University of Pittsburgh United Concordia National Dental Advisory Council

Building a bridge to the future with informatics

Titus Schleyer, DMD, PhD March 6-8, 2013

Center for Dental

Titus Schleyer, 2013

Outline
Electronic dental records: A status report Towards quality in healthcare (and dentistry) Going forward: The journey of 1,000 steps

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Healthcare: The vision

Our vision is for a healthcare system that draws on the best evidence to provide the care most appropriate to each patient, emphasizes prevention and health promotion, delivers the most value, adds to learning throughout the delivery of care, and leads to improvements in the nations health.
Institute of Medicine, Roundtable on Value & Science-Driven Health Care
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Electronic health records: The reality

[image not shown due to copyright restrictions]

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Electronic dental records: A status report

N. Dappen, http://www.daysedgeproductions.com/, 2012 5 of 32

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Dentrix Dental Systems

founded: 1985, acquired by Henry Schein in 1997 products: Dentrix, Easy Dental, Dentrix Enterprise, Specialty, LabNet, DDX, eServices, etc. # customers/market share: 45,000/37% cost: about $6,000 for base system

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Eaglesoft
founded: 1993, acquired by Patterson in 1997 products: Eaglesoft, CAESY, Dolphin Imaging, Dolphin Management, Patterson Imaging, eServices, etc. # customers/market share: 24,500/18% cost: free

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CareStream (formerly Kodak)

founded: 1983, became Carestream Dental 2007 products: PracticeWorks, SoftDent, etc. market share: 20% cost: as low as $6,000 for base system

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Smaller companies
Mogo
(www.mogo.com)

Curve Dental
(www.curvedental.com)

Dental Symphony
(www.dentalsymphony.com)

etc.
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Adoption of EDRs

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Usability problems in EDRs

Thyvalikakath T et al. Usability of four practice management systems, JADA, 2008 11 of 32

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Record a missing tooth correct path

Record a missing tooth user paths

Conclusions on usability
Significant usability problems due to:
complex information design mismatch between system and user model

difficulty in finding functionality

Participants had to exert cognitive effort that did not contribute to task completion.

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Information content of (electronic) dental records

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Fields in dental record formats

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Dental record formats - conclusions

Little agreement on content of dental records:
BDR: 367 clinical data fields paper and computer records: ~60% of BDR fields 20 percent of all BDR fields in >= 5 paper records

Paper records and CPRs correspond relatively well at the category, but not field, level:
good agreement on categories except diagnosis and risk assessment CPRs only contain 57% of fields in >= 5 paper records.

Schleyer TK, Spallek H, Hernandez P. A qualitiative investigation of the content of dental paper- and computer- based patient record (CPR) formats, JAMIA, 2007 17 of 32

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Why we love paper

Paper is flexible. Have you ever done this to your iPad?

http://www.flickr.com/flickrfavorites 2013

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Towards quality in healthcare

http://www.flickr.com/photos/wasabifish/2386306318/, 2012 19 of 32

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iom.edu/bestcare

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Patient care improved

Patient data generated during clinical encounter

Learning Healthcare System

Clinical questions answered

Data captured in EHR

Data extracted and analyzed

https://vimeo.com/50843791
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How many studies have reused EDR data for dental clinical research? literature review 1,448 citations obtained through:
MEDLINE and Embase hand-searching selected journals snowball sampling

narrative synthesis

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Reuse of EDR Data for Dental Clinical Research

Song M et al. Reusing electronic patient data for dental clinical research: A baseline review (in review)

How much data in EDRs could be reused for research?

dental research data
dental PBRNs in existence for 8 years

variety of studies on clinical topics such as caries, ONJ, outcomes of RCTs, etc.
all research data elements catalogued

EDR data
dental record information content study augmented by actual patient data
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Data sources and method

Dental Information Model (DIM) 986 (734 unique) data elements (DE) from: 10 paper- and 4 computer-based dental record formats 76 de-identified patient records from 9 dentists
match caDSR Common Data Elements 2,487 research data elements derived from: 25 dental PBRN studies 102 case report forms
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DIM to caDSR mapping results

DIM data elements that matched at least one caDSR data element:
complete 245 (33%) partial none 61 (8%) 428 (58%) 2 89

% of caDSR

Liu K et al. Use of clinical information for research in dental PBRNs: A data mapping study (in review) 27 of 32

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Going forward: The journey of 1,000 steps

Grand Tetons T. Schleyer, 2013 28 of 32

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Recommendations: EDR data

start reusing EDR data, e.g. with DQA measures develop a CQI approach for data map and homogenize EDR data from various sources leverage existing data for disease surveillance, comparative effectiveness research, disease registries, etc.
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Recommendations: Workforce
successful reuse of data requires dentists, researchers, statisticians, informaticians, etc. need to develop capacity We have an informatics competency shortage! existing programs
dental informatics biomedical informatics
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Last a small advertisement

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Thank you for your attention!

Download this talk: Contact info:
now: titus@pitt.edu starting in June: schleyer@regenstrief.org

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References
Schleyer T et al. Electronic dental record use and clinical information management patterns among practitioner-investigators in The Dental Practice-Based Research Network. J Am Dent Assoc, 2013 Thyvalikakath T et al. A usability evaluation of four commercial dental computer-based patient record systems. J Am Dent Assoc 2008 Dec;139(12):1632-42 Schleyer T et al. A qualitative investigation of the content of dental paper-based and computer-based patient record formats. J Am Med Inform Assoc 2007;14(4):515-26
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References
Smith M et al. Best care at lower cost: The path to continuously learning health care in America, The National Academies Press, 2012 Song M et al. Reusing electronic patient data for dental clinical research: A baseline review (in review) Liu K et al. Reusing clinical data for research in dental PBRNs: A data mapping study (in review) Introduction to Health Information Technology in Dentistry online course, http://dentalinformatics.org/blog/?p=617

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