Discrepancy in medications reported by elderly patients in the dental office and in their electronic medical records: A pilot study

AIMS

This study's main objective was to analyze the discrepancy between the dental medication record (DMR) and the physician-prescribed active medications recorded in the medical medication record (MMR).

METHODS

The study group consisted of 100 adults who attended the University Dental Clinic (Santiago de Compostela, Spain) requesting dental care. A dental history was created for all participants that included the DMR. The MMR were compiled from their electronic medical records.

RESULTS

About 80% of the patients consumed at least one drug (94.2% of those >65 years) and 19% took more than five drugs (26.4% of those > 65 years). In total, 54% of the patients had some discrepancy between the medications recorded in the DMR and those in the MMR (48.4% for those ≤65 years and 64.7% for those >65 years). The rate of participants who omitted some drugs was higher for those >65 years. The drugs most omitted from the DMR were analgesics/opioids, antihypertensives and anxiolytics/hypnotics/sedatives.

CONCLUSIONS

It is imperative to access the MMR of patients requesting dental care because a significant number of medications are not reflected in their DMR. These discrepancies may be particularly common and relevant in elderly patients, in whom multimorbidity and polypharmacy are more frequent.

Dentists' Information Needs and Opinions on Accessing Patient Information via Health Information Exchange: Survey Study

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.

Informatics approaches to improve the quality of dental care

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.

Informational Needs for Dental-Oriented Electronic Health Records from Dentists' Perspectives

INTRODUCTION

Information technology is vital to support dental care services and is yet to be thoroughly investigated. This study aims to assess the dentists' needs and requirements for health records from dental care providers' perspectives.

METHODS

In-depth interviews were conducted with dentists during clinic practices. This qualitative research method involves exploring the information and functions dentists use to obtain information from EHR. The target population is the dental staff interacting with the patients and accessing the electronic health records in the government and private sectors.

RESULTS

Thirty-five dentists were interviewed directly after the treatment session and asked four pre-defined questions, the dentists' needs were collected, and the met and unmet needs were presented. The interview results revealed 42 needs (15 were met and 27 were unmet), with an average of 1.17 needs per session. The information needs were categorized into foreground and background information needs and reported in nine main themes.

DISCUSSION

The interviews were analyzed, and as a result, nine themes were generated: chief complaints and symptoms, medical and health history, medications, visual representations of the problem, treatment procedures, X-ray services, needs related to advanced features, needs related to insurance coverage, and finally, information needs related to the treatment environment. The required information and functions mentioned by dentists in the study emphasize the need for integrated modules for oral and medical care services. Generally, it is evident that dentists have substantial unmet needs, and the desired EHR should have functions that cover all dentists' needs.

CONCLUSION

The study's findings demonstrate gaps between current and desired EHR to serve dentists' needs. Dentists need better access to patient history and medical information, progress notes, and X-rays to provide visualization tools for problems and patient charts. Moreover, essential needs were related to messaging capability, educational tools, availability of tutorial videos, and accessing external resources. Information needs were described and should be considered when designing EHR to meet all dentists' needs.

The Changing Face of Dentistry: Perspectives on Trends in Practice Structure and Organization

KNOWLEDGE TRANSFER STATEMENT

This perspective is intended to stimulate thoughts by clinicians, researchers, and educators about needed trends to the dental profession. With consideration of changes needed within the dental profession, improvements and implementation of diagnostic coding and value-based care could result in improved oral health for numerous Americans.

Translating Science into Improved Health for All

Our world is at a turning point with biological and social pathogens wreaking havoc at the same time that science and technology are exploding with new discoveries. It is a pivotal time for the new report Oral Health in America: Advances and Challenges to be released and a pivotal time for our profession to take action and lead. The art, science, and practice of dentistry is very different from 20 y ago when the original Surgeon General's report was released. We are on the precipice of individualized health care where providers will collaborate to deliver diagnostics and therapeutics that are data driven and inclusive of the social determinants of health. To move forward with alacrity requires a strong scientific foundation, effective educational approaches, an understanding of the upstream determinants of health, and partnerships across the health professions and beyond. Oral health has never been more important, and now is the time for our profession to further develop, elevate, and translate the science into practice and policy to improve the nation's health.

Retrospective Study of the Reasons and Time Involved for Dental Providers' Medical Consults

Background

Patient-reported medical histories and medical consults are primary approaches to obtaining patients' medical histories in dental settings. While patient-reported medical histories are reported to have inconsistencies, sparse information exists regarding the completeness of medical providers' responses to dental providers' medical consults. This study examined records from a predoctoral dental student clinic to determine the reasons for medical consults; the medical information requested, the completeness of returned responses, and the time taken to receive answers for medical consult requests.

Methods

A random sample of 240 medical consult requests for 179 distinct patients were selected from patient encounters between 1 January 2015 and 31 December 2017. Descriptive statistics and summaries were calculated to determine the reasons for the consult, the type of information requested and returned, and the time interval for each consult.

Results

The top two reasons for medical consults were to obtain more information (46.1%) and seek medical approval to proceed with treatment (30.3%). Laboratory and diagnostic reports (56.3%), recommendations/medical clearances (39.6%), medication information (38.3%), and current medical conditions (19.2%) were the frequent requests. However, medical providers responded fewer times to dental providers' laboratory and diagnostic report requests (41.3%), recommendations/medical clearances (19.2%), and current medical conditions (13.3%). While 86% of consults were returned in 30 days and 14% were completed after 30 days.

Conclusions

The primary reasons for dental providers' medical consults are to obtain patient information and seek recommendations for dental care. Laboratory/diagnostic reports, current medical conditions, medication history, or modifications constituted the frequently requested information. Precautions for dental procedures, antibiotic prophylaxis, and contraindications included reasons to seek medical providers' recommendations. The results also highlight the challenges they experience, such as requiring multiple attempts to contact medical providers, the incompleteness of information shared, and the delays experienced in completing at least 25% of the consults.

Practical Implications

The study results call attention to the importance of interdisciplinary care to provide optimum dental care and the necessity to establish systems such as integrated electronic dental record-electronic health record systems and health information exchanges to improve information sharing and communication between dental and medical providers.

Using Electronic Dental Records to Assess Osteoradionecrosis Risk in Irradiated Head and Neck Cancer

OBJECTIVE

Over the last 2 decades, investigations have demonstrated a decreased trend in the likelihood of osteoradionecrosis of the jaw (ORNJ) after extraction. The aim of this study was to explore the potential risk factors for ORNJ in irradiated head and neck cancer by using patients' electronic dental records (EDRs).

METHODS

Patients diagnosed with head and neck cancer who had irradiation between January 2010 and December 2020 were included in this retrospective cohort analysis. Patient charts showing evidence of "head and neck cancer," "oral cancer," "radiotherapy," "radiation," and "oral complication" were identified by an informatics analyst querying the EDR. Subsequently, the charts were manually reviewed, and data quality was assessed on 3 dimensions: completeness, accuracy, and consistency. The patient, tumor, systemic condition/drug, oral condition, treatment/trauma, and radiation were all categorized as potential risk factors.

RESULTS

A total of 359 patients were included. With the exception of radiation-related factors, we found that the data quality was generally sufficient to support the research. Multivariate logistic regression analysis demonstrated that the following factors were significant in predicting the occurrence of ORNJ development in irradiated head and neck cancer: smoking (odds ratio [OR], 9.0; 95% CI, 1.9 to 43.0; P = 0.006), steroid use (OR, 6.4; 95% CI, 1.3 to 30.8; P = 0.021), oral health status (OR, 23.7; 95% CI, 2.7 to 211.0; P = 0.005), and postirradiation extraction (OR, 3.8; 95% CI, 1.0 to 14.4; P = 0.050).

CONCLUSIONS

A 10-y retrospective analysis of data from an EDR revealed that smoking, steroid use, poor oral status, and postirradiation extraction are all factors linked to an increased risk of developing ORNJ. The quality of EDR data may be systematically assessed by determining the completeness, accuracy, and consistency of the underlying data. Radiation-related factors in particular were poorly documented, highlighting the need for collecting or incorporating this information into the EDR.

KNOWLEDGE TRANSFER STATEMENT

EDRs can be used to identify risk factors for developing ORNJ in irradiated head and neck cancer and can help clinicians with selecting treatments by incorporating risk and complication considerations.

How Do Dental Clinicians Obtain Up-To-Date Patient Medical Histories? Modeling Strengths, Drawbacks, and Proposals for Improvements

Background

Access 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.

Methods

There 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.

Results

From 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.

Conclusions

We 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.

Development of an electronic learning progression dashboard to monitor student clinical experiences

INTRODUCTION

Clinical experience tracking mechanisms for students at dental schools provide patient assignment, student experience, and learning progression feedback. The purpose of this study was to evaluate dental students' clinical experiences following the implementation of a learning progression dashboard (LPD).

METHODS

After developing and deploying an electronic LPD using PHP, secondary data analysis on dental students' clinical experiences from 2017-2019 was conducted. Student experience differences were compared between the year before continuous use of the LPD and the first year using it. LPD data contained the required clinical procedures dentistry students must perform across all disciplines and the number of planned, in progress, and completed tasks each student has accomplished. Using two time points, the students' experiences were compared. Univariate statistics and independent t-tests were conducted in R for detecting the differences in the number and categories of codes.

RESULTS

The number and category of codes showed significant differences between the academic year 2017-2018 and 2018-2019 for both third- and fourth-year dental students after one and two terms. Overall, students recorded a 26% greater number of treatment codes and experienced a 26% greater number of code categories compared to the previous year.

CONCLUSION

Applying information management methods such as dashboards can better inform educators on student clinical experiences and improve clinical learning outcomes for students.

Prevalence of Obstructive Sleep Apnea Syndrome: A Single-Center Retrospective Study

Obstructive sleep apnea syndrome (OSAS) is a sleep breathing disorder that often remains undiagnosed and untreated. OSAS prevalence is increasing exponentially. Starting on the dentist's role as an epidemiological and diagnostic "sentinel", the purpose of this study was to assess the prevalence of OSAS. The clinical diaries of 4659 patients were reviewed through a single-center retrospective analytic study. Descriptive statistical analysis was performed. Only 0.26% of patients reported to suffer from sleep apnea and were then diagnosed with OSAS. It was found that, out of 4487 patients, 678 suffered from hypertension (14.80%), 188 from gastro-esophageal-reflux-disease (GERD = 4.10%) and 484 from gastritis (10.78%). These results could be related to a difficult diagnosis of OSAS and to the absence of a dedicated section on sleep disorders in medical records. Therefore, the introduction of a question dedicated to sleep disorders, the administration of questionnaires (such as the STOP-BANG questionnaire) for early diagnosis, a multidisciplinary approach and pneumological examination could support the dentist in identifying patients at risk of OSAS.

Agreement in Medications Reported in Medical and Dental Electronic Health Records

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.