Why we need modern dental software and interoperability
It has always been troubling to me that patients spend years under the care of a dentist and then when moving to another practice there is loss of continuity. The patient’s record does not follow the patient.This was not as big of a problem when paper records were the mainstay because they could be physically transferred. But with computer dental records the patient record cannot be transferred from one practice to another even if using the same program. Dental software is proprietary and idiosyncratic and may not present the same granular clinically-relevant parameters to track.
But even if there was an easy way to transfer a patient record, there is another problem. Because of the “snapshot” design of most software, it is not really possible to look at a computer dental record and observe data presented over time. As a clinician, the most helpful thing for me in caring for a patient is to get a sense of the change over time in key health indicators. Here are example parameters that clinicians are interested in when assessing a patient’s trends:
The fact that dental records are organized in a way that allows clinicians to do little more than look at static images of their patients is a problem. It is even an impediment to continuity of care within a practice, let alone when the patient moves to a new dentist. Until this is rectified, we can expect the practice of dentistry to continue to struggle to recognize trends or observe outcomes in a way that is meaningful at the point of care. Thankfully we are not subjected to the same kind of administrative oversight our medical colleagues endure, but we should recognize that the effort is aimed at keeping people well with the most judicious use of funds and data. Dentistry should be able to do this without a mandate from an authoritative group.
Dentists should clamor for software that provides features that connect patient’s histories from one practitioner to another. It should be done in a way that enables the higher cognitive reasoning of clinicians by allowing the ability to easily see trends and alerts in patient’s dental health.
Imagine receiving a patient’s record in a digital, active form shown below along with a letter from the previous dentist that says:
“Thank you for continuing the care for Jane Doe. Jane has been a patient of mine for fifteen years. You will observe that Jane is struggling with chronic periodontitis and is losing clinical attachment. She has been reluctant to go to a periodontist for consideration of regenerative tissue care. Jane also has high caries risk and is developing subgingival caries. The implications of her medical history and pharmacology oral cavity reactions are notable. Unless there is a change in trends Jane should be considered for implant/prosthetic therapy. If I can provide further information please do not hesitate to contact me. These records will merge directly into your software so that no loss of continuity is experienced.”
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Or instead of only knowing how many crowns one did the previous year, what if clinicians could see how many patients were moved from high caries risk to low caries risk and under what protocol. Or, view a report of all the patients who are taking a drug with taste alteration side effects or one that is linked to lichenoid lesions so that attention can be given to those possible issues.
It is obvious how helpful it would be to have this information so that we can intelligently counsel patients about their oral health trends. Algorithms that weigh the clinical elements could be written that provide clinicians the ability to better predict outcomes. And being able to move a patient from one practice to another without loss of data for trends surely must be a goal.
Delivery of fine care takes care of production. Dentists are not bookkeepers by training. We are doctors and should have software that keeps that at the forefront of their design.