FDI World Dental Federation

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Jeremy Booth, Dental Tribune International

Wed. 27. September 2023

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GENEVA, Switzerland: Electronic health records (EHRs) have the potential to greatly improve the overall quality of dental care and research. FDI is undertaking an ambitious project that aims to lay the foundation for EHRs in dental offices around the world, and the project is being generously supported by Henry Schein. Dental Tribune International (DTI) spoke with experts at FDI and Henry Schein about the project and about why EHRs are important and how they can improve patient outcomes.

FDI’s Integrated Electronic Health Records in Dentistry project aims to lay the groundwork for enhanced interprofessional collaboration and integrated healthcare in dentistry. The organisation has convened an international group of experts from dental and other medical fields who will review the literature and existing examples of EHRs. This team will work together with national dental and health associations to identify and understand the needs of end users and consider barriers to and facilitators for the use of EHRs in daily practice. Based on this information, the team will propose a recommendation for relevant and acceptable oral health indicators to be included and routinely recorded in EHRs.

The team includes experts from the fields of preventive and restorative dentistry, oral medicine, preventive and general medicine, internal medicine and health outcomes measurement. Henry Schein is supporting the project with its global network, its broad portfolio of technological solutions and its expertise in digital health records.

Improving health outcomes

According to Prof. Mark Wolff, dean of the School of Dental Medicine at the University of Pennsylvania, there has been global recognition that oral health is intimately involved in general health and well-being and that the opposite is also true—general health affects oral health and quality of life. Prof. Wolff is part of the project team which began work earlier this year, taking what FDI said was a momentous step towards improving patient care and fostering collaboration between healthcare professions.

Prof. Wolff told DTI: “It is very clear that oral health affects our ability to concentrate and study at school, to attend work on time and do a good job. To separate out whether a patient is having cardiac, diabetic or arthritic problems and oral health problems is foolish. A patient’s medical health, and the medications they are taking, directly influence how a dentist can deliver care and how effective or ineffective it is. Oral health and general health outcomes really can be negatively affected without communication between healthcare providers and social workers.”

One of the strengths of EHRs is that they can positively influence patients’ engagement with their treatment, improving treatment acceptance and healthcare outcomes. Prof. Wolff explained: “One of the things that I think we have learned in dentistry is that we cannot cure dental disease without patient and caregiver participation, without families and individuals and an informed public. When people have access to their own records, where they can look at the interactions between the prescriptions and the medications that they receive, these individuals have a much better opportunity to improve their health in concert with their dentist or primary healthcare provider.”

According to FDi, electronic health records hold the potential to foster interprofessional collaboration and elevate patient care. (Image: Meeko Media/Shutterstock)

The time for EHRs in dentistry is now

David Kochman, chief corporate affairs officer at Henry Schein, told DTI that EHRs are overdue. “In the US every year there are an estimated two million visits to hospital emergency departments for dental pain. This increases costs for all involved and ultimately leaves a massive gap in the patient’s care journey,” Kochman pointed out. “There have been numerous studies linking chronic oral diseases—such as caries and periodontal disease—to chronic diseases such as diabetes. The mouth is a part of the body. We need to treat it as such, and there is no better time to integrate dental and medical than now.”

Kochman said that there has been a substantial push in recent decades to create the technology needed for interoperable EHRs that share patient information between EHR systems and healthcare providers. He pointed to examples such as Fast Healthcare Interoperability Resources, a standard for healthcare data exchange developed by Health Level Seven International (HL7), and said that artificial intelligence and open application programming interfaces have allowed companies like Henry Schein to develop innovative solutions and partner with industry leaders, bringing interoperability and integration to the forefront.

It takes time to build consensus in medical fields. However, Kochman said that the culmination of several factors has made Henry Schein confident that the time has arrived to empower the health professions to collaborate more closely. He said: “For some time now, people have been shouting ‘This is where we have to go, why are we not moving faster?’ But the bulk of healthcare professions still have not adopted an integrated care model, not even those who do agree with it. We have reached the inflection point where the energy has built up, and the consensus is there. From an academic standpoint, universities are starting to drive a holistic care model to the extent where students who are graduating expect there to be integration in the way that they practise and the proper technology to support it.”

“Dentistry emerged with its own record, medicine emerged with its own record, and it is just at this time that we are starting to see these records speaking to each other” – Prof. Mark Wolff, University of Pennsylvania

Prof. Wolff pointed out that the use of EHRs in US dental offices emerged as a means of practice management, helping clinics to bill patients and oversee financial aspects, rather than as a means of benefiting the health of the patient. He said that this was no longer the case: “I think that health records are emerging so that a patient who has high blood pressure in the medical record has high blood pressure in the dental record. This is where EHRs are starting to have an elevated impact. Dentistry emerged with its own record, medicine emerged with its own record, and it is just at this time that we are starting to see these records speaking to each other.”

EHRs are already in use in some countries, and Henry Schein stands out as an expert in this emerging field. Henry Schein One’s Dentrix Enterprise, for example, already interoperates with more than 40 EHRs though HL7 integrations, offering single or bidirectional care transfer of patient information that includes demographics, clinical notes, medication information and pharmacy orders. Exan, a Henry Schein One company whose software is integrated with the US health information exchange Carequality, is currently being used by the University of Pennsylvania School of Dental Medicine.

A project on a global scale

The task ahead is significant. Prof. Wolff explained: “You have to recognise that we are doing this on a global scale and that we need to understand all of the different records that are out there. We are already getting a better understanding of what is happening globally, and I think that there are a series of health items—things like dental caries and periodontal disease with inflammation that could influence heart health or diabetes—that should be shared between the health professions. And then we also need to talk about social determinants of health, such as financial, psychological and family issues. These determinants cross the professions and need to be shared.”

“There’s no doubt interoperability and integration will help shape the future of care” – David Kochman, Henry Schein

Kochman said the work being done will change dental care: “It won’t happen overnight, but the generation of practitioners graduating today (and in the future) are going to have a more holistic approach. They will also call on the industry to provide scalable, innovative, interoperable technology to play a meaningful role in helping them put the patient first. Post-pandemic, consumers are now expecting the same level of access, personalisation and fluidity in healthcare as they experience in other areas of their lives. There’s no doubt interoperability and integration will help shape the future of care, bringing the healthcare industry up to speed with consumerism and providing comprehensive care that closes the loop in the patient journey.”

Emphasising the significance of the project at the time of the launch, FDI President Prof. Ihsane Ben Yahya commented: “If harnessed effectively across all healthcare sectors, EHRs hold the potential to foster interprofessional collaboration and elevate patient care to new heights. We are thrilled to embark on this journey to comprehend the needs and preferences of dentists and dental teams concerning EHRs to enhance quality of care and fuel impactful research.”

FDI expects the results of the literature review and end user research by early 2024, and the project’s international expert advisory group is expected to convene throughout 2024 for the consensus process. FDI and Henry Schein will keep the international dental community updated as the project progresses.