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March 19, 2016 Los Angeles
This conference was supported in part by NIDCR 5R01DE021051 and 5R01DE023061 protocols. See below for related bibliography.
Researchers from Harvard School of Dental Medicine and the University of Pittsburgh, with support from the IADR Global HQ staff, Practice Management Information Corporation (PMIC) and Delta Dental, held a conference about the adoption of standardized diagnostic terminologies (DxTMs) by dental professionals to improve oral health in the United States.
Together, the participants explored the three critical challenges to enable the widespread use of DxTMs: (1) improving clinicians’ awareness of the relationship between structured diagnostic data and the ability to monitor quality and costs in their dental practices; (2) enabling the interoperability of EHR systems by using mapped DxTMs; and (3) enhancing the ease of entering diagnostic terms in EHRs at the point of care.
Please see our news page for major updates from this conference, including the harmonization of DDS with SNODENT to become SNO-DDS, or expand the links below to see more information on this event.
Conference goals addressed:
- 1. Clarify the positions of the different professional dental organizations on dental diagnostic terminologies.
- 2. Create urgency for the implementation for dental diagnostic terminology among dentists, leaders of professional boards, academic leaders, and students to improve education and patient care.
- 3. Create a working group composed of EHR vendors and informaticians tasked with developing clinician-friendly interfaces for entering diagnostic terms into EHR systems.
- 4. Create willingness among the insurance companies to use dental diagnosis terminologies as part of the billing process and clarify how use of structured dental diagnoses aids in passing RAC audits.
- 5. Address the workflow issues for providers to implement and use diagnostic terminologies.
Thank you to AADR, PMIC, the Harvard School of Dental Medicine, Delta Dental, Henry Schein, Dentrix, and Dentrix Enterprise for making this event possible. A special thanks to the University of Pittsburgh, University of Washington, and University of the Pacific for sponsoring their students to attend this event.
Welcome and Overview
Session 1: Panel Discussion on Terminologies: Reference terminologies, interface terminologies – roles and how they complement each other
Dave Preble, Daniella Meeker
Session 2: EHR User Interface and use of Diagnostic Terminologies: Relevance of EHR interoperability
Jan Horsky, John Halamka, Muhammad Walji
Session 3: Diagnostic documentation and impact on quality of patient care
Khalid Moidu, Lyle McClellan, Joel White
Session 4: Implication of widespread diagnostic term implementation for insurance companies: Lessons learned from medical coding
Bill Kohn, Mary Lee Conicella, Adele Towers
NIDCR 5R01DE021051 and 5R01DE023061 Bibliography
The * denotes shared first authors.
1. Kalenderian, E., Ramoni, R., White, J.M., Schoonheim-Klein, M.E., Stark, P.C., Kimmes, N.S., Zeller, G.G., Willis, G.P., Walji, M.F. The Development of a Dental Diagnostic Terminology. J Dent Educ. 2011 Jan;75(1): 68-76. PMID: 21205730 PMCID: PMC3107733
2. White, J.M., Kalenderian, E., Stark, P.C., Ramoni, R., Vaderhobli, R., Walji, M.F. Evaluating a Dental Diagnostic Terminology in an Electronic Health Record. J Dent Educ. 2011 May;75(5): 605-15. PMID: 21546594 PMCID: PMC3119719
3. Kalenderian E, Ramoni R.B., White J.M., Schoonheim-Klein M.E., Stark P.C., Kimmes N.S., Patel V.L., Walji M.F. The importance of using diagnostic codes. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2011 Jul;112(1): 4-5. PMID: 21669360
4. Tokede, O.*, White, J.M.*, Stark, P.C., Vaderhobli, R., Walji, M.F., Ramoni, R., Schoonheim-Klein, M.E., Kimmes, N.S., Tavares, A., Kalenderian, E. Assessing the use of a standardized dental diagnostic terminology in an electronic health record. J Dent Educ. 2013 Jan; 77(1): 24-36 PMID:23314462 NIHMSID: NIHMS387572 PMCID: PMC3545411
5. Ramoni RB, Kalenderian E, Walji MF, Simmons D, White JM, Vaderhobli R, Stewart DC. Patient safety–author’s reply to Sinykin. J Am Dent Assoc. 2013 Jan;144(1): 19-20 PMID:23283921
6. Tokede, O.*, Walji, M.F*, Ramoni, R., Schoonheim-Klein, M.E., White, J.M., Vaderhobli, R., Stark, P.C., Kimmes, N.S., Patel, V., Kalenderian, E. Treatment Planning in Dentistry using an electronic health record: implications for undergraduate education. Eur J Dent Educ. 2013 Feb;17(1): e34-43. doi: 10.1111/j.1600-0579.2012.00759.x. Epub 2012 May 18. PMID:23279411
7. Walji, M.F.*, Kalenderian, E.*, Tran, D., Kookal, K.K., Nguyen, V., Tokede, O., White J.M., Vaderhobli, R., Ramoni, R., Stark, P.C., Kimmes N.S., Schoonheim-Klein M.E., and Patel, V. Detection and characterization of usability problems in structured data entry interfaces in dentistry. Int J Med Inform. 2013 Feb;82(2): 128-38. doi: 10.1016/j.ijmedinf.2012.05.018. Epub 2012 Jun 29. PMID:22749840
8. Walji, M.F.*, Kalenderian, E.*, Piotrowski, P., Tran, D., Kookal, K.K., Tokede, O., White J.M., Vaderhobli, R., Ramoni, R., Stark, P.S., Kimmes N.S., Lagerweij, M., and Patel, V. Are Three Methods Better Than One? A Comparative Assessment of Usability Evaluation Methods in an EHR. Int J Med Inform 2014 May; 83(5): 361-7. doi:10.1016/j.ijmedinf.2014.01.010. Epub 2014 Feb 3. PMCID: 4058821
9. Walji, M.F.*, Kalenderian, E.*, Stark, P., White, J., Kookal, K., Phan, D., Tran, D., Bernstam, E., Ramoni, R. BigMouth: A Multi-Institutional Dental Data Repository. J Am Med Inform Assoc. 2014 Jul 3. pii: amiajnl-2013-002230. doi: 10.1136/amiajnl-2013-002230.
10. Reed S.G., Adibi S.S., Coover M., Gellin R.G., Wahlquist A.E., AbdulRahiman A., Hamil L.H., Walji M.F., O’Neill P., Kalenderian E. Does use of an electronic health record with dental diagnostic system terminology promote dental students’ critical thinking? J Dent Educ. 2015 Jun;79(6): 686-96. PubMed PMID: 26034034.
11. Ramoni R.B.*, Walji M.F.*, Kim S.*, Tokede O., McClellan L., Simmons K., Skourtes E., Yansane A., White J.M., Kalenderian E. Attitudes and beliefs toward the use of a dental diagnostic terminology A survey of dental providers in a dental practice. J Am Dent Assoc. 2015 Jun;146(6): 390-7. doi:10.1016/j.adaj.2015.02.007. PMID: 26025826
12. Kalenderian, E.*, Tokede, O.*, Ramoni, R.B., Khan, M, Phan, D.Q., Kimmes, N, White, J.M., Vaderhobli, R, Yansane, A., Feilzer, A.F. Walji, M.F. Dental Clinical Research: An Illustration of the Value of Diagnostic Terms. J Public Health Dent. 2015 Oct 30. doi: 10.1111/jphd.12124. [Epub ahead of print]
13. Kalenderian, E., Walji M.F., Ramoni, R.B. Applying HCI Principles in Designing Usable Systems for Dentistry in Cognitive Informatics for Biomedicine Human Computer Interaction in Healthcare. Vimla L. Patel, Thomas G. Kannampallil, David R. Kaufman, Editors. Springer, ISBN 978-3-319-17271-2 September 2015
14. Kalenderian, E., Lagerweij, M.D., Ramoni, R., Tokede, O., Vaderhobli, R., Kimmes, N.S., Walji, M.F., White, J.M. Commentary to: “Periodontal Diagnosis Affected by Variation in Terminology”. J Periodontol. 2013 Sept;84(9):1231-1232. doi: 10.1901/jop.2013.120546
15. Feilzer, A.J., Kalenderian-Groenewegen, E., Berendsen, J.A.Th. Nederlandse Norm voor diagnostische termen (NT nieuws, klinisch). Nederlands Tandartsenblad, July 2014
|800 – 830 am||Check In and Coffee|
|Elsbeth Kalenderian (MC)|
|830 – 845 am||Welcome Address|
Paul H. Krebsbach, DDS, PhD, is President of the American Association of Dental Research and the Roy H. Roberts Professor of Dentistry and Professor of Biomedical Engineering at the University of Michigan. He serves as the Chair of the Department of Biologic and Materials Sciences and Division of Prosthodontics. Dr. Krebsbach received his D.D.S. degree from the University of Minnesota and his certificate in Periodontology and Ph.D. in Biomedical Sciences from the University of Connecticut Health Center. Prior to joining the faculty at the University of Michigan, he served as a Senior Staff Fellow for three years at the National Institute of Dental and Craniofacial Research. His research program focuses on the cell and molecular biology of mineralized tissues with an emphasis on gene therapy-directed osteogenesis and bone marrow stromal cell biology.
|845 – 930 am||Keynote|
|930 – 1030 am||Session 1|
|Panel Discussion on Terminologies: Reference terminologies, interface terminologies – roles and how they complement each other|
|Vimla Patel, Dave Preble, Daniella Meeker
Vimla Patel (NYAM)
Vimla L. Patel, PhD, DSc, FRSC, is a Senior Research Scientist and Director of Center for Cognitive Studies in Medicine and Public Health at the New York Academy of Medicine in New York, USA. She is Professor of Biomedical informatics at Arizona State University with adjunct professorial appointments at Columbia University and Weil Cornell College of Medicine. From 2000-7 she was Professor of Biomedical Informatics at Columbia University in New York City and, for the next 4 years, she served as Professor and Vice-Chair of Biomedical Informatics in the Fulton School of Engineering at Arizona State University. She was trained as a cognitive scientist at McGill University in Montreal, Canada, where she then served as a Professor of Medicine and Psychology.
She is a recognized leader in cognitive science research and its application in health and health care in the field of cognitive informatics. She has a special interest in human-computer interaction and the nature of human error that compromise patient safety in healthcare. An elected fellow of the Royal Society of Canada (Academy of Social Sciences) and the American College of Medical Informatics, she was recipient of the Swedish “Woman of Science” award in 1999. She is a prolific writer with over 250 peer reviewed publications, well-funded research programs from NIH, NIMH, AHRQ, DoD, as well as a number of foundations including James S McDonnel and Josiah Macy Jr. Foundation.
Dr. Dave Preble is vice president of the ADA’s Practice Institute. He practiced general dentistry in both private practice and public health settings for over 20 years before joining the ADA. He graduated from Marquette University in 1976, Georgetown University Dental School in 1980 and St. Thomas University School of Law in 1994. Dave has earned a certificate in non-profit management from the Kellogg School of Management, is a Certified Dental Consultant and a Certified Association Executive.
Dr. Daniella Meeker, PhD, a distinguished neuroscientist and informatics expert, serves as a director of the Clinical Research Informatics program within the Southern California Clinical and Translational Science Institute. Before joining SC CTSI she was a System Engineer and an Information Scientist at RAND. Her current research is focused on distributed architectures for data management, analysis, and translational practice. Her other work includes development of collaborative platforms for knowledge management, program evaluation, social network analysis, and applied health and behavioral economics.
Dr. Meeker completed a post-doctoral fellowship at the RAND Bing Center for Health after completing a Bachelor’s degree at the University of Chicago, a PhD in Computation and Neural Systems from the California Institute of Technology, and a Master’s in Health Services Research from UCLA. Dr. Meeker currently holds a fellowship from Merkin Brain and Health Policy Innovation Program, a joint initiative between the Keck School of Medicine of USC and the Leonard D. Schaeffer Center for Health Policy and Economics that supports scientists studying the intersection of neuroscience and health policy.
She has served as the technical and implementation lead for two clinical data research networks funded by the National Institute on Aging and the Agency for Healthcare Research and Quality. She recently co-authored two reports for the Patient Centered Outcomes Research Institute on best practices in the design, implementation, and use of collaborative data networks.
|1030 – 1100 am||Break|
|1100 – 1145 am||Session 2|
|EHR User Interface and use of Diagnostic Terminologies: Relevance of EHR interoperability|
|Jan Horsky, John Halamka, Muhammad Walji
Dr. Horsky investigates how Health Information Technology (HIT) affects the process of care, patient safety and medical error. His research is concerned with the design of human interfaces, how it can make the interaction of clinicians with complex information systems more or less cognitively demanding, increase or degrade cognitive performance and lead to lower or higher risk of error. The focus of his recent research effort has been the design of effective and safe Clinical Decision Support interventions, functional integration and interoperability of multiple systems in emergency care and defining usability evaluation methods specific to HIT. Dr. Horsky received professional training and a degree in Biomedical Informatics from Columbia University.
John D. Halamka, MD, MS, is a Professor of Medicine at Harvard Medical School, Chief Information Officer of Beth Israel Deaconess Medical Center, Chairman of the New England Healthcare Exchange Network (NEHEN), co-Chair of the national HIT Standards Committee, co-Chair of the Massachusetts HIT Advisory Committee and a practicing Emergency Physician.
Dr. Halamka is also the former Chief Information Officer and Dean for Technology at Harvard Medical School, where he oversaw all educational, research and administrative computing for 18,000 faculty and 3,000 students.
Dr. Halamka holds a doctor of medicine degree from UCSF, a master’s degree in Bioengineering from the University of California, Berkeley, with a focus on technology issues in medicine, and bachelor ’s degrees in Medical Microbiology and in Public Policy from Stanford University. His research includes security / confidentiality issues, scalability issues, and implementation of standards for exchange of administrative and clinical information.
|1145 – 1230 pm||Session 3|
|Diagnostic documentation and impact on quality of patient care|
| Khalid Moidu, Lyle McClellan, Joel White
Dr. Khalid Moidu, MD, PhD is the CMIO at Netspective. He was earlier CIO of Family Physicians Group of Florida (FPG). He is a senior healthcare informatics professional, experienced in managing operations, academic programs, policy development and entrepreneurship. His interests are in building Governance structures, coordinating Implementations and managing Operations.
Moidu is a medical graduate from the Armed Forces Medical College in Pune, India, and served in the Indian Navy until 1976 to go on to practicing medicine in many parts of the world. In 1985 he began his doctorate in Medical Informatics from the Linköping University in Linköping, Sweden. His doctoral research project to use solar-powered computers to run software to support the delivery of Maternal & Child Health programs in rural India was supported by a grant from the World Health Organization.
Dr. Moidu held the position of associate professor in the Department of Health Administration and Policy at George Mason University, where he coordinated graduate education programs that prepare students to serve as applied health information technology professionals. Prior to joining Mason, he was an associate professor of health information systems at Purdue University’s Computer and Information Technology Department. His research has involved the development of an e-Prescribing application, integration of clinical and administrative data systems and clinical data device integration with health information systems. His research interests include the design and development of modular information applications to support clinicians.
From 2007 to 2021, he led the clinical informatics team at Orlando Health, a multi-hospital health system. There he worked closely with physician leadership and established an information services governance model under the Medical Staff Services to standardize clinical documentation for physicians. One project was the reduction of CPOE orders from 3600 to 1300 in a year. As the Chief Information Officer FPG, he recently oversaw the move of the EMR to a Hybrid Private Cloud infrastructure and the upgrade of the EMR to MU2 standards successfully. His current interests are to deploy Analytic Applications for decision support at all levels and make data actionable. Deployment of new apps and devices to extend coverage beyond the hospital and office encounters to engage patients.
Dr. Moidu was just added to the list of “Top thought-leaders-of-the-year” by ICT Post. He has also received numerous other distinctions and awards during his career. The publication pointed to the Maternal & Child Health program’s achievement of increased immunization levels in rural India at a lower cost.
|1230 – 130 pm||Lunch|
|130 – 215 pm||Session 4|
|Implication of widespread diagnostic term implementation for insurance companies: Lessons learned from medical coding|
| Bill Kohn, Mary Lee Conicella, Adele Towers
Dr. Bill Kohn is the Vice-president for Dental Science and Policy with Delta Dental Plans Association in Oak Brook, Illinois since February 2011. Immediately prior to this he spent 15 years at the Centers for Disease Control and Prevention (CDC) in Atlanta, Georgia, first as the Associate Director for Science and then as the Director of the Division of Oral Health. Prior to CDC he spent 7 years at the National Institute of Dental and Craniofacial Research. During his time at NIDCR he conducted clinical and basic scientific research and served in various positions including science transfer officer, Deputy Clinical Director, hospital dentistry program director and oral medicine residency director. Dr. Kohn also served in the U.S. Navy, first as a general practice resident then two years in Adak, Alaska. He also spent six years in Fairbanks, Alaska as the dental director for the U.S. Public Health Service, Tanana Chiefs Corporation Health Center, serving Fairbanks and 26 remote villages. He has also owned a private practice in Illinois.
Dr. Kohn is a diplomate of the American Board of Oral Medicine and has published and presented on a broad range of topics in dentistry. He was senior author on several CDC evidence-based national guidelines including the 2003 guidelines for infection control in dental health care settings, fluoride use to prevent caries, school-based sealant program guidelines, and the recent change in recommendations for the level of fluoride in community drinking water. He has also participated as an expert panel member for most of the American Dental Association evidence-based recommendation panels.
Mary Lee Conicella
Dr. Mary Lee Conicella is Aetna’s Chief Dental Officer. In her role, she supports the development of clinical programs that engage members, deliver superior health, and improve costs through integration. She was instrumental in developing Aetna’s Dental-Medical Integration program and has published numerous abstracts and articles with Columbia University College of Dental Medicine related to the impact dental care has on overall health.
Dr. Conicella received her B.S. in Medical Technology from the University of Pittsburgh and her D.M.D. from Temple University School of Dentistry. She practiced general dentistry for over 15 years and spent many years on the clinical faculty at the University of Pittsburgh School of Dental Medicine.
Her affiliations include the National Dental Association Corporate Round Table, Academy of General Dentistry, American Dental Association and the National Association of Dental Plans’ Clinical Workgroup. She sits on the advisory committees of several dental schools as well as The Oral Health Initiative at Drexel University College of Medicine.
Dr. Towers is the Senior Clinical Advisor for UPMC Enterprises. She is directly involved in the development of healthcare related technology, with emphasis on use of Natural Language Processing (NLP) for coding and clinical documentation improvement. Prior to this role, she has served as the Medical Director for Health Information Management at UPMC with responsibility for Clinical Documentation Improvement as well as inpatient coding denials and appeals. She has been on the faculty in the Division of Geriatric Medicine at the University of Pittsburgh for over 24 years, and continues to see patients at the Benedum Geriatric Center in UPMC. She is the former Medical Staff President at UPMC Presbyterian, and her prior positions have been as Vice Chair for Quality Improvement and Patient Safety for the Department of Medicine, Medical Director of the Benedum Geriatric Center and Medical Director of Primary Care at the Western Psychiatric Institute and Clinic. Dr. Towers has presented the experience at UPMC with use of NLP for coding at multiple regional and national conferences.
|245 – 400 pm||Breakout sessions – EHR vendors, Payors, Providers, and Dental Professional Organizations, Students|
|400 – 415 pm||Break|
|415 – 450 pm||Closing Remarks|
|450 – 500 pm||Summary and Post-Survey|
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