University  of  Pittsburgh Department  of  Biomedical  Informatics

Promoting  Interoperable  Dental  TerminologiesJodi  Schneider1,2,  Tanja  Bekhuis1,2,  Oluwabunmi  Tokede3,  Elsbeth  Kalenderian3,  Heiko  Spallek2

1Department  of  Biomedical  Informatics,  School  of  Medicine,  University  of  Pittsburgh2Center  for  Informatics  in  Oral  Health  Translational  Research,  School  of  Dental  Medicine,  University  of  Pittsburgh

3Harvard  School  of  Dental  Medicine

Problem

Patient  diagnosis,  treatment,  and  outcomes can  be  used  to:• Measure  health  care  quality,  costs  of  care,  and  treatment  effectiveness.

• Identify  disparities  in  patient  care.• Identify  risk  factors  of  disease.Standardized  terminologies  help  consolidate  data.  

Approach

We  proposed  a  plan  for  a  conference  of  stakeholders,  “Toward  a  Diagnosis  Driven  Profession”  (U13  grant  submitted  August  12,  2015),  with  three  aims:

1. Increase  understanding  of  Diagnostic  Terminologies.

2. Explore  their  potential  logistical  and  financial  impacts  on  electronic  health  record  vendors,  payers/insurers,  and  providers.

3. Create  a  working  group  to  develop  clinician-­‐friendly  interfaces  for  entering  diagnostic  terms  into  electronic  health  record  systems.  Di

agnostic  terms  in

What  is  a  Terminology?

A  terminology  is  “a  set  of  terms  representing  the  system  of  concepts   of  a  particular  subject  field”  (Shortliffe &  Cimino2006).  Using  a  unique  phrasing  to  refer  to  a  given  concept  ensures  that  information  can  be  shared  and  retrieved  effectively.Shortliffe E,  Cimino J,  editors .  Biomedical  Informatics  3rd ed.  New  York:  Springer  Science+BusinessMedia;  2006.

Diagnostic  Terminologies

Several  diagnostic  terminologies  are  in  development  and  use,  including:

Diagnostic  terminologies  are  intended  for  integration  into  electronic  records.CC-­‐BY-­‐NC  Morgan  https :/ /www.flickr.com/photos/meddygarnet/4575870327/

Interface  Terminologies  

Interface  terminologies  enable  mapping  between  different  terminologies.  They  are  designed  to  be  closer  to    a  user’s  natural  language.

Procedural  Terminologies

To  document   dental  treatment,  CDT®  Dental  Codes  -­‐ Current  Dental  Terminology®  is  used.  CDT®  is  a  standard  of  the  American  Dental  Association.  It  is  very  widely  used  in  the  United  States,  especially  for  insurance  and  billing  purposes,  as  a  HIPAA  standard  code  set.

Issues  in  Terminologies

Granularity

Flexibility

Interchange/mapping

Clarity  of  terms

Procedure  codes  are  shown  on  the  right.CC-­‐BY-­‐NC  Rob  Campbell  https:/ /www.flickr.com/photos/roberrific/15367788277/

Funded  by  Training  grant  5T15LM007059-­‐29  from  the  National  Library  of  Medicine/National  Institute  of  Dental  and  Craniofacial  Research

Diagnosis  recorded

Treatmentrecorded

Outcomes  recorded

Effectiveness  and  quality  measured.

Improvements  for  future  patients.

Continuous  learning  healthcare  relies  on  unified,  up-­‐to-­‐date  data  about  patient  diagnoses.

Dental  health  terminologies  can  describe  hierarchies  of  concepts.Example  from  SNOWMED-­‐CT,  concept:  common  cold  (disorder).CC  BY-­‐SA  Steschu.  https :/ /commons.wikimedia.org/wiki/File:SNOMED_primitive_concept.jpg#/media/File:SNOMED_primitive_concept.jpg