HL7 Meeting Highlights Progress on Medical-Dental Interoperability

At HL7’s annual Plenary and Working Group Meeting in Pittsburgh this week, stakeholders demonstrated medical-dental interoperability efforts in use cases involving sleep apnea and head and neck cancer. Panelists also discussed results of current dental-medical interoperability challenges and next steps for improving dental data exchange.

Historically, dental and medical systems have operated separately. The ASTP/ONC’s USCDI+ Dental initiative promotes interoperability between the two, seeking to enable a holistic view of a patient's health. Initially the work is enabling the integration of dental data into the Federal Electronic Health Record system. 


Ryan Lee, D.D.S., M.P.H., M.H.A., a dental/oral oncologist who serves as a dental subject matter expert for the Federal Electronic Health Records Modernization Office (FEHRM), led a discussion of opportunities and challenges as well as some use cases demonstrated at the HL7 meeting. Referring to the sleep apnea and cancer use cases demonstrated, Lee said, “that data exchange between a dentist and a physician is something that we were excited to test, and these are just two of several use cases that we at the FEHRM have helped to develop.”

Rebekah Fiehn, director, of dental benefits, coding and data exchange for the American Dental Association, explained some of the challenges from the dental provider perspective.  Dental offices “don't have chief information officers; they don't have chief technology officers, and they certainly don't have a team supporting them on their interoperability journey,” she said. “When you ask a dentist what they need for dental interoperability, they don't know what you're talking about. So it's a challenge when we engage with vendors to talk about interoperability and data exchange, they say, ‘well, we don't hear from our providers that that's needed.’ So the conversation on the provider side is still in very early stages, although, I have to say, through the efforts of the folks on this panel and several other leaders in the field, that conversation is certainly shifting. 

“The other thing that we have to remember is that many, many dentists were not able to take advantage of the incentive programs like Meaningful Use, and they don't necessarily participate in MIPS or anything like that,” Fiehn added. “So when we talk about the technology infrastructure, we're still several years behind, and that will continue to present a challenge as we talk about actually getting this technology into the dental office.”

Mark Marciante, director of digital health at Leavitt Partners, which convenes the CARIN Alliance, spoke about work to form an Oral Health Interoperability Alliance supporting efforts like USCDI+ Dental as well as better patient access to dental information. “In June we brought together both dentists and all of the major technology providers on the dentistry side, as well as some of the major leading healthcare providers and also insurance providers,” he said. “There were about 60 participants, and everybody agreed that we have a problem. Among the the things that came out from that convening is that there's a high degree of patient frustration because they're seeing in other venues that there is more interoperability, but not on the dental side.”

In the example of head and neck cancer, Marciante explained, the current process to get reimbursed is for the oncologist to create a PDF and either fax it or give it to the patient to bring to the dentist. The dentist fills that out and then faxes it back. “So even though they're able to be reimbursed, the rules are not well understood, and it creates not only friction for the patient, it also creates an opportunity for waste, fraud, and abuse,” he said. 

CARIN partnered with the FEHRM to try to bring this together so that we they leverage both existing standards and existing processes like USCDI+ Dental. Marciante said they have great partners in this, including Epic, Oracle and Henry Schein. “We heard from the dentists that they want it, and we heard a commitment from the technology providers that they're willing to move forward with it."

Brian Laskin, D.D.S., is co-founder of Toothapps and CEO and chairman of the board of the Dental Standards Institute, which is focused on innovation and patient advocacy. He said the demonstration at HL7 showed using a SMART-on-FHIR app with CDS Hooks. “We can connect dentistry and medicine in these critical use cases today,” he said. “That’s what we showed this last weekend. I think that's a huge step forward and I'm really excited to expand on that.”

At the Pittsburgh meeting, HL7 also announced that CEO Charles Jaffe, M.D., Ph.D., will step down at the end of year after nearly 20 years at the helm.

Under Jaffe’s leadership, HL7 expanded adoption of foundational data standards, including FHIR, Clinical Document Architecture (CDA), and the HL7 Version 2 messaging standard. He oversaw the integration of HL7 standards into federal regulations and championed worldwide implementation of FHIR to enable scalable, interoperable solutions across providers, payers and technology vendors.