research opportunities at the interface of dental and medical informatics

8/6/2019 Research opportunities at the interface of dental and medical informatics

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Research opportunities

at the

interface ofdental and medical

informatics

Center for Dental Informatics

University of Pittsburgh School of Dental Medicine

Titus Schleyer, DMD, PhD(with help from Mei Song, PhD)

University of Washington

School of Dentistry - Department of Oral

Medicine & School of Medicine -Biomedical and Health Informatics

August 2, 2011MacDonald Lake, Glacier Park Titus Schleyer 2001


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2 of 52Center for Dental InformaticsUniversity of Pittsburgh School of Dental Medicine

Todays talk

is intended to be more of a discussion

than a talk.

is not just about medical and dental

informatics.

may create some (healthy) tension .

hopefully will make you rethink some priorbeliefs.


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Topics

how informatics (and healthcare) areorganized

the One patient

how health records are organized

suggestions for integrative research

standards

information presentation and usability decision support for distributed care

discussion and outlook


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How informatics (and healthcare) are

organized

Shortliffe EH, Johnson SB. Medical informatics training andresearch at Columbia University. IMIA Yearbook 2002;173-180.

Basic Research

Applied Research

Medical Informatics Methods,

Techniques, and Theories

Bioinformatics

Imaging

Informatics

Clinical

Informatics

Public Health

Informatics

Molecular and

Cellular

Processes

Tissues and

Organs

Individuals

(Patients)

Populations

and Society


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Basic Research

Applied Research

Medical Informatics Methods,


BioinformaticsImaging

Informatics

Clinical

Informatics

Public Health

Informatics

Molecular and

Cellular

Processes

Tissues and

Organs

Individuals

(Patients)

Populations

and Society

Basic Research

Applied Research

Dental Informatics Methods,



Informatics

Clinical

Informatics

Public Health

Informatics

Molecular andCellular

Processes

Tissues and

Organs

Individuals

(Patients)

Populations

and Society

Basic Research

Applied Research

Nursing Informatics Methods,Techniques, and Theories


Informatics

Clinical

Informatics

Public Health

Informatics

Molecular and

Cellular

Processes

Tissues and

Organs

Individuals

(Patients)

Populations

and Society

Basic Research

Applied Research

OtherInformatics Methods,


Bioinformatics ImagingInformatics

ClinicalInformatics

Public HealthInformatics

Molecular and

Cellular

Processes

Tissues and

Organs

Individuals

(Patients)

Populations

and Society


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The One patient

healthy dentition

early childhood caries

(ECC)


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Center for Dental InformaticsUniversity of Pittsburgh School of Dental Medicine

Early childhood caries: The actors

O: Obstetrician

ON: Obstetric Nurse

GD: General Dentist P: Pediatrician

PN: Pediatric Nurse

PD: Pediatric Dentist PDN: Pediatric Dental Hygienist


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Childs

AgeHC professional(s) Clinical

Prenatal/Perinatal O, ON, GD

maternal dental hygiene

limit salivary contact

mothers oral health (e.g. pregnancy-

associated gingivitis)

Neonatal ON

mother: nutrition, oral hygiene

childs sugar intake

schedule dental exam at 6 months age

6 months P, PN, PD, PDH

mother: optimal f luoride levels

caries-risk assessment

disabilities and caries risk

7 months P, PN, PD, PDH

window of infectivity: 7 months to 36

months

eruption of deciduous teeth

1 year P and/orPD caries/oral hygiene assessment

mother: nutrition, oral hygiene

18 months PD

early childhood caries particularly

prevalent 12 to 18 months

possible restorative interventions

2 years P, PN, PD, PDH

child may start on fluoride toothpaste

oral hygiene instruction for child

pediatric care vital if no dental care

Recommended early dental interventions


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Some other examples of intersecting

interests

diabetes, cardiovascular disease andperiodontal disease

prenatal care, periodontal disease and low birth

weight post-radiation and bisphosphonate-caused

osteonecrosis

oral cancer screening, tobacco and alcohol

oral hygiene and respiratory infections kidney disease and periodontal disease

and many more


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A timely book

http://www.springer.com/public+health/book/978-1-4471-2184-8
http://www.springer.com/public+health/book/978-1-4471-2184-8http://www.springer.com/public+health/book/978-1-4471-2184-8http://www.springer.com/public+health/book/978-1-4471-2184-8http://www.springer.com/public+health/book/978-1-4471-2184-8http://www.springer.com/public+health/book/978-1-4471-2184-8http://www.springer.com/public+health/book/978-1-4471-2184-8http://www.springer.com/public+health/book/978-1-4471-2184-8http://www.springer.com/public+health/book/978-1-4471-2184-8http://www.springer.com/public+health/book/978-1-4471-2184-8http://www.springer.com/public+health/book/978-1-4471-2184-8


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How health

records areorganized

Margate, New Jersey T. Schleyer 1999


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Electronic records: Medicine


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Electronic records: Dentistry


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One integrated model: Veterans

Administration


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Advantages

eliminate dual entry of

clinical information into

separate medical and

dental systems

integrate dental progressnote creation with CPRS

transactional recording of

data in a computable

format

bidirectional information

exchange allowing for

improved clinical decision

support


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Suggestions for

integrativeresearch

Natchez Trace, Mississippi T. Schleyer 2001


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Standards

Grand Tetons, Wyoming T. Schleyer 2001


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Order from

chaos the

DentalInformation

Model (DIM)

Acharya A, Mital DP, Schleyer TK. Electronic dental records information model. International Journal of Medical Engineering and

Informatics 2009;1(4):418-34.


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Order from chaos - an information

model for general dentistry

extract data from ~100 de-identified

patient records

combine with results from previous studies

validate information item list (~1,100 fields)

through Delphi study

construct information model


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What can you do with an information

model?

Information model

Database User interface

Data interchange

Forms

National Health

Information Infrastructure/

Health Information ExchangeResearch


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The DIM on the Web

http://www.dentalinformatics.org/projectdirectory/dim/
http://www.dentalinformatics.org/projectdirectory/dim/http://www.dentalinformatics.org/projectdirectory/dim/


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Research suggestions

determine cross-discipline information

needs

map corresponding records and fields

homogenize needed vocabularies/

ontologies

implement and assess, build out from

there


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Usability of four dental computer-

based patient records

Research questions:

Which usability problems are

common in dental software?

What is the rate of completed,

incorrectly completed and

incomplete user tasks?

Thyvalikakath T et al. Usability of four practice management systems, JADA


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Results


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User adverse events

10

20

30

40

50

0

60

ES

PW

DX

SD

70


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Record a missing tooth correct path

User paths


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User paths


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Usability of dental computer-based

patient records

Significant usability problems due to:

complex information design

mismatch between system and user model

difficulty in finding functionality Participants had to exert cognitive effort that did

not contribute to task completion.


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elucidate common cognitive and decision

making needs across clinical disciplines

develop cross-discipline, modular user

interface (UI) designs

develop paradigms for information

abstraction

refine UI evaluation methodologies


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Sample project 1: Cognitive task

analysis of dental examination

What cognitive processes do dentists engage in and

what information do they use when they examine a

patient and develop a treatment plan?

Methods think-aloud method with 3 standardized patient cases

5 dental faculty and 5 general dentists

analyze the sessions to determine:

information that dentists requested

sequence in which they reviewed information

instances of concurrent review of information items


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Results

0

5

10

15

20

25

30

35

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%Average

numberoftimeseachpatientdataaccessed

Average session time in percentage (normalized) for a case of high complexity

Average of patient data accessed in 10 high complexity cases

Patient Demographics Social History Medical HistoryMedications Medical Consult Dental HistoryIntra-oral Images Radiographs Hard Tissue ChartPeriodontal Exam Oral Pathology Consult Treatment Plan Notes

Start of End of

session


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Results (cont.)

0

2

4

6

8

10

12

14

16

18

20

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%Averagenumberoftimeseachpatien

tdataaccessed

Average session time in percentage (normalized) for a case of low complexity

Average of patient data accessed in 10 low complexity

cases

Patient Demographics Medical History Dental History Extra-oral ImagesIntra-oral Images Radiographs Hard Tissue Chart Periodontal ExamFinancial Informaton Treatment Plan Notes

Start End of

sessio


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Visualization of information artifacts used over time


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Sample project 2: Cross-platform,

modular UI design

Microsoft Common User Interface (MSCUI

www.mscui.net)

sample problem: pt. identifiers
http://www.mscui.net/http://www.mscui.net/


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MSCUI: Designing for safety


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Sample design: Patient banner

(includes 26-page Design Guidance document)


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Decision supportfor distributed care

Yellowstone National Park, Wyoming T. Schleyer 2001


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We know that decision support works

Garg et al., 2005:

improved practitioner performance: 64% of studies

improved patient outcomes: 13% of studies

Jaspers et al., 2011: improved practitioner performance: 57% of studies

improved patient outcomes: 30% of studies Evidence

Garg A. et al. Effects of computerized clinical decision support systems on practitioner performance and patient outcomes. JAMA Vol. 293,

No. 10, p 1223-38

Jaspers M. et al. Effects of clinical decision-support systems on practitioner performance and patient outcomes: a synthesis of high-quality

systematic review findings. JAMIA 2011 18: 327-334


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elucidate optimal interprofessional work anddecision flow

develop appropriate inferencing mechanismsthat: are provider role and patient-specific;

adapt to short, intermediate and long-term outcomes;and

are built on evolving best practices.

implement DSSs within a distributed systemscontext (databases, communication, userinterface)


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Discussion: How do we meet these

challenges?

By getting you involved!

Th D l I f i O li


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The Dental Informatics Online

Community

established in 2007

> 1,000 members from 30 countries

self-declared interest in DI

emphasizes access to disciplineresources:

member directory

tutorials and white papers

publication archive project directory

www.dentalinformatics.org
http://www.dentalinformatics.org/http://www.dentalinformatics.org/


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http://ericwhitacre.com/the-virtual-choir
http://ericwhitacre.com/the-virtual-choirhttp://ericwhitacre.com/the-virtual-choirhttp://ericwhitacre.com/the-virtual-choirhttp://ericwhitacre.com/the-virtual-choirhttp://ericwhitacre.com/the-virtual-choirhttp://ericwhitacre.com/the-virtual-choir


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Please take a minute to write down your thoughts.

Hand in your card.

1. What was the major insight/newknowledge you gained from thistalk?

2. What kind of concrete idea(s), if any,did this talk spark?


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Thank You for Your Attention!

Questions, comments?

H. Torres-Urquidy

P. Hernandez J. Irwin A. Acharya

and many others.

H. Spallek

Thanks to:

T. Thyvalikakath

Please visit us at:

http://di.dental.pitt.edu

Twitter

Facebook /titusschleyer

Scribd

} CDI 2008
http://di.dental.pitt.edu/http://di.dental.pitt.edu/http://di.dental.pitt.edu/http://di.dental.pitt.edu/http://di.dental.pitt.edu/

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