11.r Health Informatics

8/22/2019 11.r Health Informatics

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GOOD MORNING


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HEALTH

INFORMATICS


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CONTENTS

Introduction

Definition of health informatics

Development

Infrastructure

Objective

Information skills

Requisites to be satisfied

Components


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Uses

Sources

Aspects

Standards

Subdomains

Dental informatics

Introduction

Goals

Dentiline

Opportunities and challenges


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Oral health information systems-WHO

Conclusion

References


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Introduction

If physiology literally means the logic oflife, and pathology

is the logic ofdisease, then health informatics is the logic of

healthcare. It is the rational study of the way we think about

patients, and the way that treatments are defined, selected and

evolved. It is the study of how clinical knowledge is created,

shaped, shared and applied.


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Ultimately, it is the study of how we organise ourselves to

create and run healthcare organisations. With such a pivotal

role, the study of informatics will become as fundamental to

the practice of medicine.


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Health informatics is thus as much about computersas cardiology is about stethoscopes. Rather thandrugs, X-ray machines or surgical instruments, thetools of informatics are more likely to be clinical

guidelines, formal health languages, informationsystems, or communication systems like the Internet.These tools, however, are only a means to an end,which is the delivery of the best possible healthcare


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Although the name health informatics only

came into use around 1973 (Protti, 1995), it is

a study that is as old as healthcare itself. It

was born the day that a clinician first wrotedown some impressions about a patients

illness, and used these to learn how to treat

their next patient.


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Informatics has grown considerably as a

clinical discipline in recent years fuelled, in

part no doubt, by the advances in computer

technology. What has fundamentally changed

is our ability to describe and manipulate

health knowledge at a highly abstract level, as

has our ability to build up rich communicationsystems to support the process of healthcare.


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A health information is defined as : "a

mechanism for the collection, processing,

analysis andtransmission of information

requiredfor organizing and operating health

services, and also for research and training".

( WHO 1974)


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Medical informatics began to take off in the US in the 1950swith the rise of the microchip and computers. The earliest useof computation for medicine was fordental projects in the1950s at the United StatesNational Bureau of Standards byRobert Ledley

The next step in the mid 1950s were the development of expert

systems such as MYCIN and INTERNIST-I. In 1965, theNational Library of Medicine started to use MEDLINE andMEDLARS.

At this time,Neil Pappalardo, Curtis Marble, and RobertGreenes developed MUMPS (Massachusetts General Hospital

Utility Multi-Programming System) in Octo Barnett'sLaboratory of Computer Science at Massachusetts GeneralHospital in Boston. In the 1970s and 1980s it was the mostcommonly used programming language for clinicalapplications.
http://en.wikipedia.org/wiki/Dentistryhttp://en.wikipedia.org/wiki/National_Bureau_of_Standardshttp://en.wikipedia.org/wiki/Robert_Ledleyhttp://en.wikipedia.org/wiki/MYCINhttp://en.wikipedia.org/w/index.php?title=INTERNIST-I&action=edit&redlink=1http://en.wikipedia.org/wiki/National_Library_of_Medicinehttp://en.wikipedia.org/wiki/MEDLINEhttp://en.wikipedia.org/wiki/MEDLARShttp://en.wikipedia.org/wiki/Neil_Pappalardohttp://en.wikipedia.org/wiki/MUMPShttp://en.wikipedia.org/w/index.php?title=Octo_Barnett&action=edit&redlink=1http://en.wikipedia.org/wiki/Massachusetts_General_Hospitalhttp://en.wikipedia.org/wiki/Massachusetts_General_Hospitalhttp://en.wikipedia.org/wiki/Bostonhttp://en.wikipedia.org/wiki/Bostonhttp://en.wikipedia.org/wiki/Massachusetts_General_Hospitalhttp://en.wikipedia.org/wiki/Massachusetts_General_Hospitalhttp://en.wikipedia.org/w/index.php?title=Octo_Barnett&action=edit&redlink=1http://en.wikipedia.org/wiki/MUMPShttp://en.wikipedia.org/wiki/Neil_Pappalardohttp://en.wikipedia.org/wiki/MEDLARShttp://en.wikipedia.org/wiki/MEDLINEhttp://en.wikipedia.org/wiki/National_Library_of_Medicinehttp://en.wikipedia.org/w/index.php?title=INTERNIST-I&action=edit&redlink=1http://en.wikipedia.org/w/index.php?title=INTERNIST-I&action=edit&redlink=1http://en.wikipedia.org/w/index.php?title=INTERNIST-I&action=edit&redlink=1http://en.wikipedia.org/wiki/MYCINhttp://en.wikipedia.org/wiki/Robert_Ledleyhttp://en.wikipedia.org/wiki/National_Bureau_of_Standardshttp://en.wikipedia.org/wiki/Dentistry


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Homer R. Warner, one of the fathers of medical

informatics, founded the Department of Medical

Informatics at the University of Utah in 1968.

In the 1970s a growing number of commercialvendors began to market practice management and

electronic medical records systems. Although many

products exists only a small number of health

practitioners use fully featured electronic health carerecords systems.
http://en.wikipedia.org/wiki/Homer_R._Warnerhttp://en.wikipedia.org/wiki/Homer_R._Warner


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1996-s regulatingprivacy and medical record

transmission, created the impetus for large

numbers ofphysicians to move towards using

EMRsoftware, primarily for the purpose of

secure medical billing.
http://en.wikipedia.org/wiki/Privacyhttp://en.wikipedia.org/wiki/Physicianshttp://en.wikipedia.org/wiki/Electronic_medical_recordhttp://en.wikipedia.org/wiki/Electronic_medical_recordhttp://en.wikipedia.org/wiki/Physicianshttp://en.wikipedia.org/wiki/Privacy


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Health informatics ormedical informatics is the intersectionof

information science,

computer science, and

health care.

.
http://en.wikipedia.org/wiki/Information_sciencehttp://en.wikipedia.org/wiki/Computer_sciencehttp://en.wikipedia.org/wiki/Health_carehttp://en.wikipedia.org/wiki/Health_carehttp://en.wikipedia.org/wiki/Health_carehttp://en.wikipedia.org/wiki/Health_carehttp://en.wikipedia.org/wiki/Computer_sciencehttp://en.wikipedia.org/wiki/Computer_sciencehttp://en.wikipedia.org/wiki/Computer_sciencehttp://en.wikipedia.org/wiki/Information_sciencehttp://en.wikipedia.org/wiki/Information_sciencehttp://en.wikipedia.org/wiki/Information_science


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It deals with the

resources,

devices, and

formal health languages,

information systems, or

communication systems like the Internet

methods required to optimize the acquisition, storage,retrieval, and

use of information in health and biomedicine


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Health informatics tools include not only computers

but also

clinical guidelines,

formal medical terminologies, and

information and communication systems


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The Infrastructure for Informatics

Electronic medical records.

data capture.

Computable representations of the medical literature

diagnosis.

decision support for health care professionals.

Systems for improved patient education and compliance.

Continuing medical education

Demonstration of effectiveness.

Mining data for new medical knowledge.

Universal access to these technologies.


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The primary objective of a health information system is toprovide reliable, relevant, up-to-date, adequate, timely andreasonably complete information for health managers at alllevels (i.e., central, intermediate and local),

and at the sharing of technical and scientific (includingbibliographical) information by all health personnelparticipating in the health services of a country;

and also to provide at periodic intervals, data that will showthe general performance of the health services and to assistplanners in studying their current functioning and trends indemand and work load.


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Informatics Skills

Communicatingeffectively

Structuring information, with a particular focus on the

patient record, is shown to be dependent upon the task at hand,

the channel used to communicate the message, and the agentwho will receive the message


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Questioningothers to find information is essential in clinicalpractice to fill the ever present gaps in every individualsknowledge;

Searching for knowledge describes the broader strategicprocess of knowing where to ask questions, evaluatinganswers, and refining questions in the light of previousactions, and occurs in many different settings, from when

patients are interviewed and examined, through to whentreatment options are canvassed;


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Making Decisions occurs when all the available information

needed has been assembled using the other informatics skills,

and attempts to come up with the best alternative to solve aproblem like selecting a treatment, based both upon the

evidence from science, as well as the wishes and needs of

individuals


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Requirements to be satisfied by

health information systems


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A WHO Expert Committee identified thefollowing requirements:

system should be population based avoid the unnecessary agglomeration of data

Employ functional and operational terms

Should be problem oriented

Should express information briefly and imaginatively Should make provision for the feedback of data.


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Components of a health information

The health information system is composed ofseveral related subsystems.

A comprehensive health information system

requires information and Indicators on the

following subjects


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demography and vital events

environmental health statistics

health status: mortality, morbidity, quality of life

health resources: facilities, beds, manpower

Utilization and non-utilization of health services: attendance,

admissions,

indices of outcome of medical care

financial statistics (cost, expenditure) related to the particular

objective


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Uses of health information


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To measure the health status of the people and to quantify theirhealth problems and medical and health care needs.

For local, national and international comparisons of healthstatus. For such comparisons the data need to be subjected torigorous standardization and quality control.

For planning, administration and effective management ofhealth services and programs.


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For assessing whether health services are accomplishing their

objectives in term of their effectiveness and efficiency

For assessing the attitudes and degree of satisfaction of thebeneficiaries with the health system

For research into particular problems of health and disease.


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Sources of health information


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Census

Registration of vital events

Sample registration systems

Notification of diseases

Disease registrations

Record linkage

Epidemiological surveillance

Health service records

Environmental health data

Health manpower statistics

Population surveys


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Non quantifiable information

The health information system concentrated mainly onquantifiable (statistical) data. Health planners and decisionmakers require a lot of non- quantifiable information, forinstance, information on health policies, health legislation,

public attitudes, program costs, procedures and technology.

In other word, health information system has multi disciplinaryinputs.

There should be proper storage, processing and dissemination ofinformation.


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We can formally say that health informatics is the study of

information and communication systems in healthcare. Healthinformatics is particularly focused on:

1. Understanding the fundamental nature of these informationand communication systems, and describing the principles

which shape them,

2. Developing interventions which can improve upon existing

information and communication systems,


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3. Developing methods and principles which allow such

interventions to be designed,

4. Evaluating the impact of these interventions on the way

individuals or organizations work, or on the outcome of the

work.


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Aspects of the field

architectures forelectronic medical records and other healthinformation systems used for billing, scheduling, and research

decision support systems in healthcare, including clinicaldecision support systems

standards and integration profiles (e.g. Integrating theHealthcare Enterprise) to facilitate the exchange ofinformation between healthcare information systems
http://en.wikipedia.org/wiki/Electronic_medical_recordshttp://en.wikipedia.org/wiki/Decision_support_systemhttp://en.wikipedia.org/wiki/Clinical_decision_support_systemhttp://en.wikipedia.org/wiki/Clinical_decision_support_systemhttp://en.wikipedia.org/wiki/Data_integrationhttp://en.wikipedia.org/wiki/Integrating_the_Healthcare_Enterprisehttp://en.wikipedia.org/wiki/Integrating_the_Healthcare_Enterprisehttp://en.wikipedia.org/wiki/Healthcare_information_systemhttp://en.wikipedia.org/wiki/Healthcare_information_systemhttp://en.wikipedia.org/wiki/Integrating_the_Healthcare_Enterprisehttp://en.wikipedia.org/wiki/Integrating_the_Healthcare_Enterprisehttp://en.wikipedia.org/wiki/Data_integrationhttp://en.wikipedia.org/wiki/Clinical_decision_support_systemhttp://en.wikipedia.org/wiki/Clinical_decision_support_systemhttp://en.wikipedia.org/wiki/Decision_support_systemhttp://en.wikipedia.org/wiki/Electronic_medical_records


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controlled medical vocabularies (CMVs) such as theSystematized Nomenclature of Medicine, Clinical Terms(SNOMED CT), MEDCIN, Logical Observation Identifiers

Names and Codes (LOINC), OpenGALEN CommonReference Model or the highly complex UMLS - used to allow

a standard, accurate exchange of data content between systemsand providers

use of hand-held or portable devices to assist providers withdata entry/ or medical decision-making, sometimes called

mHealth.
http://en.wikipedia.org/wiki/Controlled_vocabularyhttp://en.wikipedia.org/wiki/SNOMED_CThttp://en.wikipedia.org/wiki/MEDCINhttp://en.wikipedia.org/wiki/LOINChttp://en.wikipedia.org/wiki/OpenGALENhttp://en.wikipedia.org/wiki/UMLShttp://en.wikipedia.org/wiki/Data_exchangehttp://en.wikipedia.org/wiki/Handheld_devicehttp://en.wikipedia.org/wiki/Clinical_decision_support_systemhttp://en.wikipedia.org/wiki/MHealthhttp://en.wikipedia.org/wiki/MHealthhttp://en.wikipedia.org/wiki/Clinical_decision_support_systemhttp://en.wikipedia.org/wiki/Clinical_decision_support_systemhttp://en.wikipedia.org/wiki/Clinical_decision_support_systemhttp://en.wikipedia.org/wiki/Handheld_devicehttp://en.wikipedia.org/wiki/Handheld_devicehttp://en.wikipedia.org/wiki/Handheld_devicehttp://en.wikipedia.org/wiki/Data_exchangehttp://en.wikipedia.org/wiki/UMLShttp://en.wikipedia.org/wiki/OpenGALENhttp://en.wikipedia.org/wiki/LOINChttp://en.wikipedia.org/wiki/MEDCINhttp://en.wikipedia.org/wiki/SNOMED_CThttp://en.wikipedia.org/wiki/SNOMED_CThttp://en.wikipedia.org/wiki/SNOMED_CThttp://en.wikipedia.org/wiki/Controlled_vocabulary


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Other information projects are


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eHealth (also written e-health) is a relatively recent

term for healthcare practice which is supported by

electronic processes and communication. The term is

inconsistently used: some would argue it isinterchangeable with health care informatics and a

sub set ofhealth informatics, while others use it in the

narrower sense of healthcare practice using the

Internet. The term can encompass a range of servicesthat are at the edge of medicine/healthcare and

information technology:
http://en.wikipedia.org/wiki/Health_care_informaticshttp://en.wikipedia.org/wiki/Health_informaticshttp://en.wikipedia.org/wiki/Internethttp://en.wikipedia.org/wiki/Internethttp://en.wikipedia.org/wiki/Health_informaticshttp://en.wikipedia.org/wiki/Health_care_informatics


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mHealth (also written as m-health or sometimesmobile health) is a recent term for medical and

public health practice supported by mobile devices,such as mobile phones, patient monitoring devices,

PDAs, and other wireless devices. mHealthapplications include the use of mobile devices incollecting community and clinical health data,delivery of healthcare information to practitioners,

researchers, and patients, real-time monitoring ofpatient vital signs, and direct provision of care (viamobile telemedicine).


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Subdomains of health care informatics include:

clinical informatics,

nursing informatics,

imaging informatics,

consumer health informatics,

public health informatics,

dental informatics,

clinical research informatics,

translational research informatics.

bioinformatics, veterinary informatics,

pharmacy informatics
http://en.wikipedia.org/wiki/Health_care_informaticshttp://en.wikipedia.org/wiki/Clinical_informaticshttp://en.wikipedia.org/wiki/Nursing_informaticshttp://en.wikipedia.org/wiki/Imaging_informaticshttp://en.wikipedia.org/wiki/Consumer_health_informaticshttp://en.wikipedia.org/wiki/Public_health_informaticshttp://en.wikipedia.org/wiki/Dental_informaticshttp://en.wikipedia.org/wiki/Clinical_research_informaticshttp://en.wikipedia.org/wiki/Translational_research_informaticshttp://en.wikipedia.org/wiki/Bioinformaticshttp://en.wikipedia.org/wiki/Veterinary_informaticshttp://en.wikipedia.org/wiki/Pharmacy_informaticshttp://en.wikipedia.org/wiki/Pharmacy_informaticshttp://en.wikipedia.org/wiki/Veterinary_informaticshttp://en.wikipedia.org/wiki/Bioinformaticshttp://en.wikipedia.org/wiki/Translational_research_informaticshttp://en.wikipedia.org/wiki/Clinical_research_informaticshttp://en.wikipedia.org/wiki/Dental_informaticshttp://en.wikipedia.org/wiki/Public_health_informaticshttp://en.wikipedia.org/wiki/Consumer_health_informaticshttp://en.wikipedia.org/wiki/Imaging_informaticshttp://en.wikipedia.org/wiki/Nursing_informaticshttp://en.wikipedia.org/wiki/Clinical_informaticshttp://en.wikipedia.org/wiki/Health_care_informatics


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Dental informatics


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WHAT IS DENTAL INFORMATICS?

According to Merriam-Websters Collegiate Dictionary,

informatics is derived from the term "information science,"

which is the

collection, classification, storage, retrieval and dissemination of

recorded knowledge treated both as a pure and applied science.

When applied to a specific domain, such as medicine, nursing

or dentistry, information science becomes "informatics."


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A simple, but cogent, definition of dental informatics

is "the application of computer and information

science to improve dental practice, research,education and management.


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Informatics is focused primarily on research, development andevaluation of information models and computing applications.IT, on the other hand, is concerned with the implementationand application of computer technology andtelecommunications.

Despite the larger conceptual division, limited areas of overlapbetween informatics and IT exist, such as custom development

of software and evaluation of implemented systems.


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Dental informatics can be considered a specialty of medicalinformatics.

A number of models, methods and applications can be shared,transferred or both between the two disciplines. For instance,the National Library of Medicines, or NLMs,

MEDLINE is the worlds largest biomedical literaturedatabase and is equally applicable to all health care disciplines.The same applies to GenBank, a database of gene and proteinsequence information to which researchers from severaldomains contribute.


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Despite much common ground, there also are many aspects

that set those informatics domains apart.

For instance, most design work that informs the development

of computer-based medical records simply is not applicable for

computer-based dental records.

Dentists collect, display and analyze data differently than do

their medical counterparts.


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While the general medical and medication histories collectedby both physicians and dentists share many common elements,the dental history and the oral health status have no equivalentin medicine.

As a consequence, developing, implementing and evaluatingcomplete computer-based dental records is both a challengeand an opportunity for dental informatics, as are many otherdomain-specific aspects.


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History


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Dental informatics has developed significantly since the1960s,when the first uses of informatics approaches to addressdental issues were documented .

Similar to informatics researchers in medicine , researchers in thenascent field of dental informatics were individuals who had

been trained in dentistry and other disciplines, such as

engineering, or dentists who had partnered with otherprofessionals, such as computer scientists.


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Interest in dental informatics rose gradually, and the firstconferences and workshops on the subject took place (such asthe Symposium on Second Generation Clinical Databases and

the Electronic Dental Record [1990], the InternationalConference on Computers in Clinical Dentistry [1991,1992,1993], and the International Conference on ComputerApplications in Dental Education and Practice [1994, 1999]).


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In the early 1990s, some professional organizationssuch as theInternational Medical Informatics Association, the AmericanMedical Informatics Association, and the American DentalEducation Associationbegan to organize interest groups indental informatics.

A key development was the initiation of funding for dentalinformatics training by the National Institute of Dental andCraniofacial Research (NIDCR) in 1996, which for the firsttime recognized the need for a formal education of dental

informaticians (Schleyer and Spallek, 2001).


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The National Library of Medicine [NLM] had been fundingsimilar training in medical informatics since 1972.

Currently, two dental informatics training programs are inoperation (Columbia University, 2000;University ofPittsburgh, 2003), and they collectively graduateapproximately one or two traineesperyear


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WHAT ARE DENTAL

INFORMATICS

PRACTICAL GOALS?


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The main goal of dental informatics is to improve patient

outcomes.

Thus, the discipline must support and improve

diagnosis,

treatment and

prevention of disease and traumatic injury;

relieve pain; and

preserve and improve oral health.


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A secondary goal is to make the delivery of dental care more

efficient; for example, by maintaining or improving cost-

benefit ratios.

Dental informatics also must support research and education,

and improvements in these areas should, and often do,

translate into improved patient care


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Developing, implementing and evaluating complete

computer-based dental records is both a challenge andan opportunity for dental informatics.


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Informatics is key in helping practitioners solve clinicalproblems and keep current.

Most educational programs still subscribe to the philosophythat everything dentists need to know can be learned in dentalschool.

The trend toward problem-based learning and the development

of critical-thinking skills tells a different story.

Dentists must be as familiar with the problem-solving processas they are with the problem domain itself.

Computers can help practitioners maintain their continuingcompetency, and many dentists already are using computers tokeep abreast of new developments


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IS DENTAL INFORMATICS A

DISCIPLINE?


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Before we can answer the question of whether

dental informatics is a discipline, we should

discuss what features characterize a discipline.

Requisite features are


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a core of people who conduct research and publish in thediscipline;

an identifiable body of literature: books, journals and otherpublications;

professional societies and related activities, such as meetingsand conferences;

educational programs leading to a certificate or advanceddegree;

funded research programs.


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A core of people who conduct and publish research in dentalinformatics exists.

An informal review of the literature showed that since 1965approximately 3,500 authors have published about 2,200articles related to dental informatics and computer applicationsin dentistry in about 420 journals and conference proceedings.

Journals with significant numbers of informatics-relatedarticles include Oral Surgery, Oral Medicine, Oral Pathology,Oral Radiology and Endodontics; JADA; DentomaxillofacialRadiology; the Journal of Dental Education; and the BritishDental Journal.


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Currently, dental informatics has no mainstream journal of itsown, the emergence of special-purpose journals (such as theJournal of Computerized Dentistry) notwithstanding.

This is appropriate considering that dental informatics is in theearly stages of development and that, at this time, it is moreimportant to educate a broad audience about the possibilities ofdental informatics than to provide a specialized forum fordental informatics researchers.

Over the long term, however, the development of a dedicated,

international and multidisciplinary dental informatics journalshould be considered.


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Currently, dental informatics has no dedicated professionalsociety. Rather, its activities are integrated with those ofseveral existing associations, such as the American Dental

Education Association, or ADEA; the ADA; and the AmericanMedical Informatics Association, or AMIA.

In most cases, a section or special interest group of anassociation provides a forum for exchange between members.

Specialized conferences, such as the Conference onComputers in Clinical Dentistry, those sponsored by ADEA,the Consortium for Clinical Information Systems, and theConference on Computers in Dental Education and Practice

have been held in the past. Up until now, these conferenceshave been arranged on an ad hoc basis, and none hasdeveloped into a stable, widely accepted scientific forum


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The first educational programs leading to advanced degrees in

dental informatics were created in 1996 in response to a

request for applications issued by the National Institute of

Dental and Craniofacial Research, or NIDCR, in cooperationwith NLM.


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Anecdotal evidence suggests that dental informatics researchreceives only limited third-party funding, such as from thegovernment, the military, foundations and companies. NIDCRand NLM have funded very few grant applications in dentalinformatics, and some universities have been and are receiving

limited corporate support.

In contrast, programs sponsored by the European Union haveresulted in significant funding in dental informatics research inEurope.

Much of the research in dental informatics at this time isconducted as "unfunded" research by faculty at dental schoolsand universities around the world.


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It is instructive to compare dental informatics to its parent,medical informatics. The medical informatics researchcommunity is extremely active. Medical informatics has itsown literature that is segmented into topics such as biomedicalengineering, biomedical computing, decision support andeducation.


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Dental informatics is a nascent discipline. To what

degree it can mature successfully depends on its

ability to take advantage of opportunities andovercome some significant challenges.


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DENTILINE ?


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Lipton (1992) suggested DENTLINE, a literature databasesimilar to MEDLINE, focused exclusively on dental issues, as

one measure to make information delivery more targeted andrelevant for dental professionals.

While a system such as DENTLINE has not come into being, it ispossible to search only the dental journals in MEDLINE with

search interfaces such as PubMed, the Web interface toMEDLINE provided by the NLM. Generally, however,MEDLINE, the Unified Medical Language System, GenBank,and many other major databases continue to serve all

biomedical professionals rather than a defined subset.

Special information-filtering mechanisms could achieve the intentof DENTLINE while preserving the advantages of large,homogeneous collections of information in biomedicine.


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A major portion of Lipton's proposed goals deal with effective

knowledge management, despite the fact that they are notlabeled as such.

Knowledge management systems maintain data, information, andproblem-solving methodologies in an organized,

comprehensive, flexible, and accessible fashion.

Yet, dentistry has not succeeded in building such systems. Wecontinually create and maintain many separate and

independent stores of individual and aggregate data andinformation.


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The overwhelming majority of problem-solving methods exist informats that are inaccessible to computers (such as in research

papers, systematic reviews, textbooks, and the heads of

scientists, educators, and practitioners).

Thus, the absence of effective knowledge management hampers

progress in all fields of dentistry and retards the transition of

useful innovations to direct patient care.


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OPPORTUNITIES AND

CHALLENGES


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Dentistry is an information-intensive activity, and informaticsby its very nature supports such activities well. IT already has

significantly improved our ability to store, access, manage,filter and apply information.

When one considers what progress has been made in a myriadof aspects of human life, it is not difficult to envision how

dentistry may be transformed by becoming informatics-based.Ultimately, informatics done well simply will let usconcentrate on our jobs as dental professionals by improvingand maintaining the oral health, and consequently the generalhealth, of our patients.

These new and powerful technologies will bring culturalchanges to the dental profession itself. The following are someopportunities and challenges that informatics places before us.


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Longitudinal, lifetime, comprehensive and

patient-centered dental records. Dentistry is still largely a cottage industry. This situation

expresses itself in the minimal degree to which patientinformation is shared. Patient-centered, rather than practice-

centered, dental records can eliminate duplicate information

gathering, provide a rich context through access to prior

diagnostic and treatment records, and allow the practitioner to

concentrate on the problem at hand.


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Universally accessible patient records that ensure privacyand confidentiality.

As an increasing portion of patient-related information is

stored and transmitted digitally, dental informatics has theresponsibility to develop, implement and monitor measures to

keep it private. While no system is perfectly secure, a balance

between privacy and access must be found


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Significant reduction of practice management andadministrative overhead.

A significant portion of health care expenditures go toward

administration. One of the greatest sources of inefficiency hasbeen the lack of shared information by health care buyers,

sellers and consumers. Well-integrated information systems

can reduce this overhead significantly, through measures from

autonomous supply ordering to automated scheduling, billingand recall.


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Clinical care based on empirically determined bestpractices.

Most patients in industrialized countries already enjoy veryhigh standards of care. However, large variations in diagnosis

and treatment decisions still exist. As more patients become aware of the standard of care,

dentists will be forced to prove the quality of their care. Whilefew dental treatments are based on definitive clinical evidenceobtained through randomized clinical trials, outcomes data

aggregated over large numbers of practices and patients canhelp identify best practices. Since many patients use theInternet to access health-related information, valid and reliableinformation needs to be available and recognizable as such.


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How can the dental

profession take advantage of

these opportunities?


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A positive circumstance is that dentistry as a profession is

relatively unified

Realizing the present opportunities rests on

significant innovation,

research and development in informatics

One attempt is crafting a long-term strategy by the

development of standards related to dental

informatics


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Another challenge is to increase the quality and quantity ofdental informatics research. The standards for investigationand scientific inquiry in new disciplines develop over time,and dental informatics is no exception.

The scarcity of people formally trained in research methodsand approaches and the dearth of interdisciplinary teams thatcan solve complex research questions constrains the volumeand quality of research output.


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Support for dental informatics research from grants, contractsand funding agencies such as NIDCR or NLM is minute. The

problem, however, is two-sided.

The lack of investigators in dental informatics results in ascarcity of fundable research proposals.

Funding agencies, on the other hand, may not view dentalinformatics as a programmatic priority if demand for research

funding is not apparent.


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HOW CAN WE GET INVOLVED

IN DENTAL INFORMATICS?


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Articles on dental informatics in major

dental journals.

Meetings and conferences

Standards activities, society activities,

university committees and focus groups

Computer courses

Dental informatics degree programs


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Oral health informations

systems


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WHO has a long tradition of epidemiological surveymethods

WHO global data bank was established-1967

Emerged from gathering of information from surveys

and growing burden of dental caries, particularlynotable in the industrialized countries.

Surveys were motivated for the need for planning oforal health services and organization of public healthintervention programs.

WHO has encouraged the member states to reportinformation on the disease level for internationalcomparisons by use of standardized methodology.


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To ensure high validity and reliability- basicinstruments and record forms in the collection

of data.

High quality data through specification ofclearly defined examination procedures,

training, calibration trials, for assessment of

intra and inter examiner variability


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Tools of oral epidemiology have beeninstrumental in the establishment of oral health

information systems world wide.


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In addition to theepidemiologicalinformation, decisionmakers and planners

need information aboutrisk factors to oralhealth, OHRQOL,intervention and care,

administrativeprocedures, quality ofcare and services.


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An important public health rationale of WHO globaloral health data bank has been to provide for

epidemiological analysis of changing oral health

status, to highlight how such changes might be related

to new risk profiles in countries or regions, and to

access the impact of development or adjustmnet of

oral health systems.

Similar databanks have been developed for the WHOregional offices.


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In 1996 , WHO established an internet onlineoral health database, supported by WHO

coloborating center in oral health at malmo

university, Sweden, and the university ofNigita, Japan.

CONCLUSION


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CONCLUSION

Dentistry is a relatively small segment of the health caresystem. Thus, many companies are hesitant to invest inresearch and development because the potential payoff isconstrained by the small size of the market.

Network externalities also are a significant deterrent to

investment. Products or services, such as the telephone, thatbecome more valuable as more people use them are said tobenefit from network externalities.

For instance, when only a few practices can exchange patientinformation using computer-based patient records, or CPRs,the collective benefit is small. When most practices use suchinteroperable CPRs, however, the collective benefit is large.Globalization may improve this situation because it increases

potential markets.


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The growth of dental informatics also is hampered becausemany of its benefits are hard to measure, and achieving themrequires significant upfront and ongoing investments.

For instance, the quantifiable benefits of a computer system

for billing and electronic claims submission include time andmoney saved in preparing claims, reduced claim and paymentturnaround, and improved management of accounts receivable.

The advantages of installing a CPR, on the other hand, are

much harder to define and measure. Evaluating the return oninvestment, however, is fraught with difficulties not only indental informatics.


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The current situation simply may be symptomatic of aprofession finding its way in informatics. An encouraging signis the significant and increasing interest of many influentialstakeholders in dentistry. Hopefully, this interest can bechanneled into concerted action that benefits all of dentistry.

Success, however, also is predicated on the level ofinvolvement of each practitioner.


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"There is nothing more difficult to take inhand, more perilous to conduct, or more

uncertain in its success, than to take the lead

in the introduction of a new order of things.

Niccol Machiavellis.


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Computer technology has reshaped our livesalready. The question is to what degree it willreshape dentistry. The ubiquitous reach oftodays computer networks presagessignificant change: dentistry is not an isolatedprovince of health care anymore.

We are now, more than ever, connected to a

larger system of stakeholders, regulations,expectations, accountability and risk.

References


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References

RUSS B. ALTMAN ,Medical Informatics,Informatics inthe Care of Patients:Ten Notable Challenges, West j Med1997 Feb; 166:118-122

TITUS SCHLEYER, D.M.D., Ph.D. and HEIKO

SPALLEK, D.M.D., Ph.D.Dental informatics ,A cornerstone of dental practice , J AmDent Assoc, Vol 132, No 5, 605-613

T.K. Schleyer, Dental Informatics: A Work in Progress,

Adv. Dent. Res. 2003; 17; 9


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D.F. Sittig, M. Kirshner and G. Maupom,Grand Challenges in DentalInformatics, Adv. Dent. Res. 2003; 17; 16

T.K. Schleyer, P. Corby and A.L. Gregg, A Preliminary Analysis of theDental Informatics Literature, Adv. Dent. Res. 2003; 17; 20

Paul erik peterson, douglas brathal, oral health information systems-towards measuring progress in oral health promotion and diseasepreventiuon, bullet of world health organization,2005,83:686-693.

Titus K.L. Schleyer, Dental Informatics: An Emerging BiomedicalInformatics Discipline, Journal of Dental Education, November 2003


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S.Ramakrishna, Health informatics inIndia,CDAC, september 2008

William Harsh, Information Retreival, 2009,3rd

edition,


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Thank you

Documents

11.r Health Informatics