Electronic Dental Record Perception

Electronic dental records (EDRs) are often discussed using terms like digital dental office, integrated clinical solutions, paperless systems, and electronic patient or health records. Regardless of the terminology used, if providers see them only as a way to eliminate paper, they may set themselves up for failure. Several studies by the University of Pittsburgh looked at EDR data fields and how they are perceived and used by dental providers.

The initial study interviewed 102 general dentists using chairside computers regarding their use and views of EDRs. The average age of respondents was fifty. Eighty percent used systems from the four top vendors:  Dentrix, Eaglesoft, Softdent, and PracticeWorks. Seventy percent also used third party software for digital radiography, photos, or Invisalign.

Many providers used a combination of paper and computer records. The most frequently computerized features were billing, treatment procedures, and scheduling, and the least computerized were patient histories, complaints, and progress notes, with imaging somewhere in the middle. However, many providers maintain duplicate records either because they are taking an extended period to transition, or they have found that their EDR system does not incorporate the information they wish to record. Duplicate records present legal concerns, particularly if information conflicts.

This led to a second study that looked at the ability of current EDR vendor systems to represent the clinical information providers have traditionally stored in paper records. Given that no standard for dental record clinical content exists, the researchers compiled a baseline of 20 data fields after examining records from vendors, private practitioners, and dental schools. On average, any given paper record contained only 23-32% of those fields. These were compared with the top four EDR vendor systems. None of the vendors had data fields for chief complaint, systemic diagnosis, or problem list. Only one of the four provided a field for prognosis, risk assessment and etiology.  Eaglesoft and SoftDent devoted more fields to patient history than the other two vendors.

A final study looked at provider concerns that interfaces are not user-friendly, and that the organization of electronic dental records lacks logical order. Usability assessment of the four vendor products by five untrained novice users confirmed this by showing that even main entry tasks were far from intuitive. This places a higher priority on the need for adequate training.

Lessons Learned:

  • The purpose of electronic dental records is lost if the goal is only to eliminate paper.
  • When evaluating EDR systems, consider information content fields that are important in paper records, while realizing that no electronic system will replicate paper records.
  • Extended maintenance of duplicate electronic and paper records presents legal concerns. Transitions should be complete and within a limited time frame.
  • Systems currently available are not intuitive, requiring adapters to commit time and resources to training all users.

Schleyer, Titus. (2011, July). Electronic Dental Records. MetLife Quality Resource Guide, 2nd Edition.