Plugged In: Electronic Records Management


Part 1: Gaps in Knowledge and Standards

Dr. Jeff Glaizel

Information technology (IT) is an integral part of practising dentistry. Few dentists can imagine dentistry without a practice management system or digital radiography. According to a soon-to-be-published research paper from the University of Pittsburgh, 74% of solo practitioners and 78.7% of group practices in the United States use a computer to manage clinical information. Over 90% of Scandinavian practitioners store all information electronically.

Given our professional reliance on technology to provide services and support our practices, we would expect that (1) dentists are knowledgeable about their technology options and can make informed decisions, and (2) the dental profession provides guidance, standards and regulations related to the use of IT, to improve efficiencies in the office, decrease costs for the dentist and protect the profession, the dentist, the patient and all interested parties.

Unfortunately, I believe reality currently falls short of these expectations.

In my experience, many dentists do not have the requisite knowledge to make informed decisions about their information technology requirements. And these choices have implications—whether related to compliance with privacy guidelines, security and privacy risks, or the risk of lost working time due to a hardware or software failure.

All dentists graduate with a knowledge base that is continually updated over time. For example, consider infection control. Over the past few years, the dental regulators in British Columbia, Alberta and Ontario have enacted updated guidelines for infection control. Dentists have the necessary knowledge to make informed choices about infection control—their training in microbiology and immunology from dental school enables them to research products and services that will help them meet these new guidelines. There is also the reassurance that the product choices meet Health Canada and industry standards.

Compare this scenario with new guidelines for dental IT. In Ontario, the Royal College of Dental Surgeons of Ontario (RCDSO) enacted guidelines on electronic records management to provide dentists with a framework on the use and implementation of IT in their offices. However, due to a lack of formal IT-related training (remember that there are no dental informatics departments in Canadian dental schools) many dentists are ill-equipped to ask the proper questions, let alone make informed decisions, to ensure that their practices meet the minimum requirements described in the guidelines. Given our profession's increasing reliance on IT, this knowledge gap should be a concern.

Moreover, in a profession where almost every facet of our practice is regulated—including the materials we use, the dental team we hire, and how we build our offices—there are no dentistry-specific standards or guidelines (with the exception of the RCDSO guidelines) for dentists and the vendors developing IT solutions.

To put this in perspective, let us look at the financial risks associated with failure of hardware and software in a dental office. Consider the following scenario: you arrive at the office and your computers do not turn on. The hardware support person fixes the problem only to discover the backups you have been creating over the past 2 years are faulty.

This scenario is based on a true story. The dentist lost 2 weeks of working time and over 2 years of data. It illustrates one of many possible costly, consequences due to our dependence on technology without the appropriate training, guidance or standards to support it.

Implementing technology into our practices comes with risks. Dentists need more education, guidance, standards and support to navigate the complexities of electronic records management. This is where dental associations, regulators and dental schools have a potentially important role to play.