How is Health IT currently being used in the safety net to promote oral health?
Disparities in oral health within the safety net population are prevalent. The 2000 Surgeon General’s report on Oral Health discusses the importance of oral health as a component of overall health and wellbeing, and represented an important step in recognizing that these disparities exist and should be addressed. A July 2011 Institute of Medicine report, “Improving Access to Oral Health Care for Vulnerable and Underserved Populations” further discusses these disparities and assesses where we stand as a Nation when it comes to addressing them.
Several Healthy People 2020 objectives seek to address oral health disparities among the safety net population. Oral Health Objectives 7 through 11 focus on increasing access to preventive oral health services. Objective 10 specifically seeks to “increase the proportion of local health departments and Federally Qualified Health Centers (FQHCs) that have an oral health component” while Objective 11 seeks to increase the proportion of patients who receive oral health services at FQHCs. Integrating health IT in these environments may allow a platform to build up an integration of oral and other health records that might extend into more general dental practice. Further, health IT can also allow for robust quality improvement activities and support the use and development of evidence-based care.
In some cases, health IT is being used to address these objectives and promote oral health among safety net populations in various health centers and community-based clinics throughout the country. Community Health Centers Alliance works to facilitate providers with the selection, implementation and support of different types of health IT, including electronic oral health records. Family Health Centers of Southwest Florida provides a variety of medical, dental, and social services , available to everyone, but specifically targeting the medically underserved, migrant workers, homeless individuals, and other special populations. Their services include an integrated electronic health record system that uses an electronic oral health record to provide care to these populations.
Another example is the Marshfield Clinic in Wisconsin, which developed its own EHR system allowing for the incorporation of patients' medical and dental health information. The clinic integrated their CattailsMD and CattailsDental EHR systems, and CattailsDental is available in all of its dental clinics. After implementation in its own clinic, the Marshfield Clinic is now able to offer the Cattails software to other clinics. Cattails Dental was based upon the open source system, Open Dental, and according to Dental Informatics includes:
Other examples of health IT being adopted by safety net providers is the increasing use of telehealth. For example, Apple Tree Dental, a non-profit organization in Minnesota, has developed a Community Collaborative Practice Model of dental care. They use telehealth technologies to link multiple members of an interdisciplinary team in order to provide dental services for patients and families throughout Minnesota. Another example is the University of the Pacific’s Virtual Dental Home Demonstration Project , which makes use of telehealth to help bridge the gap in access to oral health services in the community. This project seeks to provide oral health services to underserved populations by creating a community-based oral health delivery system. Individuals receive the preventive and therapeutic services they need in community settings, such as at schools, nursing homes, head start centers, and residential treatment centers. The care is provided from a variety of dental practitioners, such as registered dental hygienists in alternative practice (RDAP), registered dental hygienists working in public health programs (RDH), and registered dental assistants (RDA). Through the Virtual Dental Home project, practitioners use a secure website to upload a patient’s dental records, including x-rays, charts, and patient history. Once uploaded, the records are reviewed by a dentist at a remote location who then develops a tentative treatment plan that is ultimately carried out by the community oral health providers. Some of the specific oral health services that are supported through this telehealth project include:
Telehealth is also being applied in a school-based setting to assist with the provision of oral health care for children. In this setting, it has the potential to reach a large number of children and reduce unnecessary time lost at work for caretakers. The opening of three teledentistry clinics in Tulare County, California is one example of school-based telehealth for oral health care. According to a report from The Children’s Partnership, these clinics “used video conferencing to bring the presence of the dentist to the project to supervise an on-site dental hygienist and conduct oral health exams.”
With respect to Meaningful Use, although the electronic oral health record systems discussed above are not currently ONC-ATCB certified, these organizations are well positioned to transition to such systems when they are available. Some of the challenges associated with adoption of EHRs may have already been addressed by these groups as they implemented their own systems and as a result, they may feel better prepared to transition to others in the future.
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