AltaMed: Integrating the Electronic Health Record with the Electronic Dental Record to Enhance Care Coordination
In recognition of September’s National Health Information Technology (IT) Week, HRSA’s Health IT website is highlighting AltaMed Health Services, community health center’s integration of the electronic health record (EHR) with an electronic dental record (EDR) to improve care coordination within their primary care centered home model of care. By demonstrating meaningful use of the EHR technology, AltaMed became eligible for the Centers for Medicare & Medicaid Services’ EHR Incentive Program in 2011.To date, over 90 medical providers and 9 dentists at AltaMed have qualified for the Meaningful Use Stage 1 incentives. Dentists at AltaMed were able to qualify as a result of their access to, and integration with, AltaMed’s certified EHR.
For over 40 years, AltaMed has provided health care to the underserved communities in East Los Angeles with a mission to provide quality, comprehensive care regardless of a patient’s ability to pay. More than 150,000 patients throughout Southern California are seen by AltaMed each year. Altamed, which operates across 43 sites, receives grants from HRSA’s Bureau of Primary Health Care (BPHC) as a Section 330 Community Health Center Grantee and offers a full range of primary medical, dental, HIV/AIDs care, including chronic care management , preventive health education, drug prevention and treatment, senior services, and women’s health services. AltaMed received the Joint Commission’s Primary Care Medical Home Designation in 2011.
Having implemented their EHR in 2009 and EDR in 2011, AltaMed integrated both systems in 2011, in order to provide complete medical and medication information for a patient during a visit with any type of medical provider, including during a dental appointment. Having this integrated information not only improves workflow and communication between the dentist and the patient but also provides access to medical images and records across all of AltaMed’s 43 sites. According to the National Quality Forum's Report: Preferred Practices and Performance Measures for Measuring and Reporting Care Coordination:, “When care is poorly coordinated with inaccurate transmission of information, inadequate communication, and inappropriate follow-up care – patients who see multiple physicians and care providers can face medication errors, hospital readmissions, and avoidable emergency department visits.” In order to improve the care coordination efforts, patient information such as medication lists, problem lists, and allergy lists for the patient can be viewed by the dental clinician while administering dental services to the patient.
Figure 1. A Screenshot of AltaMed’s Electronic Dental Record: By integrating their EHR and EDR data, dental clinicians are able to see the patient’s overall health record to inform their dental procedures.
Since the implementation of their EDR in 2011, AltaMed has collected dental quality metrics for quality improvement purposes within their organization. For example, only 12.6% of their pregnant female patients have received dental exams. Research by AltaMed suggests that the low rate of pre-natal patient dental exams may be attributable to a lack of education among women who falsely believe that cleanings and exams will harm their unborn babies. According to an Institute of Medicine and National Research Council Report on "Improving Access to Oral Health care for the Vulnerable and Undeserved Populations" (PDF-3.28MB): Oral health care during pregnancy is important because pregnant women are more susceptible to periodonitis, loose teeth, and pregnancy oral tumors . Improving the oral health of pregnant women has the potential to improve overall health, reduce complications during pregnancy, reduce the risk for early childhood tooth decay, and may also reduce premature and low birth weight deliveries. By tracking the percent of pregnant patients that receive dental exams, AltaMed can target patients and work with pregnant patients to increase their knowledge and awareness of the importance of proper dental care.
AltaMed’s data has also helped them track oral health screenings among their pediatric patients. Currently, 80% of AltaMed’s pediatric population have received a pediatric oral health screening, exceeding the 2010 National rate of 78.8% for dental care visits among children ages 2-17.4 Child preventive dental screening is important because many oral health problems including dental caries, malocclusion, and fluorosis, begin in childhood and can be prevented through regular preventive dental care and counseling.
Figure 2. AltaMed Dental Quality Metrics for 2012
Pregnant Women Receiving Dental Exam
Total Pregnant Women
Pregnant Woman With Dental Exam %
Pre-natal Dental Exam
Child Preventive Screenings
Received Preventive Screening
Number of Children that Visit AltaMed Dental Clinics
% of Child Receiving Preventive Screening
In addition to pregnant women and children, AltaMed also collects data for patients with high blood pressure, diabetes, and smoking cessation.
AltaMed’s staff and patients have been empowered by having access to electronic health and dental records, and are making great strides to improve the overall public health of their communities by both improving care coordination between primary and dental providers and enhancing education to patients on the importance of oral care - especially for pregnant woman and children.
For more information on AltaMed’s EHR and EDR services and efforts, please contact Lauren Astor, Director of Corporate Communications at Lastor@la.altamed.org or visit AltaMed’s website at http://www.altamed.org.