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. 2018 Feb;149(2):122-131.
doi: 10.1016/j.adaj.2017.09.030.

Need for diagnostic-centric care in dentistry: A case study from the Marshfield Clinic Health System

Neel Shimpi, Zhan Ye, Rajesh Koralkar, Ingrid Glurich, Amit Acharya

Need for diagnostic-centric care in dentistry: A case study from the Marshfield Clinic Health System

Neel Shimpi et al. J Am Dent Assoc. 2018 Feb.

Abstract

Background: The study objective was to evaluate the workflow of dental providers who use the existing electronic dental record (EDR) system at a large regional health care system to establish a diagnostic-centric culture as part of their dental practice. A further goal focused on identifying when improvements to the workflow and design of the EDR may be indicated.

Methods: Dental procedures performed on patients and corresponding International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) diagnoses were retrospectively mined from Marshfield Clinic's enterprise data warehouse. All dental procedures performed were selected and paired with corresponding diagnostic codes documented by dental providers. Frequency of documented diagnosis was further analyzed by characterizing correspondence with their ranking order in the diagnosis column with and without a scroll bar within the EDR user interface (UI). Accuracy of selecting appropriate ICD-9-CM for the corresponding Code on Dental Procedure and Nomenclature (CDT) was checked for 10% (n = 6,187) of the procedure-diagnosis pairs.

Results: Of the 61,511 unique procedures documented using 147 CDTs, 11% (6,914 procedures) had a corresponding "not available" option associated under the diagnoses column, whereas 89% (54,597) of dental procedures were associated with a corresponding ICD-9-CM diagnostic code. Overall tendency of dental providers to select the first or last options from the diagnostic list with a scroll bar was noted. Appropriateness of documenting corresponding ICD-9-CM to CDT procedures indicated 98% accuracy.

Conclusion: EDR UI design greatly affected documentation process. Redesigning the EDR UI from the results will increase both the quality and utility of clinical documentation.

Keywords: Code on Dental Procedure and Nomenclature; International Classification of Disease; electronic dental record; electronic health record; structured data documentation; user computer interface.

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Conflict of interest statement

Conflict of interest: None of the authors have any direct or indirect financial incentives associated with the conduct of the study or publication of study findings. None of the authors have any personal relationship with other people or organizations that could inappropriately influence/bias their work.

Figures

Figure 1
Figure 1
Re-designed Electronic Dental Record User Interface to capture ICD9 Dental Diagnosis
Figure 2
Figure 2
Sections of the EDR UI and various EDR UI designs under the diagnosis column based on the length of the candidate diagnostic list.
Figure 3
Figure 3
Proposed EDR UI design to capture multiple relevant diagnoses that was incorporated in the EDR system based on the recommendation from the study
See this image and copyright information in PMC

References

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