The Role of Communication and Information Technology and Informatics in the Patient-Dentist Relationship

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

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

9. Measure Quality Relationship • Primary Care Assessment Survey • Conceptual model of framework to measure doctor-patient relationship • Validated instrument • 4 scales measuring personal 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 Hi Quality Doctor-Patient Relationship = Improved Outcomes CIT PCC +

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 • Email • Personal Health Record • Teledentistry

22. 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 Web Portal

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

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

25. 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 Teledentsitry

26. EOHR Digital Imaging Treatment Planning Clinical

27. 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 EOHR

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

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

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

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

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. Informatics - Research • 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

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

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

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

37. Research Ontology Vocabulary Integration Usability Evidence-base Population-based Relationship Communication Patient preference Context knowledge Trust Study of Effects • 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??