dental informatics: time to join the revolution?
DESCRIPTION
The “digitization” of dental practice is rapidly progressing, but there is a large gap between the clinical and administrative use of computers. Almost all dental practices have a computer, but only a minute fraction of general dentists (1.8%) use it in the operatory. Challenges to improving oral health include documenting patient care, translating best evidence into practice, advancing knowledge through practice-based research and going beyond “drill-and-fill.” Most patient documentation is incidental, incomplete, fragmented and recorded after the appointment, making it difficult to use it for research and quality improvement. Despite an ever-increasing quantity of evidence-based resources, it is difficult for practitioners to access these resources in an efficient, timely and easy manner during patient care. While the NIDCR has initiated practice-based research in dentistry, only a small number of dentists are aware of this initiative, and many fewer participate in it. Going beyond “drill-and-fill” requires a wholesale shift in how practitioners learn about and use the latest advances emerging from dental and craniofacial research. Yet, technologically, the opportunities for addressing these needs and problems have never been greater. This presentation will review how selected dental informatics research projects can help solve some long-standing problems in dental research and practice. Join the “dental informatics revolution” by becoming a member of the Dental Informatics Online Community, participating in dental informatics research, completing an online dental informatics certificate or getting an advanced degree in dental informatics. The sky is the limit!TRANSCRIPT
Dental informatics: Time to join the revolution?
Center for Dental InformaticsUniversity of Pittsburgh School of Dental Medicine
University of Pittsburgh SDMStudent Research Group Grand Rounds
October 24, 2010
Titus Schleyer, DMD, [email protected]
Jules Eugène Lenepveu (French, 1819-1898), Jeanne d'Arc en armure devant Orléans
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Learning objectives
• describe the adoption and use of information technology in general dentistry
• discuss research challenges in oral health and potential informatics solutions
• join the “dental informatics revolution”
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Adoption and use of information technology in general dentistry
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Computerization in general practice
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Storage of patient information
Billing
Charting and imaging
Other
Schleyer TK, Thyvalikakath TP, Spallek H, Torres-Urquidy MH, Hernandez P, Yuhaniak J. Clinical computing in general dentistry. JAMIA, 2006
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Challenges to improving oral health
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Challenges to improving oral health
• Documenting patient care
• Translating best evidence into practice
• Advancing knowledge through practice-based research
• Going beyond “drill-and-fill”
Sources: NIDCR Strategic Plan 2009-2013, ADA Research Agenda 2010-11
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Challenges to improving oral health
• Documenting patient care
• Translating best evidence into practice
• Advancing knowledge through practice-based research
• Going beyond “drill-and-fill”
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Documenting patient care
• Why do you document patient care? Because …– we tell you to.– you might get sued if you don’t.– you need an idea of what you did last time.
• Why should you document patient care? To help …– you deliver better care.– understand the epidemiology of dental disease and its
trends.– improve dental care for all.
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How we could document:Natural language processing
Jeannie Irwin. Speech to chart: speech recognition and natural language processing for dental charting. PhD thesis. 2009.
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NLP prototype
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ONYX semantic model
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Challenges to improving oral health
• Documenting patient care
• Translating best evidence into practice
• Advancing knowledge through practice-based research
• Going beyond “drill-and-fill”
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Translating best evidence into practice
ADA definition:
“Evidence-based dentistry (EBD) is an approach to oral health care that requires the judicious integration of systematic assessments of clinically relevant scientific evidence, relating to the patient's oral and medical condition and history, with the dentist's clinical expertise and the patient's treatment needs and preferences.”
ADA Policy on Evidence-based Dentistry, 2/2008
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Translating best evidence into practice
Clinicalexpertise
Patients’needs &
preferences
Evidence
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A clinical question: Splinting …
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Implementing Research Findings and Evidence-Based Interventions (PI: Spallek)
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Challenges to improving oral health
• Documenting patient care
• Translating best evidence into practice
• Advancing knowledge through practice-based research
• Going beyond “drill-and-fill”
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Advancing knowledge through practice-based research
• workflows for practice-based research and clinical care separate
• research and clinical data separately acquired
• data formats/storage different
• data duplication errors , inconsistencies
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Paper-based patient record formats
Schleyer TK, Spallek H, Hernandez P. A qualitiative investigation of the content of dental paper- and computer- based patient record (CPR) formats (JAMIA, 2007)
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Fields in dental record formats
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Fields in dental record formats
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Order from chaos - an information model for general dentistry
• extract data from ~100 de-identified patient records
• combine with results from previous studies
• validate information item list (~1,100 fields) through Delphi study
• construct information model
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A brief tour of the Electronic Dental Record Information Model
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Challenges to improving oral health
• Documenting patient care
• Translating best evidence into practice
• Advancing knowledge through practice-based research
• Going beyond “drill-and-fill”
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Going beyond “drill-and-fill”
• Examples:– genetic basis of caries, periodontal disease,
cleft lip and palate, and oral cancer– oral-systemic connections– behavioral and environmental risk factors
Today, we have an unprecedented level of understanding of the etiology and biology of oral and craniofacial disease.
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Implementation and Evaluation of a Risk Assessment Tool for Periodontal Disease
(PI: Thyvalikakath)
• Determine knowledge, beliefs and attitudes of clinicians
• Evaluate changes in clinicians’ decision-making• Integrate the risk assessment tool with a
commercial electronic dental record and evaluate
Specific aims:
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How do we meet these challenges?
By getting you involved!
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How can you get involved?
• Join the Dental Informatics Online Community
• Participate in dental informatics research
• Complete an online dental informatics certificate (2011)
• Get an advanced degree in dental informatics
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The Dental Informatics Online Community
• established in 2007• > 1,000 members from 30 countries• self-declared interest in DI• emphasizes access to discipline• resources:
– member directory– tutorials and white papers– publication archive– project directory
• www.dentalinformatics.org
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Dental informatics research (dental students)
• Time utilization in clinical dentistry (Diane Ko, 2010)• Development of a 3D model for patient records in
general dentistry (Andrew Martin, 2008) • Development of a controlled terminology for dental
diagnoses and findings (Jonathan Misner, 2008) • Influence of a 3D model on clinical decision-making in
general dentistry (Amat Kamat, 2007) • Interacting with information during dental charting
(Colleen Dugan, 2005) • Appropriateness of a practice management system for
dental clinical documentation: Usability (Bryce Larsen, 2004)
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Dental informatics online certificate
• online offering through the Department of Biomedical Informatics
• Five courses– Introduction to health information technology in
dentistry– Dental informatics research– Principles of health informatics– Applied medical informatics– Software engineering
• expected start: 2011
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Dental informatics degree
• degree options– Masters (36 credits, 2 years)– PhD (72 credits, 3-5 years)
• full tuition remission and stipend through NIDCR
• 35 trainees, > 40 faculty
• offered through DBMI, one of the leading informatics departments in the US
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Thank You for Your Attention!Questions, comments?
(Yeah!)
H. Torres-Urquidy
P. Hernandez J. Irwin A. Acharya
V. Monaco
… and many others.
H. Spallek
Thanks to:
W. Chapman
T. Thyvalikakath
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Please visit us at:http://di.dental.pitt.eduTwitterFacebook /titusschleyerScribd }
Thank You for Your Attention!Questions, comments?
(Yeah!)
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Suggested readings
• Papers at CDI Publications, specifically– Informatics innovation in clinical care: a visionary scenario for
dentistry (Schleyer et al.)– A preliminary model of work during initial examination and
treatment planning appointments (Irwin et al.)– Electronic dental record information model (Acharya et al.)– A usability evaluation of four commercial dental computer-based
patient record systems (Thyvalikakath et al.)– A qualitative investigation of the content of dental paper- and
computer-based patient record formats (Schleyer et al.)• NIDCR Strategic Plan 2009-2013• ADA Research Agenda 2010-11• J. D. Bader.
Challenges in quality assessment of dental care. J Am Dent Assoc 140 (12):1456-1464, 2009.