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How can oral health records be integrated with medical EHRs?

There is a growing recognition about the importance of oral health care to patient’s general health. Rudman Exit Disclaimer and others note that dental information is valuable to overall patient care, particularly for complex medical conditions such as diabetes or cardiovascular disease, where access to a patient's dental information could assist early detection of these types of chronic conditions and a patient’s medical information is critical to their oral health care.  There are many challenges associated with integrating oral health records into the EHR. A 2008 report from Franklin Din and Valerie Powell discusses many of the challenges associated with combining these records. Specifically, the authors discuss a lack of strategic information exchange between medical and dental records which leads to four major problems:

  • Poor communication exists between medical and dental providers, particularly when it comes to real-time needs for patient care;
  • Medical and dental records often contain duplicative or inconsistent information;
  • The inclusion of dental care as a component of best practices is rare, and often the impetus for it falls on the patient; and
  • Structural barriers complicate the coordination of medical and dental care.

An October 2010 article Exit Disclaimer by Rudman and colleagues also discusses the importance of integration of medical and dental records in the continuity of care. Specifically, the article highlights the possible role for health information management professionals in the integration process and discusses several research questions which will be prudent to answer prior to integration. Rudman notes Exit Disclaimer that currently, “electronic health record data are not systematically integrated with electronic dental record data in most healthcare systems. Medical and dental care information systems have progressed independently of one another with little if any attempt to integrate the two systems of care.”  The article notes that before integration can occur, experts will need to develop standardized diagnosis coding and billing system, map codes sets, and privacy and security protocols.

The article raises several questions that must be resolved before this integration can occur including:  

  • What workflow redesign must occur to enhance the effectiveness and efficiencies of EHR adoption in both medical and dental offices?
  • What are the major barriers to integration of medical and dental records and how can they be addressed?
  • What is the cost and cost-benefit of interfacing medical and dental e-health records?

The U.S. Military’s electronic health record, AHLTA Exit Disclaimer, provides one example of how oral health records can be integrated into the EHR. According to the Department of Defense, AHLTA “is an enterprise-wide medical and dental information management system that provides secure online access to Military Health System (MHS) beneficiaries’ records.” The current version, AHLTA 3.3 Exit Disclaimer, was released in December 2008 and incorporates a specific dental module that allows for charting, documentation of dental exams, and ICD-10 and CPT codes.

Other examples are the following:

  • The Indian Health Service uses a robust EHR system that contains an oral health module. The Resource and Patient Management System (RPMS) is “intended to help providers manage all aspects of patient care electronically, by providing a full range of functions for data retrieval and capture to support patient review, encounter and follow-up.” Their Electronic Dental Record (EDR) is an off-the-shelf Dentrix product that works with the RPMS to provide an integrated clinical and practice management system. The IHS EDR provides digital radiography and imaging, a comprehensive and integrated patient record, and clinical, treatment, and epidemiological data. Through linkages with RPMS, patient registration, scheduling of appointments and clinical notes can also be coordinated with a patient’s EHR.
  • The Department of Veterans Affairs (VA) VistA System provides another example of how health IT is currently being used to support oral health. The VistA system contains a dentistry module which allows users to “enter dental treatment data, edit dental records, review, and print reports, schedule appointments for patients, perform patient inquiry, and print and transmit data electronically to update the VA central database.” The VA dentistry module, called Dental Record Manager Plus (DRM), also links with the VA’s Patient Information Management System (PIMS) to allow for additional functionalities, such as specific demographic information, appointment scheduling, and the ability to generate reports in multiple formats. One of the key benefits of the DRM is that it is fully integrated with the medical EHR, which allows dentists and physicians each access to the medical and dental records of their patients. As a result, a physician can use the dental record to explore potential systemic issues associated with poor oral health.

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