Dental Informatics

1
Dental Informatics Dental Research Making the
Connection

• NIH June 12-13, 2003
• Bethesda, MD

2
Standards in Dental Informatics

• American Dental Association Standards Committee
  on Dental Informatics

3
The Wit and Wisdom of Forest GumpIf you dont
know where you are goin, you will probably not
wind up there.
4
Do We Really Need Standards

• YES!

5
Why are U.S. railroad tracks4 feet eight and 1/2
inches apart?

• They were designed by Scottish engineers
• To match the width of wagon wheels
• That fit in the wheel ruts on British roads
• Made by Roman war chariots
• That were as wide as two horses rear ends

6
Do We Really Need Standards?

• An Innovative New Product
• Introduced By A Technology Leader
• Using A Superior Proprietary Format
• Failed
• Betamax by Sony

7
Why Does the ADA Support Standards?

• Evaluation criteria for products provide
• Enhanced safety and health
• Greater selection of products
• Easier choices
• Better and consistent quality
• Lower costs for members

8
Organization
9
Organization

• ADA sponsors the only standards programs whose
  scope exclusively addresses dentistry
• Administered by Department of Standards
  Administration
• Administration of all standards activities is
  centralized
• ADA Councils approve standards for the ADA and
  recommend experts

10
HIPAA recognition...

• Recognized for contribution to electronic
  standards in legislation
• Designated as dental procedure code source
• Asked to serve as dental content committee
• Continuing role as the only professional
  association consulting to the Secretary

11
Other Government Impact...

• FDA recognition of voluntary consensus standards
  in lieu of a 510(k)
• OMB Circular A-119 recommends government agencies
  adoption of voluntary consensus standards
• National Technology Transfer Act recommends
  government agencies adoption of voluntary
  consensus standards

12
SCDI Membership

• Balance of interests between consumer, producer,
  and general interest
• SCDI members are organizations
• Organizations appoint a representative to
  represent the organization
• Representative brings the organizations views
  and objectives to the SCDI and visa versa

13
ADA Standards Committee on Dental Informatics

• 60 members from 60 organizations
• PR-Industry (PR and Distributor) 22
• CO-User (Consumer) 18
• GI-General Interest 20
• Vacancies 3
• Accredited by ANSI to operate under ADA Standards
  Program Operating Procedures
• Actual development of standards conducted in
  Working Groups

14
Standards Committee Procedures

• Standards Committee Operating Procedures
• Approved by ADA Board of Trustees in February
  1999
• Accredited by ANSI as a Std Development
  Organization (SDO) in 2001

15
What is a Standard?

• A document that
• Defines or provides specific technical
  requirements for a material, product, process,
  procedure, service, policy, etc.
• Provides definitions dimensions, terminology,
  symbols, test methods, performance or safety
  requirements, etc.
• Is clear, concise, unambiguous and easily
  understood by those not involved in its
  development

16
What is a Technical Report?

• A document that
• Is informational in nature
• May describe a new technology
• May provide information on state of the art
• May be used in conjunction with an American
  National Standard
• May provide implementation advice about a
  standard

17
What a Standards Committee is not.

• A Data Content Committee
• A developer of dental codes and related
  terminologies
• A developer of diagnostic codes

18
ANSI Accreditation Requires...

• Balance of interests
• Consumer, General Interest, Vendor
• Open to all interested parties
• Consensus documents
• Due Process
• Written Procedures

19
As a Result..

• All documents developed by the ADA Standards
  Committees are eligible to become approved
  American National Standards or registered as ANSI
  Technical Reports

20
Informatics Committee Scope

• To promote patient care and oral health through
  the application of information technology to
  dentistrys clinical and administrative
  operations to develop standards, specifications,
  technical reports, and guidelines for components
  of a computerized dental clinical workstation

21
Informatics CommitteeScope

• electronic technologies used in dental practice
  and interoperability standards for different
  software and hardware products which provide a
  seamless information exchange throughout all
  facets of healthcare.

22
SCDI Organization

• 4 Subcommittees with 18 Working groups
• Subcommittee 10, Dental Informatics Architecture
  and Devices
• 8 Working Groups, 17 work items
• Subcommittee 11, Electronic Health Records
• 4 Working Groups, 5 work items
• Subcommittee 12, Informatics Component
  Interoperability in Dentistry
• 4 Working Groups, 4 work items
• Subcommittee 13, Electronic Dissemination of
  Dental Information
• 2 Working Groups, 2 work items

23
SCDISubcommittees

• Subcomm 10- Dental Informatics Architecture and
  Devices Dr. Scott Trapp, Chairman
• Subcomm 11- Electronic Dental Records Dr.
  Mark Diehl, Chairman

24
SCDISubcommittees

• Subcomm 12- Informatic Component Interoperability
  in Dentistry Dr. Brent Dove, Chairman
• Subcomm 13- Electronic Dissemination of Dental
  Information Dr. Gary Guest, Chairman

25
SCDI Subcomm 10Dental Informatics Architecture

• Scope To develop and promote standards for the
  device physical architecture, device-system
  physical interface, device-system informatics
  interface (API), system architecture, and
  information architecture.

26
SCDI Subcomm 10Projects

• WG 10.1- Infection Control for Dental
  Information Systems- Spec 1006
• WG 10.2- Hardware Recommendations for Dental
  Information Systems- TR 1012
• WG 10.3- Dental Information Systems Security and
  Safeguards

27
SCDI Subcomm 10Projects

• WG 10.4- Data Redundancy
• WG 10.5- Use of Handheld Computing Devices in
  Dentistry
• WG 10.6- Practice Management Performance for
  Dental Information Systems- TR 1012

28
SCDI WG 10.3 Dental Information Systems Security
and Safeguards

• Electronics Signature Applications
• TR 1016
• Administrative Procedures and their Applications
  in Dentistry- TR 1017
• Technical Security Mechanisms and Applications in
  Dentistry- TR 1019

29
SCDI WG 10.3 Dental Information Systems Security
and Safeguards

• Technical Security Services Application to
  Dentistry
• Physical Safeguards Applications to Dentistry-
  TR1020
• Internet Security Issues for Dental Information
  Systems- AIP

30
SCDI WG 10.6Practice Management Performance

• Clinical Software Performance for Dental Practice
  Software- Spec 1004
• Accounting Performance for Dental Information
  Systems- Spec 1010
• Schedule Performance for Dental Information
  Systems- AIP Revision
• Application Service Providers

31
SCDI Subcomm 11Electronic Health Record

• Scope To develop and promote standards for the
  electronic health record.

32
ANSI/ADA Specification 1000

• Standards Clinical Architecture for the Structure
  and Content of an Electronic Record
• Specification approved by ANSI in February 2001-
  Spec 1000

33
ANSI/ADA SPEC 1000Standard Clinical Data
Architecture for the Structure Content of an
Electronic Health Record

• 19 separate parts
• Not specifically made for dentistry
• Can encompass all healthcare
• Does not include coding

34
Spec. 1000 EHR Components

• Model Architecture
• Individual Ident.
• Codes Nomen.
• Individ Characteristics
• Population Charact.
• Organization
• Location
• Communication
• Health Care Event

• Health Care Material
• Health Services
• Hlth Services Resour.
• Population Hlth Facts
• Patient Health Facts
• Health Condition Diag
• Patient Service Plan
• Patient Hlth Service
• Clinical Investigation
• Comments Subj Area

35
Building a database is a lot like building a house

• Dr. Mark Diehl
• Computer Sciences Corporation
• 4/24/2003

36

• The business model tells you about the intended
  uses of the database the requirements.
• For a building this tells you the number and
  types of rooms, general floor plan, etc.

37

• The architect then creates a set of design
  drawings the conceptual data model.

• And then a set of blueprints the logical data
  model.

38

• The local construction code tells the architect
  and builder about what can be built these are
  the internal data standards.

39

• The data dictionary is the bill of materials,

obtained from a warehouse, the metadata
repository.
40

• The builder uses the blueprints to construct the
  house, with the details, like types of doors and
  windows, wall colors, floors, etc. customized to
  the buyers needs,

just like the database developer transform the
logical data model, into a database tailored to
the systems functional requirements.
41

• The implementation guide shows the database
  developer how to use the logical data model to
  create a database, just like a how to book
  tells a workman how to perform his trade.

42

• And finally, when you move in, and place your
  furniture and belongings, you populate the
  database.

43
Subcomm 11 Working Groups

• WG 11.1- Standard Clinical Architecture
• TR 1027- Implementation Guide for the Electronic
  Health Record
• WG 11.2- Consumer Guide to the Electronic Dental
  Record
• WG11.3- Universal Data Archive File

44
SCDI Subcomm 12 Informatic Component
Interoperability

• Scope To develop and promote standards for
  informatic component interoperability in
  dentistry.

45
Subcomm 12 Projects Informatic Component
Interoperability

• WG 12.1- Application of the DICOM Standard to
  Dentistry
• WG 12.2- Task-Related Testing of Digital
  Radiographic Systems

46
Subcomm 12 Projects Informatic Component
Interoperability

• WG 12.4- Guide to Digital Dental Photography
  Imaging- AIP
• WG 12.5- Dental Inter-Application Communication

47
SCDI Subcomm 13Electronic Dissemination of
Information

• Scope Develop and promote standards for quality,
  consistency, accuracy, security and functionality
  of health related information, knowledge
  representation and dissemination of information.

48
SCDI Subcomm 13Electronic Dissemination
ofDental Information

• WG 13.1- Educational Software Used in Electronic
  Media
• WG 13.3- Research Applications in Dental
  Informatics

49
ANSI/ADA Specification 1001Guidelines for Design
of Education Software

• Approved by ANSI in August 2002
• Purpose to promote quality in educational
  software
• Not domain-specific

50
Specification 1001

• Titus Schleyer Lynn Johnson- authors
• Developers can use to ensure products are of high
  instructional quality during development
  evaluation
• End users can compare education software programs
• Authors have derived validated rating instruments
  for use

51
Consequences for not participating...

• Dentists could be burdened with programs and
  systems adapted to dentistry rather than
  developed for dentistry
• Better to be proactive than reactive

52
For Additional Information

• American Dental Association-
• Department of Standards Administration
• Anyone can become a member of a working group
• www.ada.org/scdi

53
Thank you!Thank you!