Challenges of Dental EHRs

Dental informatics has lagged behind. In particular, a variety of issues has hampered the transition to electronic health records for dentistry, according to Reynolds, Harper & Dunne (citation below):

“Despite the significant conceptual breakthroughs of the 1960s, all medical informatics, including dental, have faced major impediments in the shape of systems performance and integration issues.”

This post summarizes an article by Reynolds et al. (citation below), covering the state of dental informatics. One major challenge for all dental EHRs is the need for standardized terminologies and taxonomies, which have not yet been achieved. There are differences in language by practice, by region and in different software and paper information systems. This is exxacerbated by the fact that translating paper records into electronic records has suffered from very poor usability, reducing the possibility of dentists using or wanting to use the software:

“The low historical levels of uptake in dental ICT must be connected to the difficulty of translating research projects into clinically useful tools for dental practitioners.”

Another major difficulty for dental electronic health records is the challenge of integrating a keyboard into dental workflow. Yet automated speech recognition is not yet integrated into clinical systems, and the technological challenges are still being explored.

One of the other major benefits of EHRs in hospital and ambulatory settings is the built-in clinical decision support, which offers guidelines and other key information. However, dental EHRs have not yet reached a high level of decision support:

The American Medical Informatics Association has concluded that traditional CDSS have had only a modest effect on improving prescribing while their impact on clinical outcomes is indeterminable but probably minor. It has called for a new class of ‘evidence-adaptive’ CDSS.

Clearly, dental EHRs have a long way to go. Furthermore, the lack of clearly defined paths to the incentives of meaningful use offer a further obstacle to implementation. Dental EHRs are still in the formative stages, although advances in computing power and changes in the US focus on electronic records are paving the way to significant change.

Lessons Learned:

  • Dental informatics has not developed at appropriate speed for usability.
  • Lack of standardized terminology and taxonomy reduces the efficacy of dental EHRs.
  • Usability of dental EHRs is still low, particularly when trying to integrate them into clinical workflow.
  • Dental decision support has not yet become reliable or useful.

Reynolds, P.A., Harper, J. & Dunne, S. (2008) Better informed in clinical practice – a brief overview of dental informatics. British Dental Journal 204, 313 – 317