the feasibility of an electronic dental practice-based research network

8/4/2019 The feasibility of an electronic dental practice-based research network

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The feasibility of an

electronic dentalpractice-based

research network

Center for Dental Informatics

University of Pittsburgh School of Dental Medicine

Titus Schleyer, DMD, PhD

Center for Dental Informatics Research

Seminar

September 30, 2011

Denia, Spain Titus Schleyer 2011


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2 of 25Center for Dental InformaticsUniversity of Pittsburgh School of Dental Medicine

The problem

Practice-based research is crucial forimproving oral health. However, collectingresearch data across the geographically

dispersed PBRN settings is a challenge.


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Practice-based research crucial forimproving oral health

research findings of practical relevancefrom PBRNs

continued focus on practice-based

research at the NIDCR ($75m 2005-12,$70m 2012-19)

currently over 1,400 practitioner-

investigators more than 50 studies completed or in

progress


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Sample PBRN studies

Risk factors for osteonecrosis of the jaws: acase-control study

Use of caries preventive agents in children

Restorative treatment thresholds for

interproximal caries based on radiographicimages

Postoperative hypersensitivity in Class Iresin-boned composite restorations ingeneral practice

Inter-examiner reliability of salivary diagnostictests


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Electronic dental record (EDR) data

not in PBRNs! only one small pilot study used EDR data

data entry redundant and more prone to

errors

research process slower and more costly


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Benefits of re-using EDR data

improve identification and enrollment ofeligible patients

eliminate logistical problems

reduce/eliminate secondary data entry reduce research costs and improve

efficiency

useful for real-time epidemiologic surveys,disease registries and monitoring of diseaseoutbreak


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Center for Dental InformaticsUniversity of Pittsburgh School of Dental Medicine

Computer use among dentists isrising

25% of general dentists in US are usingcomputers at chairside (2005)

EDR use is growing rapidly -> 79% of dentists use computers to

manage clinical information in DPBRN

(2010)


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Center for Dental InformaticsUniversity of Pittsburgh School of Dental Medicine

Storage of information by USgeneral dentists (2004)


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Storage of information by US solopractices in DPBRN (2010)

Storage of clinical information by US solo practices

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

Chief complaints

Progress notes

Medical history

Problems

Perio charting

Dental history

Dental status

Radiographs

Extraoral images

Intraoral images

Completed treatment

Treatment plan

Appointments

Number of offices (n=363)

Paper

Both

Computer

Not at all


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Objectives

Long-term goal:

develop a generalizable approach tousing EDR data to support dental

research

In this project:

test the feasibility of reusing EDR data

from Dentrix


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Innovation

EDR data rarely used for dental research feasibility of using EDR data in dentistry

not formally assessed

use an innovative information model todevelop a pioneering approach for dataextraction and mapping

approach generalizable to most EDRsystems


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Specific Aim 1:Determine the

level of utilizationof clinical researchdata elements by

practitioners

Paradise, Michigan T. Schleyer 2011


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Map Dentrix to PBRN researchdata elements

compare data elements in the Dentrixdata dictionary with those curated in theNCI Enterprise Vocabulary System(EVS)

total of 118 clinical data elements inDentrix

exact match: 44, partial match: 3, nomatch: 71


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Analyze electronic record keepingpractices in 100 Dentrix users

draw a random sample of 150 users fromthree PBRNs

only Dentrix users must use computer at chairside


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Perform analysis of clinical dataelement utilization

survey about the office IT infrastructure andcomputer-based documentation practices

identify use of clinical data in Dentrix database

what data fields recorded for what proportion of patients

how often it is done

data generated through a computer program

dentists review data to ensure HIPAAcompliance

data merged for analysis


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Specific Aim 2:

Develop aninfrastructure forextracting data

from Dentrix andintegrating themwith manually

collected researchdata

Kochi, India T. Thyvalikakath 2011


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Configure Dentrixs eSync to

extract research data

patient data requested by Clinical TrialManagement System (CTMA)

requested data returned by DentrixeSync

optional review by dentist prior to

transmission encrypted and secure data transmission


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Specific Aim 3:Pilot-test thefeasibility of

conducting aclinical study usingePBRN

Kochi, India T. Thyvalikakath 2011


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Simple clinical study as test case

similar to other PBRN studies

topic to be drawn from practical clinicalresearch questions

must require research data frequentlystored by dentists electronically

Dentrix data to be merged with CTMAdata


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Dental practice recruitment

use result from IT utilization survey toidentify eligible practices

practices must use Dentrix and recordthe data needed for the study

select five practices in Eastern US


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Evaluate the ePBRN in a pre/postdesign

within-subject, historically controlledexperiment design

two months each to control condition (no

ePBRN use) and intervention condition(ePBRN use)

baseline data to be collected at the

beginning of control condition contextual inquiry conducted for 4-6patient appointment observations


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Evaluate the ePBRN in a pre/postdesign (cont.)

training to use ePBRN at the start ofintervention

observations of the use of ePBRN inpatient appointments

administer PUS and QUIS instruments at

the end


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Data coding and analysis

measure quality of research data in errorrate, missing data and incomplete data

gold standard will be the originalresearch data stored on paper or inDentrix

evaluate system efficiency, usability anduser acceptance


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Where to go from here?

increase robustness and applicability ofthe ePBRN through additional clinicalstudies

add other EDRs as data sources in theePBRN

broaden the types of studies and

functions supported by ePBRN develop disease registries through the

ePBRN


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Thank You for Your Attention!

Questions, comments?

(Yeah!)

H. Torres-Urquidy

P. Hernandez J. Irwin A. Acharya

NIDCR award 1R21DE021178(Data extraction using EDR indental PBRN) and many others.

H. Spallek

Thanks to:

T. Thyvalikakath

Please visit us at:

http://di.dental.pitt.eduTwitterFacebook /titusschleyer

Scribd

}M. Song

CDI 2008
http://projectreporter.nih.gov/project_info_description.cfm?aid=8111356&icde=0http://di.dental.pitt.edu/http://di.dental.pitt.edu/http://projectreporter.nih.gov/project_info_description.cfm?aid=8111356&icde=0


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