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University of Pittsburgh School of Dental Medicine

Dr. Heiko SpallekCenter for Dental Informatics

Comprehensive IT Infrastructure

• Patient Care

• Education

• Research

• Administration

Dental Informatics Strategic Plan

For each area

• Current Status

• Plan– Level 1– Level 2– Level 3

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Status

2000: Installation of QSI* Dental Systems (predoctoral clinics)

Main areas of a clinical management system:• Patient demographics & billing area: OK• Clinical record area: none• Student progress monitoring & grading area: none

Installation uses outdated technology:

CDA requirement 2-24: “Graduates should be competent in the use of information technology resources in contemporary dental practice.”

*Quality Systems, Inc., Irvine, CA

Patient Care

Plan

The paperless school!

• Comprehensive multi-year effort

• Different levels of IT sophistication in the 3 areas of a clinical information system

Patient Care

Patient Demographics and Billing

Level 1: • Keep QSI Dental Systems, but upgrade; or • Implement new system

Level 2: • Integrate our system with the UPMC hospital system • Share demographic data across healthcare providers (LHII), e.g.

medical and medication history

Optional Patient Portal Layer:• Electronic scheduling and confirmation for patients• Complete electronic submission of pre-registration information• Review of account history and payment by credit card

Patient Care

Clinical System Level 1: • Complement QSI with QSI's Clinical Product Suite (CPS)– Limited diagnostic and treatment charting

– 1 clinical computer workstation for 6 dental units Level 2: • Chairside computing during patient care • Clinical findings, treatment plan, progress notes

– 1 clinical computer workstation for 1 dental unitLevel 3: • More advanced clinical applications, such as imaging • Semi- or automatic recording of clinical findings

– dental units with integrated computing capabilities

Patient Care

Clinical System

• Optional CAD/CAM Layer– 1-2 CAD/CAM systems

• Optional Imaging Layer– Only for levels 2 and 3:• Digital cameras• Intra-oral cameras• Digital radiography

Patient Care

Radiology: Digital Imaging

Imaging:

• Transition to digital to be implemented in phases

• Competing technologies: selection based on diagnostic task

and imaging volume for each area

• Mostly centralized imaging for QA purposes

Patient Care

Capture technology to be implemented:

• Radiology: combination of CCD/CMOS and SP (FMS,

extra-oral): bulk of imaging

Selected PAs/BWs only

• Endodontics: CCD/CMOS – in each graduate cubicle

• Implant clinic, urgent care, all graduate clinics, CCP clinics,

pediatric dentistry, anesthesia, AEGD: CCD/CMOS

Patient CareRadiology: Digital Imaging

Cone Beam CT Unit:

• Implant surgical treatment planning• TMJ studies, evaluation of osseous pathology

• Endodontic, and apical surgery treatment planning

• Orthodontic treatment planning• Pre-surgery planning: orthognathic surgery, other corrective

(clefts/defect repair/reconstruction) procedures• Localization of critical anatomy (removal of impacted teeth)

OSA, tongue posture & volume, tonsils, mastoid area• Evaluate nasal septum, turbinates, maxillary sinuses, upper

airway

Patient CareRadiology: Digital Imaging

Phase 1:

• Facilities modification: to continue through phase 4• Dedicated maxillofacial cone beam CT unit in

radiology; networked with oral surgery• One digital extra-oral, and intra-oral imaging unit in

radiology - for patients referred from OMS • Students rotated, exposed to technology, and trained

Patient CareRadiology: Digital Imaging

Phase 2:

• Orthodontics for extra-oral imaging only

• Endodontic graduate clinic area to use intra-oral units

Patient CareRadiology: Digital Imaging

Phase 3:

• Full implementation of an EPR (Electronic Patient

Record) as network ports, viewing stations in each

operatory/cubicle

• Other graduate student clinics to be included

Patient CareRadiology: Digital Imaging

Phase 4:

• Operators school-wide will have been trained in EPR

use

• Extensive training of first professional students, all

remaining staff, faculty in digital radiology equipment

and software

• Most time-consuming and labor-intensive phase

Patient CareRadiology: Digital Imaging

Students’ Progress and Grading

Level 1:• Keep QSI Dental Systems, but augment with a customized version with grading module

Level 2: • Only for clinical system levels 2 and 3• Students enter completed procedures • All entries are approved and graded by instructors• Students accumulate credits and grades toward clinical progression

Patient Care

Implementation Patient Care

Status

• Limited educational technology

• Some syllabi and course materials available through intranet

• CDA requirement 2-10: “…school must have a curriculum management plan to avoid, for instance, unwarranted repetition...”

Education

PlanLevel 1:• Presentation of learning material

–Exploit new intranet • Electronic curriculum management tool

–Automatic matching between lectures to find repetition and opportunities for integration

Level 2:• Development of educational software

–Innovative and effective teaching tools

Education

Status• Rapidly growing area

• Use of IT and informatics: often a core review criterion

• Funding for required computing support through individual projects

• Overburdened research staff: grant submission process and post-award administration

• Limited involvement of students

Research

Clinical ResearchLevel 1:• Integration of research into clinic• Implementation of a clinical information system• Researchers query patient data for epidemiology studies,

identification of study subjects

Level 2:• Integration of the research process into the workflow of

the clinical operation• Upon patient enrollment: alerts about study eligibility • Facilitate the enforcement of research protocols

Research

Grant SubmissionsLevel 1:• NIH: electronic grant submission• Centrally maintained information store for NIH

biosketches• Reduction of overhead for the research staff

Level 2:• Easy access to the salary and benefit information • Efficient development of budget overviews• Use of intranet to

• Identify researchers with matching research interests• Facilitate student involvement in faculty research

Research

Collaborative ResearchLevel 1:• State-of-the-art collaborative work environment, e.g.

Groove*• More research projects: group effort • Integration into office environment and research-specific

workflow• Facilitates real-time data sharing, common scheduling,

seamless project management Level 2:• Site license for collaborative work environment, e.g.

Groove University Department Kit*Groove Networks, Inc., Beverly, MA

Research

Post-award Administration

Level 1:• Centralized post-award management process

• Deployment of electronic means to manage this process

Research

Personnel and PRApplication Development/Database Support:• Point to existing expertise and resources • Maintain central personnel and infrastructure resources • Designate 1 FTE for research projects: 50% funded

through school

Informational/PR Needs:• Distribution of time-sensitive information • Research opportunities• Newly funded awards • New NIH regulations and policies

Research

Dental InformaticsResearch Funding: •Since inception: $777,485 •Submitted: $3,042,511

Plan:•Maintain leadership in the field•Add 2 additional faculty positions (1½ financed through soft money)

•Add 1 applied informatician (for clinical information system)

•Add 1 full-time administrative assistant financed through school

Research

In-class assignmentFive members of the Executive Committee (EC) are in favor of implemeting a laptop program in the school, requiring all students to purchase a laptop upon admission. Five other members of the EC are in favor of deploying computer workstations throughout the building instead of requiring students to purchase laptops.

Collect 5 strong pro and 5 con arguments for each proposal (total of 20 arguments).Be prepared to defend your arguments!

Status Administration

• Intranet not yet utilized to fulfill its potential• Web site missing some functionality• Common problems affecting productivity • Servers hardware and facility upgrades• Resolution and response time improved through

streamlining IT requests• No software asset inventory

Core Components Administration

• Software upgrades and maintenance• Hardware upgrades and new systems• Server room climate control and status monitoring• Network ports and security• Multiple databases and excel documents will continue to

be consolidated into database server to eliminate redundant data

Productivity Enhancements

• Intranet deployment and development – Improve current utilization– Improve the functionality of current features– Develop new features

• User identification and authentication– Biometric finger print authentication

• Establish an enterprise-level spyware protection

Administration

Training Administration

• Delegate 10% effort of dental informatics faculty to manage a comprehensive training plan

• Identify IT competencies necessary for each job• Provide qualified trainers, facilities, and courses• Encourage one-to-one training through a mentoring

program• Utilize University resources

Web Site Administration

• Enhancing the site through improving the look and functionality

• Continuing education online registration–Online registration integrated with student and

course administration

Support Infrastructure Administration

• New administrative/junior technical phone support position that will:

– Provide administrative functions, such as purchasing– Provide full-time phone service– Maintain software and hardware asset inventory– Track the status of purchase and help requests

• Locate IT service to the 3rd floor of Salk Hall• Establish regular customer service surveys• Provide periodic analysis to measure affectivity• Establish a system for feedback from users• Continue to utilize the POC group feedback