The Single Most Problematic Issue In Dentistry That You Likely Have Not Thought About

As we There seems dentists get low, is inundated always and, a patient by someone with default, that urgent is on leaders upset, the issues a in team lab all a dental case day, whose that every practice, morale is late, day.

a sick kid at home, or a slow month to turn around. So, in the dayto-day battle of delivering the highest quality care for our patients and providing the best home life for our teams and our families, it is difficult, if not impossible, to take a step back and examine the most important issues affecting the oral health of our patients (and therefore the financial health of our practices).

I would like to propose to you what I believe to be the single most problematic issue in dentistry that you likely have not thought of and the significantly impactful solutions we have to directly address this issue.

At first glance, the issue that is choking our offices, harming patient care, and blocking innovation in dentistry may seem boring or not as destructive as it truly is. But allow me to point out some of the horrific realities that are a direct result of this obstruction to quality care:

More than 2 million dental-related issues in the US end up in

hospital emergency room visits, costing American patients a useless $2 billion annually (P. Owens, R. Manski, A. Weiss, Emergency Department Visits Involving Dental Conditions, 2018, Healthcare. Cost and Utilization Project, Agency for Healthcare Research and Quality, August 2021)

For millions of patients, their electronic Personal Health Information (ePHI), including critical information, such as medical history data, is locked from being written into the dental practice “Practice Management System” (PMDS) - literally putting their lives at risk.

In the typical Dental Service Organization (DSO) using a cloudbased PMS, due to no fault of their own, anyone at the corporate center likely has access to all of the ePHI of every patient that is seen in any of the hundreds of offices that that DSO operates.

If you added up all the crucial information that we, as dentists, get from the innumerable and valuable datasets that are transferred over the broad information exchange networks that our friends in medicine leverage to improve the care of their patients, it would add up to the impressive, depressing number zero.

dentist Therefore, it may be obvious that what I think is the biggest

at this conference!”. Turns out he was having a weekend problem in dentistry, that shockingly no one is talking about, is

partying with his friends… the lack of data interoperability.

At every single one of the healthcare conferences I attend, there If you haven’t been exposed to the term before, interoperability

are three connected issues that take over the majority of the panel is the ability of computers or software to exchange information.

discussions; data interoperability, regulation compliance (HIPAA Have you ever thought about who actually owns all that informaand the Cures Act, primarily), and patient care. Of these topics, tion that you input into your PMS every day that likely sits in a

in dentistry, we have completely ignored the discussion on data server in a closet in your office? Allow me to answer this question,

interoperability for far too long. as it turns out it is a significant factor in our discussion about interoperability.

Here is one, simple example of how the lack of interoperability

“If, at this point you are thinking, ‘why have I never heard about this before’, don’t feel bad.”

As far as I am aware (and I have researched this topic extensively;

fundamentally changes the quality of care that we accept as however, I am a dentist… not an attorney), the patient legally

“normal today.” Let’s say a patient, named Lisa, moved from owns their own ePHI within your PMS. You, as the dentist of

Oklahoma to your town and presented to you as a new patient record, are a steward of this important resource of the patient. So

with pain in the lower left. What would you do? Likely, take a why, then, is it impossible to transfer the patient records between

radiograph, right? us? The answer is that PMSs have been acting like this data is theirs, essentially creating a prison of this information that pre-

Let’s stop there. Why don’t you pull up Lisa's medical history, vents patient care in the interest of keeping you hostage to their

compare what she filled out in your practice with what is on archaic systems.

record with her physician and review her medical and dental history, including the prior treatment in the lower left with radioIf this seems controversial or accusatorial, I only point out this

graphs? That, surely, would be very helpful. It just isn’t possible reality because it is important to clearly understand the blockages

because of our lack of interoperability. in order to directly address the problem and why there has been recent regulation that “forces” a solution. That regulation is the

So, we take a radiograph (panorex, CT or PA? Really, we don’t 2016 21st Century Cures Act, which carries a provision that went

know because, well, you know…). Then you test Lisa’s teeth and into effect late last year (10/6/22, to be exact) called the “Informadetermine that there is a failing root canal on tooth #19. There is tion Blocking Rule,” designed to specifically address the issue of

no obvious issue with the endo or restoration of the tooth. So, lack of interoperability in healthcare.

what is the treatment plan?

Turns out, if you had called the prior dentist or had access to the this before”, don’t feel bad. Actually, when I met the prior head

dental records, you would have found out that when the endo of the Department of Health and Human Services late last year,

was done on tooth #19, there was a hairline fracture noted on she also had NO idea how bad things were in dentistry. Being in

the pulpal floor of the tooth. If you were like me, you would the narrow lane of “dental data information exchange” that I am

have likely punted to the endodontist to make this decision, who currently working in, I often find myself as the sole dentist at an

would have treatment planned to redo the endo, and Lisa would innovative health care conference. In fact, last year, I was excited

go through multiple rounds of treatment, costs, and discomfort, to see a dental school classmate of mine on the casino floor of a

only to lose the tooth quickly thereafter. Las Vegas hotel and called out, “Wow! It’s great to see another

And we haven’t even discussed the lack of information that gets transferred from my office to the endo office.

So, what can be done about this problem? The answer is creating Standards and technology that align the profession and create secure, yet simple ways to transfer our patients’ data (remember… it is THEIR data). That work is currently going on at the ADA, Dental Standards Institute (DSI) Standards Development Organizations, as well as at innovative technology companies (that you may not have heard of yet) that are creating the network that will facilitate the reality of secure, open interoperability of Connected Dentistry ®, connecting dentistry, as well as connecting dentistry to medicine.

There is a lot of work to be done, for sure, but we are making rapid progress toward solutions. Solutions you will likely be hearing a lot about in the coming months and years.

If you would like to be involved in helping address the issue of dental interoperability, as an advocate of the mission, or actively involved in Standards development, feel free to reach out to me or any other ADA Standards Committee member.

We, in dentistry, are starting to focus on medical/dental integration, trying to connect the dots in everything from sleep issues to diabetes/periodontal disease connection. However, we cannot have medical/dental integration without both medical/dental interoperability, as well as collaboration with our physician friends.

So, please join me in attending a healthcare conference that is not “dental specific.”It is not just an eye-opening experience, but one that I firmly believe will allow dentistry to lead the way to better healthcare.

Speaking Consulting Network June 16 - 17, 2023 Nashville, TN

ADHA 2023 Annual Conference Fri, Jul 7 – Sun, Jul 9 McCormick Place - West Building, 2317 S Indiana Ave Chicago, IL

CE on the Beach July 13 – 14, 2023 Turks & Caicos

Under One Roof July 2023, 2023 Nashville, TN

Dykema July 20 – 23, 2023 Denver, CO

ADA Smile Con Oct. 5-7, 2023 Orlando, FL Orange County Convention Center

If you want to arrange a meetup, please email anneduffy@dentalentrpreneurmedia.com

We’d love to see you!