Transcript The Role of CIT in the Patient

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
Overview
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Importance of doctor-patient relationship
Problem and solutions
Defining & measuring doctor-patient
relationship
Dental CIT applications
Role of dental informatics
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Importance
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Doctor-patient relationship valued
throughout history
Linked to important health outcomes
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Increased treatment adherence
Reduce malpractice claims
Fewer tests and second opinions
Improved quality of life
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Problem
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Quality of relationship on the decline
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Consumerism
Healthcare system constraints
Poor communication skills
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Solution
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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
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Doctor-patient relationship
defined
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Sustained open trusted conversation
Sharing of information and knowledge
Exemplified in patient-centered care
model
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Patient-Centered Care Model
Exploring both
disease & illness
experience
Patient
Presents
Cues
Disease
Understanding
the whole
person
Context
Person
Illness
Finding
common
ground
Problems
Goals
Disease
Illness
Enhancing the
Patient-Doctor
Relationship
Mutual
Decision
Roles
Incorporating
Prevention and
Health Promotion
Being Realistic
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Relationship Building - PCC
PCC
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Hi Quality
Doctor-Patient
Relationship
=
Improved
Outcomes
PCC - Patient-Centered Care
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Measure Quality Relationship
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Primary Care Assessment Survey
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Conceptual model of framework to
measure doctor-patient relationship
Validated instrument
4 scales measuring personal relationship
Source: Safran 1998
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Personal Relationship Scales
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Communication and decision support
Interpersonal caring and social support
Contextual knowledge
Trust
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Personal Relationship Scales
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Communication and decision support
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Thoroughness of questions about symptoms,
attention to what patients say, clarity of explanations,
instructions, and advice and help in making decisions.
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Personal Relationship Scales
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Communication and decision support
Interpersonal caring and support
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Patience, friendliness, caring, respect, and time spent
with the patient. Sharing power and enhancing selfawareness.
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Personal Relationship Scales
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Communication and decision support
Interpersonal caring and support
Contextual knowledge of the patient
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Knowledge of the patient’s life history, medical
history, responsibilities at work, home or school,
principal health concerns, values, and beliefs.
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Personal Relationship Scales
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Communication and decision support
Interpersonal caring and support
Contextual knowledge of the patient
Trust
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Integrity, honesty, competence, and role as the
patient’s agent. Expressing a sense of security and
well-being.
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Relationship Building - CIT
CIT
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+ PCC
Hi Quality
Doctor-Patient
Relationship
=
Improved
Outcomes
CIT - Communication and Information
Technology
PCC - Patient-Centered Care
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Communication & Information
Technology
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What aspects of CIT affect patientdentist relationship
Use existing models
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PCAS for relationship
Schleyer’s taxonomy of dental CIT
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Dental CIT
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Schleyer’s Categories
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Internet
Clinical
Administrative
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CIT Internet Devices
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CIT Clinical & Administrative
Devices
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Mobile & Wearable Devices
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Internet
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Office Web portal
Email
Personal Health Record
Teledentistry
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Web Portal
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Service
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Doctor and Staff info
Location, hours
Practice philosophy
Office policies
Patient education
Automated scheduling
Automated reminders
Patient testimonials &
images
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Relationship Benefit
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Informed patient
Match & shared values
Set expectations
Sense of control
Build trust
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Email
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Service
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Secure
Web-based
Triaged
Linked to EOHR
Becomes part of PHR
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Relationship Benefit
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Ease of access
Open communication
Trust
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PHR
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Service
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Treatment history
Dental history
Meds
Family history
Radiographs
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Relationship Benefit
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Contextual knowledge
Sharing & participation
Access & control
Level power asymmetry
Trust and confidence
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Teledentsitry
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Service
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Remote care
Consultations
X-rays and images
Teleconference
Real-time, store and
forward
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Relationship Benefit
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Communication
Decision support
Contextual knowledge
Convenience
Continuity of care
Trust
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Clinical
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EOHR
Digital Imaging
Treatment Planning
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EOHR
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Service
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Exam
Charting
Treatment Planner
Clinical and
psychosocial data
Preference data
History and trends
Knowledge-based
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Relationship Benefit
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Communication
Contextual Knowledge
Confidence
Continuity of care
Trust
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Imaging
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Service
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Visual record
Treatment planning
Trend analysis
Simulations
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Relationship Benefit
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Communication
Contextual knowledge
Patient preferences
Control
Trust
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Treatment
Planning
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Service
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Values-based options
Link medical and oral
factors
Consider patient
preferences
Decision making aids
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Relationship Benefit
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Communication
Decision support
Patient preferences
Control
Trust
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Administrative: Practice Mgt.
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Services
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Appointment
scheduling
Patient registration
Tailored messages
Demographics
Insurance billing
Claims submission
Recall
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Relationship Benefit
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Communication
Contextual knowledge
Access
Confidence
Convenience
Trust
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Relationship Building - DI
CIT
DI
+ PCC
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Hi Quality
Doctor-Patient
Relationship
=
Improved
Outcomes
PCC - Patient-Centered Care
CIT - Communication and Information
Technology
DI - Dental Informatics
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Role of Informatics Research
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Define research questions and methods
that will inform the process of making
CIT more effective at building quality
patient-dentist relationships
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Informatics - Research
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Study of effects
System installation
System development
Model building
 Draws research methods from cognitive science,
psychology, decision science, human factors
engineering, and telecommunications
Source: Friedman – 1995, Tower of Science
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Model Formulation
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Research
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Ontology
Standardized
vocabulary
Problem solving
methods
Decision theory
Cognitive science
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Technology
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EOHR
PHR
Messaging
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Relationship
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Communication
Contextual
knowledge
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System Development
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Research
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Integration
Human factors
HCI
AI
Data mining
Decision
theory
Telecommun
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Technology
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EOHR
PHR
Email
Teledentistry
DSS
Treatment Plan
Practice Mgt
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Relationship
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Communication
Patient Preferences
Context knowledge
Trust
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System Installation
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Research
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Integration
UI
Organizational
theory
Cognitive
psychology
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Technology
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Website
Email
Scheduling
EOHR
POHR
Email
Teledentistry
DSS
Practice Mgt
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Relationship
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Communication
Patient Preferences
Context knowledge
Trust
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Study of Effects
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Research
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Ontology
Vocabulary
Integration
Usability
Evidence-base
Population-based
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Technology
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All applications
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Relationship
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Communication
Patient preference
Context knowledge
Trust
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Next Steps
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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??
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