Medical and dental data integration: How can this become a reality?
Growing evidence supports the need to integrate medical and dental patient care and data. However, very few organizations are positioned to address this issue as medical and dental practices continue to remain siloed in their health-care delivery.1 In order to seamlessly share patient information across medical and dental providers, we must examine health informatics and information technology, and how their use can improve collaboration and communication between health-care providers.1
Improving collaboration and communication
Informatics is a field focused on the acquisition, storage, and use of information.2 Health informatics encompasses the integration of health-care science, computer and information science, and cognitive science to support and manage health-care information.3 As a discipline, health informatics did not begin to fully develop in the United States until the mid-1970s.4
Enhancements in the quality of health-care delivery with improved health outcomes and advancements in patient education have significantly improved since then, and credit can partially be given to the evolution of informatics and information systems. The goals of informatics are to narrow the gap between data acquisition and data use in patient treatment, and to improve interoperability. With the introduction of electronic health records, communication between health-care providers has vastly improved.2
The knowledge and understanding of data processes is the driving force behind the power of data, providing a strong balance between health-care information and health-care delivery. The use of health informatics provides the necessary knowledge and tools to best use this influx of information, and the result is to achieve the highest quality of health-care delivery with improved health-care access and lower health-care cost.5
Application in dentistry
Dental informatics is a specialization within health informatics and is centered around the foundations, fundamentals, and principles of the health informatics domain. Dental informatics is a multidisciplinary field that combines dentistry and information technology to help dental professionals make informed choices to improve practice and management processes in dental care.6
Organized dentistry plays a prominent role in defining dental informatics, and the American Dental Association ensures that the profession is engaged and involved in the evolution of informatics through its Center for Informatics and Standards and the Standards Committee on Dental Informatics (SCDI).2 The main challenge of dental informatics involves an alignment of standards and having computer-savvy dental providers with dual qualifications in dentistry as well as informatics.7
With the advancements in technology and trends—especially the implementation of electronic-based health records and the push toward teledentistry—computer-based decision support has become a key factor in how dental care is provided.7 Given that dentistry is an information-intensive field, the need for dental informaticists has never been greater.2
Linking dental and medical data
The mission and goal of dental informatics is to bridge the gap between clinical care delivery in dental and medical settings.8 While dentistry and medicine share common data elements, there is a gap linking unique dental health elements to clinical health data in both operational and research data management systems. Dentistry is slow to adopt electronic dental records (EDRs), there is a lack of data standardization in the dental domain, and there’s a lack of awareness of the HITECH Act and incentives for adopting EDRs.9
The HITECH Act of 2009 created incentives related to health-care information technology, including incentives for the use of EHR systems among providers.10 In addition, the Meaningful Use (MU) program under the Centers for Medicare and Medicaid Services (CMS) was formulated, and it incentivizes health-care providers to use their EHRs by financially rewarding them when they demonstrate their use.5 Unbeknownst to many dental professionals, dentists fall under the CMS MU umbrella as well, as it states that dental providers can qualify for incentive programs if certain criteria are met.11 Aside from these challenges, there seems to be a lot of conversation about medical and dental collaboration.
Here’s where things get interesting: research has shown that more than 120 systemic diseases originate in the oral cavity.12 The systemic disease most talked about in dentistry is diabetes and its link to periodontal disease. Research suggests that the relationship between diabetes and periodontal disease goes both ways— periodontal disease may make it more difficult for patients who have diabetes to control their blood sugar, and those with diabetes are at a higher risk of periodontal complications.13 Also, complications of cardiovascular disease (CVD) are stroke and heart attack, which affect approximately 70% of the aging population.14 Inflammation is the main cause of plaque formation in CVD patients.14 The inflammatory states in periodontitis induce systemic inflammation, and uncontrolled systemic inflammation is a predictor of CVD events.14
For these reasons, collaboration with medical providers plays a vital role in how dental professionals proceed with dental treatment; likewise, it is important to inform a medical provider if a diabetic patient has uncontrolled periodontal disease. Instead of increasing a patient’s diabetes medication, it might be wise to address the periodontal disease first, then have the patient’s glucose and A1C reevaluated. In the same way, it is imperative to control periodontal disease in patients who have risk factors for CVD and inform the medical provider of this status. In sum, quality health-care delivery is addressing both systemic as well as oral health. But how are medical providers aware that a patient has uncontrolled periodontal disease? Medical and dental provider collaboration starts and ends with the sharing of patient data.
These diseases and risks are prime examples of why we need to collect a thorough medical history during a patient’s dental appointment. The medical history contains essential characteristics and information collected for observation, information that can be transformed into data. This data can potentially be shared with a patient’s medical provider.
Sharing patient data between medical and dental providers can become a reality, but not until all dental providers adopt EDRs and use them to the fullest capacity. Of course, interoperability obstacles will still exist, and informatics specialists will need to be employed to help achieve this kind of integration. Medical and dental data integration is an imperative process to improve continuity of patient care, giving care providers the means to collaborate, as well as recognize how each patient is progressing with a systemic disease from an oral health standpoint, or vice versa. This process can allow for treatment interventions to be planned accordingly, and total health can be addressed in a synchronized manner.15
The need for change
Health-care delivery now relies on EHRs, regulated medical devices, and other forms of real-world data that have impacted all aspects of health-care operations, systems, and management. Health informatics is foundational to each of these transformations and is a necessary discipline in today’s health-care delivery world. Dental informatics is positioned to solve problems within the dental domain and can be beneficial in not only dental but health-care delivery settings.
For dental informatics to be deployed in the professional setting, dental providers should consider implementing EDRs in their dental practices and embracing information technology. Regardless of the lack of federal financial incentives to adopt EHR technologies, this does not mean that ineligible dentists will not need to eventually adapt to the ever-changing technology environment.16 In fact, states may elect to impose their own EHR requirements, with direct impact for dentists in those states.16
The need to embrace information technology will rise exponentially, along with the adoption and implementation of EDRs.3 Dental informatics will largely impact clinical and managerial operations as well as policy and regulations. However, these challenges must be overcome in order to successfully achieve health-care reform and patient safety initiatives, and to fulfill true collaboration between medical and dental providers, thereby demonstrating improved quality of care within both health care and dentistry.
References
1. Acharya A. Oral health informatics research core. Marshfield Clinic Research Institute. Accessed November 25, 2020. https://www.marshfieldresearch.org/iosh/oral-health-informatics
2. Gibson J. Working smarter, not harder: How dental informatics is using data to modernize the profession. Ontario Academy of General Dentistry. March 6, 2020. Accessed November 25, 2020. https://agd.org/constituent/news/2020/03/06/working-smarter-not-harder-how-dental-informatics-is-using-data-to-modernize-the-profession
3. Marya CM, Swati S, Nagpal R, Sakshi K, and Pratibha T. Dental informatics: Integrating technology into dentistry. Austin Dent Sci. 2020;5(1):1025. https://austinpublishinggroup.com/austin-dental-sciences/fulltext/ads-v5-id1025.php
4. Dooling JA, Osborne K, Wiedemann LA. Defining the basics of health informatics for HIM professionals–Retired. J AHIMA. 2014;85(9):60-66. https://library.ahima.org/doc?oid=107443#.X56sxYhKjIU
5. Sweeney J. Healthcare informatics. HIMSS. February 2, 2017. Accessed November 14, 2020. https://www.himss.org/resources/healthcare-informatics
6. Eisenberg ES. Dental informatics–Its importance in dental education. Global Health Nexus. 2020:1(2). Accessed November 24, 2020. https://dental.nyu.edu/aboutus/news/nexus/millennium-issue/dental-informatics.html
7. Schleyer T. Dental informatics: Relatively new and innovative. Dental Economics. September 1, 2000. Accessed November 1, 2020. https://www.dentaleconomics.com/practice/article/16388380/dental-informatics-relatively-new-and-innovative
8. Dental informatics. AMIA. Accessed November 23, 2020. https://www.amia.org/programs/working-groups/dental-informatics
9. Dentrix EHR Meaningful Use Certification Program. https://www.dentrixenterprise.com/solutions/public-health/meaningful-use
10. Health Information Technology for Economics and Clinical Health (HITECH) act. ASHA. Accessed November 25, 2020. https://www.asha.org/Practice/reimbursement/hipaa/HITECH-Act/
11. Medicaid electronic health record incentive payments for eligible professionals. CMS. Updated May 2013. Accessed November 1, 2020. https://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/Downloads/MLN_MedicaidEHRProgram_TipSheet_EP.pdf
12. Rudman WJ, Hart-Hester S, Jones WA, Caputo N, Madison M. Integrating medical and dental records: A new frontier in health information management. J of AHIMA, 2010:81(10):36-39. https://library.ahima.org/doc?oid=102372#.XbQnhOhKjIU
13. Diabetes and periodontal disease. AAP. Accessed September 2, 2020. https://www.perio.org/consumer/gum-disease-and-diabetes.htm
14. Dyke TE. Update on the oral-systemic link. J Multidisciplinary Care: Decisions in Dentistry. 2020:6(1):25–29. Accessed October 31, 2020. https://decisionsindentistry.com/article/update-on-oral-systemic-link/
15. Bresnick J. Using risk scores, stratification for population health management. Health IT Analytics. December 16, 2016. Accessed February 26, 2020. https://healthitanalytics.com/features/using-risk-scores-stratification-for-population-heallh-management
16. Meaningful use. ADA. Accessed November 14, 2020. https://www.ada.org/en/member-center/member-benefits/practice-resources/dental-informatics/electronic-health-records/health-system-reform-resources/meaningful-use
SHANNON SOMMERS, MSHI, BTDH, RDH, has a bachelor of technology in dental hygiene from the State University of New York at Canton and a master of science in health informatics from the Medical University of South Carolina. She has more than 20 years of experience in dentistry and has been a dental hygienist since 2006. She aims to use her dental background and informatics skills to promote and advance dental informatics. Contact her at [email protected].
ALICIA WEBB, MSHI, BTDH, RDH, has been a clinician in dentistry since 2006 and has experience as an educator in a dental hygiene program. As one of the few registered dental hygienists to graduate with a master of science in health informatics, she wants to use her informatics knowledge along with her dental background to improve population health by developing and analyzing data-driven solutions to improve the delivery of quality dental care. Webb can be reached at [email protected].
