Brief History

Computer-based patient records were initiated in the 1960's as a way to use computers to store patient data that had been historically placed on paper.  As a tangible entity, the computer-based patient record (now called the electronic health record) has evolved slowly since its inception.  The 1960's also saw the development of many healthcare insurance companies and agencies (federal and private) that generated more and more paper forms to be completed.

As these agencies and companies began to use computer business programs to manage data, it was obvious that data entry from paper forms was labor intensive so electronic forms were created.  Initially a general business model was used to manage electronic data, and the priority for these agencies and companies was to use information technology to enhance and share data that only related to administrative functions.  Meanwhile, utilizing information technology to enhance direct patient care became a secondary priority.  However, the report from the National Committee on Vital and Health Statistics (July 2000) entitled, "Uniform Data Standards for Patient Medical Record Information" (http://www.ncvhs.hhs.gov) reversed these priorities.  This committee reports to the Secretary of Health and Human Services.

A number of, but not all, medical specialties that are involved in multidisciplinary patient care recognize the role of the dentist in the healthcare process.  These healthcare professionals also recognize the need for readily accessible information regarding the oral manifestations of systemic disease as well as the significance of the oral health treatment plan in the total care of a patient.

During the past twenty years work has proceeded on defining and documenting the structure and content of the electronic health record.  The American Health Information Management Association, which represents the health record management profession, has played a major role in this effort.  Historic and developmental aspects of the electronic health record as well as information on its structure and properties can be found at the website http://www.ehrweb.org.  The web site demonstrates the multi-disciplinary involvement in the electronic health record evolution.  Dental professionals involved in developing the electronic oral health record can benefit by visiting this web site.  The site is an archive of papers written about this issue as well as documentation of proceedings of various national meetings related to the electronic health record.

In the early 1990's the American Dental Association (ADA) began collaboration with others to describe a specific electronic oral health record that complements the electronic health record used for general healthcare.  The monograph, "The Computer-based Oral Health Record," was an early statement of this description.¹  The ADA then established a Standards Committee for Dental Informatics (SCDI).

The mission statement for the ADA's SCDI is as follows:

"To promote patient care and oral health through the application of information technology to dentistry's clinical and administrative operations;  to develop standards, specifications, technical reports, and guidelines for components of a computerized dental clinical workstation;  electronic technologies used in dental practice;  interoperability standards for different software and hardware products which provide a seamless information exchange throughout all facets of healthcare."

SCDI is also a member of the Health Informatics Standards Board (HISB) that is a sub-committee of the American National Standards Institute (ANSI).  http://www.ada.org/prof/prac/stands/index.html

SCDI's membership in HISB and ANSI is important.  While the HISB coordinates the development of health informatics standards in the United States, the ANSI represents the United States as international standards are developed.  The ANSI ensures that common conventions developed in the United States that apply to products and services can be offered to the worldwide marketplace.

Informatic standards developed in the United States have an excellent chance to be applicable worldwide, and informatic standards developed internationally may be applicable in the United States or other nations.  Therefore, the ADA's SCDI helps to provide a strong international voice on the matter of standards for the electronic oral health record from dentistry in the United States.

It is important to understand that work on the electronic oral health record is a particular aspect of what is called "Dental Informatics."^5,6  Schleyer and Spallek discuss this term and its relationship to related terms as information science and technology have evolved over the past thirty-five years.²  They outline how "informatics" has been applied to the following:

• Bibliographic referencing
• Data analysis
• Online instruction
• Image processing
• Directed reasoning for clinical decision support
• Direct machining of dental materials
• Knowledge representation of common reference material

Each of these areas contributes directly to the development of the electronic oral health record.

Careful definition of electronic oral health record concepts and using information system engineering practices^7,8 helps to define "Dental Informatics" as envisioned by Schleyer and Spallek.  The ANSI/ADA 1000 series of standards provides a statement of many of these eventual capabilities.³  The Schleyer and Spallek article offers a perspective of how the potential of "Dental Informatics" can be practically delivered to the practicing dentist.

Click Here To Navigate Within Article >> Abstract Introduction Brief History The Structure of the Electronic Oral Health Record Obtaining an Electronic Oral Health Record Using an Electronic Oral Health Record in Dental Practice Setting Electronic Oral Health Record Standards that Promote New Capabilities Educational Challenges The Benefactors Conclusion References About the Authors
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Citation Number: Vol. 3, No. 1, Page 045