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Dental informatics: Time to join the revolution?

Dental informatics: Time to join the revolution?

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Published by Titus Schleyer
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. This presentation discusses how dental informatics can help improve oral health by using electronic patient data for quality assurance, documenting patient care using natural language and delivering evidence-based decision aids with computers. Time for a revolution!
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. This presentation discusses how dental informatics can help improve oral health by using electronic patient data for quality assurance, documenting patient care using natural language and delivering evidence-based decision aids with computers. Time for a revolution!

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Published by: Titus Schleyer on Jan 03, 2012
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University of Pittsburgh SDM Current topics in dental research

January 4, 2012

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

This talk online: http://scr.bi/yYviqJ

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

Center for Dental Informatics University of Pittsburgh School of Dental Medicine

Schleyer TK, Thyvalikakath TP, Spallek H, Torres-Urquidy MH, Hernandez P, Yuhaniak J. Clinical computing in 5 of 36 general dentistry. JAMIA, 2006

Challenges to improving oral health

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Challenges to improving oral health
• a crucial question • documenting patient care • translating best evidence into practice

Sources: NIDCR Strategic Plan 2009-2013, ADA Research Agenda 2010-11
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Challenges to improving oral health
• a crucial question • documenting patient care • translating best evidence into practice

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How do you know whether you are a good dentist?
Criterion You believe that you are. The marginal gap of your crowns is < 30 micron. You make lots of money. Validity

 
 
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Your patients get better.

Center for Dental Informatics University of Pittsburgh School of Dental Medicine

How do you know your patients are getting better?

The data conundrum:
The data are there, but you can’t get to them.
Paper Computer
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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

Acharya A, et al. Electronic dental record information model. Int J Med Eng Inform. 2009;1(4):418-34.
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A brief tour of the Electronic Dental Record Information Model

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What we are currently doing …

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The story of a tooth: Datamining for …
… time span from:
– emergence of a tooth to its first restoration? – first restoration to tooth loss or extraction? – one restoration to its replacement?

… time between successive restorations dependent on restorative material? … how do caries and fracture relate to restorations (e.g. cause)? … incidence of root canal treatment by tooth, also as adverse event? … pattern of tooth loss in patients over time? … influence of patient gender and age?
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Datamining approach

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What else can you do with an information model?
Database User interface

Data interchange Forms

Information model Research
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National Health Information Infrastructure/ Health Information Exchange
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Challenges to improving oral health
• a crucial question • documenting patient care • translating best evidence into practice

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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 document right now …

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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
• a crucial question • documenting patient care • translating best evidence into practice

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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

Clinical expertise

Patients’ needs & 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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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 (www.dentalinformatics.org) • participate in dental informatics research • complete an online dental informatics certificate (2013) • get an advanced degree in dental informatics
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The Dental Informatics Online Community
• • • • • established in 2007 > 1,200 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: 2013
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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:

Please visit us at: http://di.dental.pitt.edu Twitter Facebook /titusschleyer Scribd
H. Spallek T. Thyvalikakath

}

H. Torres-Urquidy

P. Hernandez

J. Irwin

A. Acharya

… NIDCR award 1R21DE021178 (Data extraction using EDR in dental PBRN) and many others.
© CDI 2008 Center for Dental Informatics University of Pittsburgh School of Dental Medicine

M. Song

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This talk: http://scr.bi/yYviqJ

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Suggested readings


• • • •


Schleyer T, et al. Informatics innovation in clinical care: a visionary scenario for dentistry. electronic Journal of Health Informatics. 2011;6(4):e36. Irwin JY, et al. A preliminary model of work during initial examination and treatment planning appointments. Br Dent J. 2009;206(1):e1. PMID: 19119286 Acharya A, et al. Electronic dental records information model. Int J Med Eng Inform. 2009;1(4):418-34. Thyvalikakath TP, et al. A usability evaluation of four commercial dental computer-based patient record systems. J Am Dent Assoc. 2008;139(12):1632-42. PMID: 19047669 Schleyer T, et al. A qualitative investigation of the content of dental paperbased and computer-based patient record formats. J Am Med Inform Assoc. 2007;14(4):515-26. PMID: 17460133 National Institute of Dental and Craniofacial Research. NIDCR strategic plan: 2009-2013. Bethesda, MD: National Institutes of Health; 2009 May. American Dental Association. Research agenda: research of importance to the practicing dentist, 2010-11. [cited 2012 Jan 4]. Bader JD. Challenges in quality assessment of dental care. J Am Dent Assoc. 2009;140(12):1456-64. PMID: 19955057
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