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Majid IA, Alikutty FK, Qadah HZ, Kofiyh KA, Alsaadi RAD, Alsubhi RM, Irfan AN. Influence of Practice Characteristics on the Adoption of Electronic Dental Records in Jeddah, Saudi Arabia. Healthc Inform Res 2023; 29:239-245. [PMID: 37591679 PMCID: PMC10440202 DOI: 10.4258/hir.2023.29.3.239] [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: 02/13/2023] [Revised: 06/14/2023] [Accepted: 07/13/2023] [Indexed: 08/19/2023] Open
Abstract
OBJECTIVES The adoption of electronic dental records (EDRs) is less extensively studied than electronic medical records (EMRs) in Saudi Arabia. Therefore, a multivariate analysis was conducted to calculate the adoption of EDRs and determine the practice characteristics that influence adoption. METHODS An online survey was conducted with 220 dental practices in Jeddah from August to December 2021. The questionnaire contained 10 items that measured the adoption of EDRs and identified the region, district, practice characteristics, and practice size. A regression analysis was used to ascertain the relationships between EDR adoption and the predictor variables. RESULTS About 93% of the dental practices, we surveyed in Jeddah had adopted EDRs. Public dental practices and large practices were associated with higher rates of adoption (respectively, 97.0%, p = 0.016; 97.8%, p = 0.009). The logistic regression model showed statistically significant results regarding practice characteristics, practice size, and the acceptance of insurance patients. EDR adoption was 89% less likely for private dental practices, 99% less likely for smaller dental practices (≥2 dentists), and 98% less likely in dental practices that did not treat patients with insurance. CONCLUSIONS Our study sample showed a high rate of EDR adoption. Among the participants, public practices, large practices, and practices that treat patients with insurance were the most positively inclined toward EDR adoption.
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Affiliation(s)
- Irfan Adil Majid
- Department of Oral Basic Clinical Sciences, Division of Oral Medicine and Radiology, Ibn Sina National College for Medical Studies, Jeddah,
Saudi Arabia
| | - Fazeena Karimalakuzhiyil Alikutty
- Department of Preventive Dental Sciences, Division of Dental Public Health, Ibn Sina National College for Medical Studies, Jeddah,
Saudi Arabia
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Cruvinel PB, Souza-Gabriel AE, Gonçalves B, De Rossi A, Finco LL, Tirapelli C. Repair of Dental Restorations: A 10-year Retrospective Analysis of Clinical Data. Oper Dent 2022; 47:279-286. [PMID: 35653602 DOI: 10.2341/20-217-c] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/19/2021] [Indexed: 11/23/2022]
Abstract
OBJECTIVES This study collected and analyzed clinical data regarding the repair of dental restorations in patients treated in the clinics of a dental school over 10 years. METHODS AND MATERIALS Data related to repair procedures for permanent tooth restorations were extracted from the digital dental records system and filtered according to year (January 1, 2008, to December 31, 2017), age (<30, 30-60, >60), tooth group, and dental surfaces. Data were analyzed with descriptive statistics in terms of the absolute and relative frequency, and chi-square tests (95% confidence) were used to compare the frequency of repairs between years, age, tooth, and dental surfaces. RESULTS A total of 48,915 dental records were accessed by searching for general restorative procedures, of which 1,408 were repairs of dental restorations on permanent teeth. The number of repairs per year increased over the period assessed, and there was a significant increase in the years 2016 and 2017. Individuals aged between 30 and 60 years received the largest number of repairs, with significantly more repairs than the other groups. Regarding the tooth group and surface, the canines and the incisal and lingual surfaces received the least number of repairs. CONCLUSIONS The number of repairs increased over the study period. When comparing frequencies between groups, those belonging to the 30- to 60-years of age group received more repairs; the least repaired surfaces were the lingual and the incisal.
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Affiliation(s)
- P B Cruvinel
- Pedro Bastos Cruvinel, DDS, PhD, PB, PhD student, Department of Dental Materials and Prosthodontics, School of Dentistry of Ribeirão Preto, University of São Paulo
| | - A E Souza-Gabriel
- Aline Evangelista Souza-Gabriel, DDS, PhD, professor, Department of Restorative Dentistry, School of Dentistry of Ribeirão Preto, University of São Paulo
| | - Bgr Gonçalves
- Breno Gimenez Raffa Gonçalves, DDS, PhD, BGR, undergraduate student, Department of Dental Materials and Prosthodontics, School of Dentistry of Ribeirão Preto, University of São Paulo
| | - A De Rossi
- Andiara De Rossi, DDS, PhD, professor, Department of Children's Clinic, School of Dentistry of Ribeirão Preto, University of São Paulo
| | - L L Finco
- Luciano Luiz Finco, systems analyst, Section of Informatics, School of Dentistry of Ribeirão Preto, University of São Paulo
| | - C Tirapelli
- *Camila Tirapelli, DDS, PhD, professor, Department of Dental Materials and Prosthodontics, School of Dentistry of Ribeirão Preto, University of São Paulo
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Benoit B, Frédéric B, Jean-Charles D. Current state of dental informatics in the field of health information systems: a scoping review. BMC Oral Health 2022; 22:131. [PMID: 35439988 PMCID: PMC9020044 DOI: 10.1186/s12903-022-02163-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 04/06/2022] [Indexed: 11/10/2022] Open
Abstract
Background Over the past 50 years, dental informatics has developed significantly in the field of health information systems. Accordingly, several studies have been conducted on standardized clinical coding systems, data capture, and clinical data reuse in dentistry. Methods Based on the definition of health information systems, the literature search was divided into three specific sub-searches: “standardized clinical coding systems,” “data capture,” and “reuse of routine patient care data.” PubMed and Web of Science were searched for peer-reviewed articles. The review was conducted following the PRISMA-ScR protocol. Results A total of 44 articles were identified for inclusion in the review. Of these, 15 were related to “standardized clinical coding systems,” 15 to “data capture,” and 14 to “reuse of routine patient care data.” Articles related to standardized clinical coding systems focused on the design and/or development of proposed systems, on their evaluation and validation, on their adoption in academic settings, and on user perception. Articles related to data capture addressed the issue of data completeness, evaluated user interfaces and workflow integration, and proposed technical solutions. Finally, articles related to reuse of routine patient care data focused on clinical decision support systems centered on patient care, institutional or population-based health monitoring support systems, and clinical research. Conclusions While the development of health information systems, and especially standardized clinical coding systems, has led to significant progress in research and quality measures, most reviewed articles were published in the US. Clinical decision support systems that reuse EDR data have been little studied. Likewise, few studies have examined the working environment of dental practitioners or the pedagogical value of using health information systems in dentistry. Supplementary Information The online version contains supplementary material available at 10.1186/s12903-022-02163-9.
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Affiliation(s)
- Ballester Benoit
- Pôle d'Odontologie, Assistance Publique des Hôpitaux de Marseille, Marseille, France. .,Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, ISSPAM, Marseille, France.
| | - Bukiet Frédéric
- Pôle d'Odontologie, Assistance Publique des Hôpitaux de Marseille, Marseille, France.,Aix Marseille Univ, CNRS, ISM, Inst Movement Sci, Marseille, France
| | - Dufour Jean-Charles
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, ISSPAM, Marseille, France.,APHM, Hôpital de la Timone, Service Biostatistique et Technologies de l'Information et de la Communication, Marseille, France
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4
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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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Almowil Z, Zhou SM, Brophy S, Croxall J. Concept Libraries for Repeatable and Reusable Research: Qualitative Study Exploring the Needs of Users. JMIR Hum Factors 2022; 9:e31021. [PMID: 35289755 PMCID: PMC8965669 DOI: 10.2196/31021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 11/17/2021] [Accepted: 12/05/2021] [Indexed: 12/05/2022] Open
Abstract
Background Big data research in the field of health sciences is hindered by a lack of agreement on how to identify and define different conditions and their medications. This means that researchers and health professionals often have different phenotype definitions for the same condition. This lack of agreement makes it difficult to compare different study findings and hinders the ability to conduct repeatable and reusable research. Objective This study aims to examine the requirements of various users, such as researchers, clinicians, machine learning experts, and managers, in the development of a data portal for phenotypes (a concept library). Methods This was a qualitative study using interviews and focus group discussion. One-to-one interviews were conducted with researchers, clinicians, machine learning experts, and senior research managers in health data science (N=6) to explore their specific needs in the development of a concept library. In addition, a focus group discussion with researchers (N=14) working with the Secured Anonymized Information Linkage databank, a national eHealth data linkage infrastructure, was held to perform a SWOT (strengths, weaknesses, opportunities, and threats) analysis for the phenotyping system and the proposed concept library. The interviews and focus group discussion were transcribed verbatim, and 2 thematic analyses were performed. Results Most of the participants thought that the prototype concept library would be a very helpful resource for conducting repeatable research, but they specified that many requirements are needed before its development. Although all the participants stated that they were aware of some existing concept libraries, most of them expressed negative perceptions about them. The participants mentioned several facilitators that would stimulate them to share their work and reuse the work of others, and they pointed out several barriers that could inhibit them from sharing their work and reusing the work of others. The participants suggested some developments that they would like to see to improve reproducible research output using routine data. Conclusions The study indicated that most interviewees valued a concept library for phenotypes. However, only half of the participants felt that they would contribute by providing definitions for the concept library, and they reported many barriers regarding sharing their work on a publicly accessible platform. Analysis of interviews and the focus group discussion revealed that different stakeholders have different requirements, facilitators, barriers, and concerns about a prototype concept library.
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Affiliation(s)
- Zahra Almowil
- Data Science Building, Medical School, Swansea University, Swansea, Wales, United Kingdom
| | - Shang-Ming Zhou
- Centre For Health Technology, Faculty of Health, University of Plymouth, Plymouth, United Kingdom
| | - Sinead Brophy
- Data Science Building, Medical School, Swansea University, Swansea, Wales, United Kingdom
| | - Jodie Croxall
- Data Science Building, Medical School, Swansea University, Swansea, Wales, United Kingdom
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Crisan EL, Covaliu BF, Chis DM. A Systematic Literature Review of Quality Management Initiatives in Dental Clinics. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:11084. [PMID: 34769604 PMCID: PMC8582852 DOI: 10.3390/ijerph182111084] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 10/16/2021] [Accepted: 10/17/2021] [Indexed: 12/17/2022]
Abstract
By considering the recently proposed definitions and metrics, oral healthcare quality management (OHQM) emerges as a distinct field in the wider healthcare area. The goal of this paper is to systematically review quality management initiatives (QMIs) implementation by dental clinics. The research methodology approach is a review of 72 sources that have been analyzed using the Context-Intervention-Mechanism-Outcome Framework (CIMO). The analysis identifies five mechanisms that explain how quality management initiatives are implemented by dental clinics. The simplest QMIs implementations are related to (1) overall quality. The next ones, in terms of complexity, are related to (2) patient satisfaction, (3) service quality, (4) internal processes improvement, and (5) business outcomes. This paper is the first attempt to provide a critical review of this topic and represents an important advancement by providing a theoretical framework that explains how quality management is implemented by practitioners in this field. The results can be used by scholars for advancing their studies related to this emerging research area and by healthcare managers in order to better implement their quality management initiatives.
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Affiliation(s)
- Emil Lucian Crisan
- Faculty of Economics and Business Administration, Department of Management, Babes-Bolyai University, 400591 Cluj-Napoca, Romania;
| | - Bogdan Florin Covaliu
- Faculty of Medicine, Department of Community Medicine, Public Health and Management, Iuliu Hatieganu University of Medicine and Pharmacy Cluj-Napoca, 400337 Cluj-Napoca, Romania
| | - Diana Maria Chis
- Faculty of Economics and Business Administration, Department of Finance, Babes-Bolyai University, 400591 Cluj-Napoca, Romania;
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Siddiqui Z, Wang Y, Patel J, Thyvalikakath T. Differences in medication usage of dental patients by age, gender, race/ethnicity and insurance status. Technol Health Care 2021; 29:1099-1108. [PMID: 33896855 DOI: 10.3233/thc-202171] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
BACKGROUND Limited studies have investigated the medication profile of young adult dental patients despite the high prevalence of prescription opioid abuse in this population. OBJECTIVE This study investigated the extent and differences in medication usage of dental patients older than 18 years by age, race/ethnicity, gender, insurance status and mechanism of action in an academic dental clinic setting. METHODS Using an automated approach, medication names in the Electronic Dental Record were retrieved and classified according to the National Drug Code directory. Descriptive statistics, multivariable ANOVA and Post hoc tests were performed to detect differences in the number of medications by patient demographics. RESULTS Of the 11,220 adult patients, 53 percent reported taking at least one medication with significant differences in medication usage by demographics. Hydroxymethylglutaryl-coenzyme A reductase inhibitors (21-36%), and angiotensin-converting enzyme inhibitors (19-23%) ranked the top two medication classes among patients 55 years and older. Opioid agonists (7-14%), and Selective Serotonin Reuptake Inhibitors (SSRIs) (5-12%) ranked the top two medication classes among patients aged 18-54 years. CONCLUSIONS The results underscore the importance of dental providers to review medical and medication histories of patients regardless of their age to avoid adverse events and to determine patient's risk for opioid abuse.
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Affiliation(s)
- Zasim Siddiqui
- Department of Cariology, Operative Dentistry and Dental Public Health, Indiana University School of Dentistry, IUPUI Indianapolis, IN, USA
| | - Yue Wang
- Department of Cariology, Operative Dentistry and Dental Public Health, Indiana University School of Dentistry, IUPUI Indianapolis, IN, USA
| | - Jay Patel
- Department of Cariology, Operative Dentistry and Dental Public Health, Indiana University School of Dentistry, IUPUI Indianapolis, IN, USA
| | - Thankam Thyvalikakath
- Department of Cariology, Operative Dentistry and Dental Public Health, Indiana University School of Dentistry, IUPUI Indianapolis, IN, USA.,Research Scientist, Center for Biomedical Informatics, Regenstrief Institute, Indianapolis, IN, USA
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Elangovan S, Xie XJ, McBrearty C, Caplan DJ. Electronic dental record-based surveillance of non-communicable conditions. Public Health 2021; 193:146-149. [PMID: 33845348 DOI: 10.1016/j.puhe.2021.02.004] [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: 11/14/2020] [Revised: 02/03/2021] [Accepted: 02/05/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE The objective of the study is to demonstrate that electronic dental records (EDRs) can be used to mine meaningful public health information. STUDY DESIGN Retrospective electronic dental chart-based reporting of disease prevalence. METHODS Using dental EDRs (N = 104,768), the authors assessed the prevalence of common non-communicable medical conditions among unique patients seen at a United States (U.S.) dental college. RESULTS The prevalence of following conditions in patients visiting a U.S. dental college increased steadily with increasing age: hypertension, angina, stroke, myocardial infarction, congestive heart failure, diabetes, cancer, kidney disease, thyroid disease, and allergies. Prevalence of these conditions was several-fold higher in the 66+ years group than among younger adults. Prevalence of many of the assessed conditions approximated published national estimates. CONCLUSIONS In addition to the indispensable use of EDRs in dental education and patient management, EDRs can be mined to report on prevalence of non-communicable medical conditions among patients/population receiving dental care. Completeness and accuracy of entered information will significantly improve the usefulness of EDR for disease surveillance and research applications.
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Affiliation(s)
- S Elangovan
- Department of Periodontics, University of Iowa College of Dentistry and Dental Clinics, USA.
| | - X J Xie
- Department of Preventive & Community Dentistry and Associate Dean for Research, University of Iowa College of Dentistry and Dental Clinics, USA
| | - C McBrearty
- University of Iowa College of Dentistry and Dental Clinics, USA
| | - D J Caplan
- Department of Preventive & Community Dentistry, University of Iowa College of Dentistry and Dental Clinics, USA
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Duncan WD, Thyvalikakath T, Haendel M, Torniai C, Hernandez P, Song M, Acharya A, Caplan DJ, Schleyer T, Ruttenberg A. Structuring, reuse and analysis of electronic dental data using the Oral Health and Disease Ontology. J Biomed Semantics 2020; 11:8. [PMID: 32819435 PMCID: PMC7439527 DOI: 10.1186/s13326-020-00222-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2018] [Accepted: 06/09/2020] [Indexed: 01/02/2023] Open
Abstract
Background A key challenge for improving the quality of health care is to be able to use a common framework to work with patient information acquired in any of the health and life science disciplines. Patient information collected during dental care exposes many of the challenges that confront a wider scale approach. For example, to improve the quality of dental care, we must be able to collect and analyze data about dental procedures from multiple practices. However, a number of challenges make doing so difficult. First, dental electronic health record (EHR) information is often stored in complex relational databases that are poorly documented. Second, there is not a commonly accepted and implemented database schema for dental EHR systems. Third, integrative work that attempts to bridge dentistry and other settings in healthcare is made difficult by the disconnect between representations of medical information within dental and other disciplines’ EHR systems. As dentistry increasingly concerns itself with the general health of a patient, for example in increased efforts to monitor heart health and systemic disease, the impact of this disconnect becomes more and more severe. To demonstrate how to address these problems, we have developed the open-source Oral Health and Disease Ontology (OHD) and our instance-based representation as a framework for dental and medical health care information. We envision a time when medical record systems use a common data back end that would make interoperating trivial and obviate the need for a dedicated messaging framework to move data between systems. The OHD is not yet complete. It includes enough to be useful and to demonstrate how it is constructed. We demonstrate its utility in an analysis of longevity of dental restorations. Our first narrow use case provides a prototype, and is intended demonstrate a prospective design for a principled data backend that can be used consistently and encompass both dental and medical information in a single framework. Results The OHD contains over 1900 classes and 59 relationships. Most of the classes and relationships were imported from existing OBO Foundry ontologies. Using the LSW2 (LISP Semantic Web) software library, we translated data from a dental practice’s EHR system into a corresponding Web Ontology Language (OWL) representation based on the OHD framework. The OWL representation was then loaded into a triple store, and as a proof of concept, we addressed a question of clinical relevance – a survival analysis of the longevity of resin filling restorations. We provide queries using SPARQL and statistical analysis code in R to demonstrate how to perform clinical research using a framework such as the OHD, and we compare our results with previous studies. Conclusions This proof-of-concept project translated data from a single practice. By using dental practice data, we demonstrate that the OHD and the instance-based approach are sufficient to represent data generated in real-world, routine clinical settings. While the OHD is applicable to integration of data from multiple practices with different dental EHR systems, we intend our work to be understood as a prospective design for EHR data storage that would simplify medical informatics. The system has well-understood semantics because of our use of BFO-based realist ontology and its representation in OWL. The data model is a well-defined web standard.
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Affiliation(s)
- William D Duncan
- National Center for Ontological Research, Buffalo, NY, USA. .,Center for Biomedical Informatics, Regenstrief institute, Inc., Indianapolis, IN, USA.
| | - Thankam Thyvalikakath
- Center for Biomedical Informatics, Regenstrief institute, Inc., Indianapolis, IN, USA.,Dental Informatics Core, Indiana University School of Dentistry, Indianapolis, IN, USA
| | - Melissa Haendel
- Translational and Integrative Sciences Lab, Oregon State University, Corvallis, OR, USA
| | | | | | - Mei Song
- Magee-Women's Research Institute, Pittsburgh, PA, USA
| | - Amit Acharya
- Marshfield Clinic Research Institute, Marshfield, WI, USA
| | | | - Titus Schleyer
- Center for Biomedical Informatics, Regenstrief institute, Inc., Indianapolis, IN, USA.,Indiana University School of Medicine, Indianapolis, IN, USA
| | - Alan Ruttenberg
- School of Dental Medicine, State University of New York at Buffalo, Buffalo, NY, USA
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10
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Meisha DE. Evaluation of Accuracy and Completeness of Electronic Dental Records in a Dental School Setting. Open Dent J 2019. [DOI: 10.2174/1874210601913010520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background:High-quality data in Electronic Dental Records (EDR) is essential for dental schools to provide high-quality patient care, improve dental students’ professionalism, and support a platform for research. Therefore, ensuring data quality in EDRs is extremely important.Objective:To perform a quality appraisal of EDRs by evaluating their accuracy and completeness.Methods:This was a Cross-sectional Observational Study conducted over four consecutive years in a dental school setting. Manual chart reviews were performed on an annual basis. EDR data were audited for accuracy and completeness. Accuracy was evaluated by comparing the entered data with an external source, where possible. An EDR data field was considered complete if it was not missing.Results:A total of 1,720 de-identified chart reviews were studied. The accuracy of the data to identify the patient was 93%. The completeness of the essential components of EDRs was 48-94%. Completeness was highest for documenting the patient’s chief complaint (94%) and the lowest for recall plan (48%). Completeness of data documenting social and behavioral determinants of health in EDRs was 36-77%, with the highest proportion of completeness in this domain being for oral hygiene habits, smoking habits, and social history.Conclusion:The quality appraisal of EDRs varied according to the data field. Understanding patterns of accuracy and completeness in EDRs will guide training and quality enforcement activities.
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11
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Feasibility and usability of measuring receipt of sealants in 2 states. J Am Dent Assoc 2019; 150:839-845. [PMID: 31561760 DOI: 10.1016/j.adaj.2019.05.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2019] [Revised: 05/20/2019] [Accepted: 05/22/2019] [Indexed: 11/21/2022]
Abstract
BACKGROUND The authors examined the reliability and validity of the Dental Quality Alliance childhood sealant measure under actual use conditions in Texas and Florida. The 2 states provide care for almost 20% of children in Medicaid nationally. METHODS The authors used dental claims data to examine the reliability of the caries risk assessment component of the measure. They examined validity using a 3-year look-back period to identify children who were inaccurately included in the measure denominator as sealant eligible when they were not owing to already sealed, missing, or restored teeth. RESULTS The children identified at elevated risk varied between the states, with 85% at elevated risk in Texas and 39% in Florida in 2017. Different methods can be used to calculate risk, raising questions about reliability. In Texas, 31% of children included in the denominator were not eligible to receive sealants owing to already sealed, missing, or restored teeth. The magnitude of the underestimation increased with age, so by the time children were 9 years old, 40% were not measure eligible yet included in the denominator. Similar results were observed for Florida. CONCLUSIONS The authors propose eliminating the caries risk assessment requirement and incorporating a 3-year look-back period to identify already sealed, missing, or restored molars. PRACTICAL IMPLICATIONS The reliability and validity of the sealant measure needs to be enhanced. Measure misspecification in which children are not correctly identified as needing sealants can contribute to inaccurate development of quality improvement goals, performance improvement projects, or pay-for-quality programs.
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Shimpi N, Ye Z, Koralkar R, Glurich I, Acharya A. Need for diagnostic-centric care in dentistry: A case study from the Marshfield Clinic Health System. J Am Dent Assoc 2019; 149:122-131. [PMID: 29389335 DOI: 10.1016/j.adaj.2017.09.030] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Revised: 09/14/2017] [Accepted: 09/18/2017] [Indexed: 11/29/2022]
Abstract
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.
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White JM, Mertz EA, Mullins JM, Even JB, Guy T, Blaga E, Kottek AM, Kumar SV, Bangar S, Vaderhobli R, Brandon R, Santo W, Jenson L, Gansky SA. Developing and Testing Electronic Health Record-Derived Caries Indices. Caries Res 2019; 53:650-658. [PMID: 31167186 DOI: 10.1159/000499700] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Accepted: 03/18/2019] [Indexed: 12/15/2022] Open
Abstract
Caries indices, the basis of epidemiologic caries measures, are not easily obtained in clinical settings. This study's objective was to design, test, and validate an automated program (Valid Electronic Health Record Dental Caries Indices Calculator Tool [VERDICT]) to calculate caries indices from an electronic health record (EHR). Synthetic use case scenarios and actual patient cases of primary, mixed, and permanent dentition, including decayed, missing, and filled teeth (DMFT/dmft) and tooth surfaces (DMFS/dmfs) were entered into the EHR. VERDICT measures were compared to a previously validated clinical electronic data capture (EDC) system and statistical program to calculate caries indices. Four university clinician-researchers abstracted EHR caries exam data for 45 synthetic use cases into the EDC and post-processed with SAS software creating a gold standard to compare the -VERDICT-derived caries indices. Then, 2 senior researchers abstracted EHR caries exam data and calculated caries indices for 24 patients, allowing further comparisons to VERDICT indices. Agreement statistics were computed among abstractors, and discrepancies were resolved by consensus. Agreement statistics between the 2 final-phase abstractors and the VERDICT measures showed extremely high concordance: Lin's concordance coefficients (LCCs) >0.99 for dmfs, dmft, DS, ds, DT, dt, ms, mt, FS, fs, FT, and ft; LCCs >0.95 for DMFS and DMFT; and LCCs of 0.92-0.93 for MS and MT. Caries indices, essential to developing primary health outcome measures for research, can be reliably derived from an EHR using VERDICT. Using these indices will enable population oral health management approaches and inform quality improvement efforts.
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Affiliation(s)
- Joel M White
- Department of Preventive and Restorative Dental Sciences, University of California, San Francisco, San Francisco, California, USA, .,Center to Address Disparities in Children's Oral Health, University of California, San Francisco, San Francisco, California, USA,
| | - Elizabeth A Mertz
- Department of Preventive and Restorative Dental Sciences, University of California, San Francisco, San Francisco, California, USA.,Center to Address Disparities in Children's Oral Health, University of California, San Francisco, San Francisco, California, USA.,Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, San Francisco, California, USA
| | - Joanna M Mullins
- Willamette Dental Group and Skourtes Institute, Hillsboro, Oregon, USA
| | - Joshua B Even
- Willamette Dental Group and Skourtes Institute, Hillsboro, Oregon, USA
| | - Trey Guy
- Willamette Dental Group and Skourtes Institute, Hillsboro, Oregon, USA
| | - Elena Blaga
- Willamette Dental Group and Skourtes Institute, Hillsboro, Oregon, USA
| | - Aubri M Kottek
- Center to Address Disparities in Children's Oral Health, University of California, San Francisco, San Francisco, California, USA.,Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, San Francisco, California, USA
| | - Shwetha V Kumar
- School of Dentistry, The University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Suhasini Bangar
- School of Dentistry, The University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Ram Vaderhobli
- Department of Preventive and Restorative Dental Sciences, University of California, San Francisco, San Francisco, California, USA
| | - Ryan Brandon
- Willamette Dental Group and Skourtes Institute, Hillsboro, Oregon, USA
| | - William Santo
- Department of Preventive and Restorative Dental Sciences, University of California, San Francisco, San Francisco, California, USA.,Center to Address Disparities in Children's Oral Health, University of California, San Francisco, San Francisco, California, USA
| | - Larry Jenson
- Department of Preventive and Restorative Dental Sciences, University of California, San Francisco, San Francisco, California, USA
| | - Stuart A Gansky
- Department of Preventive and Restorative Dental Sciences, University of California, San Francisco, San Francisco, California, USA.,Center to Address Disparities in Children's Oral Health, University of California, San Francisco, San Francisco, California, USA.,Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, San Francisco, California, USA.,Bakar Computational Health Sciences Institute, University of California, San Francisco, San Francisco, California, USA
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Simon L, Obadan-Udoh E, Yansane AI, Gharpure A, Licht S, Calvo J, Deschner J, Damanaki A, Hackenberg B, Walji M, Spallek H, Kalenderian E. Improving Oral-Systemic Healthcare through the Interoperability of Electronic Medical and Dental Records: An Exploratory Study. Appl Clin Inform 2019; 10:367-376. [PMID: 31141831 PMCID: PMC6541474 DOI: 10.1055/s-0039-1688832] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Accepted: 04/08/2019] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVES Electronic health records (EHRs) are rarely shared among medical and dental providers. The purpose of this study was to assess current information sharing and the value of improved electronic information sharing among physicians and dentists in Germany and the United States. MATERIALS AND METHODS A survey was validated and distributed electronically to physicians and dentists at four academic medical centers. Respondents were asked anonymously about EHR use and the medical and dental information most valuable to their practice. RESULTS There were 118 responses, a response rate of 23.2%. The majority (63.9%) of respondents were dentists and the remainder were physicians. Most respondents (66.3%) rated the importance of sharing information an 8 or above on a 1-to-10 Likert scale. Dentists rated the importance of sharing clinical information significantly higher than physicians (p = 0.0033). Most (68.5%) providers could recall an instance when access to medical or dental information would have improved patient care. Dentists were significantly more likely to report this than physicians (p = 0.008). CONCLUSION Physicians would value a standardized measure of "oral health" in their EHR. Dentists were less likely to find specific medical diagnostic test results of value. Both dentists and physicians agreed that oral-systemic health was important; interoperable EHRs could facilitate information transfer between providers and enhance research on oral-systemic health connections. Both dentists and physicians believed that an interoperable EHR would be useful to practice, but desired information was different between these groups. Refinement of the information needed for shared practice is required.
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Affiliation(s)
- Lisa Simon
- 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, Division of Oral Epidemiology and Dental Public Health, UCSF School of Dentistry, San Francisco, California, United States
| | - Alfa-Ibrahim Yansane
- Department of Preventive and Restorative Dental Sciences, UCSF School of Dentistry, San Francisco, California, United States
| | - Arti Gharpure
- Department of Preventive and Restorative Dental Sciences, UCSF School of Dentistry, San Francisco, California, United States
| | - Steven Licht
- University of Pittsburgh School of Dental Medicine, Pittsburgh, Pennsylvania, United States
| | - Jean Calvo
- Department of Pediatric Dentistry, UCSF School of Dentistry, San Francisco, California, United States
| | - James Deschner
- University Medical Center, University of Mainz, Mainz, Germany
| | - Anna Damanaki
- Department of Periodontology and Operative Dentistry, University Medical Center, University of Mainz, Mainz, Germany
| | - Berit Hackenberg
- Department of Otolaryngology, Head and Neck Surgery, University Medical Center, University of Mainz, Mainz, Germany
| | - Muhammad Walji
- Department of Diagnostic and Biomedical Sciences, Technology Services and Informatics, University of Texas Health Science Center at Houston (UTHealth) School of Dentistry, Houston, Texas, United States
| | - Heiko Spallek
- The University of Sydney School of Dentistry, Westmead, New South Wales, Australia
| | - Elsbeth Kalenderian
- Department of Preventive and Restorative Dental Sciences, UCSF School of Dentistry, San Francisco, California, United States
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Chauhan Z, Samarah M, Unertl KM, Jones MW. Adoption of Electronic Dental Records: Examining the Influence of Practice Characteristics on Adoption in One State. Appl Clin Inform 2018; 9:635-645. [PMID: 30112742 PMCID: PMC6094025 DOI: 10.1055/s-0038-1667331] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Accepted: 06/25/2018] [Indexed: 10/28/2022] Open
Abstract
OBJECTIVE Compared with medicine, less research has focused on adoption rates and factors contributing to the adoption of electronic dental records (EDRs) and certified electronic health records (EHRs) in the field of dentistry. We ran two multivariate models on EDR adoption and certification-capable EHR adoption to determine environmental and organizational factors associated with adoption. METHODS We conducted telephone survey of a 10-item questionnaire using disproportionate stratified sampling procedure of 149 dental clinics in Tennessee in 2017 measuring adoption of dental information technology (IT) (EDRs and certification-capable EHRs) and practice characteristics, including region, rurality, specialty, and practice size. We used binomial logistic regression models to determine associations of adoption with predictor variables. RESULTS A total of 77% of surveyed dental clinics in Tennessee had adopted some type of EDR system. When the definitions of certification capable were applied, the adoption rates in dental clinics dropped to 58%. A binomial logistic regression model for the effects of rurality, specialization, and practice size on the likelihood that a clinic would adopt an EHR product was statistically significant (chi-square (3) = 12.41, p = 0.0061). Of the three predictor variables, specialization and practice size were significant: Odds of adopting an EHR is 67% lower for specialists than for general dentists; and clinics with two or more practicing dentists were associated with a much greater likelihood of adopting an EHR-capable system (adjusted odds ratio = 3.09, p = 0.009). CONCLUSION Findings from this study indicate moderate to high levels of overall dental IT adoption. However, adoption rates in dental clinics do remain lower than those observed in office-based physician practices in medicine. Specialization and practice size were significant predictors of EHR-capable system adoption. Efforts to increase EHR adoption in dentistry should be mindful of potential disparities in smaller practices and between dental specialties and generalists.
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Affiliation(s)
- Zain Chauhan
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, University of Miami, Miami, Florida, United States
- Center for Medicine, Health, and Society, Vanderbilt University, Nashville, Tennessee, United States
| | - Mohammad Samarah
- Computer Science and Big Data Analytics, Florida Polytechnic University, Lakeland, Florida, United States
| | - Kim M. Unertl
- Department of Biomedical Informatics, Vanderbilt University School of Medicine, Vanderbilt University, Nashville, Tennessee, United States
| | - Martha W. Jones
- Center for Medicine, Health, and Society, Vanderbilt University, Nashville, Tennessee, United States
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Acharya A, Schroeder D, Schwei K, Chyou PH. Update on Electronic Dental Record and Clinical Computing Adoption Among Dental Practices in the United States. Clin Med Res 2017; 15:59-74. [PMID: 29229631 PMCID: PMC5849439 DOI: 10.3121/cmr.2017.1380] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Revised: 11/08/2017] [Accepted: 11/21/2017] [Indexed: 11/18/2022]
Abstract
This study sought to re-characterize trends and factors affecting electronic dental record (EDR) and technologies adoption by dental practices and the impact of the Health Information Technology for Economic and Clinical Health (HITECH) act on adoption rates through 2012. A 39-question survey was disseminated nationally over 3 months using a novel, statistically-modeled approach informed by early response rates to achieve a predetermined sample. EDR adoption rate for clinical support was 52%. Adoption rates were higher among: (1) younger dentists; (2) dentists ≤ 15 years in practice; (3) females; and (4) group practices. Top barriers to adoption were EDR cost/expense, cost-benefit ratio, electronic format conversion, and poor EDR usability. Awareness of the Federal HITECH incentive program was low. The rate of chairside computer implementation was 72%. Adoption of EDR in dental offices in the United States was higher in 2012 than electronic health record adoption rates in medical offices and was not driven by the HITECH program. Patient portal adoption among dental practices in the United States remained low.
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Affiliation(s)
- Amit Acharya
- Center for Oral and Systemic Health, Marshfield Clinic Research Institute, Marshfield, Wisconsin, USA
| | - Dixie Schroeder
- Center for Oral and Systemic Health, Marshfield Clinic Research Institute, Marshfield, Wisconsin, USA
| | - Kelsey Schwei
- Center for Oral and Systemic Health, Marshfield Clinic Research Institute, Marshfield, Wisconsin, USA
| | - Po-Huang Chyou
- Biomedical Informatics Research Center, Marshfield Clinic Research Institute, Marshfield, Wisconsin, USA
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Hickin MP, Shariff JA, Jennette PJ, Finkelstein J, Papapanou PN. Incidence and Determinants of Dental Implant Failure: A Review of Electronic Health Records in a U.S. Dental School. J Dent Educ 2017; 81:1233-1242. [PMID: 28966189 DOI: 10.21815/jde.017.080] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2016] [Accepted: 04/08/2017] [Indexed: 11/20/2022]
Abstract
The aim of this study was to use electronic health care records (EHRs) to examine retrospectively the incidence of and attributes associated with dental implant failures necessitating implant removal in a large cohort of patients treated in the student clinics of a U.S. dental school over three and a half years. EHRs were searched for all patients who received dental implants between July 1, 2011, and December 31, 2014. Characteristics of patients and implants that were actively removed due to irrevocable failure of any etiology ("failure cohort") during this period were compared to those of all other patients who received dental implants during the same time frame ("reference cohort"). Differences in the frequency distribution of various characteristics between the failure and reference cohorts were compared. Of a total 6,129 implants placed in 2,127 patients during the study period, 179 implants (2.9%) in 120 patients (5.6%) were removed. In the multivariate analysis, presence of a removable (OR=2.86) or fixed temporary prosthesis (OR=3.71) was statistically significantly associated with increased risk for implant failure. In contrast, antibiotic coverage (pre- and post-surgery OR=0.16; post-surgery only OR=0.38) and implants of certain manufacturers were associated with lower risk of implant failure. In this sizeable cohort of patients receiving care in dental student clinics, the review of EHRs facilitated identification of multiple variables associated with implant failure resulting in removal; however, these findings do not suggest causative relationships. The adopted analytical approach can enhance quality assurance measures and may contribute to the identification of true risk factors for dental implant failure.
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Affiliation(s)
- Matthew Parker Hickin
- Dr. Hickin is a dentist and former resident, Division of Periodontics, Columbia University College of Dental Medicine; Dr. Shariff is a resident, Division of Periodontics, Columbia University College of Dental Medicine; Mr. Jennette is Administrator, Columbia University College of Dental Medicine; Dr. Finkelstein is Associate Professor of Dental Bioinformatics, Center for Bioinformatics and Data Analytics in Oral Health, Columbia University College of Dental Medicine; and Dr. Papapanou is Professor of Dental Medicine, Division of Periodontics, Columbia University College of Dental Medicine
| | - Jaffer A Shariff
- Dr. Hickin is a dentist and former resident, Division of Periodontics, Columbia University College of Dental Medicine; Dr. Shariff is a resident, Division of Periodontics, Columbia University College of Dental Medicine; Mr. Jennette is Administrator, Columbia University College of Dental Medicine; Dr. Finkelstein is Associate Professor of Dental Bioinformatics, Center for Bioinformatics and Data Analytics in Oral Health, Columbia University College of Dental Medicine; and Dr. Papapanou is Professor of Dental Medicine, Division of Periodontics, Columbia University College of Dental Medicine
| | - Philip J Jennette
- Dr. Hickin is a dentist and former resident, Division of Periodontics, Columbia University College of Dental Medicine; Dr. Shariff is a resident, Division of Periodontics, Columbia University College of Dental Medicine; Mr. Jennette is Administrator, Columbia University College of Dental Medicine; Dr. Finkelstein is Associate Professor of Dental Bioinformatics, Center for Bioinformatics and Data Analytics in Oral Health, Columbia University College of Dental Medicine; and Dr. Papapanou is Professor of Dental Medicine, Division of Periodontics, Columbia University College of Dental Medicine
| | - Joseph Finkelstein
- Dr. Hickin is a dentist and former resident, Division of Periodontics, Columbia University College of Dental Medicine; Dr. Shariff is a resident, Division of Periodontics, Columbia University College of Dental Medicine; Mr. Jennette is Administrator, Columbia University College of Dental Medicine; Dr. Finkelstein is Associate Professor of Dental Bioinformatics, Center for Bioinformatics and Data Analytics in Oral Health, Columbia University College of Dental Medicine; and Dr. Papapanou is Professor of Dental Medicine, Division of Periodontics, Columbia University College of Dental Medicine
| | - Panos N Papapanou
- Dr. Hickin is a dentist and former resident, Division of Periodontics, Columbia University College of Dental Medicine; Dr. Shariff is a resident, Division of Periodontics, Columbia University College of Dental Medicine; Mr. Jennette is Administrator, Columbia University College of Dental Medicine; Dr. Finkelstein is Associate Professor of Dental Bioinformatics, Center for Bioinformatics and Data Analytics in Oral Health, Columbia University College of Dental Medicine; and Dr. Papapanou is Professor of Dental Medicine, Division of Periodontics, Columbia University College of Dental Medicine.
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Kannry J, Sengstack P, Thyvalikakath TP, Poikonen J, Middleton B, Payne T, Lehmann CU. The Chief Clinical Informatics Officer (CCIO): AMIA Task Force Report on CCIO Knowledge, Education, and Skillset Requirements. Appl Clin Inform 2016; 7:143-76. [PMID: 27081413 PMCID: PMC4817341 DOI: 10.4338/aci-2015-12-r-0174] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2015] [Accepted: 12/11/2015] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION The emerging operational role of the "Chief Clinical Informatics Officer" (CCIO) remains heterogeneous with individuals deriving from a variety of clinical settings and backgrounds. The CCIO is defined in title, responsibility, and scope of practice by local organizations. The term encompasses the more commonly used Chief Medical Informatics Officer (CMIO) and Chief Nursing Informatics Officer (CNIO) as well as the rarely used Chief Pharmacy Informatics Officer (CPIO) and Chief Dental Informatics Officer (CDIO). BACKGROUND The American Medical Informatics Association (AMIA) identified a need to better delineate the knowledge, education, skillsets, and operational scope of the CCIO in an attempt to address the challenges surrounding the professional development and the hiring processes of CCIOs. DISCUSSION An AMIA task force developed knowledge, education, and operational skillset recommendations for CCIOs focusing on the common core aspect and describing individual differences based on Clinical Informatics focus. The task force concluded that while the role of the CCIO currently is diverse, a growing body of Clinical Informatics and increasing certification efforts are resulting in increased homogeneity. The task force advised that 1.) To achieve a predictable and desirable skillset, the CCIO must complete clearly defined and specified Clinical Informatics education and training. 2.) Future education and training must reflect the changing body of knowledge and must be guided by changing day-to-day informatics challenges. CONCLUSION A better defined and specified education and skillset for all CCIO positions will motivate the CCIO workforce and empower them to perform the job of a 21st century CCIO. Formally educated and trained CCIOs will provide a competitive advantage to their respective enterprise by fully utilizing the power of Informatics science.
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Valenza JA, Taylor D, Walji MF, Johnson CW. Assessing the Benefit of a Personalized EHR-Generated Informed Consent in a Dental School Setting. J Dent Educ 2014. [DOI: 10.1002/j.0022-0337.2014.78.8.tb05790.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- John A. Valenza
- Department of General Practice and Dental Public Health; The University of Texas School of Dentistry at Houston
| | - David Taylor
- Department of Diagnostic and Biomedical Sciences; The University of Texas School of Dentistry at Houston
| | - Muhammad F. Walji
- Department of Diagnostic and Biomedical Sciences and Associate Dean; Technology Services and Informatics; The University of Texas School of Dentistry at Houston
| | - Craig W. Johnson
- The University of Texas School of Biomedical Informatics at Houston
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Walji MF, Kalenderian E, Stark PC, White JM, Kookal KK, Phan D, Tran D, Bernstam EV, Ramoni R. BigMouth: a multi-institutional dental data repository. J Am Med Inform Assoc 2014; 21:1136-40. [PMID: 24993547 PMCID: PMC4215035 DOI: 10.1136/amiajnl-2013-002230] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Few oral health databases are available for research and the advancement of evidence-based dentistry. In this work we developed a centralized data repository derived from electronic health records (EHRs) at four dental schools participating in the Consortium of Oral Health Research and Informatics. A multi-stakeholder committee developed a data governance framework that encouraged data sharing while allowing control of contributed data. We adopted the i2b2 data warehousing platform and mapped data from each institution to a common reference terminology. We realized that dental EHRs urgently need to adopt common terminologies. While all used the same treatment code set, only three of the four sites used a common diagnostic terminology, and there were wide discrepancies in how medical and dental histories were documented. BigMouth was successfully launched in August 2012 with data on 1.1 million patients, and made available to users at the contributing institutions.
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Affiliation(s)
- Muhammad F Walji
- Department of Diagnostic and Biomedical Sciences Office of Technology Services and Informatics, School of Dentistry The University of Texas Health Science Center at Houston
| | - Elsbeth Kalenderian
- Oral Health Policy and Epidemiology Harvard School of Dental Medicine, Boston, Massachusetts, USA
| | - Paul C Stark
- Department of Public Health and Community Service, Tufts University School of Dental Medicine, Boston, Massachusetts, USA
| | - Joel M White
- Department of Preventive and Restorative Dental Sciences, School of Dentistry, University of California, San Francisco, CA, USA
| | - Krishna K Kookal
- Office of Technology Services and Informatics, School of Dentistry The University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Dat Phan
- School of Biomedical Informatics, The University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Duong Tran
- Office of Technology Services and Informatics, School of Dentistry The University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Elmer V Bernstam
- School of Biomedical Informatics, The University of Texas Health Science Center at Houston, Houston, Texas, USA Division of General Internal Medicine, Department of Internal Medicine, Medical School, The University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Rachel Ramoni
- Center for Biomedical Informatics, Harvard Medical School, Boston, Massachusetts, USA
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Funkhouser E, Fellows JL, Gordan VV, Rindal DB, Foy PJ, Gilbert GH. Supplementing online surveys with a mailed option to reduce bias and improve response rate: the National Dental Practice-Based Research Network. J Public Health Dent 2014; 74:276-82. [PMID: 24707895 DOI: 10.1111/jphd.12054] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2013] [Accepted: 02/21/2014] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Dentists in the National Dental Practice-Based Research Network are offered online and mail options for most questionnaire studies. We sought to quantify differences a) in characteristics of dentists who completed a questionnaire online as compared with those who completed a mail option offered to online nonresponders and b) in prevalence estimates for certain practice characteristics. METHODS Invitation letters to participants provided an identification number and log-in code with which to complete the online survey. Nonrespondents received a reminder letter after the fourth week, and after an additional 4-week period, a final reminder was sent, along with a paper questionnaire version, allowing completion online or by paper. RESULTS Of 632 US dentists who completed the survey, 84 (13 percent) used the paper version. Completion by paper was more common among males, older dentists, and those in general practice (P<0.05). The proportions of dentists who used electronic dental records, who consistently used a rubber dam when performing root canals, and who either worked with or employed expanded-function auxiliaries were lower among dentists who completed the survey using the paper-mail version than among those who completed it online; these differences remained significant in models adjusted for gender, age, and practice type. CONCLUSION Even in an era of increasingly electronic communication by dentists, not including a paper option when conducting surveys can result in overestimation of the prevalence of key dental practice characteristics.
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Song M, Liu K, Abromitis R, Schleyer TL. Reusing electronic patient data for dental clinical research: a review of current status. J Dent 2013; 41:1148-63. [PMID: 23603087 PMCID: PMC4141471 DOI: 10.1016/j.jdent.2013.04.006] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2013] [Revised: 04/04/2013] [Accepted: 04/10/2013] [Indexed: 01/07/2023] Open
Abstract
OBJECTIVES The reuse of electronic patient data collected during clinical care has received increased attention as a way to increase our evidence base. The purpose of this paper was to review studies reusing electronic patient data for dental research. DATA SOURCES 1527 citations obtained by searching MEDLINE and Embase databases, hand-searching seven dental and informatics journals, and snowball sampling. STUDY SELECTION We included studies reusing electronic patient data for research on dental and craniofacial topics, alone or in combination with medical conditions, medications and outcomes. Studies using administrative or research databases and systematic reviews were excluded. Three reviewers extracted data independently and performed analysis jointly RESULTS The 60 studies reviewed covered epidemiological (32 studies), outcomes (16), health services research (10) and other (2) topics; were primarily retrospective (58 studies); varied significantly in sample size (9-153,619 patients) and follow-up period (1-12 years); often drew on other data sources in addition to electronic ones (25); but rarely tapped electronic dental record (EDR) data in private practices (3). Type of research was not associated with data sources used, but research topics/questions were. The most commonly reported advantages of reusing electronic data were being able to study large samples and saving time, while data quality and the inability to capture study-specific data were identified as major limitations. CONCLUSIONS Dental research reusing electronic patient data is nascent but accelerating. Future EDR design should focus on enhancing data quality, begin to integrate research data collection and implement interoperability with electronic medical records to facilitate oral-systemic investigations. CLINICAL SIGNIFICANCE Measuring and improving the quality of dental care requires that we begin to reuse electronic patient data collected in practice for clinical research. Practice data can potentially serve as a useful complement to data collected in traditional research studies.
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Affiliation(s)
- Mei Song
- Center for Dental Informatics, Department of Dental Public Health, University of Pittsburgh School of Dental Medicine, Pittsburgh, PA 15261, United States.
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Acharya A, Hernandez P, Thyvalikakath T, Ye H, Song M, Schleyer T. Development and initial validation of a content taxonomy for patient records in general dentistry. Int J Med Inform 2013; 82:1171-82. [PMID: 23838618 DOI: 10.1016/j.ijmedinf.2013.06.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2013] [Revised: 05/18/2013] [Accepted: 06/01/2013] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Develop and validate an initial content taxonomy for patient records in general dentistry. METHODS Phase 1 - obtain 95 de-identified patient records from 11 general dentists in the United States. Phase 2 - extract individual data fields (information items), both explicit (labeled) and implicit (unlabeled), from records, and organize into categories mirroring original field context. Phase 3 - refine raw list of information items by eliminating duplicates/redundancies and focusing on general dentistry. Phase 4 - validate all items regarding inclusion and importance using a two-round Delphi study with a panel of 22 general dentists active in clinical practice, education, and research. RESULTS Analysis of 76 patient records from 9 dentists, combined with previous work, yielded a raw list of 1509 information items. Refinement reduced this list to 1107 items, subsequently rated by the Delphi panel. The final model contained 870 items, with 761 (88%) rated as mandatory. In Round 1, 95% (825) of the final items were accepted, in Round 2 the remaining 5% (45). Only 45 items on the initial list were rejected and 192 (or 17%) remained equivocal. CONCLUSION Grounded in the reality of clinical practice, our proposed content taxonomy represents a significant advance over existing guidelines and standards by providing a granular and comprehensive information representation for general dental patient records. It offers a significant foundational asset for implementing an interoperable health information technology infrastructure for general dentistry.
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Affiliation(s)
- Amit Acharya
- Biomedical Informatics Research Center, Marshfield Clinic Research Foundation, Marshfield, WI, USA.
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Liu K, Acharya A, Alai S, Schleyer TK. Using electronic dental record data for research: a data-mapping study. J Dent Res 2013; 92:90S-6S. [PMID: 23690362 PMCID: PMC3706179 DOI: 10.1177/0022034513487560] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Anecdotal evidence suggests that, during the clinical care process, many dental practices record some data that are also collected in dental practice based research network (PBRN) studies. Since the use of existing, electronically stored data for research has multiple benefits, we investigated the overlap between research data fields used in dental PBRN studies and clinical data fields typically found in general dental records. We mapped 734 unique data elements from the Dental Information Model (DIM) to 2,487 Common Data Elements (CDE) curated by the NIDCR's PBRNs in the Cancer Data Standards Registry and Repository (caDSR). Thirty-three percent of the DIM data elements matched at least one CDE completely and 9% partially, translating to about 9% and 2%, respectively, of all data elements used in PBRN studies. The most frequently used CDEs found in the DIM included data about dental anatomy, medications, and items such as oral biopsy and caries. Our study shows that a non-trivial number of data elements in general dental records can be mapped either completely or partially to data fields in research studies. Further studies should investigate the feasibility of electronic clinical data for research purposes.
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Affiliation(s)
- K Liu
- Center for Dental Informatics, Department of Dental Public Health, University of Pittsburgh School of Dental Medicine, Pittsburgh, PA 15261, USA.
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Garcia I, Kuska R, Somerman MJ. Expanding the foundation for personalized medicine: implications and challenges for dentistry. J Dent Res 2013; 92:3S-10S. [PMID: 23690361 DOI: 10.1177/0022034513487209] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Personalized medicine aims to individualize care based on a person's unique genetic, environmental, and clinical profile. Dentists and physicians have long recognized variations between and among patients, and have customized care based on each individual's health history, environment, and behavior. However, the sequencing of the human genome in 2003 and breakthroughs in regenerative medicine, imaging, and computer science redefined "personalized medicine" as clinical care that takes advantage of new molecular tools to facilitate highly precise health care based on an individual's unique genomic and molecular characteristics. Major investments in science bring a new urgency toward realizing the promise of personalized medicine; yet, many challenges stand in the way. In this article, we present an overview of the opportunities and challenges that influence the oral health community's full participation in personalized medicine. We highlight selected research advances that are solidifying the foundation of personalized oral health care, elaborate on their impact on dentistry, and explore obstacles toward their adoption into practice. It is our view that now is the time for oral health professionals, educators, students, researchers, and patients to engage fully in preparations for the arrival of personalized medicine as a means to provide quality, customized, and effective oral health care for all.
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Affiliation(s)
- I Garcia
- National Institute of Dental & Craniofacial Research, National Institutes of Health, 31 Center Drive, MSC 2290, Bethesda, MD 20892-2290, USA
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