Working Smarter, Not Harder: How Dental Informatics Is Using Data to Modernize the Profession
This is a Self-Instruction article worth one CE credit.
An increase in the use of information-driven technology has significantly disrupted dentistry in recent years. Examples include practice management software, digital radiography and electronic probes — all common in today’s dental office. These products improve patient care, help clinicians practice more efficiently and collect data that informs future developments. A field called “informatics” combines technology, data and information science to leverage that data and identify opportunities to improve patient care and practice efficiencies.
What Is Informatics?
Informatics is a field focused on the acquisition, storage and use of information. Health informatics integrates methods from the computer, information and cognitive sciences and telecommunications to assist in the management of healthcare information.1 While technology is an important component of informatics, it is not the driving factor; rather, informatics is built around research and information, while technology becomes the tool to leverage information.
The overarching goals of the field are to narrow the gap between data acquisition and data use in patient treatment and to improve interoperability. The introduction of electronic health records (EHRs) is one product of health informatics. EHRs laid the foundation for improved communication among providers through digitized patient records, the establishment of electronic prescribing systems, and knowledge sharing and analysis.2
Dental informatics is a subspecialty of health informatics that focuses on using computer and information science to improve dental practice, research, education and management.
“During the last several years, dental informatics has developed into a research discipline of significant scale and scope,” said Neel Shimpi, BDS, MM, PhD, chair of the dental informatics working group of the American Medical Informatics Association (AMIA). “It focuses more on people and information rather than computers themselves.”
Organized Dentistry and Dental Informatics
Organized dentistry plays a prominent role in defining dental informatics. The American Dental Association ensures the dental profession is engaged and involved in the evolution of dental informatics through its Center for Informatics and Standards and the Standards Committee on Dental Informatics (SCDI). The SCDI develops informatics standards, reports and guidelines to assist the dental profession with use and integration of dental informatics. The committee is made up of 44 members from dentistry, the dental industry, academia and government.
“We have to standardize everything,” said Mohamed F. Harunani, DDS, MAGD, who represents AGD on the SCDI. “When you take a radiograph in one system, it needs to work in another system. Things have to be interchangeable. On the SCDI, we have members from insurance companies, manufacturers, dentists and specialists coming together to agree on certain standards. We have to come to agreement on what’s acceptable both for the manufacturer and the clinician.”
He points to successfully delaying the inclusion and regulation of dental devices under the U.S. Food and Drug Administration’s (FDA’s) Unique Device Identification System. This rule requires the labeling of medical devices with a unique device identifier. For dentists, this “track and trace” regulation would require them to record data on dental implants and other devices, as well as any biologics that are regulated as medical devices by the FDA. The SCDI was able to inform the FDA that current dental practice management systems lack the ability to effectively track and trace as the regulation required. Harunani said the requirements would have been burdensome to dentists.
“There’s no place in our databases to hold that information right now,” he said.
Mark W. Jurkovich, DDS, MBA, MHI, MAGD, director of data infrastructure for the Health Care Systems Research Network, serves as vice chair of the SCDI. He said the ability to track and trace is a functionality that bodies such as the SCDI and software manufacturers should collaborate on in the future.
Jurkovich notes quite a bit of progress in the development of other areas involving dental informatics, including enhanced EHR systems for dentistry.
“As we standardize patient information even further, we’ll be able to exchange information more rapidly,” he continued. “Another standard in development will help design databases so vendors know which types of information should be included in a system and how that information should be structured.”
___________________________________________________________________________________________________
In February, Harunani represented AGD at a meeting of the SCDI. Among other roles, Harunani chairs the new SCDI work group on Administrative Efficiencies in Clinical Informatics. During the meeting, he gave an overview of the challenges created by the lack of true interoperability among dental plans, clearinghouses and dental practices that exacerbate the frustrations dentists encounter during claims submission and payment.
____________________________________________________________________________________________________
Next Steps in Dental Informatics
Dental informatics has not only helped create EHRs, but the field is also attempting to create more comprehensive operatories by making use of patient data in the records. Shimpi’s research team at the Marshfield Clinic Research Institute’s Center for Oral and Systemic Health has developed a clinical decision support tool for use in dental settings to identify undiagnosed diabetes and assess the risk of patients developing prediabetes.
“Implementing such a tool in dental settings can conduct an automatic risk assessment at the point of care by utilizing available data from the EHR,” said Shimpi.
Future developments in dental informatics could have an even greater impact on dentistry. Jurkovich says artificial intelligence (AI) systems have scanned millions of radiographs to learn how to identify caries, making them as good as or better than dentists at identifying carious lesions on a radiograph. One day, AI will be able to recognize cancerous conditions and other anomalies, and there are currently systems that can recognize bone loss as minor as 1–2 millimeters. Jurkovich said that, while these advancements will help dentists make diagnoses and treatment plan, the profession also needs to keep a close eye on how AI is used by the insurance industry.
“Insurance companies have the money to invest in AI, so they can already look at the information dentists give them to see if it’s accurate,” Jurkovich said. “It’s a way to address fraud, but it’s going to change the way insurance companies interact with the dental community. Insurance companies already have much more information about patient care than a single dentist or even a large group could possibly have, and they are investing in AI technologies that will provide them with even greater predictive capabilities.
“Pair greater predictive capabilities with the information insurers already have, and insurers could determine the best possible treatment approaches and expected outcomes for specific types of patients before the profession or academic institutions are able to.”
Jacob Krive, MBA, MS, PhD, clinical associate professor of biomedical and health information sciences at the University of Illinois at Chicago, sees opportunities to better harness the data collected in EHRs to customize healthcare delivery.
“Once we created the digital record, we came to the decision point where we asked, ‘Are we just celebrating the fact that we’re digital, or are we going to do something with it?’” he said.
According to Krive, the next step is to fully integrate and mine the data to combine evidence-based care with information technology so the healthcare industry can begin to be more predictive and innovative. He believes opportunities abound for data scientists and analysts, as well as the technology, pharmaceutical and insurance industries.
Dental informatics is still in its infancy, and its development faces many challenges. Shimpi says investment in the workforce and increased awareness are needed.
“We should focus heavily on educating the next generation of dental informaticians,” she said. “Dentistry is an information-intensive field. To facilitate this information at the point of care to its appropriate end users, and to convert the information to knowledge is going to be challenging. However, when challenges exist within a discipline, those challenges also indicate opportunities.”
__________________________________________________________________________________________________
Jennifer Gibson is a freelance writer based in the Chicago area. To comment on this article, email impact@agd.org.
References
1. Madhu, Priyanka P., et al. "Dental Informatics: A Click to the Future." Journal of Oral Health and Community Dentistry, vol. 11, no. 2, 2017, pp. 38-43.
2. Krive, Jacob. “What’s Next in Health Informatics?” UIC Health Informatics, www.healthinformatics.uic.edu/blog/whats-next-in-health-informatics/. Accessed 8 Jan. 2019.
An increase in the use of information-driven technology has significantly disrupted dentistry in recent years. Examples include practice management software, digital radiography and electronic probes — all common in today’s dental office. These products improve patient care, help clinicians practice more efficiently and collect data that informs future developments. A field called “informatics” combines technology, data and information science to leverage that data and identify opportunities to improve patient care and practice efficiencies.
What Is Informatics?
Informatics is a field focused on the acquisition, storage and use of information. Health informatics integrates methods from the computer, information and cognitive sciences and telecommunications to assist in the management of healthcare information.1 While technology is an important component of informatics, it is not the driving factor; rather, informatics is built around research and information, while technology becomes the tool to leverage information.
The overarching goals of the field are to narrow the gap between data acquisition and data use in patient treatment and to improve interoperability. The introduction of electronic health records (EHRs) is one product of health informatics. EHRs laid the foundation for improved communication among providers through digitized patient records, the establishment of electronic prescribing systems, and knowledge sharing and analysis.2
Dental informatics is a subspecialty of health informatics that focuses on using computer and information science to improve dental practice, research, education and management.
“During the last several years, dental informatics has developed into a research discipline of significant scale and scope,” said Neel Shimpi, BDS, MM, PhD, chair of the dental informatics working group of the American Medical Informatics Association (AMIA). “It focuses more on people and information rather than computers themselves.”
Organized Dentistry and Dental Informatics
Organized dentistry plays a prominent role in defining dental informatics. The American Dental Association ensures the dental profession is engaged and involved in the evolution of dental informatics through its Center for Informatics and Standards and the Standards Committee on Dental Informatics (SCDI). The SCDI develops informatics standards, reports and guidelines to assist the dental profession with use and integration of dental informatics. The committee is made up of 44 members from dentistry, the dental industry, academia and government.
“We have to standardize everything,” said Mohamed F. Harunani, DDS, MAGD, who represents AGD on the SCDI. “When you take a radiograph in one system, it needs to work in another system. Things have to be interchangeable. On the SCDI, we have members from insurance companies, manufacturers, dentists and specialists coming together to agree on certain standards. We have to come to agreement on what’s acceptable both for the manufacturer and the clinician.”
He points to successfully delaying the inclusion and regulation of dental devices under the U.S. Food and Drug Administration’s (FDA’s) Unique Device Identification System. This rule requires the labeling of medical devices with a unique device identifier. For dentists, this “track and trace” regulation would require them to record data on dental implants and other devices, as well as any biologics that are regulated as medical devices by the FDA. The SCDI was able to inform the FDA that current dental practice management systems lack the ability to effectively track and trace as the regulation required. Harunani said the requirements would have been burdensome to dentists.
“There’s no place in our databases to hold that information right now,” he said.
Mark W. Jurkovich, DDS, MBA, MHI, MAGD, director of data infrastructure for the Health Care Systems Research Network, serves as vice chair of the SCDI. He said the ability to track and trace is a functionality that bodies such as the SCDI and software manufacturers should collaborate on in the future.
Jurkovich notes quite a bit of progress in the development of other areas involving dental informatics, including enhanced EHR systems for dentistry.
“As we standardize patient information even further, we’ll be able to exchange information more rapidly,” he continued. “Another standard in development will help design databases so vendors know which types of information should be included in a system and how that information should be structured.”
___________________________________________________________________________________________________
In February, Harunani represented AGD at a meeting of the SCDI. Among other roles, Harunani chairs the new SCDI work group on Administrative Efficiencies in Clinical Informatics. During the meeting, he gave an overview of the challenges created by the lack of true interoperability among dental plans, clearinghouses and dental practices that exacerbate the frustrations dentists encounter during claims submission and payment.
____________________________________________________________________________________________________
Next Steps in Dental Informatics
Dental informatics has not only helped create EHRs, but the field is also attempting to create more comprehensive operatories by making use of patient data in the records. Shimpi’s research team at the Marshfield Clinic Research Institute’s Center for Oral and Systemic Health has developed a clinical decision support tool for use in dental settings to identify undiagnosed diabetes and assess the risk of patients developing prediabetes.
“Implementing such a tool in dental settings can conduct an automatic risk assessment at the point of care by utilizing available data from the EHR,” said Shimpi.
Future developments in dental informatics could have an even greater impact on dentistry. Jurkovich says artificial intelligence (AI) systems have scanned millions of radiographs to learn how to identify caries, making them as good as or better than dentists at identifying carious lesions on a radiograph. One day, AI will be able to recognize cancerous conditions and other anomalies, and there are currently systems that can recognize bone loss as minor as 1–2 millimeters. Jurkovich said that, while these advancements will help dentists make diagnoses and treatment plan, the profession also needs to keep a close eye on how AI is used by the insurance industry.
“Insurance companies have the money to invest in AI, so they can already look at the information dentists give them to see if it’s accurate,” Jurkovich said. “It’s a way to address fraud, but it’s going to change the way insurance companies interact with the dental community. Insurance companies already have much more information about patient care than a single dentist or even a large group could possibly have, and they are investing in AI technologies that will provide them with even greater predictive capabilities.
“Pair greater predictive capabilities with the information insurers already have, and insurers could determine the best possible treatment approaches and expected outcomes for specific types of patients before the profession or academic institutions are able to.”
Jacob Krive, MBA, MS, PhD, clinical associate professor of biomedical and health information sciences at the University of Illinois at Chicago, sees opportunities to better harness the data collected in EHRs to customize healthcare delivery.
“Once we created the digital record, we came to the decision point where we asked, ‘Are we just celebrating the fact that we’re digital, or are we going to do something with it?’” he said.
According to Krive, the next step is to fully integrate and mine the data to combine evidence-based care with information technology so the healthcare industry can begin to be more predictive and innovative. He believes opportunities abound for data scientists and analysts, as well as the technology, pharmaceutical and insurance industries.
Dental informatics is still in its infancy, and its development faces many challenges. Shimpi says investment in the workforce and increased awareness are needed.
“We should focus heavily on educating the next generation of dental informaticians,” she said. “Dentistry is an information-intensive field. To facilitate this information at the point of care to its appropriate end users, and to convert the information to knowledge is going to be challenging. However, when challenges exist within a discipline, those challenges also indicate opportunities.”
__________________________________________________________________________________________________
Jennifer Gibson is a freelance writer based in the Chicago area. To comment on this article, email impact@agd.org.
References
1. Madhu, Priyanka P., et al. "Dental Informatics: A Click to the Future." Journal of Oral Health and Community Dentistry, vol. 11, no. 2, 2017, pp. 38-43.
2. Krive, Jacob. “What’s Next in Health Informatics?” UIC Health Informatics, www.healthinformatics.uic.edu/blog/whats-next-in-health-informatics/. Accessed 8 Jan. 2019.