The Role of Communication and Information Technology and Informatics in the Patient-Dentist Relationship Michael Kirshner, DDS, MPH Dental Informatics and Dental Research: Making the Connection Bethesda, MD June 12, 2003

2 Overview Importance of doctor-patient relationship Problem and solutions Defining & measuring doctor-patient relationship Dental CIT applications Role of dental informatics

3 Importance Doctor-patient relationship valued throughout history Linked to important health outcomes Increased treatment adherence Reduce malpractice claims Fewer tests and second opinions Improved quality of life

4 Problem Quality of relationship on the decline Consumerism Healthcare system constraints Poor communication skills

5 Solution Refocus on patient centeredness Leverage communication and information technology Conduct research to study effects Look to informatics for a model that integrates CIT with human relationship

6 Doctor-patient relationship defined Sustained open trusted conversation Sharing of information and knowledge Exemplified in patient-centered care model

7 Patient-Centered Care Model Problems Goals Roles Disease Illness Enhancing the Patient-Doctor Relationship Incorporating Prevention and Health Promotion Being Realistic Context Illness Disease Person Exploring both disease & illness experience Understanding the whole person Finding common ground Mutual Decision Mutual Decision Patient Presents Cues Patient Presents Cues

8 Relationship Building - PCC PCC Hi Quality Doctor-Patient Relationship Hi Quality Doctor-Patient Relationship = Improved Outcomes Improved Outcomes PCC - Patient-Centered Care

9 Primary Care Assessment Survey Conceptual model of framework to measure doctor-patient relationship Validated instrument 4 scales measuring personal relationship Measure Quality Relationship Source: Safran 1998

10 Personal Relationship Scales Communication and decision support Interpersonal caring and social support Contextual knowledge Trust

11 Personal Relationship Scales Communication and decision support Thoroughness of questions about symptoms, attention to what patients say, clarity of explanations, instructions, and advice and help in making decisions.

12 Personal Relationship Scales Communication and decision support Interpersonal caring and support Patience, friendliness, caring, respect, and time spent with the patient. Sharing power and enhancing self- awareness.

13 Personal Relationship Scales Communication and decision support Interpersonal caring and support Contextual knowledge of the patient Knowledge of the patient’s life history, medical history, responsibilities at work, home or school, principal health concerns, values, and beliefs.

14 Personal Relationship Scales Communication and decision support Interpersonal caring and support Contextual knowledge of the patient Trust Integrity, honesty, competence, and role as the patient’s agent. Expressing a sense of security and well-being.

15 Relationship Building - CIT CIT - Communication and Information Technology PCC - Patient-Centered Care PCC Hi Quality Doctor-Patient Relationship Hi Quality Doctor-Patient Relationship = CIT + Improved Outcomes Improved Outcomes

16 Communication & Information Technology What aspects of CIT affect patient- dentist relationship Use existing models PCAS for relationship Schleyer’s taxonomy of dental CIT

17 Dental CIT Schleyer’s Categories Internet Clinical Administrative

18 CIT Internet Devices

19 CIT Clinical & Administrative Devices

20 Mobile & Wearable Devices

21 Internet Office Web portal Personal Health Record Teledentistry

22 Web Portal Service Doctor and Staff info Location, hours Practice philosophy Office policies Patient education Automated scheduling Automated reminders Patient testimonials & images Relationship Benefit Informed patient Match & shared values Set expectations Sense of control Build trust

23 Service Secure Web-based Triaged Linked to EOHR Becomes part of PHR Relationship Benefit Ease of access Open communication Trust

24 PHR Service Treatment history Dental history Meds Family history Radiographs Relationship Benefit Contextual knowledge Sharing & participation Access & control Level power asymmetry Trust and confidence

25 Teledentsitry Service Remote care Consultations X-rays and images Teleconference Real-time, store and forward Relationship Benefit Communication Decision support Contextual knowledge Convenience Continuity of care Trust

26 Clinical EOHR Digital Imaging Treatment Planning

27 EOHR Service Exam Charting Treatment Planner Clinical and psychosocial data Preference data History and trends Knowledge-based Relationship Benefit Communication Contextual Knowledge Confidence Continuity of care Trust

28 Imaging Service Visual record Treatment planning Trend analysis Simulations Relationship Benefit Communication Contextual knowledge Patient preferences Control Trust

29 Treatment Planning Service Values-based options Link medical and oral factors Consider patient preferences Decision making aids Relationship Benefit Communication Decision support Patient preferences Control Trust

30 Administrative: Practice Mgt. Services Appointment scheduling Patient registration Tailored messages Demographics Insurance billing Claims submission Recall Relationship Benefit Communication Contextual knowledge Access Confidence Convenience Trust

31 Relationship Building - DI PCC Hi Quality Doctor-Patient Relationship Hi Quality Doctor-Patient Relationship = CIT Improved Outcomes Improved Outcomes DI + PCC - Patient-Centered Care CIT - Communication and Information Technology DI - Dental Informatics

32 Role of Informatics Research Define research questions and methods that will inform the process of making CIT more effective at building quality patient-dentist relationships

33 Study of effects System installation System development Model building Draws research methods from cognitive science, psychology, decision science, human factors engineering, and telecommunications Informatics - Research Source: Friedman – 1995, Tower of Science

34 Model Formulation Research Ontology Standardized vocabulary Problem solving methods Decision theory Cognitive science Relationship Communication Contextual knowledge Technology EOHR PHR Messaging

35 System Development Research Integration Human factors HCI AI Data mining Decision theory Telecommun Relationship Communication Patient Preferences Context knowledge Trust Technology EOHR PHR Teledentistry DSS Treatment Plan Practice Mgt

36 System Installation Research Integration UI Organizational theory Cognitive psychology Relationship Communication Patient Preferences Context knowledge Trust Technology Website Scheduling EOHR POHR Teledentistry DSS Practice Mgt

37 Study of Effects Research Ontology Vocabulary Integration Usability Evidence-base Population-based Relationship Communication Patient preference Context knowledge Trust Technology All applications

38 Next Steps Conduct Informatics research on dental CIT vis-a-vis the doctor-patient relationship Build relationship with CIT developers and vendors to influence software design based on research findings Educate and engage clinicians in relationship skills More??