World Workshop on Oral Medicine VI: Utilization of Oral Medicine-specific software for support of clinical care, research, and education: current status and strategy for broader implementation

Need for diagnostic-centric care in dentistry: A case study from the Marshfield Clinic Health System

BACKGROUND

The study objective was to evaluate the workflow of dental providers who use the existing electronic dental record (EDR) system at a large regional health care system to establish a diagnostic-centric culture as part of their dental practice. A further goal focused on identifying when improvements to the workflow and design of the EDR may be indicated.

METHODS

Dental procedures performed on patients and corresponding International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) diagnoses were retrospectively mined from Marshfield Clinic's enterprise data warehouse. All dental procedures performed were selected and paired with corresponding diagnostic codes documented by dental providers. Frequency of documented diagnosis was further analyzed by characterizing correspondence with their ranking order in the diagnosis column with and without a scroll bar within the EDR user interface (UI). Accuracy of selecting appropriate ICD-9-CM for the corresponding Code on Dental Procedure and Nomenclature (CDT) was checked for 10% (n = 6,187) of the procedure-diagnosis pairs.

RESULTS

Of the 61,511 unique procedures documented using 147 CDTs, 11% (6,914 procedures) had a corresponding "not available" option associated under the diagnoses column, whereas 89% (54,597) of dental procedures were associated with a corresponding ICD-9-CM diagnostic code. Overall tendency of dental providers to select the first or last options from the diagnostic list with a scroll bar was noted. Appropriateness of documenting corresponding ICD-9-CM to CDT procedures indicated 98% accuracy.

CONCLUSION

EDR UI design greatly affected documentation process. Redesigning the EDR UI from the results will increase both the quality and utility of clinical documentation.

Medical care providers' perspectives on dental information needs in electronic health records

BACKGROUND

The authors conducted this study to identify the most relevant patient dental information in a medical-dental integrated electronic health record (iEHR) necessary for medical care providers to inform holistic treatment.

METHODS

The authors collected input from a diverse sample of 65 participants from a large, regional health system representing 13 medical specialties and administrative units. The authors collected feedback from participants through 11 focus group sessions. Two independent reviewers analyzed focus group transcripts to identify major and minor themes.

RESULTS

The authors identified 336 of 385 annotations that most medical care providers coded as relevant. Annotations strongly supporting relevancy to clinical practice aligned with 18 major thematic categories, with the top 6 categories being communication, appointments, system design, medications, treatment plan, and dental alerts.

CONCLUSIONS

Study participants identified dental data of highest relevance to medical care providers and recommended implementation of user-friendly access to dental data in iEHRs as crucial to holistic care delivery.

PRACTICAL IMPLICATIONS

Identification of the patients' dental information most relevant to medical care providers will inform strategies for improving the integration of that information into the medical-dental iEHR.