had any changes in your health history? And they say no. And then I would ask them, Are you taking any medications, prescription, or over-the-counter that you weren't taking the last time? Oh yeah, by the way, I'm taking, you know, a beta blocker or something for some kind of cardiovascular issue, and they didn't relate that to a change in their health history. So all of this information about medications, of course, is important because we want to make sure that if we prescribe any medications, that we don't want to overlook any kind of drug interactions or perhaps, again, some bleeding risk if they're taking anticoagulants or over-the-counter. And also to understand why the patient might be suffering from xerostomia or dry mouth, because it's a consequence or a side effect of a lot of medications that patients may be taking. Other information pertaining to medications would be any indicators of allergies or adverse reactions? Do they have a penicillin allergy, for example? Or do they have a, although it's not a medication issue, we certainly need to know if they have a latex allergy. We want to know if they've ever had any problems with local anesthetic. It could be an allergy to a preservative in a local anesthetic. And does the patient have any environmental or food allergies that we may want to take into consideration? So all of the things that we need to know regarding their medication history. So, Leslie, how about you continue on with some other components of the health history?

SPEAKER_00 7:16

Well, Mary, another component of the health history is vital science. That includes blood pressure, pulse, and a temperature check. You know, we got out of the habit of taking temperatures on patients after the COVID pandemic. I think everyone is glad to put the hand sanitizer, the mask, and the thermometers away. But it's still a best practice to take a patient's temperature and to record it, especially since most practices still have those digital thermometers. This is a good way to make sure the patient doesn't have a low-grade fever that they may not be aware of. We always want to take blood pressure on adults to make sure that they're not hypertensive, which could preclude treatment on the patient. And taking pulse on a patient helps to assess their level of anxiety or perhaps underlying conditions that may increase their heart rate. Next, we should make sure to include dental-specific medical considerations. Do they have any history of endocarditis? Do they have prosthetic joints that may or may not need to be premedicated? We want to check for a history of maybe radiation therapy to the head or neck, and are they taking any kind of bisphosphonate medications which could cause issues with their bones? Do they have any bleeding disorders? Another factor to consider would be social and behavioral health factors. Uh they're also important because they could have effects on oral health. For example, tobacco use, smoking, vaping, smokeless tobacco, alcohol consumption, recreational drug use. And not every dental practice has questions about recreational drug use. But it's still a good idea because remember, this is a legal document. Another component is infectious disease screening. What is our exposure risk from the patient? Have they had any recent illness or symptoms, fever in particular, or prolonged cough, exposure to infectious diseases? Have they been exposed to someone who may have had tuberculosis? Or have they traveled to a part of the world where certain infectious diseases are prevalent? Next is a review of systems. Are they in good health or do they have any recent health changes, unexplained weight loss or fatigue? And all of these things are typically presented in a checklist type format. Something that is pre-designed. As we're talking about the new ADA health history forum, these are questions that a dentist needs to take into consideration when prescribing treatment for a patient. And Mary, I just want to add that screening for aerosol transmissible diseases is a requirement in California, every patient every time, because if they have an infectious aerosol transmissible disease that could put employees at risk, OSHA wants us to make sure we don't provide treatment that could cause a serious illness for employees.

SPEAKER_01 10:31

I am so glad that you mentioned that, Leslie. And it's been sort of a thorn in my side that after the pandemic was over, immediately, and even before the pandemic was over, people got tired of asking questions about respiratory symptoms and all of that. And every time I go to my primary care physician and they ask the questions, you know, have you had a fever? Have you had any respiratory symptoms? I say, yay, because we need to know that, especially since we work in such close proximity to our patients. The other thing that we need to take into consideration with components of a medical history is what does your state dental board say about what kinds of questions need to be asked if they do? Some dental boards address it, some do not. I know that in Michigan, part of that dental medical history needs to be an assessment based on the American Society of Anesthesiologists' medical assessment form. And so that's something that we'll put a link in the show notes to where you really assess the patient's overall health. Are they at risk if we do dental treatment on them, or is it okay to proceed with treatment? So we started out the podcast talking about this new health history form that the ADA has introduced. And the two key changes or additions that the ADA recommends is asking the question about the GLP1 weight loss medications. They've become so popular. They do have some side effects that may affect the oral cavity, including dry mouth. And so we should be asking that kind of question. Sometimes patients don't think about, oh yeah, that's a prescription med I'm I'm taking. And that we should also include questions about mental health treatment. And the the way it's worded is have you, I believe it says, have you sought the services of or do you have a history of treatment for mental health? Now, this could be a touchy subject for some patients, but again, if a patient gives you a history of taking a number of like antidepressant, anti-anxiety medications, that might be an indicator to ask some additional questions about why they are taking those medications. So we just wanted to note that there are a lot of sources for health history forms. Your practice management software most likely has a health history form that is already embedded into your software, and you can use that. Many of them allow you to edit them or update them so you can utilize them. There is a company called the Dental Record, which is affiliated with the Wisconsin Dental Association, and they've had a very widely used medical dental history form for a number of years. But I really like the idea of using the form that's in your practice management software. You can pull information from different sources, but if you use that one, then you can send that form electronically to your patients ahead of time, especially for new patients. You know, we tell them, please show up 10 minutes early so you can fill out the paperwork. Well, number one, patients hate filling out paperwork, and we hear that more and more and more. And they don't always show up 10 minutes early, and then you're into the appointment for about 10 or 15 minutes because they didn't finish their paperwork. So if it's sent to the patient ahead of time, they can complete it, they can sit down where they have their medications and be able to put in the dosage amounts and the names of the meds and all that information when they're at home. You're going to get more accurate information. And then they can transmit it through a secure portal linked to your website, and you have their history information before they even come in. And the other advantage is that you can also do those updates. So I have patients coming in for their continuing care visits. Part of my confirmation is please click on this link. It takes them to a secure link in a patient portal or part of your website where they can update their health history, list new medications, and then you have that documentation when they come in. And it doesn't take time when we're there. So the other question we haven't answered yet, and Leslie is going to delve into that topic, is how often do we need to update health histories?

SPEAKER_00 15:26

Mary, that is a million-dollar question because then nobody likes to fill out forms and people don't like to refill out forms that they feel that they just filled out. And so we often hear team members ask the question how often should a patient update their health history form? Here is the current recommendation from the American Dental Association all active patients of record should update their health history every visit, meaning the updates, not necessarily filling out a whole form. And most of these forms do have a section for us to indicate that there have been some updates and changes in medication or changes in health condition. A lot of times patients don't remember to tell us unless we ask them. And then the other part of updates, patients should complete a whole new health history every two years or even sooner if major medical changes do occur.

SPEAKER_01 16:23

Fabulous, Leslie. And again, this is the recommendation from the American Dental Association. You should always check with your state dental board rules and see if they have something more stringent about updating health histories and be in compliance with your state rules. So in this episode, we've discussed changes that the ADA recommends to health history forms, and they have an updated form. If you choose to use it, you can go to the members site and you can purchase the new health history form. We gave a couple of other resources. And I think one of the really important things about this is we just went into a little more detail about why we need all this information and what is all the information that we need from these patients because it is a legal document. If there are ever any questions about treatment or something, heaven forbid happened that was an adverse reaction. This document is the doctor's defense about how they made their decisions about treating that patient. And again, we discussed how often to update those health histories. Make sure you have the most current information on your patients. The compliance divas bring clarity and simplicity to compliance by navigating the regulatory world to keep you on course. You may submit questions by email to support at the compliancedeivas.com. And all the resources we mentioned in this episode will be listed in the show notes section of your podcast app. And while you're in your podcast app, we invite you to subscribe to our podcast or you can subscribe on our website, the compliancedeivas.com, and make sure that you never miss an episode. And please, on your podcast app, leave us some feedback or a rating. See you next time.