According to the American Dental Association, Americans spent over $101 billion on dental services in 2008. In 2006, Americans had an estimated 1,943,038,670 dental procedures completed by private practitioners during almost 390 million visits.1
As the population of the United States and the average life expectancy both increase, these numbers are expected to rise. While the amount of information obtained during these visits is staggering, the data collected are rarely used in aggregate to help advance dental education, improve oral health research, assess outcomes of care, or promote evidence-based dentistry. Most of the oral health-related data instead reside in silos in dental school clinics and private practices.
Oral health researchers often rely on data from insurance companies that have a record of charged treatments. However, less than half of adult dental patients have dental insurance,2
and insurance data have limited utility for research.3–5
Similarly, Medicare has very limited reimbursement for dental treatments, which precludes it from being a viable source of oral health data.6
Patient health surveys such as the National Health and Nutrition Examination Survey7
(NHANES) or the Behavioral Risk Factor Surveillance System2
(BRFSS) have often been used to provide a view of the dental status of the U.S. population. Although data from these surveys have been used for oral health research,8,9
they can only provide a limited perspective. To date, no large oral health datasets exist for researchers, epidemiologists, or public health professionals to provide information about patients who have undergone dental treatments.
Electronic health records (EHRs) contain a wealth of information. Data extracted from EHRs differ from other data sources such as cross-sectional surveys or data obtained from payers, as they provide a more detailed and long-term view of patients, symptoms, diseases, treatments, outcomes, and differences among providers. The secondary use of health data in dentistry can provide valuable insight into oral health diseases and treatments performed on a large cohort of patients.10
EHRs also play an important role in enhancing evidence-based decision making (EBD) in dentistry and improving clinical effectiveness through assessment of outcomes of care.11
Private practices typically use technology first for billing and tracking appointments, with the natural progression to then implement EHRs for recording of dental observations, diagnosis, and treatment planning. Almost 87 percent of dentists use a computer in their private practice.12
In addition, the majority of North American dental schools already operate in a fully digital format or are on track to do so within the next two to three years. In fact, forty-two dental schools in the United States use the same EHR system.
Consortia have been developed in medicine for quality improvement,13–15
to coordinate patient services,16
to reduce disparities in patient care,17
and as a major resource for translational research.18
However, dentistry has been slow to follow. The Ivy League Dental Consortium, an agreement between the dental schools at Harvard University, University of Pennsylvania, and Columbia University, was formed in 1997 to support lifelong learning, but disbanded shortly thereafter. The American Association of Dental Schools (AADS; now the American Dental Education Association, ADEA) has had two sections with significant interest in the use of databases and electronic systems to administratively support their operations. These sections—Clinic Administration and Business and Financial Administration—have provided forums to discuss and act on common issues. During the 1980s, one of those common issues was improving Clinical Information Systems (CIS). As schools investigated this, it became apparent that this development was too costly to implement individually. The need by many schools to develop electronic CIS led to the establishment of the AADS Consortium for Clinic Information Systems, which grew from a collaborative meeting, “The Symposium on 2nd
Generation Clinical Databases and Electronic Dental Record,” held in Alexandria, Virginia, in 1990.19
Subsequently, a grant was secured from the American Fund for Dental Health to support a working group in an effort to develop a monograph20
that could serve as a guide for dental schools in their development or acquisition of oral health information systems. The monograph contained one section related to information about functionality of a computer-based oral health record with regard to registration, patient histories, and progress notes; a second section that contained functions related to processes like screening and patient assignment; and a third section on integrated information at the point of care.
Eventually, the AADS Consortium for Clinic Information Systems became the ADEA Section for Dental Informatics and expanded its scope to look at all aspects of information technology integration in the support of the dental school mission and goals. To date, no oral health consortia have been formed specifically to share data for research and education.
North American dental schools provide care for large, diverse patient populations and are regionally distributed across the United States, Canada, and Mexico. As a result, dental schools are uniquely positioned to be able to integrate data from electronic health records and use that information to improve oral health research, education, and treatment. Recognizing the benefits of data sharing, a critical mass of dental schools who use the same commercial electronic health record system, axiUm (Exan Corporation, Vancouver, Canada), have formed a consortium to work together to share data, educational tools, and enhancements to axiUm. This article will describe the formation, operations, and outcomes of this consortium.