Finding a compatible computer system is hardly as momentous as choosing a mate. But since it is often a long-term relationship that is constantly being tested, the decision is usually painstaking. When UMDNJ-New Jersey Dental School decided to computerize in 1988, a year was devoted to planning, says Cecile Feldman, DMD, MBA, director of information services and quality assurance.
"We wanted a relational database - one that would include very technical detailed information and provide quick answers to ad hoc questions. We assumed we'd find one at another dental school."
But after studying state-of-the-art systems at institutions across the country, she and Robert Saporito, DDS, now acting dean at NJDS, decided the school needed to develop its own software program.
"It was frustrating," Feldman admits. "Most of the systems we saw were geared to tracking students and finances. Very few schools had a long-term vision of what a sophisticated database could do. We wanted first and foremost to track patient care, and we also wanted data for quality assurance, outcomes research and clinical research."
Six years later - after all the attendant headaches of hardwiring the school, developing the specifications, working first with a consultant and then with programmers and database analysts, testing and refining the results - Feldman says they are pleased with what they've got. The system can provide ready answers to questions like: What is the average number of visits required to complete specific dental procedures such as a porcelain crown? In how many instances did it take more than that, and what circumstances occurred that made additional visits necessary?
"We wanted to be able to look at things like the longevity of restorations, are patients being seen for prevention, and is treatment being completed in a timely manner," she explains. "We are able to track student and faculty productivity.
"Do people feel that Big Brother is watching?
"That is not the intent of the system, although some people may feel a little like that," she responds. "But we needed to know more about what care we provide to our patients and how it is provided. We have 80,000 patient visits a year."
Two things have prevented complete computerization of patient files: The school cannot yet afford terminals for each work station in the clinic, and it doesn't yet have digitized radiographs. Still, the progress has made a big difference.
No longer do students or faculty have to pull patient records from a mass of files, decipher someone else's crabbed script - or possibly their own - or deal with a "lost" folder that turns up a week later under a pile of papers on someone's desk. Today, the chart request form is online - you know who checked a file out last and when it was returned. Patient records are also computerized. These are password-protected files - different types of passwords yield different levels of information based on the need to know.
Handwritten notes, summarizing the treatment plan and how long it is expected to take, are keyed into the system within 24 hours, Feldman says. Since New Jersey state law still requires written patient records, the duplication is not yet an unnecessary exercise. But the New Jersey Dental Association has appealed for the law to be changed, and she thinks that is likely to happen soon.
"Our target for complete computerization is the year 2000," Feldman states. "The major barrier is cost - how to finance it all."
As for dentists using the UMDNJ library's diagnostic databases, QMR and DXplain (see sidebar), she says that "currently those programs are very weak in the area of oral health care. Unless that is addressed - and we've suggested it should be - I doubt that dentists will use them much. They can be helpful for oral pathologists and for teaching students about health in general. Ease of use is what will drive them."
"Today, we focus on having the students learn how to ask the right questions and where to go to get information," she adds. "The tools have to change to help them do that. In the '80s it was rare to find students who were computer literate, but I'd say that half to two-thirds are now. And they expect these tools because many of them have been using them since high school."