Dent IT by dandanhuanghuang

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									                              Implementation of Teledentistry in
                                the Kingdom of Saudi Arabia
                                      Reem Abdulaziz AlHamidi
                        Ministry of Defence and Aviation - Riyadh Armed Forces Hospital
                                   P.O. Box 53814 Riyadh 11593 Saudi Arabia
                         Email:drreem@drreemclinic.com or drreem@healthgulf.com
ABSTRACT

     Teledentistry is a relatively new field that combines telecommunication technology and dental care. The
initial concept of teledentistry developed as part of dental informatics (a new domain combining computer
and information science, engineering and technology in all areas of oral health). History of teledentistry: The
internet and broadband high-speed connections. U.S. Army Project. Integrated Services Digital Network.
Uses of teledentistry: Patient care: In remote clinics, a patient must travel hundreds of miles to receive
specialty care. With the implementation of teledentistry, there is a potential of saving in cost and travel time
required by the patient. Continuing Dental education: Through the use of video teleconferencing equipment,
the lectures could be broadcasted to any clinic where continuing dental education is difficult to obtain.
Dentist-Laboratory communications: The ability to send color images of the patient's cases and talk about it
can help to prevent making improperly constructed appliances, thereby saving time and money. Second
opinion: A dentist renders to a patient is limited by his ability to make diagnosis when a dental practitioner is
unsure of the diagnosis; it is best to seek another opinion. Some Issues to be addressed to promote, and
implement teledentistry: Needs assessment, infrastructure and standardizations, telecommunication options,
costs, applicable computer hardware and soft ware, training of personnel a well – designed teledentistry
practice needs to consider all of these issues. With thorough planning, however, teledentistry has a bright
future.
Key words : Teledentistry, Dental informatics, Telecommunication,

Dental education

INTRODUCTION:


Health care system is being changed dramatically by the influence of computers and information technology.
The internet, World Wide Web and other developments of information revolution will redefine oral health
care system.

The new term Dental Informatics has caught the attention of dentistry field.
In this paper we will define the dental informatics and it's impact on dental health care system.




DENTAL INFORMATICS DEFINITION AND BACK GROUND:


Dental informatics is derived from medical informatics, which has established itself firmly over the past
several decades.

"Medical Informatics" term comes from the Russian, "informatika" (AI Mikhailov, "Oznovy Informatika"
["Foundation of Informatics"], 1968), then being defined as "structure and properties of scientific
information". The French later coined the words "informatique medicalè" in 1968 and henceforth, university
departments have been established with this label. Before this time, other names were used: medical
computer science, medical information science, computers in medicine, health informatics.[1]
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Then the "Medical Informatics" as defined by the Association of American Medical Colleges, 1986
Medical informatics is a developing body of knowledge and a set of techniques concerning the
organizational management of information in support of medical research, education, and patient care....
Medical informatics combines medical science with several technologies and disciplines in the information
and computer sciences and provides methodologies by which these can contribute to better use of the
medical knowledge base and ultimately to better medical care.[1]

The Dental informatics, drafted at a 1989 conference funded by the Westinghouse electronics Systems group
in Baltimore where three groups of workshop participants addressed issues relating to dental informatics,
defined it as “A new domain combining computer and information science, engineering and technology in
all areas of oral health.” [2]

In 1992 (by Eisner):
The application of computer and information science to (improve dental practice, research, and program
administration.[3]

In 2001 ( Schleyer and Spallek )
The application of computer and information sciences to improve dental practice, research, education and
management.[4]

The Dental informatics start in strong bases when the ADA (American Dental Association) developed
standard for dental informatics through the ADA standards on dental informatics (SCDI).


The scope of the SCDI is:
To promote patient care and oral health through the application of information technology to dentistry's
clinical and administrative operations; to develop standards, specifications, technical reports, and guidelines
for components of a practice: and interoperability standards for different software and hardware products
which provide a seamless information exchange throughout all facets of healthcare.[5]


The Approved Standards and Technical Reports [5]:


ADA Specification No. 1004: Computer Software Performance for Dental Practice Software.

ANSI/ADA Specification No. 1000: Standards Clinical Data Architecture for the Structure and Content of
an Electric Health Record

ANSI/ADA Specification No. 1001: Guidelines for the Design of Educational Software

ADA Technical Report No. 1006 for Infection Control for Dental Information Systems

ADA Technical Report No. 1010 for Accounting Performance for Dental Information Systems

ADA Technical Report No. 1012 for Hardware Recommendations for Dental Information Systems

ADA Technical Report No. 1016 for Electronic Signature Applications in Dentistry

ADA Technical Report No. 1017 for Administrative Procedures and their Application in Dentistry

ADA Technical Report No. 1019 for Technical Security Services and Application to Dentistry


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USING INFORMATION TECHNOLOGY TO IMPROVE THE DENTAL HEALTH CARE
SYSTEM



A. IMPLEMENTATION OF DENTAL INFORMATICS IN THE ORAL HEALTH CARE:


Using of modern Technology to manage practice in dental industry has strongly grown in recent years,
the use of digital devices like digital still camera, digital radiography, electronic patient records and
practice management software. .etc. lead to digitization of practice.
The word "digital" refers to the binary language of computers, that is, the use of the numbers 0 and 1 to
translate any data entered into your computer so that the computer can understand the language and then
allow software instructions to tell the computer how you wish to treat that data. The data might be text
information, as in a practice management software system, or more robust data such as voice commands
(audio), dental X-ray images or video signals.
Utilizing these digital technologies will lead to improving patient care in general and doctor–patient
relationship in particular.


The following are some examples of these Digital Technologies:

   1- Digital Camera:
      This is the most quickly adapted digital technology in the dental office. It is classified into: Intra-
      oral digital camera, Extra-oral digital camera.




               Fig.1 different examples of intra-oral camera.




               Fig.2 different examples of Extra-oral camera.



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2- Digital Radiography:
The production of radiographs using an electronic capture device rather than film. (e.g. Intra-oral,
panoramic, cephalometric, tomography)




   Fig.3 Digital Radiography (procedure), Digital Image (x-ray) on the screen.


3- Digital Restoration:
Dental CAD/CAM (CEREC) technology is a computer-aided design and ceramic restoration system
that can design, fabricate, and place an esthetic ceramic restoration (without the need for impression,
temporaries) in a single patient visit.




                          Fig.4 Digital Restoration.



4- Patient Education Systems:
The new form of digital technology that dentists use to increase patients education, reduce stress,
improve communication, understanding and acceptance of treatment options.
It is produced in two configurations:
CD-ROM
DVD – Digital Versatile Disk -



5- Electronic Patient Record:
An emerging concept officially known as the computer-based oral Health record (COHR). It
facilitates documentation and provides the basis for patient management and assessment of diagnosis
and care. Much more than a computerized version of a dental chart, a COHR is a sort of (personal
electronic library) providing access to all resources on a patient's health history and insurance
information. A COHR is a linking system rather than an independent database, and is more a process
than a product. A COHR system can link to separate sources detailing a patient's entire medical
history, including images, laboratory results and drug allergies. The National academy of science
institute of Medicine and the Computer-based Patient Record Institute, among others, have suggested
standard characteristics for COHRs, including common coding terminology, clinical decision
support, secure confidentiality and electronic data interchange capabilities.(6)
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6- Other Digital devices available for dental use:

   Oral CDX: it's computer–assisted, Brush Biopsy test for the detection of oral cancer.




               Fig. 5 Steps of Oral CDX

Computerized Local Anesthetic Delivery: its new computer controlled local anesthetic injection system
that can provide a more comfortable and effective anesthetic delivery.




               Fig. 6 computerized local Anesthetic Delivery.




Dental Software: Digital imaging software, Practice management software.




                                                                                                        5
                                      A




                                      B
       Fig. 7
       A- Digital imaging software.
       B- Practice management software.


Digital periodontal probe, digital blood pressure cuffs, digital thermometers.


   The Benefits Obtained by Digital Transformation:


       1. Faster and easier documentation for clinical cases and data.

       2. Simulate treatment result by showing preoperative and post operative views of dental
          condition.

       3. Co-diagnosis, when the dentist and patient examine dental view (x-ray or photo) on a
          computer screen, patient can see the dental problem and be aware about it. This will increase
          patient acceptance for treatment plan suggested by dentist.

       4.   A dentist can access all practice records any time and any where (office clinic, home)

       5. Legitimate prescriptions can be written at the dentist’s workstation and submitted electro-
          nically, with built in mechanisms to detect errors and improve accuracy.[7]

       6. The entire office staff can have access to necessary records at chair side terminals,
          eliminating the inefficiencies of retrieving and refilling paper records.[7]

       7. Digital image can be manipulated in a variety of ways, like changing density, colorization,
          3D, zooming in an area of interest which will help the dentist to do better diagnosis for the
          problem.

       8. Establish an effective and easier communication with dental laboratory.

       9. Correspond with colleagues in advance way.

       10. Ability to transfer image and / or data in the patient electronic chart.

   B. DENTISTRY AND THE INTERNET:
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   Affect of Internet Changes in our profession:

   1. Discussion Groups
   Discussion groups is one of the best aspects of the Internet. It's an on-line communication where
   dentists can share their knowledge, thought, experience to practice better dentistry.

   2. On-Line Ordering
   It's an on-line dental supplies where dentists simply log on to the web site and make the order. There
   are many different sources for finding great deals on dental supplies. They can offer better prices
   than traditional suppliers and can allow you to easily track current and previous orders to assist you
   in placing new orders

   3. On-Line Continuing Education Courses (CE):
   Learning with full multimedia (text, image, sound, video) and subsequent test can be taken anytime,
   anywhere.

   4. Patient Communication:
   Like re-call, appointment confirmations, reactivation, etc can be done by e-mail or directly on the web
   site provider services over the internet.

   5. Worldwide Web and Dental Practice Internet Site:
   This contains staff instructions, services offered, before and after cases, news letters, ask expert, etc.

   6. Online Collaboration:
   While e-mail is the number one application on the Internet, it is not ideal for exchanging patient data.
   Email is not secure, and is vulnerable to viruses and worms. Also, many Internet providers limit the size
   of e-mail attachments which can be received, and digital photos and images can be quite large. One of
   the most exciting uses of the Internet for dental applications is online collaboration.
   How it works: An account is set-up with a web site that specializes in storing digital images and notes.
   [8]

   7. Application Service Providers:
   A final advantage to having Internet access is the opportunity to use an Application Service Provider, or
   ASP. ASPs are software programs that run on secure servers and require a minimal amount of
   information to be stored on computer. The best use of this technology is to have an entire practice
   management software program reside on their servers, and not on your computers. The advantages are
   the fact that as long as you have Internet access and a web browser, you can access these data from any
   computer in the world. [8]



C. TELEDENTISTRY: THE FUTURE OF DENTISTRY

Its initial concept was developed as a part of Dental informatics and defined as a set of establishing
technologies which allows for the diagnosis and treatment of patients at sites remote from the healthcare
providers. Traditionally, this includes the transfer of still or video images and data over communications
lines from a distant site for consultation and evaluation by dental specialists. It also includes remote
education of both patients and dental providers. [9]


Uses of Teledentistry:


       1. Patient Care:

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        In remote clinics, a patient must travel hundreds of miles to receive specialty care. With the
        implementation of teledentistry, there is a potential of saving in cost and travel time required by
        the patient.[10]

        2. Continuing Dental Education:
        Through the use of video teleconferencing equipment, the lectures could be broadcasted to any
        clinic where continuing dental education is difficult to obtain.[10]

        3. Dentist-Laboratory Communications:
        The ability to send color images of the patient's cases and talk about it can help to prevent
        making improperly constructed appliances thereby saving time and money. [10]

        4. Second Opinion:
        A dentist’s judgment rendered to a patient is limited by his ability to make diagnosis when a
        dental practitioner is unsure of the diagnosis; it is best to seek another opinion.




               Fig.8 Uses of Teledentistry


BARRIERS AND CHALLENGES TO IMPLEMENT DENTAL INFORMATICS

   1.   Lack of data standard (content, vocabulary and data format).
   2.   Legal and social issues.
   3.   Cost and benefits.
   4.   Leadership issues.


RECOMMENDATIONS

   1. Develop a Dental informatics organization with professional leadership.
   2. Dental informatics Centers should become an integral part of the Dental curriculum.
   3. Dental informatics Centers should be established and funded to provide trained manpower and to
      conduct research in dental informatics.
   4. More publication in scientific journal s about Dental informatics.
   5. Frequent evaluation by professional societies about Dental informatics.



SAMPLE SITES FOR HEALTH CARE INFORMATION ON THE WEB (AT KSA)


Ministry of Health  http://www.moh.gov.sa

King Faisal Specialist Hospital & Research Center  http://www.kfshrc.edu.sa/

Health Outreach Program (HOP) at KFSH&RC  http://www.kfshrc.edu.sa/mop/

E-Health Centre at KFSH&RC  http://www.kfshrc.edu.sa/telemedicine/
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Sultan Bin Abdulaziz Humanitarian City http://www.humanitariancity.org.sa/

Health gulf  http://www.healthgulf.com/

Saudi Center for Organ transplantation-Riyadh  http://www.scot.org.sa/

Saudi Medical Journal  http://www.smj.org.sa/

SaudiDent.com online organization  http://www.saudident.com




REFERENCES:


[1] American Medical Informatics Association, available at: "www.amia.org ".

[2] Chen JW, Hobdell MH, Teledentistry and it's use in dental education, T. of American Dental
Association,Vol.134.March 2003,342-346.

[3] Eisner. Dental Informatics and Dental Research. Available at: "www.dentalinformatics.com/resources/".

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[4] Center for dental Informatics – University of Pittsburgh – school of Dental Medicine. Available at:
"www.dental.pitt.edu/informatics/".

[5] American Dental Association. Dental Informatics. Standards and Technical Reports. Available at:
"www.ada.org".

[6] The Latest Word. Health care informatics online, available at:" www.healthcare-informatics.com".

[7] Bauer JC, Brown WT. The digital transformation of oral health care: Teledentistry and electronic
commerce. JADA 2001: 132 (2): 204-9.

[8] Clinical Dentistry and the Internet. Dental Technology Consultants, available at: "www.dtc4u.com".

[9] Vandre RH, Kudry KVL. Teledentistry and the future of dental practice. DentomaxillofacRadiol, 1999;
28(1): 60-1.

[10] Rocca MA, Kadryk VL, Pajak JC, Morris T. The evolution of Atele dentistry system within the
department of Defense. Proc AMIA symp 1999:921-4, available at: "www.amia.org/pubs/symposia.




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