A Feasibility Evaluation Study for Linking Electronic Health to Dental Records Open Access

Dever, Sara (2017)

Permanent URL: https://etd.library.emory.edu/concern/etds/rv042t85n?locale=en
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Abstract

Background: Large volumes of patients lacking dental insurance and financial resources are presenting to emergency department settings for dental treatment, creating significant public health issues and increased expenses. Emergency department physicians and private-practice dentists lack timely, accessible communication. The data exchange between electronic health and dental records exist separately between medical and dental providers in the private-sector, and need to harmonize for effective communication and improved treatment options.

Purpose: To assess the feasibility of linking electronic health records in Grady Memorial Hospital's Emergency Department, to electronic dental records at private-practice dentists in metro Atlanta, Georgia.

Methods: A systematic literature review was conducted to explore current electronic health and dental record systems, public health policies, and interoperability standards for systems integration. Questionnaires were developed, and interviews were conducted with subject matter experts from emergency health care, private-practice dentistry, and electronic health and dental software technology. Expert opinions and requirements were gathered for linking electronic health records to electronic dental records.

Results: Oral health disparities would be reduced, access to dental care would increase, costs of care would be reduced, and improved treatment options would occur. Systems integration is technologically feasible through data linkage via a patient identifier, and interoperability is supported through a query-based and pushed-based approach. It is not feasible based on financial and policy considerations.

Conclusions: Further government mandates and polices with incentives extending beyond Meaningful Use needs to occur before linking electronic health records to dental records will occur in the private-sector.

Table of Contents

CHAPTER I: INTRODUCTION

Introduction and Rationale....................................................................................................................................................1

Patient Populations..............................................................................................................................................................2

Figure 1: Nationwide Dental-Related Emergency Department Visits: 2000 to 2012.......................................................................4

Patient Medical and Dental Records........................................................................................................................................5

Current Status of Patient Records..........................................................................................................................................6

Review of the Literature.......................................................................................................................................................6

Table 1: Key Words Utilized for Systematic Review from 2001 to 2017........................................................................................7

Public Sector.......................................................................................................................................................................7

Private Sector.....................................................................................................................................................................8

Medical-Dental Integration Programs.....................................................................................................................................9

Interoperability and Data Standards.....................................................................................................................................10

EHR/EDR Interoperability and Barriers..................................................................................................................................11

Linking Systems and Research.............................................................................................................................................14

Fast Healthcare Interoperability Resource® (FHIR®)...............................................................................................................15

Patient Barriers to Dental Care.............................................................................................................................................16

Figure 2: Dental Insurance Coverage Status: 1996.................................................................................................................17

Figure 3: Dental Insurance Coverage Status: 2010.................................................................................................................18

Conclusion........................................................................................................................................................................19

Problem Statement.............................................................................................................................................................19

Purpose Statement.............................................................................................................................................................20

Research Questions............................................................................................................................................................20

Significance Statement.......................................................................................................................................................21

Definition of Terms.............................................................................................................................................................22

CHAPTER II: METHODOLOGY

Introduction......................................................................................................................................................................36

Method.............................................................................................................................................................................37

Data Types and Description.................................................................................................................................................38

Subject Matter Expert Questions..........................................................................................................................................38

Project Design...................................................................................................................................................................38

Procedures........................................................................................................................................................................39

Instruments......................................................................................................................................................................39

Analysis............................................................................................................................................................................39

Emergency department physician.........................................................................................................................................40

Table 2: Questions and Answers from Emergency Department Physician....................................................................................40

Dentists in metro, Atlanta...................................................................................................................................................45

Table 3: Questions and Answers from Private-Practice Dentist in Atlanta #1...............................................................................45

Table 4: Questions and Answers from Private-Practice Dentist in Atlanta #2...............................................................................49

Electronic health record technology employee........................................................................................................................52

Table 5: Questions and Answers from Electronic Health Record Software Technology Employee.....................................................53

CHAPTER III: RESULTS

Introduction......................................................................................................................................................................57

Key Findings......................................................................................................................................................................58

Table 6: Research Questions and Synthesis of Expert Opinions of the Project..............................................................................58

Other Findings....................................................................................................................................................................61

Figure 4: Data Mapping Via Patient Identifier..........................................................................................................................62

Summary...........................................................................................................................................................................63

CHAPTER IV: KEY FINDINGS AND DISCUSSION

Introduction.......................................................................................................................................................................64

Summary of Project............................................................................................................................................................65

Implications.......................................................................................................................................................................67

Limitations.........................................................................................................................................................................68

Recommendations and Next Steps.........................................................................................................................................68

Conclusion.........................................................................................................................................................................69

CHAPTER V: PUBMED SUMMARY

Introduction.......................................................................................................................................................................71

Purpose.............................................................................................................................................................................71

Methods.............................................................................................................................................................................72

Conclusions........................................................................................................................................................................73

Recommendations...............................................................................................................................................................74
For More Information...........................................................................................................................................................75

APPENDIX A: SUBJECT MATTER EXPERT QUESTIONS........................................................................................................76

REFERENCES.....................................................................................................................................................................85

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