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Dental Interoperability

March 2019

 

 

HL7 Work Group White Paper

 

 

Sponsored by:

Patient Care Work Group

 

 

 

 

 

NOTE:  This Work Group White Paper (WGWP) has been reviewed and approved by the authoring Work Group listed above.  It has not been balloted or subject to formal review by the full HL7 organization. This WGWP expires five years from the date of publication.

 

 

 

Point of Contact Name and Email:  Todd Cooper and Jean Narcisi

 

HL7 Patient Care Work Group Project Lead:  Laura Heermann Langford  RN, PhD

 

 

 

 

Instructions: If Work Group does not want to require Copyright, delete the optional section below.

Copyright © 2019 Health Level Seven International ® ALL RIGHTS RESERVED. The reproduction of this material in any form is strictly forbidden without the written permission of the publisher.  HL7 and Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. Pat & TM Off.


IMPORTANT NOTES:

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Terminology

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Current Procedures Terminology (CPT) code set

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SNOMED CT

International Healthcare Terminology Standards Developing Organization (IHTSDO) http://www.ihtsdo.org/snomed-ct/get-snomed-ct or info@ihtsdo.org

Logical Observation Identifiers Names & Codes (LOINC)

Regenstrief Institute

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World Health Organization (WHO)

NUCC Health Care Provider Taxonomy code set

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Table of Contents



Table of Figures

 

 

 

Contributor

Affiliation

Todd Cooper

Trusted Solutions Foundry, Inc. 

Mark JurkovichUniversity of Minnesota
Jean Narcisi American Dental Association (ADA)
Lynne VanArsdaleHumans of Healthcare

 

 







Version

Date

 1.0

2018.12.28  – initial draft to organize discussions and submissions - structural organization - to date for discussion before and during the HL7 January 2019 WGM in San Antonio, Texas, U.S.A.



 

Executive Summary

Though the subject of interoperability is often discussed around a person’s medical and health records, and though numerous standards have been developed in support of oral health and dental care, the actual exchange of this information is generally limited to only that which documents and triggers payment for services rendered.  Dental information is largely “off the grid”, lost in a digital divide in the healthcare space between clinical care providers and “community” health providers, which in addition to dental care also include vision, nutritional, mental health, and social care services.  The generally recognized benefits of interoperability including improved safety, care quality, efficiency and accessibility, are therefore not realized and the opportunities not even discussed in any serious manner.

This white paper, created as part of the Health Level Seven (HL7) Dental Interoperability Investigational Project (DIIP)[1], reviews the standards that have been developed to support dental informatics, but then focuses on when, why and between whom this information might be exchanged.  Focus is placed on not only stakeholder value propositions but also the challenges that contribute to hindering and even blocking seamless information exchange for dental care.  Recommendations are then provided for interoperability principles that should be advanced, as well as specific follow-up projects, including standards-related development activities, that will have a high potential to achieve real and sustained integration of dental information across communities and health care providers.

Recommendations fall into a few key areas:

  1. Create a broad-based dental interoperability community of interest within those organizations and experts who are working on the broader standards-based health interoperability solutions;
  2. Detail out key use cases that will drive the requirements for the development of guidance documents and implementation projects;
  3. Create guidance and implementable-artifacts that support the integration of dental information using technologies and architectures that are in current use internationally for the exchange of other types health information;
  4. Create guidance and implementable-artifacts that support the exchange of dental information using HL7 Fast Health Interoperability ResourcesÒ (FHIR) technology;

These recommendations represent highly achievable objectives with clear stakeholder value that may be initiated early in 2019, with completion and implementation projects coming in late 2019 and 2020. 


[1] HL7 project #1482.  See http://www.hl7.org/special/Committees/projman/searchableProjectIndex.cfm?action=edit&ProjectNumber=1482 (last accessed 2018.12.28).

Overview

Scope

This white paper aims to provide information related to existing and emerging dental informatics standardization, the healthcare challenges and benefits that could be addressed by dental information exchange, and recommendations for specific standardization projects that would advance the ability of stakeholders to realize interoperable dental care healthcare solutions.  

It is intended to be international in scope and not limited to a specific realm.  Though some use cases will be rooted in regional and national care systems, the intent is to leverage these to identify general capabilities that would support effective care around the world.

The white paper is not intended to provide in depth understanding of any particular dental informatics or general health informatics topic.  The intent is to build upon existing standards and technical architectures and capabilities, adding support for dental informatics and not "reinventing the wheel."  

Intended Audience

Dental interoperability requires collaboration between dental informatics experts, practicing oral health care providers, digital health technology standardization and implementation experts, public health policy experts, and others.  This white paper seeks to provide the background information that is needed by all these stakeholders to understand the value of the seamless exchange of oral health and dental care information and the role that they might play in advancing standards and solutions that will contribute to genuine and sustainable dental interoperability.  

Background

The Dental Interoperability Investigative Project (DIIP) (HL7 PSS #1482), of which this white paper is the primary deliverable, was identified as the starting point to understand at least some of the underlying issues that have inhibited widespread interoperability of dental information - as has been accomplished with many other areas of health and healthcare specialization.  From the start, it was clear that this was not due to a lack of dental informatics standards - there are many core standards as identified in subsequent sections with more in the pipeline - but as is often the case, the challenges are directly related to business models and identifying the specific scenarios that would benefit most from interoperable exchange of dental information, whether by messages, documents, API's, SOA architectures, etc.  

It was also clearly understood that though dental informatics does present some unique semantic and coordination elements, when it comes to interoperability - the seamless exchange and use of granular health information - the inclusion of dental content should be incremental, maximally leveraging what already exists and especially what has been implemented and is in current "business as usual" use.  

By definition, an HL7 investigative project is intended to take less than one year, and that is the case with this document as well.  The intent is to paint a clear picture of what use case scenarios might be facilitated by dental interoperability, what existing standards should be leveraged, and what "gaps" might be filled to enable advancement in this area - ultimately making the integration of oral health and dental care information as simple as any other health-related content, and across the continuum of care.

Finally, to underscore the "short fuse" nature of this project and the intent to leverage it to facilitate the building of a community of interest within HL7 and to identify high-value standardization and implementation projects related to dental interoperability, this is an "unballoted white paper" that has not gone through a formal HL7 consensus balloting process and thus does not get published with an HL7-logoed document.  Instead, it is approved by the primary sponsoring working group - Patient Care - and can also be updated as subject area understanding and activity evolves.

Document Organization and Flow

The white paper is organized as follows:     

Executive Summary Overview of the core content of each section, including the conclusions and recommendations for subsequent standardization activities.
Dental InteroperabilitySurvey of the challenges and opportunities within the arena of dental informatics:  Why it generally remains "off the grid", what stakeholders are involved in and can benefit from dental interoperability, and a summarization of use case scenarios (detailed in an appendix) that highlight the systems and interactions that are involved.
Dental Informatics StandardizationReview of the existing and in-development standards that lay the foundation for the exchange of oral health and dental care information. In the spirit of "don't reinvent the wheel"!
Principles & ProjectsIdentification of interoperability principles or objectives that are of particular importance to enabling dental interoperability realization, as well as those gap-filling standards development efforts that will facilitate integration of dental content.


A number of appendices are included to supplement the core content of the white paper, including a significant section on use case scenarios.  The final "Open Issues / Opportunities" section should be used to capture areas that may be considered for future revisions of the paper.

Dental Interoperability

The Challenge:  Why hasn't this happened yet?

There are many many definitions of interoperability.  The basic, most common definition comes from the IEEE: 

the ability of two or more systems or components to exchange information and to use the information that has been exchanged.

Simple enough, but many other definitions and descriptions have been crafted, making the dialog around standards-based interoperability that much more challenging.  These definitions range from the Wikipedia-based "conceptual interoperability" 7-level model advanced by Tolk, to the Center for Medical Interoperability model with 5 different levers (from technical / infrastructural to contextual / dynamic).  Even HIMSS recently (2019 January) unveiled a new description of interoperability:  foundational, structural, semantic & organizational, with "organizational" being the main new element that factors in, for example, security federations or "realms" and inter-organizational care coordination processes and policies.  Each model has aspects or subjects related to interoperability and then maturity levels starting from "work of art" connectivity (heavy lifting required) to "seamless" (automatically - no assembly required).

In discussing the topic of dental interoperability - both within HL7 communities as well as in the "real world" - frequent responses include "Isn't it already?" or "Never thought about it" or "Why - is there any need?"  Generally, dental information remains "off the grid" - and the reasons are many and varied, though the following perspectives are often proffered:

  • Bigger Fish to Fry - of all the healthcare challenges individuals face, integration of dental information is just not as important (read: potential adverse medical risk) as other areas such as cardiac care or cancer treatment.  Thus the "interoperability oxygen" is sucked out of the room leaving few resources or interest for integration of dental information.  Even though the close connection between oral health and other areas of healthcare are widely recognized, and the potential benefits well established, the relative inefficiencies and risks associated with the status quo are generally deemed acceptable, at least for the foreseeable future;
  • Better Things to Spend Money On - Interoperability does come with a price tag, often requiring significant resources up front, even though the payback (e.g., from gains in efficiency and quality) may be achieved in a relatively short period.  With that, dental interoperability is often far enough down the priority list that it never quite makes it to the funding cutoff level; related to the previous rationale, dental care is on many interoperability roadmaps, but often as a "last mile" effort;
  • Who really benefits?  As is often the case in healthcare, especially in countries such as the U.S., those who need healthcare, those who provide that care, those who pay for the care, and who actually benefits (and how they benefit) from that care are misaligned.  This is especially true of dental care ranging from young children to senior adults - those who are the most vulnerable and have the fewest resources.  The underlying negative impact and costs of poor oral health across society is often not understood or not recognized ("denial"); any advancement of dental interoperability thus has to enable addressing these misaligned business drivers, thus increasing the priority and funding available to tackle the challenges;
  • It is a cottage industry!  Though that could been said of healthcare in general not that many years ago, this does remain very true in dental care (as well as vision care and others). Dentists are generally very focused on their own private practice and how to build that practice and maximize profits.  Interoperability is often seen as cost-without-return and potentially, enabling individuals to too easily check out the "competition"; It is often said, then that there is no "market" for dental interoperability - seamless information exchange comes with a price that keeps the cost-benefit analysis tilted in the no-interop direction;
  • Who will be legally responsible?  In many jurisdictions, the fact that dental information is available (including images and recent procedures), many dentists say, "I'm legally responsible for the care that I provide - regardless of what the patient tells me or what I see was done immediately before."  This legal liability perspective, though grounded in an element of truth, results in inefficiencies such as repeated imaging and other diagnostic procedures, even when interoperable dental information might be available; 
  • Join the community - With the increasing focus on person-centric health and wellness ... and healthcare ... there is an increasing recognition of the divide between traditional medical care (primary care, secondary & tertiary care settings) and the community-based health services that represent where individuals spend the majority of their lives and first seek health support.  Dental care is one of many areas that are a major part of an individual's life (along with nutrition, wellness / fitness / exercise, vision, mental health, etc.) but remain disconnected from their healthcare information; even though community information exchanges (CIE) have started to integrate with some health information exchanges (HIE), much of the focus is on social indicators and coordination and dental care is not part of the discussion;

There are many more explanations for why dental interoperability remains elusive, and each of the points above can be argued in either direction - especially when considering international variations in care models.  When talking to individuals, though, everyone wants ALL their health information to be centrally integrated and accessible and under their personal control ... from their teeth to their toes.  Though the arguments above may help understand the challenges that must be surmounted, they are rooted in socio-economic factors - healthcare industry / business model issues and not the result of a lack of technology, or even technical informatics standards.  And this at a time of informatics technology sea change - to cloud-based knowledge-driven personalized (precision) healthcare.  Dental informatics - and interoperability - must not only show up on the radar but has to do so in this rapidly evolving information environment where Data is King and is increasingly the foundation of innovation and improvements in health technology and services.

Clearly, addressing these socio-economic issues is beyond the scope of this white paper, no less the charter of organizations such as HL7.  Understanding the "Why not yet?" factors are key, though, to identifying where the greatest benefits - "low hanging fruit" - might be found and focusing interoperability standardization efforts.  

Stakeholders:  Who benefits from dental information exchange?

Interoperability is fundamentally concerned with facilitating interactions between individuals, organizations and their their information systems. Understanding each stakeholder and their potential benefit from seamless dental information exchange is key to identifying the value that can be achieved through dental interoperability.  Conversely, understanding the challenges that each faces - both technically and socio-economically - is key to ensuring that standards-based solutions are properly targeted and implementable.

The table below presents some of the stakeholders that frequently came up during discussions around use case scenarios.  It is not perfect.  There are probably omissions, each row could be partitioned into more granular identifiers, etc.  It does provide a starting point, though, for understanding the breadth of the dental interoperability ecosystem landscape.

Note: This white paper assumes that it is generally recognized that dentists are physicians or medical care professionals, though there are those who would argue that point.  "Dentists are Physicians" (ADA Letter) provides a good backgrounder.  That said, by convention, this white paper differentiates (for pragmatic simplicity alone) between dental care and healthcare.  This is consistent elsewhere in the industry, such as electronic dental records vs. electronic health records.


StakeholderDescription / RoleBenefitsChallenges
Person / Patient

The primary beneficiaries of interoperable dental care are individual patients. As seen in the use case scenarios below, though, specific oral health and care delivery challenges vary from children to seniors, from low-income individuals who have challenged access to regular dental care, to those who can afford the best care but find significant challenges coordinating between different providers and specialists.

quality / safety, availability / access, lower costs, portabilityzero control over interoperability between care team / providers
Dental ProfessionalDentists and other dental care professionals often have no / highly limited access to their patients' current and past (even yesterday's) health information. This begins with basic PAM information (Problems / Allergies / Medications) to referrals (both making and receiving) and summary reports, to posting findings back to primary healthcare providers (based on oral health observations such as oral cancer indications). Dental professionals include general practice dentists, to specialists such as pediatric, orthodontists, endodontists, oral surgeons, and others (see Glossary Appendix).Provide more informed & coordinated care, efficiency, liability mitigationInteroperability cost-benefit-risk analysis often erases most value
Healthcare Professional

Range from primary care physicians (incl. pediatricians and gerontologists) to oncologists, surgeons, nurses, etc. Oral health and dental care information is typically not integrated into their EHR systems - it is "off the grid" even when there is a need to include dental procedures in care plans, to make referrals and to close-the-loop on the results.

See above for for Dental ProfessionalsGiven all the other information access challenges, dental has very low priority.
Healthcare ProviderA few hospitals and hospital systems integrate dental services; however, this is fairly infrequent. As a result, when patient care requires coordination with a dental professional, it is typically left to the patient to work out the details, including the referral (why dental care is being recommended / required).

Dental Payors

Beyond private payment for treatment, which in many cases severely limits care options, dental insurers and "clearing houses" - organizations that coordinate and facilitate transactions between payors and dental care providers.

Increased granular data allows for analytics to improve care quality and efficiency and thus reduce costs.Privacy
Healthcare Payors<healthcare insurers / payors, public & private; incl. U.S. ACO?>

Clinics

<public, specialized dental to children/family/senior to general w/ dental component>

Clinics can specialize solely in dental care or they can include other specialties, including general primary care, vision, mental health services, and others. Clinics can



Vendors<dental IT, digital health - incl. EHR, etc.>

Info ExchangesRegional health information exchanges (HIE) that typically connect healthcare providers, especially hospitals and hospital systems, and community information exchanges (CIE) that facilitate information exchange between non-medical care, community-based services providers, including family and senior support services, mental health services, nutrition (meals) services - All are

Public Health Org.<responsible for public health esp. for low income, children / seniors, etc.>

Military

Or any organization that is responsible for mission critical personnel (e.g., astronauts) that will be deployed in environments for potentially long periods of time where dental care is not easily available. In these cases, oral health assessment and dental care planning is crucial to ensure that foreseeable challenges are recognized and risk mitigated.

Deployment readiness assessment + care planning and coordination can be automated and scaled across large groups (e.g., 100,000's)
Regulatory

Equipment and materials used in dental care, as well as care quality monitoring and assessment, are often under the purview of governmental regulatory authorities. This includes tracking of dental implants whose use is growing at a rapid rate in some regions.


Either a lack of needed informatics standards OR a significant lack of recognition and use by digital health solutions.


The next section provides use case information that helps understand how these various stakeholders can work together in an interoperable ecosystem to integrate dental information ... to value!

Use Cases:  Identifying Interoperability Opportunities and Value

<summarize use cases identified to date … simple table incl. from Confluence page>
<point to details in appendices>

Dental Informatics Standardization 

Background

The discussion around dental interoperability occurs in the context of a very rich set of dental informatics standards and does not seek to “reinvent the wheel”.   In order to determine the optimal ways in which standards-based interoperable exchange of dental information can be achieved, the foundation of key dental informatics standards and projects must be established.  The sections below focus on key standards development organizations (SDOs) that have been active in this subject area, along with a sampling of key standards that should be included in any dental interoperability guidance. 

SDO:  American Dental Association (ADA)

<background & links @ ADA, standards SCDI etc.>

<SCDI Structure including 11.9 Interoperability / Core data elements & 11.1 ...>

<ADA 1084 standard>  

<ADA 1067?>

<see SNOMED below>

SDO:  SNOMED International

<SNODENT w/ ADA management>

<incl. general use of SNOMED for casting healthcare / EHR integration in general>

SDO:  Digital Imaging and Communications in Medicine (DICOM)

DICOM is the international standard for medical imaging interoperability. It actively collaborates with other SDOs, including HL7, ISO, IEC, SNOMED, LOINC, ADA, IEEE, and IHE to ensure all stakeholders are engaged in effective standardization for medical imaging. 

DICOM WG-22 Dentistry, whose Secretariat is the ADA, is the focal point for addressing the needs of dental imaging within the DICOM Standard.

Among the features of DICOM for dental interoperability are:

SDO:  Health Level Seven (HL7)

HL7 since the early 90's has advanced standards that enable interoperability throughout the world.  Its "V2" (HL7 Version 2) messaging-based standard is the primary way information is exchanged within and between care providers today, while the "CDA" (Clinical Document Architecture) standard is the main format for documents in global use.  The merging HL7 Fast Healthcare Interoperability Resources (FHIR) standard is quickly becoming the de facto RESTful "API" standard for seamless information exchange, both inside and outside healthcare organizations, within countries and across international boundaries.  Given the large number of subject areas that fall under the general topic of "healthcare interoperability", HL7 has a set of working groups that cover everything from computer terminologies and message / document formatting to patient care, to security and privacy, to financial management, to analytics and clinical decision support.  Given the expanse of this subject area, HL7 also works closely with other SDOs, including those mentioned in this white paper, seeking to reduce duplicative effort (especially given limited resources and subject matter experts) and to ensure standards-based approaches are well coordinated.  There are also over 30 country "affiliates" that actively participate in the development of HL7 standards, especially ensuring its applicability to solve interoperability challenges in each region.

Within the area of dental informatics, HL7 has collaborated with the ADA, SNOMED, DICOM, ISO/TC 215 and others and has advanced three formal dental projects:

Project #1274  HL7 CDA® R2 Periodontal Attachment Implementation Guide: Exchange of C-CDA Based Documents, Release 1 (status: published STU; Attachments WG; US Realm)

Project #1402  HL7 CDA® R2 Orthodontic Attachment Implementation Guide, Release 1 (status:  ballot comment resolution almost complete; Attachments WG; US Realm)

Project #1406  EHR System Dental Functional Profile (status:  active; HL7 EHR WG)

In the case of the two CDA attachments address documentation of the provision of periodontal and orthodontic care, especially to close the loop for care reimbursement from payor organizations.  The EHR-S Dental functional profile, built starting with requirements from the ADA 1067 Electronic Dental Record System Standard Functional Requirements standard, this project will specify "a list of mandatory and optional standard functional requirements for electronic health records systems used in the practice of dentistry and its various specialties" profiling the foundational HL7 EHR-S Functional Model Release 2.  This effort is being coordinated with experts from the ADA SCDI WG 11.1 Standard Clinical Data Architecture and others.

<INCLUDE link to EHR-S FP Spreadsheet that will be used>

This DI investigational project seeks to build upon the foundation of these three standardization efforts, to identify how best to advance broad-based seamless exchange of oral health and dental care information addressing specific use case needs and value propositions, within the context of an HL7 dental interoperability community of interest.

Additional SDOs & Standards

<include ISO/TC 106 Dentistry and other standards organizations>

<include IHE … for XDS.b, etc.>

<terminology standards including LOINC & SNOMED – here or mention / include above in SNOMED section>

Principles & Projects


Recommended Principles – Establishing Value-Rich Interoperability 

<what can be done, should be done vs. what has sufficient value attached to enable funders and policy developers to enable the needed governance>

<build table:  principle - description - example application>

<person-centric>

<granular>

<images and data>

<not reinventing the wheel>

<today & tomorrow, V2 & FHIR>

<make it as easy as possible ... for everyone ... all stakeholders!>

Recommended Projects – Advancing Achievable Interoperability

<sync with executive summary>

 

<identify specific recommended community action @ HL7 and beyond>

 

<use existing standards and infrastructure maximally – don’t reinvent the wheel!>

<international>

 

<V2 / CDA / XDS.b etc. solutions … especially that tie into current national health info exchange infrastructures deployed around the world>

 

<HL7 FHIR-based guidance>

 

<ADA 1084 as an HL7 CDA OR cross-paradigm standard>

Appendix A:  Use Cases

Overview

<only selected examples are detailed here – additional use cases can be detailed more formally>

Ed. Note:  Each of these use cases has been advanced by experts and organizations that see them as having key value – in other words, they would be willing to see them supported through to implementation projects.

<intent of the level and type of content in the descriptions below>

<incl.  Realms covered by use case: primary focus vs. international scope>

<sources of descriptive subsections, incl.  EHR-S spreadsheet, Sequoia, WP template, etc. etc. etc.>

Use Case:  Dental Care Referral

<EHR integration>

<from PCP to Dentist; from military care provider to dentist>

<from Dentist to care team

<oral health as early indicators>

<#1 use case from dentists>

<include images [THC1] integration>


 [THC1]Ed. Note:  Do we need another use case that focuses on image exchange?

<from home page:

<Interested parties include EHR WG; SMART on FHIR community; vendors; clinicians; ...>

Widely recognized that early detection of medical issues can result from dental care / examinations


Registry  (Altarum) + Quality Metrics?

Use Case:  Pre-surgery Care Coordination

<FROM Home Page:

Patients for certain medical procedures are often required to undergo an oral health assessment from their dentist. Coordination of this care relies on very limited information exchange, especially if dental care is required before allowing the medical procedure to proceed.

Use Case:  Soldier Readiness Assessment & Care Coordination

<Nancy Orvis’ #1 use case>

<REFERENCE for background>

NOTE:  In U.S., new recruits have on an average 6+ cavities

Question:  Military-Civilian dental care intersection / coordination; 

Question:  Continuity of care from new recruit to active service to veteran


Use Case:  Post-Acute Dental Care Planning & Coordination

<FROM Home Page:

Patient is in an accident that requires emergency oral surgery followed by extensive follow-up care by a dentist. Little detailed information before and after the acute episode is available, and coordination of subsequent care including providing detailed care information is challenging.

Use Case:  Geriatric Oral Health Assessment & Care

<See West Health materials … including graphic>

<include memory care / dementia patients>

NOTE: Especially with dementia / memory loss patients where little info is available and they have a hard time explaining where the pain is coming from, etc.

Use Case:  School-based Health "Nurse" & Dental Care Integration

<include content from EHR-mHealth + HIMSS '19 Showcase discussion>

<See Altarum HIMSS Showcase sheet:  Primary Care is gateway to oral care for children!>

Use Case:  Transnational Dental Care

<Very popular from Mexico to Cuba to Malaysia etc.>

<IPS w/ Dental Section>

<e.g., "dental tourism">

<from home page:

Dental Patient Summary

See Catherine Chronaki & Portugal work; note that in IPS and IPSSS (JIC), there is no mention of dental care.

Use Case:  Global Dental Forensics

<dental information is often used in forensics cases for person identification ... around the world.  This use case looks at the standards that exist, what the process looks like today - in jurisdictions around teh world - and how improved dental interoperability might impact this area>

Use Case:  Dental Implant Tracking & Safety

<include MRI safety challenges + follow-up care history needed>

<materials safety>

device use & tracking

tracking device usage from the dentist office to the hospital is always challenging; use of UDI? allow for post-care quality assessment based on device usage information; PHD and PoCD devices, as well as health & wellness

Use Case:  Community & Health Information Exchange Integration

<does EHR integration belong here as well or as its own set of use cases?>

<care coordination + security / privacy support + business model challenges + …>

<basic value @ allergy lists, medication [THC1] lists, medical assessments of relevance, etc.>  PAM <problems / allergies / medications>

<bi-directional!>

<community care coordination – a la MoW @ West Health for senior nutrition & health monitoring>


 [THC1]Do we need a use case that focuses on medications / reconciliation specifically?  Or include those for each of the EHR / EDR / HIE / CIE items included here?


Single authoritative health record - EHR & EDR integration

What a patient tells their dentist is different from their doctors. The resulting records are often significantly different!


Additional Use Cases

<What a patient tells their dentist is different from their doctors. The resulting records are often significantly different!>

<quality assessment analytics>

<decision support / CDS hooks / predictive analytics>

<social determinants of health>

Cancer / Oncology Patients (Wayne?)

Lab Orders / Results coordination

Mobile Health Portals (using mHealth framework, etc.)

Blockchain & Smart Contracts / benefits discovery etc.  

Appendix B:  Glossary

This glossary is provided for the sole purpose of enhancing readability and understandability of this white paper.  It is not intended to be comprehensive nor definitive - but hopefully, useful!   Term definitions are sourced from the ADA Glossary of Dental Clinical and Administrative Terms, where additional terms can also be reviewed.

Open Issues / Opportunities

Add open issues below (eventually to Jira task list):

  • Address any in-line comments in the draft document
  •