Development and evaluation of patient medical summary from health information exchange to improve dental care

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Project Summary To avoid potential harm and improve dental treatment success, dental clinicians (DCs) must obtain an up-to- date medical and medication history of their patients. Recent studies have reported discrepancies with patient- reported medical histories in electronic dental records (EDRs), and inconsistencies in physicians’ responses to DCs’ medical consults leading to delayed dental care. Large healthcare organizations (HCO) such as dental schools and health management organizations implemented integrated medical-dental electronic health record (EHR) (integrated EHR-EDR) to improve communication and referral between medical and dental professionals. However, deploying such systems alone will not resolve the current barriers because the relevant patient-specific information may be fragmented across different HCOs, stored in various EHR sections. Besides, most dental professionals are not credentialed with HCOs to have access to an integrated EHR-EDR system. The emergence of community and vendor-supported health information exchanges (HIEs) and the development of technologies and standards to exchange and display pertinent information is an opportunity for DCs to establish an integrated care delivery model regardless of their practice setting. The long-term goal is to improve communication and referrals between dental clinicians and medical professionals to improve patient care and promote screening and preventive management of chronic diseases. This proposal aims to develop and evaluate a usable patient medical summary (PMS) imported from the state- wide community Indiana Health Information Exchange (IHIE) that updates a dental clinician about their patients’ medical history and can be used even in solo- and small group dental practice settings. The central hypothesis is that the PMS will have a higher percentage of complete and up-to-date medical information, which will reduce the average time required to assess a dental patient case and determined by DCs to be clinically useful. The three specific aims are: 1) Validate the relevance and timeliness of information items that contribute to the PMS to assess a patients’ medical status; 2) develop prototypes that integrate the PMS with an EDR through user-centered design methods; 3) evaluate the effectiveness and efficiency of the PMS with general and specialist dentists. The two primary outcomes are a Fast Healthcare Interoperability Resources (FHIR)-based PMS application and a reconfigured Consolidated Clinical Document Architecture (C-CDA) that reduce dental clinicians’ reliance on patients and physicians’ office for information and reduce patients’ burden to share information with DCs. The proposed study will lay the foundation for an interprofessional dental- medical care delivery that enhances dental and overall care among the US population, promotes preventive management, and reduces dental care costs.