How dental informatics can improve your bottom line

Dental informatics is evolving into an integral component of modern dental education, as evidenced by the plethora of presentations on the subject at the American Dental Educators Association (ADEA) annual meeting last month.

"I have been affiliated with ADEA for over 20 years," wrote Titus Schleyer, DMD, PhD, director of the Center for Dental Informatics at the University of Pittsburgh, in his blog March 20. "During that time, I have watched dental informatics grow up from a concept that no one was familiar with into a domain that literally permeates all aspects of dental care, education, and research."

Healthcare is an information-intensive field, Dr. Schleyer emphasized, and that is the definition of informatics: gathering, analyzing, and managing information to enhance the decision-making process.

"What I would like to do is enable students to think not just about computers but about information," Dr. Schleyer told DrBicuspid.com. "It is the lifeblood of dentistry. You can be terrific with using a handpiece, but if you don't manage the patient information very well, you're not going to be a good dentist."

Dr. Schleyer said he was thrilled at the number of presentations involving informatics at the recent ADEA meeting, which included a session on "Data Mining From Electronic Patient Records to Measure Patient and Student Outcomes," as well as 27 talks on a variety of dental informatics topics.

In addition, the ADEA TechExpo showcased several applications developed specifically for dental education -- including the new Applied Dental Education Practice Tool (ADEPT) developed by DrBicuspid.com in conjunction with William Wathen of the Baylor College of Dentistry that is currently in beta testing.

But there is still much work to be done before dental practitioners can take full advantage of the goldmine of information that becomes available through the application of information technologies, Dr. Schleyer told DrBicuspid.com.

"What you can see in dental education in general is that students are being more exposed to digital technologies," he said.

"Most schools use Axium to do patient records, plus some sort of learning management system and simulators like DentSim. So from an experience perspective, the students are being more exposed to these technologies, which is good. But does that make them better at understanding information itself and thinking about it conceptually? The answer is it doesn't automatically do that."

'In its infancy'

Conceptually, IT use in dental schools is only in its infancy, he and colleagues from the University of Pittsburgh recently wrote in the Journal of Dental Education. But opportunities abound for improving how IT can be used to support clinical care, education, and research.

For example, "in clinical care there is a need to move electronic dental records beyond replicating paper, connect information on oral health to that of systemic health, facilitate collaborative care through teledentistry, and help clinicians apply evidence-based dentistry and preventive management strategies," they wrote (JDE, January 2012, Vol. 76:1, pp. 142-153).

In addition, educators should adopt an evidence-based approach to IT use for teaching, leverage technology-mediated changes in the balance of power between faculty and students, improve technology support for clinical teaching, and build an information infrastructure centered on learners and organizations.

Other opportunities include reusing clinical care data for research studies, helping advance computational methods for research, applying generalizable research tools in dentistry, and reusing research data and scientific workflows.

"In the process, we transition from a focus on IT -- the mere technical aspects of applying computer technology -- to one on informatics: the what, how, and why of managing information," Dr. Schleyer and his colleagues wrote.

Electronic dental records

Dentists don't have much experience utilizing metrics, Dr. Schleyer noted. But the Center for Dental Informatics is working to change that through various clinical research studies designed to improve dentists' abilities to utilize IT in their practices and make the information these digital tools gather easier to analyze.

"There is much you can learn from the data you have about what kind of practice you are running," he said. "This is the first thing practice-management consultants do: they look at your data."

Take electronic dental records (EDRs), for example. Current iterations of EDRs lack flexibility and functionality, according to Dr. Schleyer.

"We need different paradigms for designing EDRs," he said. "Say I want to report on all crowns I have placed that lasted less than six months. I shouldn't have to hire a programmer to find this information. It should be easy to gather this information and analyze how to do better dentistry. But right now we don't give dentists these tools."

Dr. Schleyer's team has conducted a number of studies designed to help improve EDR design (BMC Medical Informatics and Decision Making, February 2, 2010; Vol. 10:7; Journal of the American Dental Association, December 2008, Vol.139:12, pp. 1632-1642). Most recently, in a study that is still being written, they worked with 10 dentists who were each given a patient's chief complaint and then asked to explain to an experimenter their step-by-step decision-making process as they worked through the assessment and treatment plan.

"We did this study because it is an extremely important baseline for designing better interfaces for EDRs," he said. "We had the dentists work through the patient cases at their own pace. In order to design a good EDR, you have to understand your customer. The industry needs to invest more time in understanding how dentists think. If they did this they would have much more successful EDRs."