Electronic Dental Records for Practice Management: Today’s Dilemma or Tomorrow’s Reality?

Margaret I. Scarlett, DMD, President, Scarlett Consulting, Atlanta, Georgia

Medical records and dental records have evolved differently—and separately—over time. But that might be changing over the next few years because of the rapid advancement of information technology systems.

Over the past several years, leading dental professional organizations have developed an interest in electronic medical and dental records, their use, and standards for such use in their role of health care management. The president of the American Dental Association (ADA), Dr. Robert Brandjord, voices the urgency of adoption: “Moving to electronic health records is essential if we are to offer our patients the highest possible level of care.” For example, in January 2006, the ADA established a position paper for addressing research topics of importance to the practicing dentist. A key item listed for research under “practice management modalities” was to “evaluate the electronic patient record and other aspects of oral health informatics, and their application to dental practice.” (Full document available at https://www.ada.org/prof/resources/positions/doc_research.pdf. Accessed July 18, 2006.)

HIMSS: A New Organization for Electronic Medical Records

On June 7-9, 2006, the ADA joined dozens of other health care provider organizations, health care practitioners, leading medical record industry leaders, and health care policy leaders in sponsoring the “Healthcare Information and Management Systems Society” (HIMSS) meeting in Washington, DC. Keynote speakers at the conference included politicians, government officials, and health care leaders who all called for a coordinated response to the adoption of electronic medical records.

HIMSS may be a new health care organization, but it is already becoming an important player in the adoption of health care records. “The HIMSS Summit 2006 is the only national conference on health care information technology that engages visionaries from the public and private sector,” said HIMSS president and CEO, H. Stephen Lieber. “This program bridges the gap between public policy, business, and practice. Our paper-based health care system is a relic of the past that must change for all Americans.”

Key speakers at the conference included Congress members Rep. Tim Murphy (R-PA), Sen. Edward Kennedy (D-MA), and Sen. Debbie Stabenow (D-MI). With the theme “Achieving National Healthcare Transformation...From Policy to Practice,” more than 1,000 attendees participated in sessions that addressed relative practice issues and standards issues for over 90 different items for electronic health records. They also listened to the Congress members who addressed pertinent policy issues. Rep. Murphy, who is also a psychologist, recanted the problems he knows of firsthand in the system: “The doctor/patient relationship has been divided by a wall of paperwork, inefficiencies, and errors leading to massive expenses.”

HIMSS is the key health care industry membership organization focused on electronic record systems in health care. This year, HIMSS also sponsored six conferences to assist independent physician practices convert from paper to electronic medical records (EMRs), as well as the June 2006 conference. There are also state HIMSS affiliates developing across the country.

How This Might Work In Dentistry: What the Future Holds

EMRs? What does this have to do with dentistry? As we move from treating teeth to a system of medically managing oral disease throughout one’s lifespan, dentists may find that EMRs provide valuable data on their patients’ medical conditions, current prescription medicines, and potential drug interactions.

It’s also clear that EMRs are becoming an invaluable part of doing business in the health care environment. For several years now, the ADA has been meeting to develop standards for electronic dental records. The greatest progress in electronic dental records has occurred in periodontal charting, orthodontic charting, and within the Veteran’s Administration (VA) dental system. In fact, the VA’s VISTA system software (not to be confused with the operating system that Microsoft will soon be releasing) for its electronic health records (EHRs) already has an integrated medical/dental model. With the VA software, a clinician can easily move from medical charting to dental charting, diagnosis, treatment, and laboratory records. There is a free online version of the government-produced software that any dental practice can access.

Since the Surgeon General’s report on oral health was released in 2000, we know that the mouth is not only a mirror of wellness to the body, but it also has critical linkages between systemic and oral health. Therefore, EMRs are today’s—and tomorrow’s—approach to health care.

How would this work in practice? One example would be the monitoring of certain diseases and conditions. Already, saliva testing is being used in 28 states as part of key diagnostics for things such as patient pharmaceutical compliance, substance abuse, and disease monitoring. Some EMRs keep records of all saliva testing, monitoring and plotting these under the laboratory section of the chart, and then correlating the results to the various drug dosages or treatments. The future really is now!

Got EMRs? Disaster Preparedness and EMRs

Some lessons learned about not having electronic records have been painful. During Hurricane Katrina, for example, both medical and dental paper records were ruined, along with paper financial records. What this meant is that in the aftermath many people died or became ill because they did not have medical records or life-saving drugs, such as insulin or heart medications. Paper dental records were destroyed that could have been used to identify missing persons or persons who died in this tragedy.

Right now, a number of dental companies offer electronic dental records that emphasize electronic dental charting, supply management, and even financial records. However, each of the current systems has both advantages and disadvantages. Some are limited in their interoperability with other systems, and even with other digital systems, like digital diagnostic devices for caries detection, digital dental radiography, digital photography, digital patient imaging, CAD/CAM systems, or patient education systems.

With many of these systems, the dentist has to pay a technician to adapt the software to integrate or be interoperable with other systems. This is not an optimal arrangement and it is expensive to customize. New systems or updated models are needed for today’s practitioners.

The lucky health care practitioners and health care institutions in Katrina’s path walked out of their offices with electronic tapes of patient records that could later be available for patient care. However, a leading New Orleans hospital had paper records located on the ground floor of its operations; it had not yet converted to electronic patient records, and only their electronic financial records were backed up. This ultimately proved to be problematic for patients and staff, as well as for the financial stability of the institution.

Currently, national advisory groups are developing real-time surveillance that might take key data from hospitals and outpatient physician, dental, and veterinary practices to monitor health crises like pandemic flu, SARS, or biologic threats. The purpose of the Nationwide Health Information Network (NHIN) forum is to identify and catalogue the list of functional requirements that will frame the development of a NHIN.

Time for EMRs

Electronic records have the advantage of computer-limited access, ease of transportation, and security for any electronic system. For example, HIMSS and others have been working with the Department of Health and Human Services to disseminate the use of a decision tool for health care providers to evaluate how to protect the privacy of patients with disabilities in disaster or emergency response situations.

In general, IT has come to the medical world, not just for disasters but for everyday use. And efforts are accelerating in both government and industry. In government, Dr. David Brailer of the office of the National Coordinator for Health Information Technology is spearheading efforts for the development of a nationwide health care information exchange and the development of regional health information networks (for more information, go to https://www.hhs.gov/healthit/NHIN_Forum1.html. Accessed July 18, 2006).

There are more national organization players in this arena. In industry, the Certification Commission for Healthcare Information Technology (CCHIT) is working with the American Hospital Association to evaluate the use of in-patient EMRs. CCHIT is the recognized certification authority for EHRs and their networks, and is an independent, voluntary, private-sector initiative. The American Medical Informatics Association also has a dental working group that can be accessed through www.amia.org/mbrcenter/wg/di/ (accessed July 18, 2006).

The mission of CCHIT is “to accelerate the adoption of health information technology by creating an efficient, credible, and sustainable product certification program.” They are carefully collaborating with HIMSS, nursing informatics, and health care organizations to assure interoperability between different industry-developed products. The goal is to allow patient records to be shared seamlessly among different providers and hospitals, while preserving patient privacy as regulated under HIPAA. Dentistry hasn’t come as far in developing integrated systems, but progress is being made.

Dentistry has been developing informatics (meaning computerized) standards since the early 1990s through the ADA National Standards committee. Current efforts with dental records have been activated by a flurry of new activity. Dental health care providers can become informed or involved by joining some of the online groups.

For example, dentists can sign up for the dental working group of the American Medical Informatics Association (AMIA). AMIA’s perspective is that EHRs are crucial to the successful transformation of health care in the United States. They have launched a campaign called the “GotEHR?” initiative. The campaign emphasizes the use of EMRs for high-quality, safe, and cost-effective health care services. Secondly, it also promotes the idea that EHRs can strengthen the relationship between patients and clinicians. AMIA also has a computerized dental records working group that dentists can join by signing up at https://www.amia.org/mbrcenter/wg/di/ (accessed July 18, 2006).

Research is continuing on how to best use computers in the dental office. The National Library of Medicine awarded a grant of $280,000 to the Center for Dental Informatics at the University of Pittsburgh School of Dental Medicine for the development and implementation of an online community for dental informatics researchers. Dentists can sign up for this at https://www.dentalinformatics.com (accessed July 18, 2006). The Center addresses research issues such as how chairside computers are being used, the usability of practice management systems, and user interface projects to assure that computers are more user friendly in the dental office.

Regardless of the entry point for dental informatics information, going to one of these resources makes good sense. It is well worth it to investigate these resources in this rapidly changing area of the practice of dentistry.