Record Your Accomplishments for Future Establishments

Whether it was legal binding or not, proper record-keeping has and should always be part of the taught curriculum of any well-structured orthodontic postgraduate program. If properly inculcated, these records are priceless resources not only from a medico-legal point of view but also from a research one for any orthodontist. The best example to my mind is that of Dr Wick Alexander, whose clinic maintains records up to 30 years following successful completion of treatment. His lectures of retention are based on meticulous preservation of the same, and one can learn a lot from his organization abilities.

Coming to the Indian scenario, we are in the midst of a great change my friends and colleagues, a change for the better or worse only time may tell. The phase-wise national implementation of the Clinical Establishment Act is in its final stages and this is set to revamp and revise the way health care (oral health care in our case) is delivered and maintained in this country. While some might have taken a sigh of relief, there still remain unresolved issues that need to be addressed.

It is definitely praiseworthy that the minimum space and infrastructure details have been postulated in this legislation; this not only prevents clammy and cramped up clinical work spaces but also allows for the implementation of some of the other salient features of the act. For instance, upon complete implementation it would now be mandatory to tabulate and share the outpatient details with the local health office on a quarterly basis with the additional requirement of maintenance of their records for a yet unspecified time, but the global standard is set at 5 years minimum so it may be assumed to be the same in India for now. Thus, having the necessary space and armamentarium would allow for the execution of the same to some extent.

The Indian practice scenario does not have an active record-maintenance protocol per se, especially in the private sector. Additionally, the yet unspecified time to maintain such records raises some ambiguity in the law’s smooth implementation and enforcement akin to the recent hike of fines in the Motor Vehicle Act. This may catch a lot of practitioners with a sudden jolt. Moreover, over the course of time, an average practice may accumulate massive quantities of physical records such as study and articulated models.

This is where I think that digitization of records may help ease the burden but the armamentarium needs to be more cost-effective along with legislations providing a framework for a water-tight and well-defined digital data and privacy policy to ensure safety and confidentiality of patient data from tampering and unsolicited distribution. It is already well known that the scanned models or direct intra-oral are as or if not more accurate than conventional stone models. ¹ The developed nations are at the near-completion stage of this transition from physical to digital records, but mind you the change was done due to an impending foresight of logistical difficulties of storage rather than an upcoming medico-legal legislation. Even some of the prestigious orthodontic examinations such as the Membership in Orthodontics, Royal College of Surgeons, Edinburgh (M.Orth, RCS, Ed) have now advocated the submission of digital models of their intended exam cases replacing the physical submission of the same which more often than not proved quite tedious to safely travel with to international centers (see https://www.rcsed.ac.uk/exams/exam-regulations?examdefid=2afe02cf-151f-458e-8364-4303b7d52883&name=Membership%20in%20Orthodontics%20-%20Part%20B%20-%20Clinical%20Examination). Hence, I am in no doubt that sooner or later, we as responsible orthodontists should and would have to jump on the digital bandwagon, the only question remains as to how soon, and at what monetary and infrastructural costs. We must also accept that with changing times and laws, we must ourselves also adapt to the current environment to better serve our society and our professional needs in the present as well as the future, and in my humble opinion, a well thought and drafted record-keeping policy would go a long way in achieving this. Lastly, it must be pointed out that our country has no dearth of clinical data and material in terms of sheer quantity and variety of clinical presentations, but unfortunately many a time due to substandard record-keeping and -maintenance, we are yet to fully utilize this data to define and refine our outcomes, thereby depriving our talented fraternity of praiseworthy recognition in the international orthodontic community. By going digital, perhaps the data could facilitate and initiate well-structured and long-term clinical trials in numerous centers across the country which could be pathbreaking for mainstreaming orthodontics. It is a brave new world no doubt but we must tread forward albeit cautiously and steadily