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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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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,
Techniques, and Theories
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,
Techniques, and Theories
BioinformaticsImaging
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
BioinformaticsImaging
Informatics
Clinical
Informatics
Public Health
Informatics
Molecular and
Cellular
Processes
Tissues and
Organs
Individuals
(Patients)
Populations
and Society
Basic Research
Applied Research
OtherInformatics Methods,
Techniques, and Theories
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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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/978-1-4471-2184-88/6/2019 Research opportunities at the interface of dental and medical informatics
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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/8/6/2019 Research opportunities at the interface of dental and medical informatics
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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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University of Pittsburgh School of Dental Medicine
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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University of Pittsburgh School of Dental Medicine
Research suggestions
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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University of Pittsburgh School of Dental Medicine
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
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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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Research suggestions
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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University of Pittsburgh School of Dental Medicine
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/8/6/2019 Research opportunities at the interface of dental and medical informatics
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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-choir8/6/2019 Research opportunities at the interface of dental and medical informatics
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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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Center for Dental Informatics
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
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/Recommended