records and a connection to the internet is having a computer operating system that is regularly updated to address any newly identified security vulnerabilities. Standards are another area that is key to information exchange, and they are changing rapidly. Exchange formats used by our medical colleagues can include continuity of care documents (CCDs) and can consist of a download of medical information that could be very extensive, making them less useful because of the time it takes to review the information. Over the past few years, the United States and most of the world has been moving toward a standard that can streamline these documents to more specific needs and be transferable in real time. This standard is called HL7 FHIR, where HL7 stands for Health Level Seven International, the standards organization that develops exchange tools and protocols, and FHIR stands for Fast Healthcare Interoperability Resources. U.S. government agencies, such as the Centers for Medicare & Medicaid Services and the Department of Health and Human Services, have been encouraging and working to make FHIR the primary exchange format. FHIR tools allow for much more focused, and thereby limited, information exchange. A specific American National Standards Institute (ANSI)– and ADA-approved dental standard, No. 1084, Core Reference Data Set, serves as the basis for development of some of the FHIR exchange sets used in dentistry. We are gradually seeing the adoption of FHIR capabilities by some dental EHR systems due to demand by users. The Veterans Health Administration and some federally qualified health centers have been some of the leaders in pushing the dental EHRs they use into having this capability. Yet, CCDs remain far and away the most common form of document exchanged. Recently, the ADA Standards Committee on Dental Informatics completed a new ANSI-approved standard, the Oral Dataset Interoperability Standard (ODIN). ODIN provides for the permissioning, data bundling, authentication and necessity validation for structured electronic data elements to support key information exchange among and between
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dental and other healthcare settings. This includes the bidirectional electronic sharing of essential patient demographic, dental and medical encounter data, as well as patient clinical data in a structured, computable format between dental or other healthcare venues. Another major effort by the federal government is creating “exchanges” where patient information can be readily identified and moved to another entity with patient permission. Referred to as QHINs (qualified health information networks), they must pass rigorous criteria and use common methods to exchange information. This may be the path parts of dentistry will need to use, simply to contain costs. The most likely path will be for the dental EHR vendors to develop a pathway with a QHIN. If a dentist is then seeking information on a specific patient, that information request would be “packaged” by the dental EHR, then the information packet would be forwarded to the QHIN (hopefully with directional information on where to find the patient information). The original QHIN then works with all other QHINs in the exchange, and each QHIN or QHINs that contain information for the patient accesses it from an EHR system and forwards it back to the original/requestor QHIN and subsequently to the dental EHR or another tool that allows viewing of the information requested (if available). All of this takes place in real time, measured in seconds (minutes at most). Depending on the capabilities of the dental EHR, the information could immediately populate a patient’s record (likely after a single approval click from a staff member), update information when it is “new,” reduce patient time and make the information much easier for the clinician to locate. This is an example of true interoperability, and improved patient satisfaction, patient care and patient safety would be the result. Many states have developed health information exchanges (HIEs) during the last decade or so. Some of these may require all healthcare professionals, including dentists, to participate. The healthcare professionals contract with a firm (much like the QHIN described
above) to provide exchange services. A “roster” of all patients that the healthcare professional has records on is uploaded (and regularly updated) to this firm so that information requests can locate where the patient may have records and provide for rapid information exchange.
A Possible Path Today, there are numerous resources available; however, many require a level of baseline knowledge to be useful to the average person. Depending on whether you are a solo practitioner, a small group or part of a larger group such as a DSO, the path forward could be very different. If exchanging information beyond phone calls, texts and emails is new to you, you may want to use a basic approach to familiarize yourself with the processes. It may also result in better security and meeting state or federal privacy and security requirements. A great source for learning more about information exchange in general is healthit.gov/topic/health-itand-health-information-exchange-basics/ health-it-and-health-information-exchange.
Some Initial Steps 1. Make sure your operating system is up to date and you either regularly check for updates or have automatic updates turned on. Many dentists already use a technology company to take care of their computer systems; if so, the technology company should be doing this regularly. 2. Talk with colleagues who refer to you or whom you refer to. Find out if they are using portals, what information you should exchange with them, etc. 3. Explore with your patients what medical care systems they are members of, and find out if they use their medical care system’s patient portal. Often, they will also know the name of the EHR system their medical care system uses (patients frequently refer to “MyChart” or similar, and those names are usually proprietary to the EHR vendor). 4. Find out from your patients if they would use online forms, online scheduling, online payments, etc. While there are costs involved in these services, they