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FAQ: What is the difference between
dental IT and Dental Informatics?
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  1. What is the difference between Dental IT and Dental Informatics
  2. How does Dental Informatics inform the development of Dental Information Technologies?
  3. What kind of Dental Informatics applications can improve dental practice?
  4. How are Dental Informatics and Dental Information Technology used in practice building, practice management and business administration?
  5. How can Dental Informatics enhance the patient experience?
  6. How can clinical care be affected by Dental Informatics applications?
  7. Are electronic clinical records and charting (i.e., The Electronic Oral Health Record - EOHR) the way of the future?
  8. Where does professional dental education benefit from Dental Informatics?
  9. Will Dental Informatics play a role in improving the quality of dental treatment?
  10. What are some of the challenges facing Dental Informatics?

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  1. What is the difference between Dental Informatics and Information Technology?

  2. There is a definite distinction between Dental Informatics (DI) and Information Technology (IT) use in dentistry. IT provides the hardware devices and software programs that capture, store, retrieve and display information (i.e., data), whereas, DI focuses on the creation, management, modeling, structure and usability of the information (i.e., data) within and across different systems.

    However the two domains are not mutually exclusive, the primary focus of each is different. IT focuses on hardware and software devices, whereas Dental Informatics focuses on research, development, and evaluation of information models and computing applications.

    Most dentists are familiar with IT used in the dental practice.  Some examples of dental practice IT includes, computerized billing, insurance form generation, intra-oral cameras and digital x-ray machines. Dental informatics uses IT as a source of data but takes it a step further by using data (often from multiple inputs) and by evaluating, massaging, enhancing and managing the data. With the ultimate goal of presenting the data back to the user in ways that will improve the quality, efficiency, safety and effectiveness of care.  Examples of applied dental informatics applications includes, alerts and reminders, decision support, secure messaging, terminology and nomenclature standards, and e-prescribing.

    Many dental information technology tools incorporate and embed dental informatics in the technology. For example, a practice management system is an information technology that captures and stores data. The system also provides reports and analyses that utilize decision algorithms and data mining capabilities both of which are considered informatics tools.

    Another example of a Dental Informatics role is defining nomenclature, standards and protocols for the exchange and sharing of information across disparate systems to support integration, interfacing and interoperability, such as dental office and lab, dentist referral to specialist, tele-dentistry and secure dentist-patient and dentist-dentist communication.
    Dental Informatics focuses on research and application in the conceptualization, organization, relevance and utilization of information, whereas Dental Information Technologies provide the software design and development as well as the creation of the input and output devices.
    See also http://www.dentalinformatics.org/learningcenter/faq.html#it for more discussion about the distinction between DI and IT

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  3. How does Dental Informatics inform the development of Dental Information Technologies?

  4. The next generation of Dental Information Technologies, particularly those used by dentists in their practices, will depend on the results of Dental Informatics research and infrastructure. The table below presents four areas where Dental IT will be impacted by Dental Informatics – Clinical, Imaging, Bioinformatics, and Population. In each of these areas informatics research must be conducted, challenges overcome and applications designed, developed, tested and implemented.  In some areas the work is well underway with applications now being used by practitioners while others require additional research and development.

     

     

    Basic Research

    Informatics Challenges

    Applications Infrastructure

    Office Applications

    Clinical

    Coding, data structures, high performance computing

    Vocabularies, automated retrieval from repositories

    Distributed medical records, clinical trials, teledentistry

    EDR, Outcomes Predictor, Treatment Planner, Clinical Decision Support Tool

    Imaging

    3-D modeling, visualization, data representation

    Ontology-based reference models and classification

    3-D anatomy atlases, radiological diagnosis

    3-D modeler, X-Ray analyzer, dynamic neuromuscular occlusal simulation, Haptic feedback simulation

    Bioinformatics

    Biochips, algorithms for DNA sequencing, patient specific drugs

    Linking genomic and patient data, security, ethics

    Genetic-based patient records and protocols

    Biometric nano-robotics, bioassay caries/periodontal analyzer

    Public/
    Population

    Databases, searching, data analysis theories and algorithms

    Integration and validation of information, knowledge discovery

    Data mining, citizen-based services, social networks shared knowledge-base

    Blogs, web portals, PHR

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  5. What kind of Dental Informatics applications can improve dental practice?

  6. Dental informatics is the “application of computer and information science to improve dental practice, research and program administration” (Eisner, 1999). Applied dental informatics is often thought of in terms of the use of hi-tech devices and appliances by dentists, for example intra-oral imagery, laser handpieces, and office management systems. However, it is the clinical content (i.e. data, information and knowledge) that is captured and utilized by the devices and applications that falls more directly into the realm of applied dental informatics and serves as the foundation for the next generation of informatics-based applications.

    Dental Informatics has the potential to improve the effectiveness, efficiency and overall quality of oral care dental professionals are able to provide to patients as well as enhance patient experience and office management processes.  The following applications leverage the foundations of dental informatics from the perspective of the use of a knowledgebase derived from large data sets.

    Dental Informatics Applications:

    • Patient Risk Profiler
      • A system to profile patient risk for specific chronic oral disease status (e.g., chronic periodontitis, temporomandibular joint dysfunction, or caries) based on a few variables (age, gender, current oral status, number of carious teeth, tobacco use, xerogenic medications, etc.). The system would rely on outcomes data from a large cross-section of the U.S. population to generate its predictions.

    • Outcomes Database
      • A population-based system to assess the likelihood of successful outcomes for dental treatments such as implants, periodontal surgery, prostheses, and cast, amalgam, plastic, and ceramic restorations based on unique and specific patient profile markers as well as techniques and materials used.

    • 3-D image modeler and predictor
      • 3-D image manipulation and simulation systems to illustrate the effect on the patient’s appearance of proposed procedure, such as maxillofacial surgery, orthodontics, periodontal grafts, and cosmetic dentistry. Such a system would also help clinicians incorporate and normalize the expectations of the patient, dentist and parent (if the patient is a child).

    • Evidence-based  Treatment Planner
      • An automated treatment planning system for all dental diagnoses for use by clinicians. Such a system should be based on the best available evidence from clinical trials. When such evidence does not exist, the system should be able to extract similar cases from a nationwide diagnosis and treatment outcome database to identify best practices (based on expert opinion, consensus, and other less robust evidence). 
      • An automated treatment planner would be similar to a clinical decision support system (guidelines-based) for clinicians. It would serve as a tool for dentists to identify appropriate treatment options that are tailored to patient oral disease, patient characteristics, patient medical health states, current acute and chronic disease states and patient preferences. Remember that most of dental treatment is either elective or preventive for the vast majority of patients in the US who can afford dental care or have dental insurance. Therefore involving the patient’s preferences is a valuable and important aspect of dental care.

    • Decision Support Tool
      • A decision support system for patients that would help them learn about all the personally relevant and applicable dental treatment options.  Such a support system would also assist patients in a decision making process that would lead to a values-based choice among the various alternatives. Such a system would empower patients to become more engaged in both the decisions surrounding their care, as well as in preventive health practices.

    • Intelligent time series comparative X-ray analysis
      • Procedures and processes to capture and analyze digital x-rays progressively over time to track hard tissue changes, compensating for most radiographic technique artifacts such as exposure and beam angulation variations.

    • Nano-robotics
      • Nano-robots that would be used intra-orally to monitor and transmit information on various markers of oral health status, such as salivary pH fluctuations and long-term trends, degree of mineralization shifts at certain index tooth surfaces, salivary enzyme and bacteriologic make-up changes over time, and information about crevicular fluid flow and make up. The results reported by the nano-robot would be recorded in a patient-specific database and used to monitor and alert the dentist to alterations that point to precursors of disease. (An informatics challenge would be to figure out what information to capture; how to record, classify, categorize, store, and retrieve it; how to effectively and efficiently mine the huge amounts of data obtained; and how to use the knowledge gained from the data mining.) Therapeutic applications of the nano-robot technology would also be feasible, although in terms of dental informatics the actual therapeutic application is a secondary goal.

    • Haptic feedback simulation training
      • Computer-based, simulations that incorporate haptic feedback and thus allow students and clinicians to develop and enhance their fine motor skills and sensitivities related to clinical surgical and operative procedures.

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  7. How are Dental Informatics and Dental Information Technology used in practice building, practice management and business administration?

  8. Originally the sole component of computerization in the dental office, computerized practice management systems, are no longer restricted to automating insurance claims processing and generating periodontal recall lists. Today the business of running a dental practice includes managing the practice, reaching out to patients and colleagues through  applications such as dental practice web portals, secure messaging, online patient registration and appointment scheduling as well as connectivity to personal health records and specialty referrals. Practice management involves marketing, promotion, recruitment, and retention and above all customer service. Customer (i.e. patients) relation management is a key component of a successful dental practice.

    Dental Informatics plays a significant role in patient relation management.  DI is involved in defining data elements that are mined to create business intelligence used to support patient relations management. The accumulation of both identified and anonymozied patient data can be used within and among dental practices to build large data sets which can be mined to learn more about patient behaviors and preferences. These data become essential components of business intelligence that will be used to target and tailor customer relation activities.

    Some practice and patient management application in which Dental Informatics and business intelligence data are involved are listed below.

    Practice Management

    • Web Portal
      • Locating a new dentist
      • Learning about your practice
    • Patient education
    • Pre visit preparation
    • After visit summaries
    • Patient registration and scheduling
    • Electronic insurance claims processing
    • Electronic prescriptions
    • Recall tracking
    • Reminder systems
    • Secure messaging
    • Connectivity to patients
      • Cell phones – i-phone
      • PDA
      • Email
      • Personal Health Record
    • Practice promotion
    • Patient recruitment and retention
    • Social marketing, networking and social support through Blogs and patient to patient online interaction

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  9. How can Dental Informatics enhance the patient experience?

  10. Personal interaction with computerized information and communication is becoming widespread in health care, including dentistry. Whether it is learning about diseases and treatments from the Internet, viewing intra-oral images in a dental office, blogging on the web to learn about ‘someone like me’ or using a patient decision aid to decide on the most appropriate treatment plan, patients and care-givers use dental informatics applications to seek and receive information related to dental procedures and dental care.

    The role of Dental Informatics in relation to patient experiences is centered on providing the knowledge and data to support targeted and tailored information. Getting the right information to the right person at the right time in the right way from the right source will most often lead to an enhanced and meaningful patient experience. However, getting to that point is no simple task and it can not be accomplished with IT alone. It is the role of Dental Informatics to determine the “what” and combine with IT to provide the “how”.

    Throughout these processes the quality of the patient experience is paramount. The following informatics-based applications are used to inform and education patients, and at the same time enhance the experience of patients with their dentist and the dental team.

     

    Patient Experience

    • Educational software and materials
    • Patient decision aid
      • Preference-based
      • Values-based
      • Suited for elective treatment with no one best option
      • Support self-care
      • Increased patient involvement in managing their wellness and making health care decisions
    • Intraoral images
      • Personalized image forecasting
      • 3-D imaging using patient data
      • Used in cosmetics, maxillofacial reconstruction, orthodontics
      • Help normalize expectations
    • Patient specific risk assessment and instructions
    • Social network w/ patient community
    • Medical Dental interface ( between MD-DDS-DH-RN, other)
    • Web portal, web blog
    • Information Therapy (© Healthwise )
    • Online ongoing care relationship
      • Web delivered
      • Avatar Nurse/Coach
      • Tailored push-pull technology

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  11. How can clinical care be affected by Dental Informatics applications?

  12. Dental Informatics plays a significant role in the continuum of patient care from the pre-visit preparation, to treatment delivered in the dental operatory, to the after visit summary, to follow up and ongoing treatment outside the dental office. This role will increase as access to and integration of  patients’ medical histories become part of the patient clinical record and as more health care is delivered outside the clinical setting. Effective, efficient, safe, high quality dental care is enhanced through the availability of a wide range of Dental Informatics-based applications utilized in the course of clinical care.  The following lists many Dental IT applications that may be considered part of the clinical process. For each application a list of Dental Informatics dependencies are included.

     

    Clinical care

    • Pre-visit preparation
      • Web-based Avatar or coach
      • SOAP triage
      • Medical, and social history
    • Oral Exam
      • Smart imaging and sensors
      • Decision Support
      • Rules based profiler and predictor
    • Patient Risk Assessment and Profile
      • Disease specific
      • Periodontal, TMD, Caries
      • Cardiac, Diabetic, Hypertension, etc.
      • Rely on population-based epidemiologic outcomes data
      • Medical-Dental interface – health assessment
    • Digital radiography and imaging
      • Artificial Intelligence used to analyze digital images for early disease detection and diagnosis
    • Outcomes database
      • Population-based
      • Treatment outcomes
      • Procedures, techniques, materials
    • Voice Recognition
      • Standardized vocabulary and nomenclature
      • Dental ontology
      • Coded meta-thesaurus
      • Natural Language processing
      • Effective and efficient user input and output devices more suitable for chair-side computing
    • Diagnostic predictive modeling
      • Predict risk of future disease
      • Based on population data and individual history
      • Accuracy requires large database of retrospective data
      • Mostly radiographic evidence with Quantitative Laser Fluorescence
    • Tele-consultation & referral
      • Controlled dental vocabulary
      • Integrated and interfaced with EOHR/ EMR/ PHR
      • Nationwide clinical trials database
    • Microscopic and Nano-robotic systems
      • Intra-oral monitoring
      • Uses multiple biomarkers
      • Remote transmission and feedback loops
      • Micro-assay
      • Smart sensors
      • Linked to PHR/EOHR/EMR
      • Disease specific risk profilers
      • Decision Support
      • Predictive modeler
      • National Database
    • Personalized image forecasting
      • 3-D imaging using patient data
      • Used in cosmetics, maxillofacial reconstruction, orthodontics
    • Information Therapy Ix – after visit summary
      • Validated source referrals
      • Linked to PHR
      • Linked to EOHR
      • Patient experience database (Social Networks)
    • Ongoing care
      • Chronic disease mgt

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  13. Are electronic clinical records and charting (i.e., The Electronic Oral Health Record - EOHR) the way of the future?

  14. Electronic health records are gaining use in dentistry and they will likely replace paper-based records in the future. For now the use of EOHR chair-side is limited, yet it offers a number of distinct advantages over paper-based records. In addition to being available at all times at multiple locations, being legible, and being transferable, an essential quality and safety value electronic records can provide is decision support and evidence-based guidelines. The following are some examples of specific informatics-based clinical records applications that may become standards of care in dentistry.

    Clinical Records & Charting

    • Electronic Oral Health Record
      • Evidence based clinical guidelines
      • Risk profiler
      • Decision support
      • Best practices
      • Materials assessments
      • Disease tracking
    • Universally accessible continuous longitudinal electronic patient oral health records and medical history
    • Medical alert systems
    • Materials alert systems
      • National products and materials, procedures outcomes database
    • Personal Health Record
      • Direct patient entry
      • Radiographic findings
      • Lab and bio-assay results
    • Treatment planning with decision support
      • Evidence-based, population based
      • Active guidelines
      • Tailored treatment options
      • Treatment outcomes database
      • Evidence based tailored Patient Decision Aid
    • Medication assessment with Point of Care decision support
    • Continuous speech recognition
    • Remote access to EOHR
      • Professional consultation

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  15. Where does professional dental education benefit from Dental Informatics?

  16. Professional education, especially continuing dental education, is already benefiting from information technologies and dental informatics through online courses and virtual experiences and simulations.  Additional areas where Dental Informatics will support education for dentists include tele-consultation and virtual reality simulations.

    Professional Education

    • Tele-consultation with real-time video, imaging and radiographic presentations
      • Clinician to clinician
      • Clinician to patient
    • Virtual reality
      • Experience tailored to unique patient profile
      • Visual-sensory
      • Haptic feedback
      • Self-learning systems
    • 3-D simulation
      • Smart imaging systems

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  17. Will Dental Informatics play a role in improving the quality of dental treatment?

  18. The answer to this question will be determined with the evolution of the next generation of dental information technology and communication based tools.  For example, if large generalizable data sets of treatment outcomes combined with evidence-based treatments procedures become available and are incorporated into effective treatment planning tools that are used by dentists, then one expects the quality of care to increase.

    Many aspects of Dental Informatics can have a large and positive impact on the quality of care delivered by clinicians.  However, the challenges for Dental Informatics, like those facing Medical Informatics, are significant and require effort from a wide range of stakeholders in many sectors – government, industry, academia, clinical practice and consumers.

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  19. What are some of the challenges facing Dental Informatics?

  20. In order to consider the design and development of many of the applications mentioned a core set of data/information/knowledge is required.  The acquisition, classification, storage and retrieval of this information are necessary steps that must precede the possibility of realizing the envisioned applications.  The grand challenge of Dental Informatics is not to dream up possible applications that may be beneficial and move dentistry into the information age; rather the grand challenge of dental informatics is to figure out what information to collect, how to collect it, and then how to use it.  The following challenges are a view from 50,000 feet rather than from the clinicians’ chair-side perspective.

    • Knowledge based ontology

    To develop a knowledge-based ontology of dental concepts from which one could extract a standardized controlled clinical terminology to describe dental signs, symptoms, conditions, diseases, and treatments (i.e., procedures, methods, techniques, materials, and devices).  Such an ontology forms the basis of the field of Dental Informatics.  This ontology must contain elements, such as permanent clinical concepts and non-semantic identifiers; allow for a polyhierarchy; include formal definitions; not allow “not elsewhere classified” terms; employ multiple granularities; and allow for recognized redundancy (Cimino, 1998; Rector, 1999).  Without such a standardized controlled terminology, all other clinical data and knowledge bases will not be of much use.

    • Evidence base of  knowledge

    To develop an evidence base of etiology, diagnosis, prevention, treatment, and treatment outcomes (including materials, methods, techniques, and usage) for a large proportion of dental patients and dental practices.  Such a knowledge base would require tracking of genomic, psychosocial, and physiologic dental health markers; prevention regimens; materials; techniques; treatments; outcome results; side effects; and environmental influences (local and global). Some of the key informatics contributions to such an effort would include the development of large, integrated clinical databases of de-identified patient data (Tierney and McDonald, 1991; Hayden, 1997).

    • Comprehensive, interoperable, continuous EOHR

    To develop 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.

    • Nationwide Oral Health Database

    To develop a nationwide oral health database that contains basic patient-level diagnostic, treatment, and outcome data linked to a nationwide medical database (Heid et al. 2002; ANSI 2003).  Such a resource would allow dentists to identify relationships between dental diseases or conditions, and medical diseases, conditions or medications. 

    • Automatic Smart data capture

    To automate data capture, integration, and synthesis to create real-time, knowledge-based, clinical monitoring systems based on both continuously and intermittently available analog and digital data.  These systems must allow data from multiple input sources of widely varying degrees of accuracy and reliability.  These monitors will require the development of robust algorithms for information and knowledge processing and must also be capable of determining how, when, and whom to notify if a significant clinical event is detected.

    • Standardized Clinical Terminology

    To develop a standardized clinical terminology to describe dental signs, symptoms, conditions, diseases, and treatments (procedures, methods, techniques, materials, and devices).  Such a terminology forms the basis of the field of Dental Informatics.  Without a standardized terminology, all other clinical data and knowledge bases will not be of much use.

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    References

    Anderson LH, Integrated Office Technology. Journal of the American Dental Association 2004: 135; 18S-22S.

    ANSI/ADA Specification No. 1000: Standards Clinical Data Architecture for the Structure and Content of an Electric Health Record (http://www.ada.org/prof/prac/stands/informatics.html#1000)

    Cimino JJ. Desiderata for controlled medical vocabularies in the twenty-first century.
    Methods Inf Med. 1998 Nov;37(4-5):394-403.

    Clancy JM, Lindquist TJ, Palik JF, Johnson LA. A comparison of student performance in a simulation clinic and a traditional laboratory environment: three-year results. J Dent Educ. 2002 Dec;66(12):1331-7.

    Eisner J. The future of dental informatics. Eur J Dent Educ. 1999;3 Suppl 1:61-9.

    Feuerstein P., Can Technology Help Dentists Deliver Better Patient Care. Journal of the American Dental Association 2004: 135; 11S-16S.

    Freriks G. Identification in healthcare. Is there a place for Unique Patient Identifiers? Is there a place for the Master Patient Index? Stud Health Technol Inform. 2000;77:595-9.

    Grannis SJ, Overhage JM, McDonald CJ.  Analysis of identifier performance using a deterministic linkage algorithm. Proc AMIA Symp. 2002;:305-9.

    Hayden WJ. Dental health services research utilizing comprehensive clinical databases and information technology. J Dent Educ. 1997 Jan;61(1):47-55.

    Heid DW, Chasteen J, Forrey AW. The electronic oral health record. J Contemp Dent Pract. 2002 Feb 15;3(1):43-54.

    Kirshner M. (2003) The role of information technology and informatics research in the dentist-patient relationship. Adv Dent Res. 2003 Dec;17:77-81.

    Schleyer TL (2000). Nanodentistry. Fact or fiction? J Am Dent Assoc 131(11):1567-8.

    Schleyer TK, Spallek H, BartlingWC, Corby P (2003). The technologically well-equipped dental office. J Am Dent Assoc 134: 30-41.

    Sittig, DF, Grand challenges in medical informatics? J Am Med Inform Assoc. 1994 Sep-Oct;1(5):412-3.

    Sittig DF, Kirshner M, Maupome G. (2003)  Grand challenges in dental informatics. Adv Dent Res. 2003 Dec;17:16-9.

    Rector AL. Clinical terminology: why is it so hard? Methods Inf Med. 1999 Dec;38(4-5):239-52.

    Tierney WM, McDonald CJ. Practice databases and their uses in clinical research. Stat Med. 1991 Apr;10(4):541-57.

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Last update: Feb. 5, 2015
Authored by: Michael Kirshner, DDS, MPH

 

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