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What should be considered before adoption of a health IT system for oral health?

There are particular items to consider before selecting and implementing any health IT tool.  Some key considerations include costs – both upfront and recurring, necessary functionalities, and technological and workforce capacity.  Certification is also critical, as is the case now with Meaningful Use, which is discussed in greater depth elsewhere in this module.

The evaluation of expected costs is crucial in determining whether or not providers can adopt health IT into their clinics and offices, and is often one of the strongest and most common barriers.  Potential upfront costs can include hardware and software, training, initial productivity loss as users adapt to a new system, labor hours to transfer paper records into the system, and outside consulting services.  Common recurring costs stem from upgrades to hardware and software, maintenance, and licensing fees.  Return on Investment (ROI) is another concern of providers, which can vary across different types of dental practices and be particularly difficult to measure.  A 2008 study published in the Journal of Dental Education determined that for the electronic patient record used by the dental care site studied, “The payback of the initial investment was a mere 2.5 years.”

The expected benefits associated with the adoption of health IT are important to note, though ultimately they may be different with dental and medical health IT adoption. Cost savings, for example those related to reduction in cost of care or due to avoiding repeating tests unnecessarily, are often highlighted as one of the expected benefits of adoption of health IT. Others include increased efficiency with respect to delivery of care, facilitating health information exchange between dentists and other providers, and improvement in the overall quality of care, among many others.

Also important to consider are the functionalities that a clinic needs in its health IT tools.  Functionality such as the ability to track medical history, demographic information, patient identification, privacy and security protection, and medication information are all elements to consider. A 2003 article in the Journal of the American Dental Association (JADA) examined clinical and administrative functions of EHRs, classifying functions as “must-have,” “nice-to-have,” or “optional” for dentists. Those functions identified as “must-have” or “nice-to-have” include:

• Collection of medical and dental health status for each patient;
• Medical alerts;
• Recording planned and completed procedures;
• The ability to track patient care and progress through a variety of indicators such as medical/dental history, signs and symptoms, diagnoses and outcomes;
• Graphical documentation of missing teeth, fillings, and other indications or oral health status; and
• The capability to capture, store, display and analyze digital images from a variety of sources. 

With respect to meaningful use criteria, a number of key functionalities should be considered, such as clinical decision support, exchange capabilities, laboratory and radiology results, and reporting capabilities. (Please refer to the section below for more extensive information on meaningful use.) These components should also address the needs of the patient population – for example, a clinical decision support system can prompt a provider to conduct a risk assessment for dental caries or an alert that indicates that it is time to take new x-rays of the patient.  Also, the office’s current technology capabilities and workforce should be evaluated to determine what additional technological equipment or additional staff or training is needed.

Related Resources

• The Electronic Oral Health Record (PDF - 609KB)  – The Journal of Contemporary Dental Practice (2002).
• Introduction to Dental Informatics – University of Illinois College of Dentistry (2006).
• Getting Started – HRSA Health IT Adoption Toolbox.
• System Implementation – HRSA Health IT Adoption Toolbox
• 2015 EHR deadline 'just around the corner' – American Dental Association (ADA) (2008).
• A Qualitative Investigation of the Content of Dental Paper-based and Computer-based Patient Record Formats – Journal of the American Medical Informatics Association (JAMIA) (2007).
• Specifications & Technical Reports – Developed by the American Dental Association (ADA).