BEHAVIORAL AND PUBLIC HEALTH RESEARCH • Howard Bailit – Health Services Research • Kathryn Atchison - Using IT to Improve the Dental Health Care System • Michael Kirshner – The Role of Dental Informatics in the Patient-Dentist Relationship • Sabine Koch – Designing Clinically Useful Systems.
General Theme • Dentistry is not well positioned to embrace new technologies • There are features of the Dental Care Delivery System that act as barriers to adoption of new technologies and thus will make informatics-based solutions to population-based research difficult.
Issue 1: We are too small • Dentistry is a small market, which may preclude entry of innovative proprietary technologies from industry. • 100,000 potential US customers • Solutions from Sweden • Innovative partnerships with government, academia, and industry to address what is perceived as a health care issue - and thus a social responsibility • Solutions should be marketed globally
Issue 2: But it ain’t broke… • There are no generally perceived big problems by most dentists and by regulatory bodies. • e.g., Medication errors causing deaths • Solutions are piecemeal • Solve small problems • Informatics may improve doctor-patient relationship (informatics may provide models of interaction improving communication and trust) • Informatics research on model building; system development; system installment; study of effects • Uniform data collection protocols for insurance • IOM: Develop methods for improved quality (practice management approaches)
Issue 3:If you have seen one dental office….you’ve seen one dental office • Dental care delivery is poorly designed structurally to accommodate new technologies. • No central data collection (no hospitals, frag. Insurance) • No standards for collecting data • No generally accepted vocabulary (diagnostic codes) • No practice based networks • Need for community networks to identify practice characteristics across large numbers of providers. • RWJ “Pipelines” project • May provide population-based network to identify practice patterns
Issue 4: My overhead is high enough already • Dental offices do not perceive a value-added benefit of adding additional technology • Benefits may not be obvious such as: • Decision support/expert systems • Longitudinal tracking of disease • Improved imaging • Begin exposure to the technologies in schools • UCLA (SOAP) • Uppsala
Issue 5: No one is looking at my charts. • Most dentists have little experience with or appreciation of population-based research issues. • Demonstrate the benefit of “population” thinking at the level of the individual practice with use of technology. • Establish practice-based networks to improve quality of clinical decision making by characterizing “what works” in practice.
Conclusion • Very encouraged to see population-based research “at the table” • Informatics offers solutions • HSR issues - identify optimal practices • Adoption of new ideas will be evolutionary (not revolutionary) and will likely results from changes made during dental training. • Dental schools may need to lead the way