DENTAL INFORMATICS

- Is the application of computer and information to improve dental practice,

research, education, and management.
- A sub-discipline of biomedical informatics
Scope of Dental Informatics

Uses of Dental Informatics

- Informatics is key in helping practitioners solved clinical problems and keep
current.
- Computers can help practitioners maintain their continuing competency, and
many dentists already are using computers to keep abreast of new
developments.

Dental Informatics can improve

Effectiveness

Efficiency

Quality of oral care

Patience experience

Office management processes

 Dental Informatics Applications

3D image Diagnostic
After visit Alerts and Computerized Connectivity
modeler and predictive
summaries reminders billing to patients
predictors modeling

Dental Informatics Applications

Intra-oral cameras and imaging

Voice Recognition

Web Portal and blogs

Pre visit preparation

Tele-consultation and referral

Outcome databases

Dental Informatics Applications

Electronic Oral Evidence-based

Health Treatment
Decision support Records(EOHR) Planning

Digital E-prescribing Haptic feedback

Radiography simulation
training
REVIEW ON HARDWARE AND SOFTWARE
l Hardware is a physical component of computer that consist of interconnected
electronic components that can be used to control computer’s operation.

l Software is a series of instructions, knowledge or programs that are used to run

computers and perform specific tasks

INFORMATICS
l Informatics studies knowledge representation, retrieval, and communication in both
natural and engineered systems. It has dimensions that are computational, cognitive
and social.
AN INFORMATICS MODEL OF THE CLINICAL PROCESS

Figure 1. Waterfall model of the clinical process.

AN INFORMATICS MODEL OF THE CLINICAL PROCESS

1. Data acquisition - involves developing an initial impression of the patient, obtaining
historical data, conducting a physical examination and recording the data developed by
these activities.
2. Data analysis - is often termed the diagnostic process. It usually consists of both
deductive and inductive activities whereby individual elements in the database are
evaluated for significance and relevance, and then attempted to be fit into a pattern of
knowledge.
3. Action plan – each diagnosis is associated with one or more plans of actions.
Likewise, each of these plans of action, or treatment plans, is associated with a
prognosis. Each of the possible plans of action assumes one or more interventions may
be undertaken.

4. Interventions - are the technical and therapeutic measures undertaken by the

practitioner or at the practitioner's direction for the benefit of the patient. Interventions
are a complex interplay between dental arts and sciences. Interventions rely on finely-
honed microsurgical skills, the employment of proven methods and techniques, and the
availability of efficacious materials, devices and therapeutic agents.

5. Outcome assessment - has evolved to viewing dentistry in terms of management

models that measure the effectiveness and appropriateness of the services. It may
indicate additional, unplanned services be provided.

Within this model, dental informatics will make increasing contributions in areas ranging
from applications in dental education, through computer assisted diagnosis and treatment
planning, diagnostic systems and imaging, patient management, quality assurance and
risk management, and the activities of the research and development community and the
dental supporting industries.

APPLYING INFORMATICS CONCEPTS TO DENTISTRY

Applying informatics concepts to dentistry means blending information systems theory
and technology, the dental arts and sciences, and the clinical process.

• Dental arts - the dental arts are the humane component of dental healthcare.
• Dental Sciences - deal with all factors supporting the physical practice of dentistry.
• Clinical process - clinical process concentrates on the study of the patient with our
particular attention directed toward the oral and maxillofacial environment.

Fundamental areas in which dentistry can best be automated as:

a.) Information - Clinical information, and hence all information derived from it, is
disorganized and incomplete because existing conventions for manually recording data
are not widely adhered to.
b.) Memory - Most clinicians rely on their human initiative and memory to couple dental
healthcare information to the case at hand.
c.) Coordination - The need for extensive, coordinated care across healthcare
disciplines continues to grow. For many patients, particularly in the outpatient setting of
dental private practice, there is no rapid and effective means for the dental practitioner
to interact with physicians, clinical laboratories or pharmacies.
d.) Feedback - currently, it is difficult at best to gather evaluation data on specific cases
or patient groups using manual techniques, even if partially automated.

INFORMATICS APPLICATIONS IN DENTAL PRACTICE

Practice Applications in Dental Informatics
Three areas that can help improve dental practice and patient care:
(1)patient record keeping;
(2)fiscal practice management and
(3) clinical decision support.

ISSUES IN DENTAL INFORMATICS PRACTICE APPLICATIONS

Since there are so many areas where informatics technology can improve dental
practice and patient care, it was decided to examine dental practice in the same manner
that dentists approach patients. This organizational format was adopted in order to help
focus dental informatics issues.

l Patient identification - administrative/management systems must address this

issue.
l Problem identification - identifying all problems relevant to the health care of the
patient Establishing the diagnosis
l Developing of the treatment plan
l Implementing the treatment plan - treatment plans can be established and
outlined according to goals and objectives
l Treatment outcomes
l Follow-up - Using computer systems in patient care will greatly improve patient
follow-up and referral for consultation.

DENTAL INFORMATICS AS COMBINING PEOPLE, TASKS, AND MACHINES

Systems are composed of elements such as machines, programs,
supportingequipment, human interaction, an operating environment, and supplies. In this
system description, the key components are the human, the machine and its program
elements. Automated systems do not replace personnel and human activities: they
augment human capabilities and enhance their functions and operations.

Within the entire system, certain operations will be better performed primarily by
human activity while others are best accomplished when left mostly to machines and
programs. Emphasis on human capabilities is currently the best solution for tasks
requiring creative, cognitive and judgmental activities.

ELEVEN FUNDAMENTAL DATA OPERATIONS WHICH, LOGICAL PROCESSING

STEPS, A COMPUTER USES TO PREPARE DATA FOR HUMAN USE AS
INFORMATION.
These are given with examples appropriate to dental informatics:
1. Data Capture
2. Data Verification
3. Classification
4. Arrangement
5. Aggregation
6. Decomposition
7. Calculation
8. Storing
9. Retrieval
10. Reproduction
11. Communication

THE ROLE OF DENTAL INFORMATICS IN THE EVOLUTION OF COMPUTERS

Three specific workshop groups addressed issues relating to dental practice, education,
and research. The following four recurring themes were identified by the workgroups.

1) The principal focus of dental informatics applications should be on dental practice

where they
can impact most directly on the delivery of oral health care.
2) The profession needs to support and facilitate the process of planning for both the
short and
long tern. At a minimum planning should take place at two levels:
(a) each major dental organization should develop a strategic plan based upon its own
mission and needs;
(b) each of the plans should be integral to an overall plan for the entire profession.
3) Mechanisms should be developed early to ensure communication and networking
among the various components of dentistry including dental professional organizations,
dental schools, the dental research community, federal dental services, individual dental
practitioners of general dentistry and the dental specialties, dental auxiliaries, the dental
trades, other health professions, and appropriate members of the computer and
telecommunications industry.
4) There is a strong need for the various sectors of the dental profession to achieve
agreement on the important issue of standards related to nomenclature, classification
and coding of diseases, and the size and number of database fields. There should be
consensus on the issue of compatibility of information systems so connectivity can be
maximized.

COMPUTER APPLICATIONS FOR DENTAL TASKS

Task in Dentistry Potential Computer Applications
Dental Education, Dental Licensure Staff Patient simulation programs to develop
Training and Continuing Dental Education decision making skills and encourage life-
long, independent learning
Patient Billing Billing statements generated at the time of
appointment
Dental Insurance Claims Generate paper forms; electronic
transmission of claims to insurance
companies; determination of patient
 eligibility on-line;
Dental Patient Records Voice entry of examination findings with
visual confirmation of entries through
graphic display
Literature Review On-line access to National Library of
Medicine and other bibliographic data
bases.
Clinical Decision Making Clinical assisted decision support software
will selectively provide drug interaction
information, differential diagnosis
assistance

COMPUTER APPLICATIONS FOR DENTAL TASKS

Task in Dentistry Potential Computer Applications
Constructing Prosthetic Devices Computer Assisted Design/Computer
Assisted Milling devices to make crowns
and inlays in one appointment.
Dental Radiographs Computer enhancement of digitized
radiographic images
Ordering Office Supplies On-line, electronic catalogs
Health Histories, Examinations and Interactive programs for patients to
Treatment Plans provide current information
Treatment Planning and Case On-line access to National Library of
Presentation Medicine and other bibliographic data
bases.

Assessing Treatment Outcomes Aggregate data bases for each practice

will be passively constructed in the routine
course of filing the electronic dental patient
records, making it possible to periodically
review patient profiles and outcomes of
treatment

IMPLICATIONS FOR COMPUTERIZED DENTAL RECORD SYSTEMS

Electronic Dental Record Industry

1. Size of Potential Market

The dental delivery system is relatively small and will decrease in size over the
next 20 years. Even if one software vendor were to capture a large percentage of the
dental market, say five percent, it would mean some 5,000 practices. This is a relatively
small number and few companies may want to invest a great deal of money developing
software and associated distribution systems that are unique to dentistry.

2. Marketing Costs
An attractive alternative might be to sell dental record software by mail or from
local software retail stores. The problem with this solution for most dentists is the need
for local support to install and maintain systems.

3. Installation, Training, and Support

The installation and training costs for electronic dental records will be relatively
high, and dentists cannot afford to spend a great deal of money on this technology. With
solo offices predominating, the installation will require a team of people going to each
office and converting paper records, fiscal and patient, to electronic.

IMPLICATIONS FOR COMPUTERIZED DENTAL RECORD SYSTEMS

Features of Electronic Dental Record Systems

a. Integration of Fiscal and Clinical Records

It is unreasonable to expect that dentists and their staffs would accept clinical
record systemsthat are separate from fiscal programs. On this basis an acceptable
record package must include fully integrated clinical and fiscal management programs.

b. Clinical Record Content

The accounting profession has established a standard data set needed for
effective review of the fiscal operation of businesses including dental practices
c. Practice Efficiency
 Dentists will be unlikely to make a large investment in computer hardware and
software unless there is strong evidence that this technology will result in higher practice
incomes. Incomes can increase as a result of reducing the cost of producing technical
dental services or the cost of administering the practice.

d. Decision-Assist Systems
For both fiscal and clinical decision-making solo dentists must rely on the
knowledge they have obtained during their training and from continued education once
through training.

Individual Patients
In a busy solo or group practice it is difficult to stop in the middle of treating patients
and to seek advice from colleagues or check the latest literature. Decision-assist systems
that are fully integrated within computerized patient records have great potential for
solving this problem. These systems will provide dentists immediate access to information
that is directly related to the care of a specific patient.

Aggregates of Patients
Dentists have very little fiscal and almost no clinical data on aggregates of patients.
This is because the cost of collecting and analyzing data from paper records is very
expensive. A related problem is that most dentists have never been trained to use data
on groups of patients. On the financial side, dentists use accountants and other business
specialists to assist them in collecting and interpreting aggregate data such as cash flow,
production costs, taxes, and more generally practice efficiency. These specialists have to
gather data from practices manually in order to assess the fiscal health of practices and
to make recommendations. This is an expensive process, because of the time needed to
collect and analyze data.

e. Query Systems and Normative Data

A related issue is the need to have simple query systems that will allow dentists to
quickly and efficiently generate customized reports on the fiscal and clinical operations of
their practices.

f. System Reliability
 A successful system must be very reliable, since dentists cannot afford to have
their systems down for more than a few hours.

g. User Friendly
It is obvious that the complex fiscal and clinical information system just described
must, at the same time, be very easy to learn and use.