NYSDA NEWS May 2019
It’s Stylish to have Standards
Life would be a whole lot different and not particularly safe or pleasant if there were no standards governing everything from construction to patient care.
Sharon Pollick, D.M.D.
It’s the year 1974 at a Lower Moreland High School in Huntingdon Valley, PA-sponsored dance. Four anxious, unattached teen girls, including myself, are huddled around sporting shag hair styles, flutter-sleeve shirts and patchwork skirts. Standing around in our wedges, we’re jabbering about boys, rating and debating if they “lived up to our standards” for a date or, possibly, as a mate.
At a young age, long before high school, we are taught to have pride in ourselves and in what we do and to do the best we can to at least a minimum standard. There is a code on etiquette--a proper way to hold a tea cup and an accepted way to greet someone. We expect a firm handshake and good eye-to-eye contact. Imagine if one of the world’s busiest bridge, like the George Washington, with average of 289,0001 crossings a day, had no measures to maintain its structure?
Who recalls their first anatomy examination in dental school? I can tell you I don’t. But I do know the goal was to pass it as part of reaching the next step on the ladder to graduation. The exam is part and parcel of maintaining standards of knowledge for our profession.
Necessary Though Not Always Apparent
Standards are ubiquitous. They are used in our daily lives, but often go unnoticed because they are seamless. We can agree that we are all too familiar with having to comply with requirements in school and with the qualifications necessary to maintain professional licensure. And imagine what life would be like if there were no building codes--doorways could be made in any shape and dimension, contrary to current laws that dictate a specific size to accommodate wheelchairs and similar devices for a growing disabled population--2 or if we stopped following technical requirements for building cars and airplanes. Most professions, just like dentistry, set principles or canons of ethics to practice by.
Having a set of fundamentals that create guidelines to practice by serves to keep the public safe, and it allows for comparison of cases and their outcomes. Safety is a primary tenant of life; acknowledging this at a young age is smart. Assuring the security of our patients, children, spouses and parents is paramount. Similarly, securing patient data and analyzing it retrospectively helps us to treat them better. The information we obtain in the process of caring for patients is valuable for data analysis and for evaluating outcome success. Data can then be used to assist in creating information about evidence-based dentistry. Our focus as oral healthcare experts is to provide the best care possible based on the most current information available. But we need to ask ourselves, as a profession, are we doing our very best to stay ahead of all the issues?
Standards Improve Care
The ADA has created a body to set standards for dental products and electronic and digital products. Radiographic sensors and computer hardware and the dental software we use are all tied to a specific code. The Standards Committee for Dental Products (SCDP) and the Standards Committee for Dental Informatics (SCDI) both function to create and maintain these standards, to help us deliver the best care possible. States have done the same. And for the past several years, dentists who practice in New York have been mandated to utilize an electronic means to provide patient prescriptions.
Regardless of the reasons for adoption of this mandate, it was supposed to create a better and safer experience. For the most part, it has; however, there are still problems with the process—for example, the pharmacy is out of stock of an item prescribed to a patient. There isn’t always a way for the pharmacist to alert the provider in a timely manner. As a result, if it’s the end of the work day, when the doctor leaves the office, his or her prescription software, of course, remains in the office on the computer. Now, the doctor is not able to re-write the script. The patient has to go to another pharmacy, which requires a new script, delaying filling the medication until the next day. A new problem has been created as a result of this rule. We didn’t have this before, requiring workarounds.
Technology has enhanced the way we provide care to patients despite the drawbacks--the biggest negative being the cost to purchase and maintain the equipment. We are also learning that technology is a double-edged sword. On one hand, we have seamless information at a moment’s notice; on the other, we have an overabundance of data that can be overwhelming and can cloud the picture. It has created what some in different circles call “Dr. Burnout.”3 This is not your new competitor across the street. It’s the result of added work to achieve excellence, and it is taking a toll on providers. We are aware of it and what comes as a result of it, 4,5 but continue to trudge ahead because we believe the added work will create a better outcome for our patients.
Would informatics make the process better if the software was set to link the pharmacy inventory with the orders coming into the store? This would send an immediate message to the provider that the pharmacy is out-of-stock, signaling to the dentist to send the prescription to a new pharmacy, sidetracking and preventing a potential treatment delay.
Know Your Patients
When a person presents as your patient, do you obtain identification? We are
supposed to, particularly if the person has insurance, and a majority of patients have at least some form of medical insurance. It’s also incumbent upon us to collect an inclusive and accurate medical history that covers medications taken and allergies the patient has. Imagine a compliant hypertensive patient who takes medications regularly. What determines if the patient has hypertension? Knowing this is part of a standard set in part by the American Heart Association. How do we treat these patients when they come to our office? That will be determined by and dependent upon the situation and the patients’ presentation.
In this case, we’ve created a specific standard. In actuality, we follow a norm every day with every patient. What about the patient who presents with an excruciating toothache, a BP of 159/95 and a history of hypertension but who dutifully takes his or her daily meds and whose BP is usually very well controlled? Do we send this patient to his or her physician for guidance on their BP before treating the patient’s dental disease? Most likely not, because the patient’s BP probably won’t come down to normal until the tooth is treated and he or she is out of pain. We would call the physician to advise of the patient’s status and to ask for guidance on managing the BP.
Where do Standards Come From?
That brings us to the question of who writes the standards that we practice under? There is a large body of knowledgeable experts advising and providing input into the creation of these standards. They include representatives from all over the dental industry--from dental insurance to software companies, to digital radiography and imaging equipment and other product industry leaders, including dental providers. Collaboration is essential to creating seamless intuitive products. There is a need for dentists to become involved in the process and for all involved to understand the constraints of the others, thereby constructing the best possible standard. This can’t happen unless we, dentists, are involved in the process.
Any dentist who wishes to join in the process may. For me, it has been an exciting commitment. It means I attend two meetings a year, which allows for my input into creating the Standard Clinical Data Architecture, in essence, the framework for all data--patient demographics; chief complaint; PMH & current history; medications; allergies and so on, down to post treatment. This working group has been tasked with creating a dental electronic record that mirrors the current HL76 medical record, a technical document with over 130 pages that requires bimonthly meetings to complete this voluminous task. Fortunately, there is a well-rounded, bright professional team working to complete this very important model. There are another 10 or more working groups doing the same with other informatics topics.
It’s inspiring to work with so many committed professionals, but we can always use new innovative minds and ideas from dentists who are attuned to what our needs are, including the specialties. Technology is forever changing and for that reason, it’s important that we always have the best and the brightest.
Fashions go in and out of style, just as technology is forever changing. Let’s keep standards in fashion and in style.
Sharon Pollick is an oral and maxillofacial surgeon, who, as liaison from the Suffolk County Dental Society Executive Board, serves on the ADA Standards Committee for Dental Informatics and cochair of WG 11.1. She is a member as well of the NYSDA Information Technology Committee and is chief of dentistry, Long Island Community Hospital. Queries about this article can be sent to her at girldoc@aol.com
References
2 https://disabilitycompendium.org/sites/default/files/user-uploads/2017_AnnualReport_2017_FINAL.pdf/.
3 https://cdn1.sph.harvard.edu/wp-content/uploads/sites/21/2019/01/PhysicianBurnoutReport2018FINAL.pdf/.
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| Dr Sharon Pollick, Oral & Maxillofacial Surgeon |
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