Dental Informatics & Dental Informatics & Dental Research: Dental Research:

Making the ConnectionMaking the Connection

NIH June 12-13, 2003NIH June 12-13, 2003

Bethesda, MDBethesda, MD

Standards in Dental Standards in Dental InformaticsInformatics

American Dental Association American Dental Association Standards Committee on Standards Committee on

Dental InformaticsDental Informatics

The Wit and Wisdom of The Wit and Wisdom of Forest GumpForest Gump

If you don’t know where you If you don’t know where you are goin’, you will probably are goin’, you will probably

not wind up there.not wind up there.

Do We Really Need Do We Really Need StandardsStandards

YES!YES!

Why are U.S. railroad tracksWhy are U.S. railroad tracks4 feet eight and 1/2 inches 4 feet eight and 1/2 inches apart?apart?

They were designed They were designed by Scottish engineersby Scottish engineers

To match the width To match the width of wagon wheelsof wagon wheels

That fit in the wheel That fit in the wheel ruts on British roadsruts on British roads

Made by Roman war Made by Roman war chariotschariots

That were as wide as That were as wide as two horses’ rear endstwo horses’ rear ends

Do We Really Need Do We Really Need Standards?Standards? An Innovative New An Innovative New

ProductProduct Introduced By A Introduced By A

Technology LeaderTechnology Leader Using A Superior Using A Superior

Proprietary FormatProprietary Format FailedFailed Betamax by SonyBetamax by Sony

Why Does the ADA Why Does the ADA Support Standards?Support Standards?

Evaluation criteria for products Evaluation criteria for products provide:provide:– Enhanced safety and healthEnhanced safety and health – Greater selection of productsGreater selection of products– Easier choicesEasier choices

Better and consistent qualityBetter and consistent quality Lower costs for membersLower costs for members

OrganizationOrganization

S CD en ta l P rod u c ts

S CD en ta l In fo rm atics

A m erican D en ta l A ssoc ia tionS tan d ard s C om m ittees (S C )

OrganizationOrganization ADA sponsors the only standards ADA sponsors the only standards

programs whose scope exclusively programs whose scope exclusively addresses dentistryaddresses dentistry

Administered by Department of Administered by Department of Standards AdministrationStandards Administration

Administration of all standards Administration of all standards activities is centralizedactivities is centralized

ADA Councils approve standards for ADA Councils approve standards for the ADA and recommend expertsthe ADA and recommend experts

HIPAA recognition...HIPAA recognition...

Recognized for contribution to Recognized for contribution to electronic standards in legislationelectronic standards in legislation

Designated as dental procedure code Designated as dental procedure code sourcesource

Asked to serve as dental content Asked to serve as dental content committeecommittee

Continuing role as the only Continuing role as the only professional association consulting to professional association consulting to the Secretarythe Secretary

Other Government Other Government Impact...Impact...

FDA recognition of voluntary consensus FDA recognition of voluntary consensus standards in lieu of a 510(k)standards in lieu of a 510(k)

OMB Circular A-119 recommends OMB Circular A-119 recommends government agencies adoption of government agencies adoption of voluntary consensus standardsvoluntary consensus standards

National Technology Transfer Act National Technology Transfer Act recommends government agencies recommends government agencies adoption of voluntary consensus adoption of voluntary consensus standardsstandards

SCDI MembershipSCDI Membership

Balance of interests between Balance of interests between consumer, producer, and general consumer, producer, and general interestinterest

SCDI members are organizationsSCDI members are organizations Organizations appoint a Organizations appoint a

representative to “represent” the representative to “represent” the organizationorganization

Representative brings the Representative brings the organization’s views and objectives to organization’s views and objectives to the SCDI and visa versathe SCDI and visa versa

ADA Standards ADA Standards Committee on Dental Committee on Dental

InformaticsInformatics 60 members from 60 organizations60 members from 60 organizations

– PR-Industry (PR and Distributor)PR-Industry (PR and Distributor) 2222– CO-User (Consumer)CO-User (Consumer) 1818

– GI-General InterestGI-General Interest 2020– VacanciesVacancies 3 3

Accredited by ANSI to operate under Accredited by ANSI to operate under ADA ADA Standards Program Operating ProceduresStandards Program Operating Procedures

Actual development of standards Actual development of standards conducted in Working Groupsconducted in Working Groups

Standards Committee Standards Committee ProceduresProcedures

Standards Committee Operating Standards Committee Operating ProceduresProcedures– Approved by ADA Board of Trustees Approved by ADA Board of Trustees

in February 1999in February 1999 Accredited by ANSI as a Std Accredited by ANSI as a Std

Development Organization (SDO) Development Organization (SDO) in 2001in 2001

What is a Standard?What is a Standard? A document that:A document that:

– Defines or provides specific technical Defines or provides specific technical requirements for a material, product, requirements for a material, product, process, procedure, service, policy, etc.process, procedure, service, policy, etc.

– Provides definitions dimensions, Provides definitions dimensions, terminology, symbols, test methods, terminology, symbols, test methods, performance or safety requirements, performance or safety requirements, etc.etc.

– Is clear, concise, unambiguous and Is clear, concise, unambiguous and easily understood by those easily understood by those notnot involved in its developmentinvolved in its development

What is a Technical What is a Technical Report?Report?

A document that:A document that:– Is informational in natureIs informational in nature– May describe a new technologyMay describe a new technology– May provide information on “state of May provide information on “state of

the art”the art”– May be used in conjunction with an May be used in conjunction with an

American National StandardAmerican National Standard– May provide implementation advice May provide implementation advice

about a standardabout a standard

What a Standards What a Standards Committee is not….Committee is not….

A Data Content CommitteeA Data Content Committee A developer of A developer of dental codesdental codes

and and related terminologiesrelated terminologies A developer of A developer of diagnostic diagnostic

codescodes

ANSI Accreditation ANSI Accreditation Requires...Requires...

Balance of interestsBalance of interests– Consumer, General Interest, VendorConsumer, General Interest, Vendor

Open to all interested partiesOpen to all interested parties Consensus documentsConsensus documents Due ProcessDue Process Written ProceduresWritten Procedures

As a Result…..As a Result….. All documents developed by the ADA All documents developed by the ADA

Standards Committees are eligible to Standards Committees are eligible to become approved American National become approved American National Standards or registered as ANSI Standards or registered as ANSI Technical ReportsTechnical Reports

Informatics Committee Informatics Committee ScopeScope

““To promote patient care and oral To promote patient care and oral health through the application of health through the application of information technology to dentistry’s information technology to dentistry’s clinical and administrative clinical and administrative operations; to develop standards, operations; to develop standards, specifications, technical reports, and specifications, technical reports, and guidelines for components of a guidelines for components of a computerized dental clinical computerized dental clinical workstation; workstation;

Informatics CommitteeInformatics CommitteeScopeScope

electronic technologies used in electronic technologies used in dental practice; and dental practice; and interoperability standards for interoperability standards for different software and hardware different software and hardware products which provide a products which provide a seamless information exchange seamless information exchange throughout all facets of throughout all facets of healthcare.”healthcare.”

SCDI OrganizationSCDI Organization 4 Subcommittees with 18 Working groups 4 Subcommittees with 18 Working groups Subcommittee 10, Dental Informatics Subcommittee 10, Dental Informatics

Architecture and DevicesArchitecture and Devices– 8 Working Groups, 17 work items8 Working Groups, 17 work items

Subcommittee 11, Electronic Health RecordsSubcommittee 11, Electronic Health Records– 4 Working Groups, 5 work items4 Working Groups, 5 work items

Subcommittee 12, Informatics Component Subcommittee 12, Informatics Component Interoperability in DentistryInteroperability in Dentistry– 4 Working Groups, 4 work items4 Working Groups, 4 work items

Subcommittee 13, Electronic Dissemination Subcommittee 13, Electronic Dissemination of Dental Informationof Dental Information– 2 Working Groups, 2 work items2 Working Groups, 2 work items

SCDISCDISubcommitteesSubcommittees

Subcomm 10- Dental Informatics Subcomm 10- Dental Informatics Architecture and Devices – Dr. Scott Architecture and Devices – Dr. Scott Trapp, ChairmanTrapp, Chairman

Subcomm 11- Electronic Dental Subcomm 11- Electronic Dental Records – Records – Dr. Mark Diehl, Dr. Mark Diehl, Chairman Chairman

SCDISCDISubcommitteesSubcommittees

Subcomm 12- Informatic Component Subcomm 12- Informatic Component Interoperability in Dentistry – Dr. Interoperability in Dentistry – Dr. Brent Dove, Chairman Brent Dove, Chairman

Subcomm 13- Electronic Subcomm 13- Electronic Dissemination of Dental Information Dissemination of Dental Information – Dr. Gary Guest, Chairman – Dr. Gary Guest, Chairman

SCDI Subcomm 10SCDI Subcomm 10Dental Informatics Dental Informatics

ArchitectureArchitecture

Scope: To develop and promote Scope: To develop and promote standards for the device physical standards for the device physical architecture, device-system architecture, device-system physical interface, device-system physical interface, device-system informatics interface (API), informatics interface (API), system architecture, and system architecture, and information architecture.information architecture.

SCDI Subcomm 10SCDI Subcomm 10ProjectsProjects

WG 10.1- Infection Control for Dental WG 10.1- Infection Control for Dental Information Systems- Information Systems- Spec 1006Spec 1006

WG 10.2- Hardware Recommendations WG 10.2- Hardware Recommendations for Dental Information Systems- for Dental Information Systems- TR 1012TR 1012

WG 10.3- Dental Information Systems WG 10.3- Dental Information Systems Security and SafeguardsSecurity and Safeguards

SCDI Subcomm 10SCDI Subcomm 10ProjectsProjects

WG 10.4- Data RedundancyWG 10.4- Data Redundancy WG 10.5- Use of Handheld Computing WG 10.5- Use of Handheld Computing

Devices in DentistryDevices in Dentistry WG 10.6- Practice Management WG 10.6- Practice Management

Performance for Dental Information Performance for Dental Information Systems- Systems- TR 1012TR 1012

SCDI WG 10.3SCDI WG 10.3 Dental Information Dental Information

Systems Security and Systems Security and SafeguardsSafeguards

Electronics Signature ApplicationsElectronics Signature Applications– TR 1016TR 1016

Administrative Procedures and their Administrative Procedures and their Applications in Dentistry- Applications in Dentistry- TR 1017TR 1017

Technical Security Mechanisms and Technical Security Mechanisms and Applications in Dentistry- Applications in Dentistry- TR 1019TR 1019

SCDI WG 10.3SCDI WG 10.3 Dental Information Dental Information

Systems Security and Systems Security and SafeguardsSafeguards

Technical Security Services & Technical Security Services & Application to DentistryApplication to Dentistry

Physical Safeguards & Applications Physical Safeguards & Applications to Dentistry- to Dentistry- TR1020TR1020

Internet Security Issues for Dental Internet Security Issues for Dental Information Systems- Information Systems- AIPAIP

SCDI WG 10.6SCDI WG 10.6Practice Management Practice Management

PerformancePerformance

Clinical Software Performance for Clinical Software Performance for Dental Practice Software- Dental Practice Software- Spec 1004Spec 1004

Accounting Performance for Dental Accounting Performance for Dental Information Systems- Information Systems- Spec 1010Spec 1010

Schedule Performance for Dental Schedule Performance for Dental Information Systems- Information Systems- AIP RevisionAIP Revision

Application Service ProvidersApplication Service Providers

SCDI Subcomm 11SCDI Subcomm 11Electronic Health Electronic Health

RecordRecord

Scope: To develop and promote Scope: To develop and promote standards for the electronic standards for the electronic health record.health record.

ANSI/ADA Specification ANSI/ADA Specification 10001000

Standards Clinical Architecture for Standards Clinical Architecture for the Structure and Content of an the Structure and Content of an Electronic RecordElectronic Record

Specification approved by ANSI in Specification approved by ANSI in February 2001- February 2001- Spec 1000Spec 1000

ANSI/ADA SPEC 1000ANSI/ADA SPEC 1000Standard Clinical Data Standard Clinical Data

Architecture for the Structure Architecture for the Structure & Content of an Electronic & Content of an Electronic

Health RecordHealth Record

19 separate parts19 separate parts Not specifically made for dentistryNot specifically made for dentistry Can encompass all healthcareCan encompass all healthcare Does not include codingDoes not include coding

Spec. 1000 EHR Spec. 1000 EHR ComponentsComponents

Model ArchitectureModel Architecture Individual Ident.Individual Ident. Codes & Nomen.Codes & Nomen. Individ Individ

CharacteristicsCharacteristics Population Charact.Population Charact. OrganizationOrganization LocationLocation CommunicationCommunication Health Care EventHealth Care Event

Health Care MaterialHealth Care Material Health ServicesHealth Services Hlth Services Resour.Hlth Services Resour. Population Hlth FactsPopulation Hlth Facts Patient Health FactsPatient Health Facts Health Condition DiagHealth Condition Diag Patient Service PlanPatient Service Plan Patient Hlth ServicePatient Hlth Service Clinical InvestigationClinical Investigation Comments Subj AreaComments Subj Area

Building a database Building a database is a lot like building is a lot like building a housea house

Dr. Mark DiehlDr. Mark Diehl

Computer Sciences CorporationComputer Sciences Corporation

4/24/20034/24/2003

The business model The business model tells you about the tells you about the intended uses of intended uses of the database – the the database – the requirements.requirements.

For a building this For a building this tells you the tells you the number and types number and types of rooms, general of rooms, general floor plan, etc.floor plan, etc.

And then a set of And then a set of blueprints – blueprints – the the logical data logical data model.model.

The architect then The architect then creates a set of creates a set of design drawings – design drawings – the conceptual the conceptual data model.data model.

The local The local construction code construction code tells the architect tells the architect and builder about and builder about what can be built – what can be built – these are the these are the internal data internal data standards.standards.

The data dictionary is The data dictionary is the bill of materials,the bill of materials,

obtained from a warehouse, the metadata repository.

The builder uses the blueprints The builder uses the blueprints to construct the house, with the to construct the house, with the details, like types of doors and details, like types of doors and windows, wall colors, floors, etc. windows, wall colors, floors, etc. customized to the buyer’s needs,customized to the buyer’s needs,

just like the database developer transform the logical data model, into a database tailored to the system’s functional requirements.

•The implementation guide shows the database developer how to use the logical data model to create a database, just like a “how to” book tells a workman how to perform his trade.

And finally, when And finally, when you move in, and you move in, and place your furniture place your furniture and belongings, and belongings, you populate the you populate the database.database.

Subcomm 11 Working Subcomm 11 Working GroupsGroups

WG 11.1- Standard Clinical WG 11.1- Standard Clinical ArchitectureArchitecture– TR 1027-TR 1027- Implementation Guide Implementation Guide

for the Electronic Health Recordfor the Electronic Health Record WG 11.2- Consumer Guide to the WG 11.2- Consumer Guide to the

Electronic Dental RecordElectronic Dental Record WG11.3- Universal Data Archive WG11.3- Universal Data Archive

FileFile

SCDI Subcomm 12SCDI Subcomm 12 Informatic Component Informatic Component

InteroperabilityInteroperability

Scope: To develop and promote Scope: To develop and promote standards for informatic standards for informatic component interoperability in component interoperability in dentistry.dentistry.

Subcomm 12 ProjectsSubcomm 12 Projects Informatic Component Informatic Component

InteroperabilityInteroperability

WG 12.1- Application of the WG 12.1- Application of the DICOM Standard to DentistryDICOM Standard to Dentistry

WG 12.2- Task-Related Testing of WG 12.2- Task-Related Testing of Digital Radiographic SystemsDigital Radiographic Systems

Subcomm 12 ProjectsSubcomm 12 Projects Informatic Component Informatic Component

InteroperabilityInteroperability

WG 12.4- Guide to Digital Dental WG 12.4- Guide to Digital Dental Photography & Imaging- Photography & Imaging- AIPAIP

WG 12.5- Dental Inter-WG 12.5- Dental Inter-Application CommunicationApplication Communication

SCDI Subcomm 13SCDI Subcomm 13Electronic Dissemination Electronic Dissemination

of Informationof Information

Scope: Develop and promote standards for Scope: Develop and promote standards for quality, consistency, accuracy, security quality, consistency, accuracy, security and functionality of health related and functionality of health related information, knowledge representation information, knowledge representation and dissemination of information.and dissemination of information.

SCDI Subcomm 13SCDI Subcomm 13Electronic Dissemination Electronic Dissemination

ofofDental InformationDental Information

WG 13.1- Educational Software WG 13.1- Educational Software Used in Electronic MediaUsed in Electronic Media

WG 13.3- Research Applications WG 13.3- Research Applications in Dental Informaticsin Dental Informatics

ANSI/ADA Specification ANSI/ADA Specification 10011001

Guidelines for Design of Guidelines for Design of Education SoftwareEducation Software

Approved by ANSI in August 2002Approved by ANSI in August 2002 Purpose to promote quality in Purpose to promote quality in

educational softwareeducational software Not domain-specificNot domain-specific

Specification 1001Specification 1001

Titus Schleyer & Lynn Johnson- authorsTitus Schleyer & Lynn Johnson- authors Developers can use to ensure products Developers can use to ensure products

are of high instructional quality during are of high instructional quality during development & evaluationdevelopment & evaluation

End users can compare education End users can compare education software programssoftware programs

Authors have derived validated rating Authors have derived validated rating instruments for useinstruments for use

Consequences for not Consequences for not participating...participating...

Dentists could be burdened Dentists could be burdened with programs and systems with programs and systems adaptedadapted to dentistry rather to dentistry rather than developed for dentistrythan developed for dentistry

Better to be proactive than Better to be proactive than reactivereactive

For Additional For Additional InformationInformation

American Dental Association-American Dental Association-

Department of Standards Department of Standards AdministrationAdministration

Anyone can become a member Anyone can become a member of a working groupof a working group

www.ada.org/scdiwww.ada.org/scdi

Thank you!Thank you!