Link to CDI Main

Project on Clinical Data Integration

Articulating Dental and Medical Care and Data for Patients

Microbes, pathogens, metabolic processes, and disease processes do not respect arbitrary barriers derived from human social structures like the division of health care delivery, electronic or handwritten patient records, insurance/claim streams, quality assurance, health care organization accreditation, research, and provider education into medical and dental categories.

 

See Institute of Medicine (IOM) report regarding “medically necessary” about dental care in Medicare:  “Such a restrictive definition may suggest that periodontal or other tooth-related infections are somehow different from infections elsewhere and imply that the mouth can be isolated from the rest of the body, notions neither scientifically based nor constructive for individual or public health” in Extending Medicare Coverage for Preventive and Other Services by Field MF, Lawrence RM, and Zwanziger L, eds; Committee on Medicare Coverage Extensions, Division of Health Care Services, IOM, 2000.

Pertinent Books:

·         Genco RJ and Williams RC, eds. (2010). Periodontal Disease & Overall Health: A Clinician's Guide. Colgate-Palmolive. At: http://www.colgateprofessional.com/professional-education/articles/periodontal-disease-and-overall-health-a-clinicians-guide

·         Glick M, ed. (2014). The Oral-Systemic Health Connection: A Guide to Patient Care (Quintessence Books) http://www.quintpub.com/display_detail.php3?psku=B6508#.U9_1B_k7uSo

·         Lamster IB, ed.(2014). Diabetes Mellitus and Oral Health: An Interprofessional Approach. Wiley Blackwell. 272 pp.

·         Powell V, Din FM, Acharya A, Torres-Urquidy MH, eds. (2012). Integration of Medical and Dental Care and Patient Data, Springer-UK (Medicine) http://www.springer.com/public+health/book/978-1-4471-2184-8

Project located provisionally in: RMU School of Communication and Information Systems (SCIS), AnnMarie LeBlanc, MFA, Dean

Department of Computer and Information Systems (C&IS), Prof. John Turchek, Interim Head

Working informally in cooperation with (thanks to you all!): University of Pittsburgh Center for Dental Informatics, Titus Schleyer, DMD, PhD, Director; Edward P. Heinrichs, DMD, Periodontics Program, University of Pittsburgh, Brian L. Mealey, DDS, Graduate Program Director and Director of the Specialist Division in the Department of Periodontics, University of Texas Health Science Center, San Antonio; Allan G. Farman, BDS, MBA, DSc, PhD, University of Louisville, Franklin A. Din, DMD, MA, EDS Global, an HP company; Mário Macedo, Instituto Politécnico de Tomar, Escola Superior Tecnologia Abrantes, Abrantes, Portugal, Stefan Schulz, DrPhil, IMBI, Albert-Ludwigs-Universität, Freiburg im Breisgau, Germany, Francisco Ramos-Gomez, DDS, MS, MPH, Professor, Section of Pediatric Dentistry, UCLA School of Dentistry; Gregory Sawyer, DDS, Los Gatos Dental Group; Erin O'Donnell Dotzler, Director, Public Practice and Scientific Affairs, American Academy for Periodontology; Arden W. Forrey, PhD, School of Dentistry, University of Washington, Shirley E. Williams, RN (retired from Trident Technical College, Charleston, SC), Harry Rhodes (American Health Information Management Association (AHIMA)). Thanks to Sarah Purdy, MD (School of Social and Community Medicine, University of Bristol) for help in keeping links useful and current.

At RMU: Valerie Powell, PhD, RT(R), University Professor Emerita, C&IS

*Book published 2012; see: http://www.springer.com/public+health/book/978-1-4471-2184-8

According to the Washington (PA) Observer-Reporter (February 1, 2012), a woman was accused in Waynesburg, PA, USA, of robbing a bank so she could buy dentures: http://www.observer-reporter.com/or/story11/02-01-2012-Bank-robbery; see also the Huffington Post: http://www.huffingtonpost.com/2012/02/02/toothless-bank-robber-needed-dentures_n_1249198.html See also: http://www.richmond.com/news/local/crime/man-accused-in-dentures-theft-held-without-bond/article_c89fa650-c712-11e3-9134-001a4bcf6878.html?mode=image&photo=

 

Other Pages:

2.    Page 2: Dr. Titus Schleyer, Informatics Agenda for Integrating Medical and Dental Care and Patient Data and Achieving Care Quality” See: MedDentDataArtic2.htm

3.    Page 3: References on Interrelationships between Oral and Systemic Conditions, Patient Care, Integration of Medical and Dental Care, Disparities in Care. See: MedDentDataArtic3.htm

4.    Page 4: A Model for Communication Among Dental and Medical Providers See: MedDentDataArtic4.htm

5.    Page 5: Dental Informatics: Electronic Oral Health Records (EOHRs) in Education. See: MedDentDataArtic5.htm

6.    Page 6: Medical/Dental Integration in U.S. Federal Systems: VA Dental System, Military ALHTA, IHS RPMS: MedDentDataArtic6.htm

7.    Page 7: Discrepancies between medical and dental records at present without articulation of care and data: [REMOVED for subsequent revision and publication*.]

8.    Page 8: Viewing (aggregate) dentogingival epithelial surface area (DGES) as a (single) open wound: MedDentDataArtic8.htm

9.    Page 9: Oral health care is significant for care of diabetes,
other chronic conditions, prenatal care. See: MedDentDataArtic9.htm

10. Page 10: The need to coordinate medical and dental insurance: See MedDentDataArtic10.htm

11. Page 11: A communication model for articulation of care from medical and dental providers. See MedDentDataArtic11.htm

12. Page 12: Inflammation and Periodontal Disease. See:MedDentDataArtic12.htm

13. Page 13: Higher Education Programs. See: MedDentDataArtic13.htm

14. Page 14: International Perspectives. See: MedDentDataArtic14.htm

15. Page 15: Importance of Oral Health in Pediatric Care. See: MedDentDataArtic15.htm

16. Page 16: White Paper: “A Primer on Data Standards and Coded Terminologies,” by Franklin A. Din. DMD, MA: [REMOVED for subsequent revision and publication.]

17. Page 17: Examples of Integration in EHR Standards Harmonization: MedDentDataArtic17.htm

18. Page 18: Community Meeting on Integration of Medical and Dental Care and Data: MedDentntDataArtic18.htm

19. Page 19: Obsolescence of the Healthcare Model used by U.S. Healthcare and its Effects on the Future of Healthcare in the U.S.: MedDentDataArtic19.htm

20. Page 20: Contact Points between Medical and Dental Care: Stroke, Heart Disease, Metabolic Syndrome, Inflammation, Atherosclerotic lesions, Sjögren’s Diagnosis, Osteonecrosis of the Jaw, etc.: [Removed 2012 for subsequent revision and publication in http://www.springer.com/public+health/book/978-1-4471-2184-8.]

21. Page 21: Listings of Integrated (Medical/Dental) EMRs/EHRs: MedDentDataArtic21.htm

22. Page 22: Integrated (medical/dental/orthodontic) Systems in Pediatric Care: MedDentDataArtic22.htm

23. Page 23: Medcare, Medicaid, and Oral Health; Medicare Data Flawed for Certain Health Care Research: MedDentDataArtic23.htm

24. Page 24: Dental Performance Measures: MedDentDataArtic24.htm

25. Page 25: Pathogen Page: MedDentDataArtic25.htm

26. Page 26: Periodontal Disease and Morbidity/Mortality: MedDentDataArtic26.htm

27. Page 27: Insurance/Payer-Related Studies: MedDentDataArtic27.htm

28. Page 28: Examples of Integration of Systemic and Oral Health Care: MedDentDataArtic28.htm

29. Page 29: NIH PMI RFI Response on Biospecimen Collection: MedDentDataArtic29.htm

 

Please see the Strategic Plan (2010) of HHS/HRSA: “Expand oral health and behavioral health services and integrate into primary care settings,” at: http://www.hrsa.gov/about/strategicplan.html .

Please see the web site of the National Association for Community Health Centers, Inc. (NACHC): http://www.nachc.com/

Please see the web site of the Institute for Oral Health: www.institutefororalhealth.org/

Please see the web site of Software Advice: www.softwareadvice.com/

Please see the web site of the International Association for Dental Research (IADR): http://www.dentalresearch.org/i4a/pages/index.cfm?pageid=3533 .

 

“Health Care Reform Must Include Dental Care,” by Dr. Charles N. Bertolami, Herman Robert Fox Dean of the New York University College of Dentistry: http://www.rollcall.com/news/34231-1.html

 

Florida Caries Program at: http://www.flphi.org/Portals/0/SOHIP/Docs/Early-Childhood-Caries.pdf  

 

UCLA School of Dentistry Announces: “UCSF/UCLA Center to Address Disparities in Children's Oral Health” For information, please contact Prof. Francisco Ramos-Gomez, DDS, MS, MPH, UCLA School of Dentistry

 

Healthyheartdentistry: http://www.healthyheartdentistry.com/; http://www.pharmaden.net/

 

Contributors:

·         Franklin A. Din, DMD, MA, Executive Director, Medical Informatics Center of Excellence, EDS/HP, Camp Hill, PA

·         Titus Schleyer, DMD, PhD, Director, Center for Dental Informatics, University of Pittsburgh, Pittsburgh, PA

·         Amit Acharya, BDS, MS, PhD, Marshfield Clinic Research Foundation / Biomedical Informatics Research Center (MCRF/BIRC). Marshfield, WI

·         Allan G. Farman, BDS, MBA, Dsc, PhD, Oral Surgery & Maxillofacial Surgery, University of Louisville, Louisville, KY

·         Valerie J.H. Powell, RT(R), PhD., Professor, Computer & Information Systems, Robert Morris University, Moon Township, PA

·         Miguel Humberto Torres-Urquidy, DDS, MS, CDC, Atlanta, GA, and Center for Dental Informatics, University of Pittsburgh, Pittsburgh, PA

·         Shin Mey Rose Yin Geist, DDS, MS, ABOM (oral medicine), University of Detroit Mercy, School of Dentistry, Detroit, MI

·         Edward P. Heinrichs, DMD, Associate Professor of Periodontics, School of Dental Medicine, University of Pittsburgh, Pittsburgh, PA

·         Erin O'Donnell Dotzler, Director, Public, Practice and Scientific Affairs, American Academy for Periodontology, Chicago, IL

·         Kerry Gutshall, Public Practice and Scientific Affairs Program Manager, American Academy for Periodontology, Chicago, IL

·         Peter J. Groen, Computer & Information Science Department, Shepherd University, Shepherdstown, WV (co-author of Medical Informatics 20/20, (Jones & Bartlett, 2007))

·         Arden W. Forrey, PhD, Department of Restorative Dentistry, School of Dentistry, University of Washington, Seattle, WA

 

Topic: Diabetes Care and Periodontal Care (The “Periodontal Dimension” of Chronic Care 1)

Progress on listing “was referred for or had a dental appointment (including periodontal screening)” as a standard measure of performance for diabetes care:

1.   American Diabetes Association (ADA): 2008 ADA Standards of Care (SOC): dental disease is listed under “history of diabetes-related complications” and dental referral is listed in Table 7 among the “components of the comprehensive diabetes evaluation.” (both on page 6 of the SOC): http://care.diabetesjournals.org/content/vol31/suppl_1/

2.   http://www.diabeteseducator.org/ProfessionalResources/AADE7/ American Association of Diabetes Educators (AADE7) includes “saw a dentist” as a measure.

3.   The National Committee for Quality Assurance (NCQA) does not yet have a Healthcare Effectiveness Data and Information Set (HEDIS) code for "regular dental referral" for diabetes care. According to NCQA Standards and Measures interpretation question, tracking number 29728, April 4, 2008, "We will keep this in mind during our ongoing re-evaluation of this measure."

·         Information on the interelationship(s) of diabetes and periodontal diseases is available online at http://www.perio.org/resources-products/pdf/lr-diabetes.pdf : Mealy BL and Oates TW, "Diabetes Mellitus and Periodontal Diseases," J Periodontol 2006;77:545-56. This is a review commissioned by the American Academy of Periodontology (Chicago, IL), http://www.perio.org/

·         Contact at the American Academy of Periodontology (AAP): Erin O'Donnell Dotzler, Director, Public, Practice and Scientific Affairs, American Academy for Periodontology, 737 N. Michigan Ave, Suite 800, Chicago, IL  60611 ; Email: erin@perio.org ; Phone: 312.573.3247; Fax: 312.573.3234

·         Example of NQMC (National Quality Measures Clearinghouse; AHRQ) measure that would accomplish what is needed:
Diabetes mellitus: percent of patients who obtained a dental exam in the last 12 months.  HRSA Health Disparities Collaboratives: Diabetes Collaborative 2006 Jun NQMC:001600; see http://www.qualitymeasures.ahrq.gov/Browse/DisplayOrganization.aspx?org_id=1344&doc=4065 .

·         See “– Diabetes also increases the incidence of dental disease …” http://www.ahrq.gov/qual/diabqguide.pdf

Topic: Heart Disease and Periodontal Disease (The “Periodontal Dimension” of Chronic Care 2)

·         Robert J. Ostfeld, “Periodontal Disease and Cardiology,” “Report of the Independent Panel of Experts of the Scottsdale Project,” Grand Rounds Supplement September 2007, p. 3.

·         See Consumer Reports (May 2008), page 55: CRMay2008Page55

Topic: Stroke and Periodontal Disease (The “Periodontal Dimension” of Chronic Care 3)

·         NewsRx (2006) (Managed Care Weekly Digest): “Earlier periodontal treatment leads to lower medical costs.” See comments on cerebrovascular disease (CVD).

Topic: Pneumonia and Oral Health (The “Periodontal Dimension” of Chronic Care 4)

·         See Consumer Reports (May 2008), page 55: CRMay2008Page55

Quotes and Statements:

·         Quality of Care and Communication: “I think the healthcare system has plenty of opportunities to improve the quality of care by simply improving the communication among the people who provide it. However, there are several reasons why this is not happening very much now. Many of them are historical and ‘ingrained’ in the way each discipline practices, but others are contemporary barriers. … we have to acknowledge that technology is only a piece of the puzzle. It certainly will not be the silver bullet for solving healthcare communication problems. It needs to work hand-in-hand with efforts to (1) augment standards of care to represent the best evidence available; (2) break down professional, systemic, cultural and personal barriers to improved communication; and (3) make the patient the central and focal point of healthcare.” Dr. Titus Schleyer, University of Pittsburgh Center for Dental Informatics, January 22, 2008.

·         “[Powell] would also like to see dental referrals for patients with diabetes so that they will be screened for periodontal disease. Diabetes can lead to gum disease, which may impede a person's ability to follow a prescribed diet,” Dr. Valerie Powell, Robert Morris University. Source: http://www.rmu.edu/OnTheMove/wpnews.full_story?inws_seqno=15390&it=&icalledby=umbraco&iattr=

·         Dr. Titus Schleyer, University of Pittsburgh Center for Dental Informatics: “Informatics Agenda for Integrating Medical and Dental Care and Patient Data and Achieving Care Quality” See http://www.infroref.org/MedDentDataArtic2.htm

·         Dr. Arden W. Forrey, School of Dentistry, University of Washington: “I am a contributor to the new HITSP Education, Communication and Outreach - ECO Committee so the integration of information is a key issue and I have asked that ECO develop a co-ordination with IOM on the IOM 2003 report and first develop the recommendation for the common vocabulary of competencies for the health professional disciplines to which the specialty disciplines’ (e.g. medicine, dentistry) competency vocabularies can be related; that provides the framework for curricular integration of informatics knowledge areas. I have also been working with our AHIMA certified Health Informatics and Health Information Management (HIHIM) program here on a cross-disciplinary informatics framework for joint instructional approaches to EHRs that include the uses of VistA to probe many of the Conceptual Content and Implementing Technology issues…”

·         We have not thought through and have not provided for the integrated process of communication that would support coordinated care for a patient by a family physician and a periodontist, for example. Periodontists communicate typically within the dental "silo," such as with dentists, and rarely with healthcare professionals in the medical "silo." The report that a periodontist might send to the patient's family physician, endocrinologist, diabetologist or cardiologist might not be the same as a report intended for the patient's dentist. Dr. Valerie Powell, Robert Morris University, Source: Modern Healthcare, April 11, 2008, at http://www.modernhealthcare.com/apps/pbcs.dll/article?AID=/20080411/REG/219726573

 

Links:

·         WHO Diabetes: http://who.int/topics/diabetes_mellitus/en/

·         American Diabetes Association (ADA): http://www.diabetes.org/

·         Canadian Diabetes Association: http://www.diabetes.ca/

·         Diabetes UK: http://www.diabetes.org.uk/

·         Diabetes Australia: http://www.diabetesaustralia.com.au/

·         Australian Diabetes Society: http://www.diabetessociety.com.au/

·         Diabetes India: http://www.diabetesindia.com/

·         Diabetes Deutschland: http://www.diabetes-deutschland.de/

1.   Diabetes Home Page: https://www.lifereader.com/research-articles/diabetes-homepage

2.   ADA on Oral Care: http://www.diabetes.org/living-with-diabetes/treatment-and-care/oral-health-and-hygiene/

3.   ADA on Periodontal Disease (search): http://google.diabetes.org/search?site=Diabetes&client=default_frontend&sort=date%3AD%3AL%3Ad1&entqr=0&oe=UTF-8&ie=UTF-8&ud=1&proxystylesheet=default_frontend&output=xml_no_dtd&q=periodontal+disease

4.   A search of the ADA site for articles on diabetes and periodontal disease produces over 30 results.

5.   ADA Diabetes Advisor on “Learn What You Can Do to Take Care of Your Gums, Teeth, Skin, and Feet? http://www.diabetes.org/in-my-community/local-offices/new-orleans-louisiana/assets/files/protect-your-eyes.pdf

6.   http://care.diabetesjournals.org/content/vol31/suppl_1/ includes 2008 ADA Standards of Care (SOC): dental disease is listed under “history of diabetes-related complications” and dental referral is listed in Table 7 among the “components of the comprehensive diabetes evaluation.” (both on page 6 of the SOC)

·         University of Washington course: “Department of Pediatrics Conjoint 516, Spring Quarter 2006: What Every Physician Should Know About Oral Health,” http://courses.washington.edu/ohcourse/index.html - see also regarding this course Mouradian, WE, Reeves, A, Kim, Sara, Lewis, C, Keerbs, A, Slayton, RL, Gupta, D, Oskounian, D, Kalet, T, and Marshall, SG, “A New Oral Health Elective for Medical Students at the University of Washington,” Teaching and Learning in Medicine 18, 4 (October 2006):336-342.

·         Consumer Reports (May 2008) on dental care and diabetes, heart disease, and pneumonia: CRMay2008Page55 .

·         NewsRx (2006) (Managed Care Weekly Digest): “Earlier periodontal treatment leads to lower medical costs.”

·         American Dental Association (ADA) Standards Committee on Dental Informatics (SCDI): http://www.ada.org/prof/resources/standards/informatics.asp

·         American Academy of Periodontology (AAP): www.perio.org

·         HRSA Strategic Plan (2010): http://www.hrsa.gov/about/strategicplan.html

·         Medicare Lawsuit: http://www.medicareadvocacy.org/2011/07/fournier-v-leavitt/ ; http://www.drbicuspid.com/user/documents/content_documents/sup_ocd/2011_08_15_16_50_24_535_Medicare_lawsuit.pdf

·         CDT codes - Code on Dental Procedures and Nomenclature:
http://www.ada.org/prof/resources/topics/cdt/index.asp

·         DICOM Working Group 22 (Dentistry; 2005):
http://medical.nema.org/Dicom/minutes/Committee/2005/2005-09-29/WG-22_Report_2005-08-27.doc

·         ADEA: http://www.adea.org/Pages/default.aspx See Dominick P. DePaola, Harold C. Slavkin, “Reforming Dental Health Professions Education: A White Paper

·         HITSP ECO: http://hitsp.wikispaces.com/Education,+Communications+and+Outreach

·         Journal of Contemporary Dental Practice: http://www.thejcdp.com/issue009/index.shtml

 

DISLAIMER: No information on these pages should be necessarily construed as a position of Robert Morris University, of the University of Pittsburgh or its Center for Dental Informatics, of the American Academy of Periodontology, of the American Association of Diabetes Educators, of the University of Washington, or of the Governor’s Commission on Chronic Care Management, Reimbursement, and Cost Reduction, Pennsylvania.

 

Updated: January 15, 2016

 

Robert Morris University

Wheatley Center, Room 324

Moon Township, PA 15108 USA

Project established early 2008.

Contact: Valerie J.H. Powell, RT(R), PhD, C&IS Department, phone: 412-397-6452; fax: 412-397-6469; e-mail: powell@rmu.edu