University of Pittsburgh SDM

Student Research Group Grand Rounds

October 24, 2010

Dental
informatics:
Time to join the
revolution?
Titus Schleyer, DMD, PhD
titus@pitt.edu
Jules Eugène Lenepveu (French, 1819-1898),
Jeanne d'Arc en armure devant Orléans

Center for Dental Informatics

University of Pittsburgh School of Dental Medicine
 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

Center for Dental Informatics MH, Hernandez P, Yuhaniak J. Clinical computing in
University of Pittsburgh School of Dental Medicine general dentistry. JAMIA, 2006 5 of 37
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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Center for Dental Informatics
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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

Evidence

Patients’
Clinical
needs &
expertise
preferences

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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

Center for Dental Informatics 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”
Today, we have an unprecedented level of
understanding of the etiology and biology of
oral and craniofacial disease.
• Examples:
– genetic basis of caries, periodontal disease,
cleft lip and palate, and oral cancer
– oral-systemic connections
– behavioral and environmental risk factors

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 Implementation and Evaluation of a Risk
Assessment Tool for Periodontal Disease
(PI: Thyvalikakath)
Specific aims:
• 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

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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?
Thanks to:

H. Spallek T. Thyvalikakath H. Torres-Urquidy

P. Hernandez J. Irwin A. Acharya

… and
many
others.
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 Thank You for Your Attention!
Questions, comments?

Please visit us at:

http://di.dental.pitt.edu
Twitter

}
Facebook /titusschleyer
Scribd

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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.

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