The Role of Communication and Information Technology and Informatics in the PatientDentist Relations

1
The Role of Communication and Information
Technology and Informatics in the
Patient-Dentist Relationship

• Michael Kirshner, DDS, MPH
• Dental Informatics and Dental Research
• Making the Connection
• Bethesda, MD
• June 12, 2003

2
Overview

• Importance of doctor-patient relationship
• Problem and solutions
• Defining measuring doctor-patient relationship
• Dental CIT applications
• Role of dental informatics

3
Importance

• Doctor-patient relationship valued throughout
  history
• Linked to important health outcomes
• Increased treatment adherence
• Reduce malpractice claims
• Fewer tests and second opinions
• Improved quality of life

4
Problem

• Quality of relationship on the decline
• Consumerism
• Healthcare system constraints
• Poor communication skills

5
Solution

• Refocus on patient centeredness
• Leverage communication and information technology
  
• Conduct research to study effects
• Look to informatics for a model that integrates
  CIT with human relationship

6
Doctor-patient relationship defined

• Sustained open trusted conversation
• Sharing of information and knowledge
• Exemplified in patient-centered care model

7
Patient-Centered Care Model
Exploring both disease illness experience
Understanding the whole person
Finding common ground
Problems
Context
Disease
Person
Patient Presents Cues
Mutual Decision
Illness
Goals
Disease
Illness
Roles
Enhancing the Patient-Doctor Relationship
Incorporating Prevention and Health Promotion
Being Realistic
8
Relationship Building - PCC
Hi Quality Doctor-Patient Relationship

PCC
Improved Outcomes

• PCC - Patient-Centered Care

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Measure Quality Relationship

• Primary Care Assessment Survey
• Conceptual model of framework to measure
  doctor-patient relationship
• Validated instrument
• 4 scales measuring personal relationship

Source Safran 1998
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Personal Relationship Scales

• Communication and decision support
• Interpersonal caring and social support
• Contextual knowledge
• Trust

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Personal Relationship Scales

• Communication and decision support
• Thoroughness of questions about symptoms,
  attention to what patients say, clarity of
  explanations, instructions, and advice and help
  in making decisions.

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Personal Relationship Scales

• Communication and decision support
• Interpersonal caring and support
• Patience, friendliness, caring, respect, and time
  spent with the patient. Sharing power and
  enhancing self-awareness.

13
Personal Relationship Scales

• Communication and decision support
• Interpersonal caring and support
• Contextual knowledge of the patient
• Knowledge of the patients life history, medical
  history, responsibilities at work, home or
  school, principal health concerns, values, and
  beliefs.

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Personal Relationship Scales

• Communication and decision support
• Interpersonal caring and support
• Contextual knowledge of the patient
• Trust
• Integrity, honesty, competence, and role as the
  patients agent. Expressing a sense of security
  and well-being.

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Relationship Building - CIT
Hi Quality Doctor-Patient Relationship

Improved Outcomes
PCC
CIT

• CIT - Communication and Information Technology
• PCC - Patient-Centered Care

16
Communication Information Technology

• What aspects of CIT affect patient-dentist
  relationship
• Use existing models
• PCAS for relationship
• Schleyers taxonomy of dental CIT

17
Dental CIT

• Schleyers Categories
• Internet
• Clinical
• Administrative

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CIT Internet Devices
19
CIT Clinical Administrative Devices
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Mobile Wearable Devices
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Internet

• Office Web portal
• Email
• Personal Health Record
• Teledentistry

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Web Portal

• Service
• Doctor and Staff info
• Location, hours
• Practice philosophy
• Office policies
• Patient education
• Automated scheduling
• Automated reminders
• Patient testimonials images

• Relationship Benefit
• Informed patient
• Match shared values
• Set expectations
• Sense of control
• Build trust

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Email

• Service
• Secure
• Web-based
• Triaged
• Linked to EOHR
• Becomes part of PHR

• Relationship Benefit
• Ease of access
• Open communication
• Trust

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PHR

• Service
• Treatment history
• Dental history
• Meds
• Family history
• Radiographs

• Relationship Benefit
• Contextual knowledge
• Sharing participation
• Access control
• Level power asymmetry
• Trust and confidence

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Teledentsitry

• Service
• Remote care
• Consultations
• X-rays and images
• Teleconference
• Real-time, store and forward

• Relationship Benefit
• Communication
• Decision support
• Contextual knowledge
• Convenience
• Continuity of care
• Trust

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Clinical

• EOHR
• Digital Imaging
• Treatment Planning

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EOHR

• Service
• Exam
• Charting
• Treatment Planner
• Clinical and psychosocial data
• Preference data
• History and trends
• Knowledge-based

• Relationship Benefit
• Communication
• Contextual Knowledge
• Confidence
• Continuity of care
• Trust

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Imaging

• Service
• Visual record
• Treatment planning
• Trend analysis
• Simulations

• Relationship Benefit
• Communication
• Contextual knowledge
• Patient preferences
• Control
• Trust

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Treatment Planning

• Service
• Values-based options
• Link medical and oral factors
• Consider patient preferences
• Decision making aids

• Relationship Benefit
• Communication
• Decision support
• Patient preferences
• Control
• Trust

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Administrative Practice Mgt.

• Services
• Appointment scheduling
• Patient registration
• Tailored messages
• Demographics
• Insurance billing
• Claims submission
• Recall

• Relationship Benefit
• Communication
• Contextual knowledge
• Access
• Confidence
• Convenience
• Trust

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Relationship Building - DI
Hi Quality Doctor-Patient Relationship

Improved Outcomes
PCC
CIT

DI

• PCC - Patient-Centered Care
• CIT - Communication and Information
  Technology
• DI - Dental Informatics

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Role of Informatics Research

• Define research questions and methods that will
  inform the process of making CIT more effective
  at building quality patient-dentist relationships

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Informatics - Research

• Study of effects
• System installation
• System development
• Model building
• Draws research methods from cognitive science,
  psychology, decision science, human factors
  engineering, and telecommunications

Source Friedman 1995, Tower of Science
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Model Formulation

• Research
• Ontology
• Standardized vocabulary
• Problem solving methods
• Decision theory
• Cognitive science

• Relationship
• Communication
• Contextual knowledge

• Technology
• EOHR
• PHR
• Messaging

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System Development

• Research
• Integration
• Human factors
• HCI
• AI
• Data mining
• Decision theory
• Telecommun

• Technology
• EOHR
• PHR
• Email
• Teledentistry
• DSS
• Treatment Plan
• Practice Mgt

• Relationship
• Communication
• Patient Preferences
• Context knowledge
• Trust

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System Installation

• Research
• Integration
• UI
• Organizational theory
• Cognitive psychology

• Relationship
• Communication
• Patient Preferences
• Context knowledge
• Trust

• Technology
• Website
• Email
• Scheduling
• EOHR
• POHR
• Email
• Teledentistry
• DSS
• Practice Mgt

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Study of Effects

• Research
• Ontology
• Vocabulary
• Integration
• Usability
• Evidence-base
• Population-based

• Relationship
• Communication
• Patient preference
• Context knowledge
• Trust

• Technology
• All applications

38
Next Steps

• Conduct Informatics research on dental CIT
  vis-a-vis the doctor-patient relationship
• Build relationship with CIT developers and
  vendors to influence software design based on
  research findings
• Educate and engage clinicians in relationship
  skills
• More??