COMMENTARY

Dental Electronic Records Lag Behind

Larry F. Emmott, DDS

Disclosures

December 12, 2011

The Effect of Electronic Health Records on the Use of Clinical Care Guidelines for Patients With Medically Complex Conditions

Fricton, J, Rindal DB, Rush W, et al.
J Am Dent Assoc. 2011;142:1 133-1142

Study Summary

With the emergence of health information technology, the hope is that dental providers will be able to use electronic medical records (EMRs) to improve quality of care and safety for patients with medically complex conditions. In this 18-month study, Fricton and colleagues randomly assigned each of 15 dental clinics to 1 of 3 groups to evaluate the impact of 2 clinical decision support approaches for medically compromised patients. Group 1 used provider activation through electronic dental records (EDRs) with a flashing alert that directed dental providers to Web-based personalized care guidelines when a scheduled patient had a medical complication such as diabetes. In group 2, a patient activation system was generated that alerted the patient rather than the treating dentist. This alert encouraged the patient to ask his or her dental care provider to review care guidelines specific to the patient's medical conditions. In group 3, no alerts were sent. The researchers measured the effectiveness of the alerts by monitoring traffic to the protocol Website.

The results were interesting. Dentists in groups 1 and 2 increased their visits to the personalized care guidelines in the first 6 months. Provider alerts resulted in more visits to the Website than patient alerts. Group 3, who received no alerts, took no action. These findings would appear to indicate that the use of clinical decision support can improve patient care. However, the effects faded over time. Within 18 months, both alert groups had reverted to the pretest levels, even though they continued to receive alerts.

Viewpoint

Much has been written about electronic record systems in healthcare. Still, much confusion persists about what these systems are, how they should work, and what value they might provide.

At a very basic level, an EDR is simply a digital or electronic dental chart. All the information or data that were formerly stored on paper are created in a digital format and stored as an electronic record. This includes charting, treatment planning, procedure notes, medical histories, laboratory slips, laboratory results, prescriptions, photographs, radiographs, models, finances, and more. It is now possible to create a completely digital or electronic version of a patient's dental chart using the available dental practice management systems (PMS). However, as good as these systems are, they are not achieving the full promise or capacity of EDRs.

An ideal EDR collects all relevant medical and dental data about an individual and organizes it in a meaningful way. Here is the kicker: This allows data to be accessed anytime, anywhere, by anyone with a legitimate reason to use it.

Limitations of Current Dental Record-Keeping Systems

Current products may do a fine job of creating a digital dental chart. However, these dental chart data are often confined to the specific dental office in which the data are stored. This creates a challenge for multiple offices. Current products make it difficult, if not impossible, to transfer data to another office, even if the other office is using the same PMS. In addition, data cannot be imported into the PMS from an outside source.

For example, patient Jones could go to dental office A and fill out a complete intake form with demographic information, such as name, address, and contact information, as well as a complete medical history listing medical conditions, allergies, medications, and past illnesses. Then, patient Jones moves and goes to dental office B. Office B needs all the same demographic and medical history information (eg, name, address, medications, allergies) as office A. With a true EDR, all those data could simply be transferred digitally from office A to office B. With our current systems, even those that can create a completely electronic dental chart at the local level, it is not possible to transfer the data from one office to another.

At the next level of review of types of record systems, the EDR is really just a subset of the EMR. Using our example, we should be able to transfer pertinent personal and medical data about patient Jones, not just from dentist to dentist, but from physician to dentist. In that case, when patient Jones goes to physician C and fills out the intake form (name, address, medications, allergies, etc.), those data are stored in a format that can be transferred to dentist alpha or to dentist G, hospital F, specialist E, or insurance provider L.

What This Means to Your Practice

Shared data should work better than our old system of paper and its redundant, incomplete data collection system. It will certainly save a lot of time and will improve patient care by providing more accurate information in a timely fashion.

Does the fact that Web activity in the study by Fricton and colleagues faded over time indicate that EMR has limited value? I don't think it does that at all. The researchers made some attempts to explain the drop-off. No real data explain it, but to me it is obvious. If I am a treating dentist and I have already accessed the online protocol guiding me through the latest techniques and procedures to treat a patient with diabetes 3 times in the last couple of months, when I get the alert for the fourth time, I will probably figure that I am up on the latest guidelines and I won't bother to check out the Web page again.

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