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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. Importance of doctor-patient relationship

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slide1

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
Overview
  • Importance of doctor-patient relationship
  • Problem and solutions
  • Defining & measuring doctor-patient relationship
  • Dental CIT applications
  • Role of dental informatics
importance
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
problem
Problem
  • Quality of relationship on the decline
    • Consumerism
    • Healthcare system constraints
    • Poor communication skills
solution
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
doctor patient relationship defined
Doctor-patient relationship defined
  • Sustained open trusted conversation
  • Sharing of information and knowledge
  • Exemplified in patient-centered care model
patient centered care model
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

relationship building pcc
Relationship Building - PCC
  • PCC - Patient-Centered Care

Hi Quality

Doctor-Patient

Relationship

=

PCC

Improved

Outcomes

measure quality relationship
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

personal relationship scales
Personal Relationship Scales
  • Communication and decision support
  • Interpersonal caring and social support
  • Contextual knowledge
  • Trust
personal relationship scales1
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.
slide12

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.
personal relationship scales2
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.
slide14

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.
relationship building cit
Relationship Building - CIT
  • CIT - Communication and Information Technology
  • PCC - Patient-Centered Care

Hi Quality

Doctor-Patient

Relationship

=

Improved

Outcomes

CIT

PCC

+

communication information technology
Communication & Information Technology
  • What aspects of CIT affect patient-dentist relationship
  • Use existing models
    • PCAS for relationship
    • Schleyer’s taxonomy of dental CIT
dental cit
Dental CIT
  • Schleyer’s Categories
    • Internet
    • Clinical
    • Administrative
internet
Internet
  • Office Web portal
  • Email
  • Personal Health Record
  • Teledentistry
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

Web Portal
email
Service

Secure

Web-based

Triaged

Linked to EOHR

Becomes part of PHR

Relationship Benefit

Ease of access

Open communication

Trust

Email
slide24
Service

Treatment history

Dental history

Meds

Family history

Radiographs

Relationship Benefit

Contextual knowledge

Sharing & participation

Access & control

Level power asymmetry

Trust and confidence

PHR
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

Teledentsitry
clinical
EOHR

Digital Imaging

Treatment Planning

Clinical
slide27
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
imaging
Service

Visual record

Treatment planning

Trend analysis

Simulations

Relationship Benefit

Communication

Contextual knowledge

Patient preferences

Control

Trust

Imaging
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

Treatment Planning
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

Administrative: Practice Mgt.
relationship building di
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

role of informatics research
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
informatics research
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

model formulation
Research

Ontology

Standardized vocabulary

Problem solving methods

Decision theory

Cognitive science

Relationship

Communication

Contextual knowledge

Model Formulation
  • Technology
    • EOHR
    • PHR
    • Messaging
system development
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
system installation
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
study of effects
Research

Ontology

Vocabulary

Integration

Usability

Evidence-base

Population-based

Relationship

Communication

Patient preference

Context knowledge

Trust

Study of Effects
  • Technology
    • All applications
next steps
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??