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Farajollahi B, Sheikhtaheri A, Ahmadi M. Barriers and facilitators for the implementation of electronic dental record systems: Perspectives from a developing country. Int J Med Inform 2024; 192:105622. [PMID: 39244920 DOI: 10.1016/j.ijmedinf.2024.105622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2024] [Revised: 08/28/2024] [Accepted: 09/03/2024] [Indexed: 09/10/2024]
Abstract
INTRODUCTION The need for dental data in healthcare services and the inadequacy of paper records due to their inherent limitations have led to a shift towards electronic dental record systems (EDR). Implementing EDR comes with numerous barriers and challenges. Therefore, this research was conducted to identify the implementation barriers and facilitators for EDRs. METHODS This descriptive-analytical cross-sectional study was conducted on dentists working in public and private clinics in Tehran, Iran. A questionnaire consisting of three sections was designed to collect data on the demographic information of dentists, the barriers in five categories including financial barriers (6 questions), organizational barriers (11 questions), technical barriers (5 questions), personal barriers (3 questions), and ethical and legal barriers (6 questions), as well as facilitators for the implementation of EDR (15 questions) based on the literature, using a five-point Likert scale. 130 dentists from 60 dental clinics participated in the study. The data were analyzed using descriptive statistics (calculating frequency distribution, mean, and standard deviation). The mean scores were classified into four categories based on quartiles from very low importance to very high importance including very low importance (mean ≤ 1.25), low importance (1.25 ≥ mean < 2.5), important (2.5 ≥ mean < 3.75), and very high importance (mean ≥ 3.75). Finally, each of the barriers and facilitators among user dentists and non-user dentists was compared using the Mann-Whitney U test. The data were analyzed using SPSS software. RESULTS The findings indicate that dentists consider all barriers and challenges in implementing EDR to be important, and all the proposed facilitators for addressing these challenges to be very important. Among these important barriers are the rapid turnover of managers and policymakers at higher levels (3.69 out of 5) as a personal barrier, legal issues related to electronic records (3.65 out of 5) as an ethical-legal barrier, the lack of necessary standards for data exchange between different systems (3.64 out of 5) as a technical barrier, dentists' limited awareness of the benefits of this system (3.63 out of 5) as a personal barrier, and the lack of suitable legal infrastructure for EDR implementation (3.62 out of 5) as an ethical-legal barrier. Additionally, among the very important facilitators, training dentists and staff on EDR (4.31 out of 5) is noteworthy. CONCLUSION To address the important barriers to EDR implementation, including legal-ethical barriers, legal institutions, and regulators must establish relevant laws and regulations to overcome these obstacles. Furthermore, if system users learn about the features, goals, benefits, and positive impact of EDR on their work and gain the necessary awareness, their resistance to changes will decrease, and their interest and readiness to accept EDR will increase.
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Affiliation(s)
- Boshra Farajollahi
- Department of Health Information Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Abbas Sheikhtaheri
- Health Management and Economics Research Center, Health Management Research Institute, Iran University of Medical Sciences, Tehran, Iran; Department of Health Information Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran.
| | - Maryam Ahmadi
- Department of Health Information Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
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Kalenderian E, Zouaidi K, Yeager J, Urata J, Yansane A, Tokede B, Rindal DB, Spallek H, White J, Walji M. Learning from data in dentistry: Summary of the third annual OpenWide conference. Learn Health Syst 2024; 8:e10398. [PMID: 38633022 PMCID: PMC11019381 DOI: 10.1002/lrh2.10398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 10/03/2023] [Accepted: 10/05/2023] [Indexed: 04/19/2024] Open
Abstract
The overarching goal of the third scientific oral health symposium was to introduce the concept of a learning health system to the dental community and to identify and discuss cutting-edge research and strategies using data for improving the quality of dental care and patient safety. Conference participants included clinically active dentists, dental researchers, quality improvement experts, informaticians, insurers, EHR vendors/developers, and members of dental professional organizations and dental service organizations. This report summarizes the main outputs of the third annual OpenWide conference held in Houston, Texas, on October 12, 2022, as an affiliated meeting of the American Dental Association (ADA) 2022 annual conference.
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Affiliation(s)
- Elsbeth Kalenderian
- School of DentistryMarquette UniversityMilwaukeeWisconsinUSA
- School of DentistryUniversity of California at San Francisco (UCSF)San FranciscoCaliforniaUSA
- School of DentistryUniversity of PretoriaPretoriaSouth Africa
| | - Kawtar Zouaidi
- Department of Diagnostuc SciencesUTHealth School of DentistryHoustonTexasUSA
| | - Jan Yeager
- School of DentistryUniversity of California at San Francisco (UCSF)San FranciscoCaliforniaUSA
| | - Janelle Urata
- School of DentistryUniversity of California at San Francisco (UCSF)San FranciscoCaliforniaUSA
| | - Alfa Yansane
- School of DentistryUniversity of California at San Francisco (UCSF)San FranciscoCaliforniaUSA
| | - Bunmi Tokede
- Department of Diagnostuc SciencesUTHealth School of DentistryHoustonTexasUSA
| | - D. Brad Rindal
- Institute for Education and ResearchHealthPartners Research InstituteMinneapolisMinnesotaUSA
| | - Heiko Spallek
- School of DentistryUniversity of SydneyCamperdownNew South WalesAustralia
| | - Joel White
- School of DentistryUniversity of California at San Francisco (UCSF)San FranciscoCaliforniaUSA
| | - Muhammad Walji
- Department of Diagnostuc SciencesUTHealth School of DentistryHoustonTexasUSA
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Li S, Felix Gomez GG, Xu H, Rajapuri AS, Dixon BE, Thyvalikakath T. Dentists' Information Needs and Opinions on Accessing Patient Information via Health Information Exchange: Survey Study. JMIR Form Res 2024; 8:e51200. [PMID: 38206667 PMCID: PMC10811575 DOI: 10.2196/51200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 10/18/2023] [Accepted: 11/22/2023] [Indexed: 01/12/2024] Open
Abstract
BACKGROUND The integration of medical and dental records is gaining significance over the past 2 decades. However, few studies have evaluated the opinions of practicing dentists on patient medical histories. Questions remain on dentists' information needs; their perception of the reliability of patient-reported medical history; satisfaction with the available information and the methods to gather this information; and their attitudes to other options, such as a health information exchange (HIE) network, to collect patient medical history. OBJECTIVE This study aims to determine Indiana dentists' information needs regarding patients' medical information and their opinions about accessing it via an HIE. METHODS We administered a web-based survey to Indiana Dental Association members to assess their current medical information-retrieval approaches, the information critical for dental care, and their willingness to access or share information via an HIE. We used descriptive statistics to summarize survey results and multivariable regression to examine the associations between survey respondents' characteristics and responses. RESULTS Of the 161 respondents (161/2148, 7.5% response rate), 99.5% (n=160) respondents considered patients' medical histories essential to confirm no contraindications, including allergies or the need for antibiotic prophylaxis during dental care and other adverse drug events. The critical information required were medical conditions or diagnosis, current medications, and allergies, which were gathered from patient reports. Furthermore, 88.2% (n=142) of respondents considered patient-reported histories reliable; however, they experienced challenges obtaining information from patients and physicians. Additionally, 70.2% (n=113) of respondents, especially those who currently access an HIE or electronic health record, were willing to use an HIE to access or share their patient's information, and 91.3% (n=147) shared varying interests in such a service. However, usability, data accuracy, data safety, and cost are the driving factors in adopting an HIE. CONCLUSIONS Patients' medical histories are essential for dentists to optimize dental care, especially for those with chronic conditions. In addition, most dentists are interested in using an HIE to access patient medical histories. The findings from this study can provide an alternative option for improving communications between dental and medical professionals and help the health information technology system or tool developers identify critical requirements for more user-friendly designs.
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Affiliation(s)
- Shuning Li
- Department of Dental Public Health and Dental Informatics, Indiana University School of Dentistry, Indianapolis, IN, United States
| | - Grace Gomez Felix Gomez
- Department of Dental Public Health and Dental Informatics, Indiana University School of Dentistry, Indianapolis, IN, United States
- Regenstrief Institute, Inc, Center for Biomedical Informatics, Indianapolis, IN, United States
| | - Huiping Xu
- Department of Biostatistics and Health Data Sciences, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Anushri Singh Rajapuri
- Department of Dental Public Health and Dental Informatics, Indiana University School of Dentistry, Indianapolis, IN, United States
| | - Brian E Dixon
- Regenstrief Institute, Inc, Center for Biomedical Informatics, Indianapolis, IN, United States
- Department of Epidemiology, Indiana University Richard M Fairbanks School of Public Health, Indianapolis, IN, United States
| | - Thankam Thyvalikakath
- Department of Dental Public Health and Dental Informatics, Indiana University School of Dentistry, Indianapolis, IN, United States
- Regenstrief Institute, Inc, Center for Biomedical Informatics, Indianapolis, IN, United States
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Nath S, Jiang T, Barrow J, Simon L. Treatment deferral for elevated blood pressure at a dental school clinic. J Dent Educ 2024; 88:51-55. [PMID: 37727061 DOI: 10.1002/jdd.13369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 07/07/2023] [Accepted: 09/05/2023] [Indexed: 09/21/2023]
Abstract
OBJECTIVES Current guidelines by the American Dental Association (ADA) recommend deferral of elective dental care for elevated blood pressure. However, it is unknown how frequently this impacts dental treatment. The purpose of this study was to evaluate rates of asymptomatic hypertension and treatment deferral at a dental school clinic. METHODS This was a retrospective study with data extracted from a chart review of all patients presenting for care at a dental school teaching practice. Differences in dental procedures, the time between visits, and the number of antihypertensive medications were calculated between patients with and without a blood pressure reading exceeding current guidelines for elective treatment. RESULTS Among 26,821 individuals, 1265 had a visit with elevated blood pressure. Blood pressure readings at the next visit were significantly lower (systolic blood pressure 137 [95% confidence interval {CI} 135-138] mmHg, diastolic blood pressure 82 [95% CI 81-83 mmHg], p < 0.001), although only 24 patients reported taking a new medication. Only 4.1% of these patients had a procedure deferred; for those that did, the average intervisit time was 88.2 days (95% CI 77.7-98.7 days). CONCLUSIONS The majority of patients with blood pressure readings exceeding current ADA recommendations for treatment were treated without evidence of harm. Patients were also unlikely to return to the clinic with new medications for blood pressure after a visit with an elevated blood pressure reading. Oral health providers must weigh the risks and benefits of care deferral and can consider an expanded role in hypertension management in dental settings when caring for patients with elevated blood pressure.
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Affiliation(s)
- Sapna Nath
- Department of Oral Health Policy and Epidemiology, Harvard School of Dental Medicine, Boston, Massachusetts, USA
| | - Tien Jiang
- Department of Oral Health Policy and Epidemiology, Harvard School of Dental Medicine, Boston, Massachusetts, USA
| | - Jane Barrow
- Department of Oral Health Policy and Epidemiology, Harvard School of Dental Medicine, Boston, Massachusetts, USA
| | - Lisa Simon
- Department of Oral Health Policy and Epidemiology, Harvard School of Dental Medicine, Boston, Massachusetts, USA
- Department of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, Massachusetts, USA
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Simon L, Cardenas V, Davila-Parrilla L, Marsh RH, Samuels-Kalow M. Challenges connecting emergency department patients with oral health care: A qualitative analysis of patients, emergency department clinicians, and dentists. J Am Dent Assoc 2023; 154:1087-1096.e4. [PMID: 38008526 PMCID: PMC10823431 DOI: 10.1016/j.adaj.2023.09.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 07/25/2023] [Accepted: 09/05/2023] [Indexed: 11/28/2023]
Abstract
BACKGROUND Unmet dental need shares many risk factors with unmet health-related social needs (HRSN) such as housing and food security and are a common cause for seeking treatment at the emergency department (ED). METHODS The authors recruited a purposive sample of English-speaking and Spanish-speaking patients, ED clinicians at 3 urban EDs, and dentists from nearby communities to participate in qualitative interviews to explore barriers to and facilitators of screening for HRSN and unmet dental needs in the ED. Themes were identified from transcripts using a modified grounded theory approach. RESULTS Interviews were conducted with 25 ED patients, 19 ED clinicians, and 4 dentists. Four themes were identified: (1) a preference for formalized resources, which more frequently exist for HRSN than for oral health; (2) frequent use of ad hoc resources that are less reliable or structured, particularly for dental referral information; (3) limited knowledge of oral health care resources in the community; and (4) desire for more assistance with identifying and addressing resource needs for both HRSN and oral health. Patients were amenable to screening through a variety of modalities and felt it would be helpful, but clinicians emphasized the need for easier referral processes because of frequent failure to connect patients to oral health care. CONCLUSIONS More robust infrastructure and clinician support are needed to ensure successful referral and screening without undue provider burden for both medical and dental clinicians. PRACTICAL IMPLICATIONS Patients are amenable to screening for unmet oral health needs and HRSN in the ED, which may improve access to care.
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Walji MF. Informatics approaches to improve the quality of dental care. Orthod Craniofac Res 2023; 26 Suppl 1:98-101. [PMID: 36919982 DOI: 10.1111/ocr.12655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 03/02/2023] [Accepted: 03/03/2023] [Indexed: 03/16/2023]
Abstract
Despite technological advances, challenges exist in US dental care, including variations in quality of care, access and untreated dental needs. The implementation of learning health systems (LHSs) in dentistry can help to address these challenges. LHSs use robust informatics infrastructure including data and technology to continuously measure and improve the quality and safety of care and can help to reduce costs and improve patient outcomes. The use of EHRs and standardized diagnostic terminologies are highlighted, as they allow for the storage and sharing of patient data, providing a comprehensive view of a patient's medical and dental history, and can be used to identify patterns and trends to improve the delivery of care. The BigMouth Dental Data Repository is an example of an informatic platform that aggregates patient data from multiple institutions and is being used to for scientific inquiry to improve oral health.
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Affiliation(s)
- Muhammad F Walji
- Department of Diagnostic and Biomedical Sciences, Texas Center for Oral Healthcare Quality and Safety School of Dentistry, University of Texas Health Science Center at Houston, Houston, TX, USA
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Janakiram C, Okunev I, Tranby EP, Fontelo P, Iafolla TJ, Dye BA. Opioids for acute and chronic pain when receiving psychiatric medications. PLoS One 2023; 18:e0286179. [PMID: 37751410 PMCID: PMC10522028 DOI: 10.1371/journal.pone.0286179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 05/07/2023] [Indexed: 09/28/2023] Open
Abstract
BACKGROUND People with mental health disorders (MHD) like depression and anxiety are more likely to experience substance use disorders (SUDs) than those without MHD. This study assesses opioid prescription patterns for acute or chronic pain management in patients receiving medication for depression and/or anxiety. METHODS AND FINDINGS Cross-sectional data trend analysis of 24.5 million adult medical claims was conducted using medical and pharmacy data (2012-2019) for adults aged 21-64 from the IBM Watson MarketScan Medicaid Multi-State Database. Information on sex, age, race, provider type, acute or chronic pain, and prescriptions for opioids and antidepressant and/or antianxiety medication from outpatient encounters were analyzed. For those receiving opioid prescriptions within 14 days of a pain diagnosis, ICD-10-CM codes were used to categorize diagnoses as chronic pain (back pain, neck pain, joint pain, and headache); or acute pain (dental-, ENT-, and orthopedic-related pain). Nearly 8 million adults had at least one prescription for antidepressant or antianxiety medications (MHD), with 2.5 million of those (32%) also diagnosed with an acute or chronic pain condition (pain + MHD). Among the pain + MHD group, 34% (0.85 million) received an opioid prescription within 14 days of diagnosis. Individuals with chronic pain diagnoses received a higher proportion of opioid prescriptions than those with acute pain. Among individuals with pain + MHD, the majority were aged 50-64 (35%), female (72%), and non-Hispanic white (65.1%). Nearly half (48.2%) of the opioid prescriptions given to adults with an MHD were provided by physicians. Compared to other physician types, Health Care Providers (HCPs) in emergency departments were 50% more likely to prescribe an opioid for dental pain to those with an MHD, whereas dentists were only half as likely to prescribe an opioid for dental pain management. Although overall opioid prescriptions for pain management declined from 2012 to 2019, adults with an MHD received opioids for pain management at nearly twice the level as adults without an MHD. CONCLUSIONS Although HCPs have reduced opioids for acute or chronic pain to patients at high-risk for SUD, for example, those with MHD, the use of opioids for pain management has remained at consistently higher levels for this SUD high-risk group, suggesting the need to revisit pain management guidelines for those receiving antidepressant or antianxiety drugs.
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Affiliation(s)
- Chandrashekar Janakiram
- Amrita School of Dentistry, Amrita Vishwa Vidhyapeetham, Cochin, India
- National Library of Medicine, National Institute of Health, Bethesda, Maryland, United States of America
| | - Ilya Okunev
- Health Data Analytics Institute, Dedham, Massachusetts, United States of America
| | - Eric P. Tranby
- Analytics and Evaluation, Care Quest Institute for Oral Health, Boston, Massachusetts, United States of America
| | - Paul Fontelo
- National Library of Medicine, National Institute of Health, Bethesda, Maryland, United States of America
| | - Timothy J. Iafolla
- National Institute of Dental and Craniofacial Research, National Institutes of Health, Bethesda, Maryland, United States of America
| | - Bruce A. Dye
- National Institute of Dental and Craniofacial Research, National Institutes of Health, Bethesda, Maryland, United States of America
- University of Colorado School of Dental Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States of America
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Frantsve-Hawley J, Abt E, Carrasco-Labra A, Dawson T, Michaels M, Pahlke S, Rindal DB, Spallek H, Weyant RJ. Strategies for developing evidence-based clinical practice guidelines to foster implementation into dental practice. J Am Dent Assoc 2022; 153:1041-1052. [PMID: 36127176 DOI: 10.1016/j.adaj.2022.07.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 07/09/2022] [Accepted: 07/13/2022] [Indexed: 10/31/2022]
Abstract
BACKGROUND Professional and other organizations, including oral health care organizations, have been developing evidence-based clinical practice guidelines (CPGs) to help providers incorporate the best available evidence into their clinical decision making. Although the rigor of guideline development has increased over time, ongoing challenges prevent the full adoption of CPGs into clinical practices that experience variability in provider expertise and opinion, patient flow pace, and use of electronic dental records. These challenges include lack of relevant evidence, failure to keep guidelines up to date, and failure to adopt strategies aimed at overcoming the barriers preventing implementation into clinical practice. RESULTS This article provides a brief overview of strategies that can be used to overcome common challenges to guideline adoption. Such strategies include creating evidence-based CPGs that use additional sources of evidence and methods to inform guideline development and accelerate the guideline updating and dissemination process (that is, evidence directly from clinical practice, big data, patients' values and preferences, and living guidelines) and applying implementation strategies that have been documented as improving translation of CPGs into routine clinical practice (that is, guideline implementability, implementation science, and computable guidelines). PRACTICAL IMPLICATIONS Adopting newer strategies for developing and translating evidence into practice could lead to improvements in patient care and population health.
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Accuracy of parent-reported health history in a dental setting. J Am Dent Assoc 2022; 153:1053-1059. [PMID: 36058728 DOI: 10.1016/j.adaj.2022.07.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 07/24/2022] [Indexed: 11/21/2022]
Abstract
BACKGROUND Obtaining thorough documentation of a patient's medical history is important for dental care professionals, as oral health is connected intricately to systemic health. The purpose of this study was to assess the accuracy of parent-reported health history for pediatric patients in a dental setting. METHODS A retrospective chart review was conducted on 863 patients 17 years and younger. Parent-reported health history was compared with subsequent physician-to-dentist consultations. The most common diagnoses were grouped on the basis of International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, categories. RESULTS The sensitivity of parent report of health conditions was highest for reporting mental and behavioral disorders (75.1%; 95% CI, 69.6% to 80.0%), followed by nervous system diseases (63.0%; 95% CI, 47.5% to 76.8%), respiratory conditions (47.9%; 95% CI, 37.6% to 58.4%), congenital conditions (46.3%; 95% CI, 30.7% to 62.6%), and cardiovascular conditions (25.0%; 95% CI, 11.4% to 43.4%) and was lowest for hematologic conditions (12.2%; 95% CI, 4.1% to 26.2%). Parents of children 6 years and older and those with private insurance had higher sensitivity for reporting mental and behavioral conditions than those with children younger than 6 years or having Medicaid (P < .0001). The specificity of parent-reported health conditions ranged from 96.0% for mental and behavioral disorders to 99.8% for hematologic conditions. CONCLUSIONS Sensitivity varied widely, showing that parents may be unreliable in their report of children's health histories and that dentists cannot rely solely on parents when obtaining health history. PRACTICAL IMPLICATIONS In advocating for patient safety, especially for those with special needs and complex medical conditions, this study supports the use of medical evaluation before dental treatment and for the integration of dental and electronic health records.
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Li S, Rajapuri AS, Felix Gomez GG, Schleyer T, Mendonca EA, Thyvalikakath TP. How Do Dental Clinicians Obtain Up-To-Date Patient Medical Histories? Modeling Strengths, Drawbacks, and Proposals for Improvements. Front Digit Health 2022; 4:847080. [PMID: 35419556 PMCID: PMC8995974 DOI: 10.3389/fdgth.2022.847080] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2022] [Accepted: 03/08/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundAccess to up-to-date patient medical history is essential for dental clinicians (DCs) to avoid potential harm to patients and to improve dental treatment outcomes. The predominant approach for dental clinicians (DCs) to gather patients' medical history is through patient-reported medical histories and medical consults. However, studies reported varied concordance and reliability of patient-reported medical conditions and medication histories compared to the patient medical records and this process also places a significant burden on patients. Information technology tools/platforms such as an integrated electronic health record containing an electronic dental record module may address these issues. However, these integrated systems are expensive and technically complex and may not be easily adopted by DCs in solo and small group practice who provide the most dental care. The recent expansion of regional healthcare information exchange (HIE) provides another approach, but to date, studies on connecting DCs with HIE are very limited. Our study objectives were to model different aspects of the current approaches to identify the strengths and weaknesses, and then model the HIE approach that addresses the weaknesses and retain the strengths of current approaches. The models of current approaches identified the people, resources, organizational aspects, workflow, and areas for improvement; while models of the HIE approach identified system requirements, functions, and processes that may be shared with software developers and other stakeholders for future development.MethodsThere are three phases in this study. In Phase 1, we retrieved peer-reviewed PubMed indexed manuscripts published between January 2013 and November 2020 and extracted modeling related data from selected manuscripts. In Phase 2, we built models for the current approaches by using the Integrated DEFinition Method 0 function modeling method (IDEF0), the Unified Modeling Language (UML) Use Case Diagram, and Business Process Model and Notation (BPMN) methods. In Phase 3, we created three conceptual models for the HIE approach.ResultsFrom the 47 manuscripts identified, three themes emerged: 1) medical consult process following patient-reported medical history, 2) integrated electronic dental record-electronic health record (EDR-EHR), and 3) HIE. Three models were built for each of the three themes. The use case diagrams described the actions of the dental patients, DCs, medical providers and the use of information systems (EDR-EHR/HIE). The IDEF0 models presented the major functions involved. The BPMN models depicted the detailed steps of the process and showed how the patient's medical history information flowed through different steps. The strengths and weaknesses revealed by the models of the three approaches were also compared.ConclusionsWe successfully modeled the DCs' current approaches of accessing patient medical history and designed an HIE approach that addressed the current approaches' weaknesses as well as leveraged their strengths. Organizational management and end-users can use this information to decide the optimum approach to integrate dental and medical care. The illustrated models are comprehensive and can also be adopted by EHR and EDR vendors to develop a connection between dental systems and HIEs.
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Affiliation(s)
- Shuning Li
- Dental Informatics, Indiana University School of Dentistry, Indianapolis, IN, United States
- *Correspondence: Shuning Li
| | - Anushri Singh Rajapuri
- Dental Informatics, Indiana University School of Dentistry, Indianapolis, IN, United States
- Center for Biomedical Informatics, Regenstrief Institute, Inc., Indianapolis, IN, United States
| | - Grace Gomez Felix Gomez
- Dental Informatics, Indiana University School of Dentistry, Indianapolis, IN, United States
- Center for Biomedical Informatics, Regenstrief Institute, Inc., Indianapolis, IN, United States
| | - Titus Schleyer
- Center for Biomedical Informatics, Regenstrief Institute, Inc., Indianapolis, IN, United States
- Indiana University School of Medicine, Indianapolis, IN, United States
| | - Eneida A. Mendonca
- Center for Biomedical Informatics, Regenstrief Institute, Inc., Indianapolis, IN, United States
- Indiana University School of Medicine, Indianapolis, IN, United States
| | - Thankam P. Thyvalikakath
- Dental Informatics, Indiana University School of Dentistry, Indianapolis, IN, United States
- Center for Biomedical Informatics, Regenstrief Institute, Inc., Indianapolis, IN, United States
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Walji MF, Spallek H, Kookal KK, Barrow J, Magnuson B, Tiwari T, Oyoyo U, Brandt M, Howe BJ, Anderson GC, White JM, Kalenderian E. BigMouth: development and maintenance of a successful dental data repository. J Am Med Inform Assoc 2022; 29:701-706. [PMID: 35066586 PMCID: PMC8922177 DOI: 10.1093/jamia/ocac001] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 12/10/2021] [Accepted: 01/20/2022] [Indexed: 12/27/2022] Open
Abstract
Few clinical datasets exist in dentistry to conduct secondary research. Hence, a novel dental data repository called BigMouth was developed, which has grown to include 11 academic institutions contributing Electronic Health Record data on over 4.5 million patients. The primary purpose for BigMouth is to serve as a high-quality resource for rapidly conducting oral health-related research. BigMouth allows for assessing the oral health status of a diverse US patient population; provides rationale and evidence for new oral health care delivery modes; and embraces the specific oral health research education mission. A data governance framework that encouraged data sharing while controlling contributed data was initially developed. This transformed over time into a mature framework, including a fee schedule for data requests and allowing access to researchers from noncontributing institutions. Adoption of BigMouth helps to foster new collaborations between clinical, epidemiological, statistical, and informatics experts and provides an additional venue for professional development.
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Affiliation(s)
- Muhammad F Walji
- Department of Diagnostics and Biomedical Sciences. School of Dentistry, University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Heiko Spallek
- Faculty of Dentistry. The University of Sydney, Sydney, Australia
| | - Krishna Kumar Kookal
- Department of Diagnostics and Biomedical Sciences. School of Dentistry, University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Jane Barrow
- Office of Global and Community Health. Harvard School of Dental Medicine, Boston, Massachusetts, USA
| | - Britta Magnuson
- Department of Diagnostic Sciences. Tufts School of Dental Medicine, Boston, Massachusetts, USA
| | - Tamanna Tiwari
- Department of Community Dentistry & Population Health. University of Colorado School of Dental Medicine, Aurora, Colorado, USA
| | - Udochukwu Oyoyo
- Office of Dental Education Services. Loma Linda University School of Dentistry, Loma Linda, California, USA
| | - Michael Brandt
- Office of Information Resources. University of Buffalo School of Dental Medicine, Buffalo, New York, USA
| | - Brian J Howe
- Department of Family Dentistry. University of Iowa College of Dentistry and Dental Clinics, Iowa City, Iowa, USA
| | - Gary C Anderson
- Department of Developmental and Surgical Sciences. University of Minnesota School of Dentistry, Minneapolis, Minnesota, USA
| | - Joel M White
- Department of Preventive and Restorative Dental Science. School of Dentistry, University of California at San Francisco, San Francisco, California, USA
| | - Elsbeth Kalenderian
- Office of Global and Community Health. Harvard School of Dental Medicine, Boston, Massachusetts, USA
- Department of Preventive and Restorative Dental Science. School of Dentistry, University of California at San Francisco, San Francisco, California, USA
- Department of Dental Management Sciences. School of Dentistry, University of Pretoria, Pretoria, South Africa
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12
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London SD, Fontelo P, Boroumand S, Dye BA. COVID-19 provides an opportunity for integration of dentistry into the health informatics system. J Am Dent Assoc 2022; 153:3-8. [PMID: 34996533 PMCID: PMC8599016 DOI: 10.1016/j.adaj.2021.11.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 10/11/2021] [Accepted: 11/09/2021] [Indexed: 12/11/2022]
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13
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Bangar S, Neumann A, White JM, Yansane A, Johnson TR, Olson GW, Kumar SV, Kookal KK, Kim A, Obadan-Udoh E, Mertz E, Simmons K, Mullins J, Brandon R, Walji MF, Kalenderian E. Caries Risk Documentation And Prevention: eMeasures For Dental Electronic Health Records. Appl Clin Inform 2022; 13:80-90. [PMID: 35045582 PMCID: PMC8769809 DOI: 10.1055/s-0041-1740920] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 10/30/2021] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Longitudinal patient level data available in the electronic health record (EHR) allows for the development, implementation, and validations of dental quality measures (eMeasures). OBJECTIVE We report the feasibility and validity of implementing two eMeasures. The eMeasures determined the proportion of patients receiving a caries risk assessment (eCRA) and corresponding appropriate risk-based preventative treatments for patients at elevated risk of caries (appropriateness of care [eAoC]) in two academic institutions and one accountable care organization, in the 2019 reporting year. METHODS Both eMeasures define the numerator and denominator beginning at the patient level, populations' specifications, and validated the automated queries. For eCRA, patients who completed a comprehensive or periodic oral evaluation formed the denominator, and patients of any age who received a CRA formed the numerator. The eAoC evaluated the proportion of patients at elevated caries risk who received the corresponding appropriate risk-based preventative treatments. RESULTS EHR automated queries identified in three sites 269,536 patients who met the inclusion criteria for receiving a CRA. The overall proportion of patients who received a CRA was 94.4% (eCRA). In eAoC, patients at elevated caries risk levels (moderate, high, or extreme) received fluoride preventive treatment ranging from 56 to 93.8%. For patients at high and extreme risk, antimicrobials were prescribed more frequently site 3 (80.6%) than sites 2 (16.7%) and 1 (2.9%). CONCLUSION Patient-level data available in the EHRs can be used to implement process-of-care dental eCRA and AoC, eAoC measures identify gaps in clinical practice. EHR-based measures can be useful in improving delivery of evidence-based preventative treatments to reduce risk, prevent tooth decay, and improve oral health.
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Affiliation(s)
- Suhasini Bangar
- Department of Diagnostic and Biomedical Sciences, School of Dentistry at Houston, University of Texas Health Science Center, Houston, Texas, United States
| | - Ana Neumann
- Department of Diagnostic and Biomedical Sciences, School of Dentistry at Houston, University of Texas Health Science Center, Houston, Texas, United States
| | - Joel M. White
- Department of Preventive and Restorative Dental Sciences, University of California San Francisco School of Dentistry, San Francisco, California, United States
| | - Alfa Yansane
- Department of Preventive and Restorative Dental Sciences, University of California San Francisco School of Dentistry, San Francisco, California, United States
| | - Todd R. Johnson
- Department of Diagnostic and Biomedical Sciences, School of Dentistry at Houston, University of Texas Health Science Center, Houston, Texas, United States
| | - Gregory W. Olson
- Department of Diagnostic and Biomedical Sciences, School of Dentistry at Houston, University of Texas Health Science Center, Houston, Texas, United States
| | - Shwetha V. Kumar
- Department of Diagnostic and Biomedical Sciences, School of Dentistry at Houston, University of Texas Health Science Center, Houston, Texas, United States
| | - Krishna K. Kookal
- Department of Diagnostic and Biomedical Sciences, School of Dentistry at Houston, University of Texas Health Science Center, Houston, Texas, United States
| | - Aram Kim
- Department of Oral Health Policy and Epidemiology, Harvard School of Dental Medicine, Boston, Massachusetts, United States
| | - Enihomo Obadan-Udoh
- Department of Preventive and Restorative Dental Sciences, University of California San Francisco School of Dentistry, San Francisco, California, United States
| | - Elizabeth Mertz
- Department of Preventive and Restorative Dental Sciences, University of California San Francisco School of Dentistry, San Francisco, California, United States
| | | | - Joanna Mullins
- Willamette Dental Group, Hillsboro, Oregon, United States
| | - Ryan Brandon
- Willamette Dental Group, Hillsboro, Oregon, United States
| | - Muhammad F. Walji
- Department of Diagnostic and Biomedical Sciences, School of Dentistry at Houston, University of Texas Health Science Center, Houston, Texas, United States
| | - Elsbeth Kalenderian
- Department of Preventive and Restorative Dental Sciences, University of California San Francisco School of Dentistry, San Francisco, California, United States
- Department of Oral Health Policy and Epidemiology, Harvard School of Dental Medicine, Boston, Massachusetts, United States
- Department of Dental Management, School of Dentistry, University of Pretoria, Pretoria, South Africa
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14
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Dental services use before and after inpatient admission among privately insured adults in the United States. J Am Dent Assoc 2021; 152:991-997. [PMID: 34489069 DOI: 10.1016/j.adaj.2021.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 05/30/2021] [Accepted: 06/03/2021] [Indexed: 11/21/2022]
Abstract
BACKGROUND Oral health has been connected to worse outcomes among hospitalized patients, but access to oral health care services in the hospital setting is limited. It is unknown how a hospital admission affects subsequent dental services use. METHODS The authors conducted a retrospective analysis of insurance claims data from a national private insurer. Patients were included if they were admitted to the hospital and had visited a dentist at least once in the year before or after admission. Total number of dental visits, as well as Code on Dental Procedures and Nomenclature codes associated with these visits in the year before and after a hospital stay, patient demographic characteristics, hospital admission diagnosis, and length of stay were recorded. Differences in dental services use before and after the hospital stay were calculated. RESULTS In total, 107,116 patients met inclusion criteria. There were fewer dental visits after admission (mean [standard deviation {SD}] 1.6 [1.7] than before admission (mean [SD] 1.9 [1.8]; P < .0001). Fewer procedures were recorded in the year after discharge (mean [SD] 7.0 [11.4] total Code on Dental Procedures and Nomenclature codes versus 8.5 [12.5] in the year before admission; P < .0001). The number of diagnostic and restorative services delivered was higher after admission, and the number of periodontic, endodontic, oral surgery, and prosthodontic services decreased (overall Pearson χ2, P < .0001). CONCLUSIONS Patients are less likely to visit a dentist after a hospital stay, although impact on oral health is unknown. PRACTICAL IMPLICATIONS Hospitalization may contribute to already existing oral health disparities. Hospital teams and dentists should work together to enhance access to oral health care after hospital admission.
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15
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Leveraging Clinical Decision Support and Integrated Medical-Dental Electronic Health Records to Implementing Precision in Oral Cancer Risk Assessment and Preventive Intervention. J Pers Med 2021; 11:jpm11090832. [PMID: 34575609 PMCID: PMC8470765 DOI: 10.3390/jpm11090832] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 08/18/2021] [Accepted: 08/20/2021] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Precision medicine is focused on serving the unique needs of individuals. Oral and oropharyngeal cancer risk assessment identifies individual risk factors while providing support to reduce risk. The objective is to examine potential current and future strategies to broadly implement evidence-based oral and oropharyngeal cancer risk assessment and screening in dental practices throughout the United States. METHODS Feasible and effective oral cancer risk assessment and risk reduction strategies, ripe for implementation in dental practice, were identified in the published literature. RESULTS The Screening, Brief Intervention, Referral for Treatment (SBIRT) model is a feasible approach to assessing individual oral cancer risk and providing risk reducing interventions in the dental setting. HPV is a more recently identified risk factor that dentistry is well positioned to address. Evidence supporting the utilization of specific risk assessment tools and risk reduction strategies is summarized and future opportunities discussed. DISCUSSION Current knowledge of risk factors for oral and oropharyngeal cancers support the recommendation for dental providers to routinely assess all patients for risk factors, educate them about their personal level of cancer risk, and recommend actions to reduce relevant risk factors. Individuals ages 9-26 should be asked about their HPV vaccination status, educated about HPV and oropharyngeal cancer and receive a recommendation to get the HPV vaccination.
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Tenuta LMA, Canady C, Eber RM, Johnson L. Agreement in Medications Reported in Medical and Dental Electronic Health Records. JDR Clin Trans Res 2021; 7:189-193. [PMID: 33792413 DOI: 10.1177/23800844211004525] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION The historical separation between medicine and dentistry has resulted in the creation of separate health records, which have the potential to negatively impact patient care and safety. Of particular importance, errors or omissions in medication lists in separate electronic health records (EHRs) may lead to medical errors and serious adverse outcomes. OBJECTIVE This study aimed to compare medication lists reported in the EHRs of active patients treated by both the University of Michigan School of Dentistry and Michigan Medicine to determine if differences exist. METHODS In this cohort study, EHRs of a population of 159,733 patients that the University of Michigan medical and dental clinics share in common were investigated for agreement in the reporting of 16 medications. After exclusion of minors and patients not seen in the last 5 y, records of 27,277 patients were examined. RESULTS The maximum percentage of agreement in medications reported in both records was 52% for levothyroxine, and the minimum was 7% for sildenafil. The medical record had a significantly higher number of unique medications than the dental record, suggesting higher underreporting in the dental setting. CONCLUSION The lack of agreement in the report of medications with serious dental and medical implications argues in favor of unification of records and use of available technology to increase accurate medication reporting. KNOWLEDGE TRANSFER STATEMENT The results demonstrate a lack of agreement between medications reported in medical and dental records, which can have serious implications to patients' health. A unified health record, employing available technology to increase accurate medication reporting, would mitigate this problem.
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Affiliation(s)
- L M A Tenuta
- Department of Cariology, Restorative Sciences and Endodontics, School of Dentistry, University of Michigan, Ann Arbor, MI, USA
| | - C Canady
- Office of Dental Informatics, School of Dentistry, University of Michigan, Ann Arbor, MI, USA
| | - R M Eber
- Department of Periodontics and Oral Medicine, School of Dentistry, University of Michigan, Ann Arbor, MI, USA
| | - L Johnson
- Office of Dental Informatics, School of Dentistry, University of Michigan, Ann Arbor, MI, USA.,Department of Periodontics and Oral Medicine, School of Dentistry, University of Michigan, Ann Arbor, MI, USA
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Taylor HL, Apathy NC, Vest JR. Health information exchange use during dental visits. AMIA ... ANNUAL SYMPOSIUM PROCEEDINGS. AMIA SYMPOSIUM 2021; 2020:1210-1219. [PMID: 33936497 PMCID: PMC8075496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Dental and medical providers require similar patient demographic and clinical information for the management of a mutual patient. Despite an overlap in information needs, medical and dental data are created and stored in multiple records and locations. Electronic health information exchange (HIE) bridge gaps in health data spread across various providers. Enabling exchange via query-based HIE may provide critical information at the point of care during a dental visit. The purpose of this study is to characterize query-based HIE use during dental visits at two Federally Qualified Health Centers (FQHCs) that provided on-site dental services. First, we determine the proportion of dental visits for which providers accessed the HIE. Next, site, patient and visit characteristics associated with query-based HIE use during dental visits are examined. Last, among dental visits with HIE use, the aspects of the HIE that are accessed most frequently are described. HIE use was low (0.17%) during dental visits, however our findings from this study extend the body of research examining HIE use by studying a less explored area of the care continuum.
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Affiliation(s)
- Heather L Taylor
- Indiana University Richard M. Fairbanks School of Public Health, Indianapolis, IN
- Regenstrief Institute, Indianapolis, IN
| | - Nate C Apathy
- Indiana University Richard M. Fairbanks School of Public Health, Indianapolis, IN
- Regenstrief Institute, Indianapolis, IN
| | - Joshua R Vest
- Indiana University Richard M. Fairbanks School of Public Health, Indianapolis, IN
- Regenstrief Institute, Indianapolis, IN
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Gesko DS, Worley D, Rindal BD. Creating systems aligned with the triple-aim and value-based care. J Public Health Dent 2020; 80 Suppl 2:S109-S113. [PMID: 33051878 DOI: 10.1111/jphd.12409] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 10/01/2020] [Accepted: 10/01/2020] [Indexed: 12/22/2022]
Abstract
HealthPartners is an integrated health care system in the upper Midwest striving to provide value-based care that aligns with the triple-aim care. The dental delivery system at HealthPartners is focused on prevention by utilizing risk assessment tools (caries, periodontal disease, and oral cancer) built in to our record system. Integration with medical delivery system is facilitated by a shared electronic health record. Measurement is critical to determining if we accomplish our goals. The dentist compensation system is aligned with our care agenda. Implementation strategies, lessons learned, and future directions are discussed in the context of journey to achieve the triple-aim and value-based care.
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Affiliation(s)
| | - Don Worley
- HealthPartners Dental Group, Bloomington, MN, USA
| | - Brad D Rindal
- HealthPartners Institute, HealthPartners Research Foundation, USA
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19
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Sturrock A, Preshaw PM, Hayes C, Wilkes S. A critical synthesis of the role of the pharmacist in oral healthcare and management of medication-related osteonecrosis of the jaw. BDJ Open 2020; 6:13. [PMID: 32821431 PMCID: PMC7419284 DOI: 10.1038/s41405-020-0043-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 06/25/2020] [Accepted: 06/29/2020] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE To consolidate extant published evidence in relation to the potential of integrating oral healthcare for patients at risk of developing medication-related osteonecrosis of the jaw (MRONJ). METHODS A critical synthesis and consolidation of five publications was undertaken. As a mechanism of situating the extant work within the context of primary healthcare provision, the Rainbow Model of Integrated Care was applied as a theoretical lens through which the conceptual findings could be collectively applied to practice. RESULTS The critical synthesis revealed a thematic emergence relating to both formative and normative integration. The most salient of these were the identification of limited shared clinical records, and disconnection of oral healthcare provision from patients' general medical care. The three levels of the Rainbow Model of Integrated Care reflected a series of issues for address. CONCLUSION In the context of collaborative, multi-disciplinary working for patients at risk of development of MRONJ, pharmacists are a professional group which this research reveals to be an underutilised resource. Reduction of oral health inequality at all levels of patient care is a key priority and this research highlights areas for address in relation to requirements for interprofessional education, optimal communication and policies reflective and facilitative of these.
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Affiliation(s)
- A. Sturrock
- Faculty of Health Sciences and Wellbeing, The Sciences Complex, University of Sunderland, City Campus, Chester Road, Sunderland, SR1 3SD UK
| | - P. M. Preshaw
- National University Centre for Oral Health, National University of Singapore, Singapore, Singapore
- Newcastle University, Newcastle upon Tyne, UK
| | - C. Hayes
- Faculty of Health Sciences and Wellbeing, The Sciences Complex, University of Sunderland, City Campus, Chester Road, Sunderland, SR1 3SD UK
- Universities of Cumbria and Liverpool Hope, Liverpool, UK
| | - S. Wilkes
- Faculty of Health Sciences and Wellbeing, The Sciences Complex, University of Sunderland, City Campus, Chester Road, Sunderland, SR1 3SD UK
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Simon L. How Will Dentistry Respond to the Coronavirus Disease 2019 (COVID-19) Pandemic? JAMA HEALTH FORUM 2020; 1:e200625. [DOI: 10.1001/jamahealthforum.2020.0625] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Lisa Simon
- Harvard School of Dental Medicine, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
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