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Health Information Technology

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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, Exit Disclaimer “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 Exit Disclaimer works to facilitate providers with the selection, implementation and support of different types of health IT, including electronic oral health records. Exit Disclaimer Family Health Centers of Southwest Florida provides a variety of medical, dental, and social services Exit Disclaimer, 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 Exit Disclaimer 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 Exit Disclaimer includes:

  • A dental dashboard;
  • Workflow management tools including tooth charting;
  • Periodontal charting and treatment planning;
  • Access to centralized medications, allergies, special conditions, problems list, demographics and HIPAA forms;
  • Access to medical appointments to support better coordination of care; and
  • Highly secure remote access supporting alternate devices (laptops and tablets).

Other examples of health IT being adopted by safety net providers is the increasing use of telehealth. For example, Apple Tree Dental, Exit Disclaimer 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 Exit Disclaimer, 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 Exit Disclaimer 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:

  • Dental disease risk assessment;
  • Preventive procedures such as fluoride varnish, dental sealants, dental prophylaxis and periodontal scaling; and
  • Use of interim therapeutic restorations on teeth with caries to stabilize patients until they can see a dentist.

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 Exit Disclaimer of school-based telehealth for oral health care. According to a report from The Children’s Partnership, Exit Disclaimer 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.

Related Resources

  • Improving Access to Oral Health Care for Vulnerable and Underserved Populations Exit Disclaimer - Institute of Medicine (IOM) (July 2011)
  • Oral Health Disparities Collaborative Implementation Manual - HRSA Health Disparities Collaboratives (2008).
  • Project: Dentists Care Exit Disclaimer - Florida Dental Association. Dental access care program throughout the state of Florida whereby on a volunteer basis, dentists provide preventive and restorative dental services to the safety net population in Florida.
  • Access to Care Resource Guide Exit Disclaimer - Project: Dentists Care (2011). Provides information on dental programs throughout Florida for underserved Floridians. The programs are broken out by County for easy navigation. Listings include clinic location, information on whether or not the clinic is a Project: Dentists Care clinic or associate, whether there are income requirements for care, what populations are served, and a variety of other information.
  • The National Network for Oral Health Access (NNOHA) Exit Disclaimer is a nationwide network of dental providers who care for patients in safety-net systems. These providers understand that oral disease can affect a person's speech, appearance, health, and quality of life and that inadequate access to oral health services is a significant problem for low-income individuals. The members of NNOHA are committed to improving the overall health of the country's underserved individuals through increased access to oral health services. The NNOHA Web site is a collection of information, contacts, and resources for current and prospective members
  • Electronic Dental Record – Powerpoint Presentation by Frank Mazzeo (2010), President and CEO of Family Health Centers of Southwest Florida, Inc.
  • Electronic Oral Health Record – Powerpoint Presentation by Frank Mazzeo
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