building a bridge to the future with informatics

7/28/2019 Building a bridge to the future with informatics

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University of Utah

School of DentistryBuilding a bridge to the

future with informatics

Titus Schleyer, DMD, PhDApril 17, 2013

Center for Dental

University of Pittsburgh

Titus Schleyer, 2013


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Center for Dental2 of 32

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 healthpromotion, delivers the most value, adds

to learning throughout the delivery of

care, and leads to improvements in thenations health.

Institute of Medicine, Roundtable on Value & Science-Driven Health Care


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Electronic health records: The reality

The New Yorker, 2012


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Electronic dental records:

A status report

N. Dappen, http://www.daysedgeproductions.com/, 2012


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Dentrix Dental Systems

founded: 1985, acquired by HenrySchein 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 in1997

products: Eaglesoft, CAESY, DolphinImaging, Dolphin Management,Patterson Imaging, eServices, etc.

# customers/market share: 24,500/18%

cost: free


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CareStream (formerly Kodak)

founded: 1983, became CarestreamDental 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.
http://www.mogo.com/http://www.curvedental.com/http://www.dentalsymphony.com/http://www.dentalsymphony.com/http://www.curvedental.com/http://www.mogo.com/


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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


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Record a missing tooth correct path


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Record a missing tooth user paths


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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 thatdid 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 atthe 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 ofdental paper- and computer- based patient record (CPR) formats, JAMIA, 2007


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Paper is flexible.

Have you everdone this to youriPad?

Why we love paper

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


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Towards quality in healthcare

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


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iom.edu/bestcare


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Data extracted

and analyzed

Patient data generated

during clinical encounter

Data captured in

EHR

Clinicalquestions

answered

Patient care

improved

Learning

Healthcare

System


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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, JoD (in print)


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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 ascaries, 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 recordformats

76 de-identified patient records from 9 dentists

caDSR Common Data Elements

2,487 research data elements derived from: 25 dental PBRN studies

102 case report forms

match


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DIM to caDSR mapping results

DIM data elements that matched at leastone caDSR data element:

complete partial none245 (33%) 61 (8%) 428 (58%)

% of

caDSR 9 2 89

Liu K et al. Use of clinical information for research in dental PBRNs: A data mapping study, JDR (in print)


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Going forward:

The journey of1,000 steps

T. Schleyer, 2013Grand Tetons T. Schleyer, 2013


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Recommendations: EDR data

start reusing EDR data, e.g. with DQAmeasures

develop a CQI approach for data

map and homogenize EDR data fromvarious sources

leverage existing data for disease

surveillance, comparative effectivenessresearch, disease registries, etc.


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Recommendations: Workforce

successful reuse of data requiresdentists, researchers, statisticians,informaticians, etc.

need to develop capacity We have aninformatics competency shortage!

existing programs

dental informatics

biomedical informatics


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Last a small advertisement
http://dentalinformatics.org/blog/?p=617


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Thank you for your attention!

Contact info:

now: [email protected] starting in June:

[email protected]

Download this talk:


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References

Schleyer T et al. Electronic dental record use andclinical 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 fourcommercial 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-basedpatient record formats. J Am Med Inform Assoc2007;14(4):515-26


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References

Smith M et al. Best care at lower cost: The path tocontinuously learning health care in America, TheNational 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

building a bridge to the future with informatics

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