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