The feasibility of an electronic dental practice-based research network

Titus Schleyer, DMD, PhD
Center for Dental Informatics Research Seminar

September 30, 2011
Denia, Spain © Titus Schleyer 2011

Center for Dental Informatics University of Pittsburgh School of Dental Medicine

The problem
Practice-based research is crucial for improving oral health. However, collecting research data across the geographically dispersed PBRN settings is a challenge.

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Practice-based research crucial for improving oral health
• research findings of practical relevance from PBRNs • continued focus on practice-based research at the NIDCR ($75m 2005-12, $70m 2012-19) • currently over 1,400 practitionerinvestigators • more than 50 studies completed or in progress
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Sample PBRN studies
• Risk factors for osteonecrosis of the jaws: a case-control study • Use of caries preventive agents in children • Restorative treatment thresholds for interproximal caries based on radiographic images • Postoperative hypersensitivity in Class I resin-boned composite restorations in general practice • Inter-examiner reliability of salivary diagnostic tests
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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 of eligible 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 disease outbreak
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Computer use among dentists is rising
• • • 25% of general dentists in US are using computers at chairside (2005) EDR use is growing rapidly -> 79% of dentists use computers to manage clinical information in DPBRN (2010)

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Storage of information by US general dentists (2004)

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Storage of information by US solo practices in DPBRN (2010)
Storage of clinical information by US solo practices
Appointments Treatment plan Completed treatment Intraoral images Extraoral images Radiographs Dental status Dental history Perio charting Problems Medical history Progress notes Chief complaints 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Paper Both Computer Not at all

Number of offices (n=363)

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Objectives
Long-term goal: • develop a generalizable approach to using 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 to develop a pioneering approach for data extraction and mapping approach generalizable to most EDR systems

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Specific Aim 1: Determine the level of utilization of clinical research data elements by practitioners

Paradise, Michigan © T. Schleyer 2011

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Map Dentrix to PBRN research data elements
• compare data elements in the Dentrix data dictionary with those curated in the NCI Enterprise Vocabulary System (EVS) total of 118 clinical data elements in Dentrix exact match: 44, partial match: 3, no match: 71
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• •

Analyze electronic record keeping practices in 100 Dentrix users
• • • draw a random sample of 150 users from three PBRNs only Dentrix users must use computer at chairside

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Perform analysis of clinical data element utilization

survey about the office IT infrastructure and computer-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 HIPAA compliance data merged for analysis
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Specific Aim 2: Develop an infrastructure for extracting data from Dentrix and integrating them with manually collected research data
Kochi, India © T. Thyvalikakath 2011

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Configure Dentrix’s eSync to extract research data
• • patient data requested by Clinical Trial Management System (CTMA) requested data returned by Dentrix eSync optional review by dentist prior to transmission encrypted and secure data transmission
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Specific Aim 3: Pilot-test the feasibility of conducting a clinical study using ePBRN

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 clinical research questions must require research data frequently stored by dentists electronically Dentrix data to be merged with CTMA data
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Dental practice recruitment
• • • use result from IT utilization survey to identify eligible practices practices must use Dentrix and record the data needed for the study select five practices in Eastern US

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Evaluate the ePBRN in a pre/post design
• within-subject, historically controlled experiment 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 4-6 patient appointment observations
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Evaluate the ePBRN in a pre/post design (cont.)
• training to use ePBRN at the start of intervention • observations of the use of ePBRN in patient appointments • administer PUS and QUIS instruments at the end

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Data coding and analysis
• • measure quality of research data in error rate, missing data and incomplete data gold standard will be the original research data stored on paper or in Dentrix evaluate system efficiency, usability and user acceptance

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Where to go from here?
• increase robustness and applicability of the ePBRN through additional clinical studies add other EDRs as data sources in the ePBRN 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?
Thanks to:

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

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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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