The primary goal of this proposal is to conduct a randomized clinical trial to evaluate the effectiveness of an integrated electronic health record system that includes a eMedical Record (EMR), eDental Record (EDR), and a Personal eHealth Record (PHR) to improve the quality and safety of dental care for patients with chronic illnesses. Chronic medical conditions such as diabetes, heart disease, pulmonary disease, and conditions that cause xerostomia (dry mouth) have a profound effect on the quality and safety of dental care if neglected. If these medical conditions are not identified and addressed in routine dental care, the quality and safety of the care is adversely affected. The emergence of EDRs in dental offices offers new opportunities for measurement and improvement of the quality and safety of care of by dentists. An EDR integrated with an EMR and PHR provides a unique opportunity to improve the dental care of patients with chronic conditions by both alerting patients to their special care requirements as well alerting dentists at the point of care. Furthermore, the integration of an EMR, PHR, and EDR into an integrated electronic health record system adds great potential for improved health information exchange, enhanced communication, and improved and cost effective care, particularly for patients with chronic illnesses. We propose a 3-arm, 2-year prospective, group-randomized clinical trial of 47 dentists in 17 clinics to evaluate the effectiveness of two interventions that utilize simple reminders within the integrated electronic health record. The study examines two interventions versus a usual care (UC) control. The interventions are designed to address how, and to whom, special dental care needs are communicated. The interventions are: 1) a reminder to patients delivered primarily via their PHRs through email or if email is not available through phone by the dental clinic staff and/or postal mail (Group A) or 2) a point-of-care reminder to the dentist within the EDR (Group B). These reminders reflect the special dental care needs of four chronic conditions: diabetes mellitus, congestive heart failure, chronic obstructive pulmonary disease, and xerostomia (dry mouth) as caused by medications or related conditions. This project demonstrates how leveraging an integrated electronic health record system can improve patient outcomes, increase awareness and improve clinical decision-making by identifying problems needing remediation and providing immediate evidence-based recommendations.
| Fricton, James; Rindal, D Brad; Rush, William et al. (2011) The effect of electronic health records on the use of clinical care guidelines for patients with medically complex conditions. J Am Dent Assoc 142:1133-42 |
