NIH Director Urges More Progress on Merging Medical, Dental Records

Feb. 22, 2023
‘Somewhere along the way, the head was somehow dissociated from the rest of the body. What we really want to do here is put the head back on the rest of the body,’ says Lawrence Tabak, D.D.S., Ph.D.

Several academic medical centers have made progress on merging medical and oral health records, but in a Feb. 21 speech to the Michigan Medicine Learning Health System Collaboratory, Lawrence Tabak, D.D.S., Ph.D., acting director of the National Institutes of Health (NIH), urged other academic medical centers with schools of dentistry to make this a priority.

“We need to somehow convince all schools of dentistry — particularly those that are associated with schools of medicine or osteopathy — that that they need to embark on this journey. My hope is that those institutions that have already done it, or are in the middle of doing it, will serve as great role models for this purpose,” Tabak said.

“Somewhere along the way, the head was somehow dissociated from the rest of the body. What we really want to do here is put the head back on the rest of the body, both figuratively and of course metaphorically. Using one common platform makes a lot of sense. It allows for health data exchange and it also allows you to aggregate data from multiple EHRs — and to make that available for either research purposes or population health trends within your own organization," he said. "And there are efforts underway, such as the Dental Data Exchange from HL7, which is using the FHIR resource set to define standards for the bidirectional exchange. That bidirectionality is something that's really important for this to work optimally. In the course of delivering dental treatment, you do, of course, need to understand the medical record very carefully. It's through efforts like this that one day — and perhaps that's already begun on your campus — physicians will be informed about the patient's oral health status as well.”

Last December, Healthcare Innovation wrote that the HL7 Dental Data Exchange Project was seeking vendor partners to participate in the piloting of the HL7 Clinical Document Architecture (CDA) and FHIR Dental Data Exchange implementation guides, with testing to occur in September 2023.

This implementation guide provides HL7 FHIR resources to define standards for bidirectional information exchange between a medical and a dental provider or between dental providers.

The Dental Data Exchange Project leverages the American Dental Association’s ANSI/ADA Standard No. 1084: Reference Core Data Set for Communication Among Dental and Other Health Information Systems as the foundation for the technical specifications in both standards.  Participation in the project is open to all, but the target audience for participation includes dental and medical health record vendors, clearinghouses, payers, health information exchanges, health systems, dental support organizations and technology leaders from dental practices.

Signs of progress

One example of progress involves UCSF Health and UCSF Dentistry, which last December announced it was the first academic health system in the West to merge medical and oral health records into a unified electronic health record in Epic.

Since Dec. 5, 2022, UCSF Health patients who also receive dental care through UCSF Dentistry have been able to access both sets of records and appointments in one place, while their providers are gaining a more complete picture of patients’ health through UCSF Health’s Epic electronic record system.

UCSF said that connecting the records is a major step in integrating oral health with other health disciplines, enabling clinicians to work together to provide comprehensive care to patients.

The medical and dental records integration is a key step in further fostering collaboration and innovation among UCSF’s clinical, teaching and research programs, according t Michael Reddy, D.M.D., DMSc, dean of the UCSF School of Dentistry and associate vice chancellor of Oral Health Affairs at UCSF, in a statement. “We know that oral health impacts a wide range of conditions, from heart disease to preterm birth, but until now it has been difficult for healthcare providers to make those connections for individual patients.”

Another example involves several health systems in New York City implementing a single instance of Epic. The Columbia University College of Dental Medicine (CDM) is a participating organization, along with ColumbiaDoctors, New York-Presbyterian, and Weill Cornell Medicine. The project of the tripartite consortium, called EpicTogether, provides a unified, coordinated patient experience that facilitates providers’ care for their patients and will enhance coordination between departments and institutions.

Epic provides modules for clinical specialties—in the case of dental, a module called Wisdom—while also integrating with core modules such as ambulatory care, scheduling, registration, and revenue cycle. At the time it was in the planning stages, CDM said the transition to the Epic EHR would provide several exciting opportunities. “Student, resident and faculty providers will deliver care to patients in an integrated medical-dental record that offers a comprehensive view of key items such as medical history, allergies, and medications. For DDS students, the move to an integrated medical-dental record builds on the integrated education they receive in the first two years of their program with the Vagelos College of Physicians and Surgeons, the medical school at Columbia University Irving Medical Center. For all students and residents, the integrated platform Epic provides will more closely approximate the system environment in which they will be providing care upon graduation and throughout their careers.”

In terms of data resources for dental research, Tabak also pointed to the BigMouth dental data repository, which includes data from 11 dental schools. It was first established in 2012, and has data on 4.6 million patients with quarterly data updates. It has a query interface for non-technical users across all institutions.

BigMouth is hosted at the University of Texas Health Science Center at Houston and includes dental schools participating in the Consortium of Oral Health Research and Informatics (COHRI).

The work began at four dental schools — at the University of Texas Health Science Center at Houston (UTHealth), Tufts University, the University of California San Francisco (UCSF), and Harvard University. They worked to establish the technical foundation, develop a data governance framework, and address areas that need to evolve in order to facilitate the use of the repository for clinical and quality improvement research.

“One institution has added medical electronic record data to BigMouth and about 25 percent of the patients overlap,” Tabak said. “I hope this is the very beginning of a trend that moves us all into this direction, where all the institutions that have agreed to share data do so not only with oral health data, but also with all forms of medical data.”

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