Dental EHRs and Data Acquisition

A wide variety of critics of electronic dental records focus not just on the cost and disruption of implementation, but upon the data available in an electronic record. The article summarized here set out to compare the clinical data in each format (paper and electronic) and assess their fit for dental needs.

In the study, only 1.8% of the practices were paperless; almost all of them used paper records for at least some part of the patient information. By and large, that was because the electronic record either did not record that kind of information or because it was too awkward or interruptive to enter that data into the computer during the patient visit.

First, the authors created what they call the Baseline Dental Record, which was created by examining 10 paper records. The records were from a variety of sources: 4 practicing dentists, 2 dental schools and 4 from commercial vendors. Three textbooks were also consulted. Twenty categories with 363 data fields were produced. The resulting baseline was mapped to the ANSI/ADA 1000 Specification data model.

Then the baseline was compared to 4 EDRs: Dentrix, Eaglesoft, Softdent & PracticeWorks. Note that the software versions were current at the time the article was written, but have now been surpassed by upgrades and new versions. These four systems had 80% of the electronic market at the time and were well-respected.

The baseline was also compared to the existing paper records, to properly compare. Paper records averaged 210 data fields, and varied wildly in the clinical content they contained. For instance:

“The [Baseline] contains a total of 89 fields for [Past and Present Illnesses], of which only 31 appear in five or more of the paper-based records; 47 appear in only one or two paper-based formats (examples: “Prosthetic valves or joints,” “Syphilis,” and “Tobacco habit”).”

Electronic records averaged 174 data fields and all completely lacked the categories of “Chief complaint,” “Systemic diagnoses,” and “Problem list.” When comparing the paper and electronic records, the authors noted that the electronic records did not group data into the same shared categories that the paper records used. Instead, the categories were spread across several areas, or named differently than on the paper records.

Overall, “fields found in the majority of paper records are sometimes found rarely or not at all in paper records, and vice versa.” This is an interesting finding, suggesting that the use of an electronic or paper record could actually change workflow and quality of care based on the data available. In addition, in any single record (paper or electronic), only 60% of the baseline fields occurred, and only 20% of the data appeared in at least five of the records.

The authors of the study shared the results with vendors, all of whom pointed to the free text fields available in the dental EHRs for storing additional data. However, for ease of use and search, that suggestion falls short of dental reality. This study reveals that electronic and paper records contain about the same amount of information, and that even paper records do not collect the same information. There are usability and navigation issues with electronic records, but it may be that the easy customization of paper records is its main attraction.

Lessons Learned:

  • When evaluating Dental EHRs, review the types of clinical data available to the system.
  • Paper and electronic records do not always contain the same data fields, and often the arrangement is quite different.
  • Free text fields are the vendor’s suggestion for how to handle missing data fields.

Schleyer, Spallek & Hernandez. (2007) “A Qualitative Investigation of the Content of Dental Paper-based and Computer-based Patient Record Formats” Journal of the American Medical Informatics Association 14(4).