Living Up to Predictions: Complete Patient Information

In 2003, Sitting, Kirshner & Maupome wrote a vision of the “Grand Challenges in Dentistry,” chronicling a scenario of a future patient’s visit to a dentist’s office:

“During the [online] registration process, Gloria was asked about her previous dental treatment and medical history. To give Dr. Brown accurate information, Gloria logged into her Personal Electronic Medical and Oral Health Record and added Dr. Brown to the authorization list… Gloria approved the release of the protected information, which gave Dr. Brown additional privileges to view previously restricted data. Two days before her appointment, Gloria received an e-mail welcoming her to Dr. Brown’s practice and confirming the appointment. She was also given a user ID and password to the private and confidential “new patient” portion of Dr. Brown’s Web site. Gloria logged on and ‘participated’ in a new-patient pre-visit interview with an avatar on the computer.”

From the patient side, the increased ease of access and reduced time spent duplicating information would obviously be a benefit. But what about for clinicians?

“Back in Dr. Brown’s office, a new-patient report had been automatically generated that combined data from Gloria’s registration, pre-visit interview, and previous medical and dental records. Using Gloria’s universal ID and his own authenticated dentist ID, Dr. Brown logged onto Gloria’s electronic health record and reviewed the past five-year history of Gloria’s full-mouth x-rays, which included an analysis of the changes in alveolar bone height and density, and an assessment of activity of caries lesions.”

A decision-support system helped the (hypothetical) Dr. Brown choose between care options, given Gloria’s immunological profile, and her salivary test provided information about her genetic risks for various ailments. Consulting with Gloria, Dr. Brown used a 3-D system to provide visualizations of each option, along with automatically generated statistical risks.

Many other features are included in this hypothetical, futuristic scenario. But reading this, it becomes clear how integrated and integral the oral and health records are to overall patient care. Treating the whole patient demands complete information. The authors define the characteristics such an electronic record needs:

“A comprehensive electronic oral health record that is seamlessly integrated into the automated medical record. Such a system would consist of a database of patients’ health-related information entered by any healthcare worker. It would allow clinicians to document findings and plans, provide links to online information resources, facilitate real-time clinical decision support, and facilitate the transmission of information to other clinicians.”

The prediction in 2003 was that such an electronic record system would be a challenge, but a do-able one. One of the major challenges was seen to be the need for a universal patient identifier; another was the need for standardized, cross-practice terminology. Now that it’s 2012, let’s take up the battle cry and make it happen.

Lessons Learned:

  • A clinically useful dental EHR provides the health information of the whole patient.
  • Salivary diagnostics could position dental information as a key participant and requisite of an EHR that enables holistic patient treatment through health information exchange.
  • Since at least 2003, predictions of dental EHRs have emphasized the need for standardized terminology and decision support.

Sittig, D.F., Kirshner, M. & Maupome, G. (2003) “Grand Challenges in Dental Informatics.” Advances in Dental Research 17(1): 16-19.