Preventative oral health care and maintenance as critical components when assessing an individual for overall wellness is increasing in recognition across health care disciplines. With oral inflammation having a direct influence on a multitude of systemic conditions, there is no disputing that dental hygienists are integral members of a patient’s comprehensive health care team. Clinical practice that once involved scaling root planing for all diseased patients is now being joined with salivary diagnostics, pH and nitric oxide testing yielding results specific to the patient’s health and genetics. However, if the standard of oral health care is to be elevated and dental hygienists are to truly be members of a patient’s comprehensive health care team, then the way we communicate with providers outside of the dental setting must change. Electronic health records (EHRs) have been a mainstay documentation system in medicine that allows providers to easily communicate about patient care within their community of professionals. Whether it is sending a quick message, attaching labs or radiographs, reviewing changes in medications, or viewing when the patient was last seen by a provider, EHRs create a seamless space for all of this to occur. (1) Yet, dentistry still uses their own stand-alone software program and are left updating their own medical histories, inputting vital signs for the visit, and creating their own documentation, irrespective of the rest of the medical team. Having a community of providers that can collaborate and consult with one another ultimately elevates the standard of patient care. This article looks to the success of EHRs and how they could be integrated into dentistry.
Efficacy of Electronic Health Records
EHRs have historically been used in medicine to retain patient’s health information, which includes their social history, medical history, medications they may be taking, vital signs, lab panels, radiology results, and notes from physicians or nurses. (2) Complete and accurate EHRs are critical to assessing a patient’s comprehensive health history and help to reduce accidents in patient care. EHRs have been combining health related information from various disciplines for years, which facilitates better communication between patients and multiple medical providers. (2,3) Many EHR users have attributed this documentation system to improved workflow, enhanced productivity, efficiency, and reduced number of errors by providers and staff. (1,2,4) Not only do EHRs allow providers to document specifics regarding patient’s medical care, but they also provide a space to monitor trends in infectious diseases and identify social determinants of health. (1,3). The conditions that patient’s live, where they work, and how they access health care can drastically impact the delivery of care, which is a significant aspect individualizing treatment. This type of medical recording system goes far beyond just documentation of visits and medications, but allows providers to have an understanding of demographics in the area they are providing care. (1)
EHRs also eliminate patients from having to recall their own medical history when seeking care with a new provider or specialist. (2,3,5) Rather, this system collects all information so that providers can easily communicate and patients do not have to serve as the “middle man” when recalling their unique health record. The efficiency and accuracy of this level of patient care should be the standard across health care disciplines, however the stand-alone dental software that most dental offices use segregates dental from medicine. (3) As dentistry continues to produce more research reflecting the evidence behind the oral systemic connection, it seems obvious that medical and dental integration become more commonplace. Communication between providers is a critical component of interprofessional collaboration, which could lead to improved patient outcomes. (3)
Although EHRs can provide up to date medical knowledge and can monitor a provider’s performance and quality of care delivery, limitations with this recording system are evident. (2) Some of the biggest challenges faced by the medical and dental community when integrating new software are cost, and not having adequate training and evaluations for competency. (5) It has been proposed that incorporating more education on EHR documentation in school curriculum could help facilitate a smoother transition into the workplace and set the precedence for interprofessional collaboration in academia. It also supports providers in a way that they can comfortably, safely and efficiently use EHRs. (4) This is a trend that healthcare is gradually recognizing as dentistry moves toward a model that understands “whole body health”.
Electronic Health Records in Dental
Stand-alone dental software is still commonplace in smaller dental settings, while EHRs are utilized more within large organizations, like federally qualified health centers (FQHC). (5) Dental settings typically rely on patients to complete a health history form prior to establishing care, which should be updated at each visit. With electronic dental records not being as comprehensive as medical history taken in a medical setting, there is a risk that some critical information could be left out if a patient forgets or chooses not to disclose certain information. (43 One study conducted an interview of caretakers and asked questions regarding their child’s medical history. Results indicated that 53% of parents were unable to provide the child’s specific medical diagnosis and 29% could not list the child’s medications. (3) If dental professionals are aware of the oral systemic link and ideally strive for prevention and maintenance of their patient’s oral health, how is this to be achieved if the provider does not have a clear picture of the systemic conditions that are plaguing their patients? Patients are not always aware of the oral systemic connection, so it is the responsibly of the oral health care provider to have accurate records of the patient’s condition(s) so that quality of patient care is not compromised. (3)
EHRs integrated into dentistry have the potential to dismantle stand-alone dental records and promote a health care delivery system where providers across various disciplines can easily communicate. (3) The oral systemic connection will continue to be researched and more information will contribute to the overall body of dental knowledge. However, until the communication barrier between health care providers is disseminated, achieving true oral systemic health will be challenging. Working as a team member for the overall health and wellness of patients is a multidisciplinary approach and is not the sole responsibility of just one provider. Rather, it is the responsibility of the entire health care team comprised of a number of specialties. (3)
What does it all mean?
Implementing this type of recording system will present with resistance to change and the strategy used to adequately train and monitor for competency will be critical. (1,2,3) EHRs make it easier to share information between providers and eliminates the risk of adverse health outcomes as a result of not having all of the patient’s necessary information. Incorporating this training into dental and medical school curriculum could help facilitate oral systemic care provided to patients prior to students entering the workforce. (3,4) This could ultimately help move the standard of health care delivery and documentation toward interprofessional collaboration if students are sensitized to this from academia. Oral health care providers could have a better understanding of not only the patient’s medical history, but their social determinants of health and other pertinent information that could be influencing how they access or receive dental care.
References
1. Kruse CS, Stein A, Thomas H, et al. The use of electronic health records to support population health: A systematic review of the literature. J Med Syst. 2018; 42:1-16.
2. Campanella P, Lovato E, Marone C, et al. The impact of electronic health records on healthcare quality: a systematic review and meta-analysis. Eur J Public Health. 2015; 26(1): 60-64.
3. Claman DB, Molina JL, Peng J, et al. Accuracy of parental self-report of medical history in a dental setting: Integrated electronic health record and nonintegrated dental record. Pediatr Dent. 2021;43(3): 230-236.
4. Puranik C, Slavik A, Pickett K, et al. Development of integrated electronic medical and dental record competencies and impact of training modalities. J Dent Educ. 2023;87: 660-668.
5. Alanazi A, Alghamdi G, Aldosari B. Information needs for dental-oriented electronic health records from dentists’ perspectives. Healthcare. 2023;11: 2-11.
