How Do Dental Clinicians Obtain Up-To-Date Patient Medical Histories? Modeling Strengths, Drawbacks, and Proposals for Improvements

Abstract

BackgroundAccess to up-to-date patient medical history is essential for dental clinicians (DCs) to avoid potential harm to patients and to improve dental treatment outcomes. The predominant approach for dental clinicians (DCs) to gather patients' medical history is through patient-reported medical histories and medical consults. However, studies reported varied concordance and reliability of patient-reported medical conditions and medication histories compared to the patient medical records and this process also places a significant burden on patients. Information technology tools/platforms such as an integrated electronic health record containing an electronic dental record module may address these issues. However, these integrated systems are expensive and technically complex and may not be easily adopted by DCs in solo and small group practice who provide the most dental care. The recent expansion of regional healthcare information exchange (HIE) provides another approach, but to date, studies on connecting DCs with HIE are very limited. Our study objectives were to model different aspects of the current approaches to identify the strengths and weaknesses, and then model the HIE approach that addresses the weaknesses and retain the strengths of current approaches. The models of current approaches identified the people, resources, organizational aspects, workflow, and areas for improvement; while models of the HIE approach identified system requirements, functions, and processes that may be shared with software developers and other stakeholders for future development.MethodsThere are three phases in this study. In Phase 1, we retrieved peer-reviewed PubMed indexed manuscripts published between January 2013 and November 2020 and extracted modeling related data from selected manuscripts. In Phase 2, we built models for the current approaches by using the Integrated DEFinition Method 0 function modeling method (IDEF0), the Unified Modeling Language (UML) Use Case Diagram, and Business Process Model and Notation (BPMN) methods. In Phase 3, we created three conceptual models for the HIE approach.ResultsFrom the 47 manuscripts identified, three themes emerged: 1) medical consult process following patient-reported medical history, 2) integrated electronic dental record-electronic health record (EDR-EHR), and 3) HIE. Three models were built for each of the three themes. The use case diagrams described the actions of the dental patients, DCs, medical providers and the use of information systems (EDR-EHR/HIE). The IDEF0 models presented the major functions involved. The BPMN models depicted the detailed steps of the process and showed how the patient's medical history information flowed through different steps. The strengths and weaknesses revealed by the models of the three approaches were also compared.ConclusionsWe successfully modeled the DCs' current approaches of accessing patient medical history and designed an HIE approach that addressed the current approaches' weaknesses as well as leveraged their strengths. Organizational management and end-users can use this information to decide the optimum approach to integrate dental and medical care. The illustrated models are comprehensive and can also be adopted by EHR and EDR vendors to develop a connection between dental systems and HIEs.

Relationship between Organizational and Information System Users’ Satisfaction Variables: A Literature Review

“…The organization (data quality, environment, and equipment contamination) and lack of sufficient preparation in responding are some of the health information system challenges. (Li et al, 2022) 47 Qualitative The models for current approaches identified the people, resources, organizational aspects, workflow, and areas for improvement; while models of the HIE approach identified system requirements, functions, and processes that may be shared with software developers and other stakeholders for future development. (Lutfi et al, 2022) 428 Quantitative The influence of performance expectancy (PE), effort expectancy (EE) and facilitating conditions (FC), on intention toward mlearning use but did not support the significant influence of social influence (SI).…”

Discrepancy in medications reported by elderly patients in the dental office and in their electronic medical records: A pilot study

“…16 To help alleviate these discrepancies, various strategies have been suggested, such as combining patient-reported medical histories and medical consultations, an integrated electronic health record containing a dental record module, and a regional healthcare information exchange. 58 Implementation of the electronic medical record has not resulted in the absence of discrepancies in medication lists. 59 Among the most common reasons for dental providers to seek medical consults, almost 40% are related to medication information and 1 out of every 4 requests concern medication lists.…”

Dental innovations which will influence the oral health care of baby boomers

“…Research programs aimed at evaluating outcomes in closing gaps for older adult populations confirmed that the use of an integrated health record was successful in alleviating deficiencies in preventive care (e.g., vaccinations) and disease management (e.g., Diabetic hemoglobin HbA1C monitoring) 95 . Record integration would help dental providers make quicker and better clinical decisions and ensure high quality care especially for older adults who have complex medical histories 96 . In 2018, 7 in 10 dentate adults aged 50 years or older reported having gone to a dentist in the past year.…”

“…95 Record integration would help dental providers make quicker and better clinical decisions and ensure high quality care especially for older adults who have complex medical histories. 96 In 2018, 7 in 10 dentate adults aged 50 years or older reported having gone to a dentist in the past year. Although COVID-19 has had a dramatic impact on care utilization, the youngest baby boomers are still part of the workforce and are highly likely to obtain dental insurance through their employers.…”