The Benefits of Electronic Health Records

Background

The introduction of electronic health records (EHRs) has provided value to healthcare providers by promoting efficiency and effectiveness. It is an empowering tool for medical professionals that allows access to patient health information as well as the exchange of patient treatment information that facilitates shared decision making and improves patient health outcomes (Acharya et al., 2017, p. 328). Advantages of a medical-dental iEHR digital environment were identified as 1. access to dental information and history, 2. improved communication with the dentist, 3. holistic care and continuity of care, 4. improved patient care coordination, 5. faster access to patient dental information, and 6. reducing narcotics abuse (Acharya et al., 2011, p. 390).

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It is vital to explore the reasons why such integration is beneficial for healthcare delivery. The oral cavity is considered to be the “window” to overall health with numerous systemic and chronic conditions such as diabetes or hypertension having oral manifestations. It is a two-way path since symptoms can appear in the oral cavity while poor oral care can exacerbate symptoms to these medical conditions (Adibi et al., 2017, p. 2). Early identification and intervention can improve both oral health and glycemic outcomes. Having access to relevant information with the integration of records can help both medical professionals and dentists to identify patients with a disease that are potentially at risk or underdiagnosed (Adibi et al., 2017, p. 5).

A number of health care professionals including cardiologists, emergency medicine physicians, primary care, oncologists, and neurologists feel the need to access a patient’s dental information in order to coordinate or provide competent medical care (Acharya et al., 2011, p. 391). The incomplete or inaccurate medical information provided to medical professionals without integrated records can reduce the quality of care and may lead to life-threatening adverse events.

Unfortunately, dental and medical fields have historically operated in completely different domains, divided into the levels of policy, insurance coverage, and education among others (Chauhan et al., 2018, p. 636). There is a difference in approach to documentation and record-keeping standards between medical and dental domains which causes a number of communication and technical issues in establishing a universal documentation standard and ensuring interoperability without disruption (Acharya et al., 2017, p. 333). Recently, policy and research are driving forward improvements in an interprofessional collaboration that offers value in exchanging patient data between dental and medical fields.

Nevertheless, the digital health environment has created an opportunity for integrating medical and dental records into iEHR which focuses on the development of unified platforms that span diverse specialties and support communication and exchange of knowledge and patient information (Acharya et al., 2017, p. 333). To begin the process of creating an integrated IT health ecosystem, dentistry needs to be included as a critical component and requires the development and use of certified EHR’s in the sector (Chauhan et al., 2018, p. 642). A significant challenge to designing dental EHR’s is to incorporate evidence-based information needs of the dentist and then seamlessly integrate the system into the workflow (Song et al., 2010, p. 1).

Establishing the critical role of dentistry and dental EHR’s in the healthcare system that offers a holistic approach to patient care, it is important to examine the components that dental patient record systems should have. Convenient access to patient dental information and clinical diagnosis and treatment is beneficial. A recommendation that could be implemented is to create a separate tab or pop-up list that focuses on the dental domain which medical professionals can view to see relevant dental history, appointments, and progress notes. High priority was assigned to communication assignments, system design, and medications while less relevant aspects include tooth and periodontal charts, images, terminology (Acharya et al., 2017, p. 336).

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The fast-paced nature of a dental office requires quick access to clinical information essential to diagnosis and treatment. These include data previously entered both digitally and on paper such as tooth conditions, radiographs, insurance coverage and authorization. Dentists also indicated the capabilities of EHR to present better visual representations in addition to traditional radiographs and intraoral pictures, such as mounted case images and 3D models with the best image quality (Song et al., 2010, p. 4).

Dentists require a variety of information needs from EHR such as chief complaints and symptoms, treatment options and procedures, and problem parameters. Previous medical history such as pre-existing and health conditions should be accessible due to direct relation with dental conditions. In studies with electronic dental records (EDR), dentists commonly used the technology to search for previous treatments and procedures (i.e. length of files in a root canal case) (Song et al., 2010, p. 3). It is the knowledge of these direct needs in dentistry practice that should be driving the design of integrated EHR systems.

In terms of inputs for patients’ EHR, the necessary entries based on a study by Sadoughi et al. (2017, p. 30) are periodontal status and legal consent which are considered the first priorities of information. Meanwhile, in a survey by Shea et al. (2018, p. 2), the major features requested in dental EHRs include oral health risk assessment, fluoride varnish applications, and dental referrals. This is particularly relevant to specializations such as pediatrics, where primary care physicians place significant importance on elements of oral health information, nearly as important as traditional primary care information such as immunizations (p. 3).

Dentists have made notable progress in recent years to adopt EHRs despite lacking regulatory incentives that the medical field does. On average EHR systems at a facility costs $10,000-$20,000 with additional training, maintenance, and support expenses. Costs associated with EHR adoption often exceed reported benefits by more than 23% (Maryland Health Care Commission, 2018). Enhancements to EHR, are usually overlooked, especially for pediatric dentistry due to lack of return on investment despite potentially tremendous benefits (Shea et al., 2017, p. 5). Large dental practices see EHRs as vital to creating efficiency while smaller practices, which are the majority of dental providers see it as largely disruptive to workflow.

EHR are meant to introduce standardized tools for diagnosis and documentation. The standardized dental diagnostic terminologies (SDDxTS) were created decades ago. Although with the rise of EHRs, one of the most commonly used terminologies, the Dental Diagnostic System (DDS) is seeing some rise in adoption, there are inherent barriers to implementation by EHR systems and clinical institutions. Factors discouraging adoption include poor usability within EHR and lack of small-scale applicability (Ramoni et al., 2017, p. 319). While the inclusion of dental requirements into EHR is innovative, it also needs to be practical through the use of standardized terminology to achieve widespread traction.

Despite all the studies examined above suggesting the benefits of dental-medical iEHR integration and a large number of these articles conducting interviews and surveys where the majority of medical professionals and dental professionals are in support of this, there are still evident divisions. There is variability in the implementation of iEHR, on which clinical indices should be included and the frequency of updates. The American Dental Association has a list of recommended indices that should be included in dental records, but there is no present guidance on updates (Tokede et al., 2016, 158). Similar to terminology, to ensure the effectiveness and validity of integrated records, the first step would be to establish national standards for included elements and frequency of updates of iEHR.

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References

Acharya, A. et al. (2011) ‘Medical providers’ dental information needs: a baseline survey.’, The Studies in Health Technology and Informatics, 148, pp. 387–391.

Acharya, A. et al. (2017) ‘Medical care providers’ perspectives on dental information needs in electronic health records.’, The Journal of the American Dental Association, 148(5), pp.328–337. Web.

Adibi. S. et al. (2017) ‘Medical and dental electronic health record reporting discrepancies in integrated patient care’, JDR Clinical and Translational Research, pp. 1–6. Web.

Chauhan, Z. et al. (2017) ‘Adoption of electronic dental records: examining the influence of practice characteristics on adoption in one state.’, Applied Clinical Informatics, 9(3), pp.635–645. Web.

Maryland Health Care Commission (2018) Dental electronic health record adoption. Web.

Ramoni, R.B. et al. (2017) ‘Adoption of dental innovations’, The Journal of the American Dental Association, 148(5), pp.319–327. Web.

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Sadoughi, F. et al. (2017) ‘Assessing dental information requirements of electronic health records of Zahedan dental school.’, The Studies in Health Technology and Informatics, 238, pp. 28-31.

Shea, C.M. et al. (2018) ‘Providers’ preferences for pediatric oral health information in the electronic health record: a cross-sectional survey’, BMC Pediatrics, 18(5), pp. 1–7. Web.

Song, M. et al. (2010) ‘How information systems should support the information needs of general dentists in clinical settings: suggestions from a qualitative study’, BMC Medical Informatics and Decision Making, 10(7), pp. 1–9. Web.

Tokede, O. et al. (2016) ‘Clinical documentation of dental care in an era of EHR use’, The Journal of Evidence-Based Dental Practice, 16(3), pp. 154–160. Web.

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