Agenda for AADR-sponsored conference “Toward a Diagnosis Driven Profession 2016”

Researchers from Harvard School of Dental Medicine, the University of Pittsburgh School of Dental Medicine and The University of Sydney, Faculty of Dentistry have been planning with support from the IADR Global HQ staff, Practice Management Information Corporation (PMIC) and Delta Dental a conference about the adoption of standardized diagnostic terminologies (DxTMs) by dental professionals to improve oral health.


Time Event
8:00 – 8:30 am Check In
8:30 – 8:45 am Welcome Address
Paul Krebsbach
8:45 – 9:30 am Keynote
James Cimino
9:30 – 10:30 am Session 1
Panel Discussion on Terminologies: Reference terminologies, interface terminologies – roles and how they complement each other
Vimla Patel, Dave Preble, Bedirhan Ustun, Daniella Meeker
10:30 – 11:00 am Break
11:00 – 11:45 am Session 2
EHR User Interface and use of DxTMs
Jan Horsky, John Halamka, Muhammad Walji
11:45 – 12:30 pm Session 3
Diagnostic documentation and impact on quality of patient care
Khalid Moidu, Lyle McClellan, Joel White
12:30 – 1:30 pm Lunch
1:30 – 2:15 pm Session 4
Implication of widespread diagnostic term implementation for insurance companies
Bill Kohn, Mary Lee Conicella, Adele Towers
2:45 – 4:00 pm Breakout sessions – EHR vendors, Payors, Providers, Professional Organizations, Students
4:00 – 4:15 pm Break
4:15 – 4:50 pm Closing Remarks
Lynn Mouden
4:50- 5:00 pm Summary and Post-Survey

Please join us in shaping the future of diagnostic terminology in dentistry, its usability in the EHR, and in discussing the roles of ICD, SNODENT and DDS, the diagnostic terminologies increasingly utilized by dentists globally.

Saturday, March 19, 2016 from 8:00 AM to 5:00 PM (PDT) – Add to Calendar

JW Marriott Platinum Ballroom C – 900 West Olympic Boulevard Los Angeles, CA 90015 – View Map


Stay tuned to learn here at the DIOC blog more about the conference.

We are looking forward to see you in Los Angeles,
Elsbeth and Heiko

Elsbeth Kalenderian, DDS, MPH, PhD, Chair, Oral Health Policy and Epidemiology, Chief of Quality, Harvard Dental Center, Harvard School of Dental Medicine

Heiko Spallek, DMD, PhD, MSBA, Professor and Pro-Dean, The University of Sydney, Faculty of Dentistry

Big Data for Oral Health Knowledge: What is Big Data?

Many may be familiar with this map:

This image is in the public domain due to its age. Author died in 1858, material is public domain.

Original map made by John Snow in 1854. Cholera cases are highlighted in black. Click here for larger version.

The map depicts clusters of cholera cases in the London epidemic of 1854; the cholera cases are highlighted in black. The physician, John Snow, studied the outbreak by mapping the data from an EHR onto Google Maps and discovered that cholera is spread by contaminated water. Well kind of—it was the 19th century after all. He recorded the details about the cases by talking to residents and illustrated them as dots on a map. While some state that this was the founding event of the science of epidemiology, my question is the following: Is this an example of Big Data?

While there is probably no correct answer to this question, Dr. Snow clearly combined two disparate data sources, medical records of confirmed cases and location data, and visualized the results to gain insight. His discovery influenced public health and the construction of improved sanitation facilities. He proved that the cause of cholera stemmed from contaminated water from specific pumps, debunking the popular belief that cholera spread by breathing bad air. Dr. Snow integrated unstructured data sources to find correlations without definitive causation, as he was unable to show the bacterium Vibrio cholerae by chemical and microscope examination. Thus, my answer is the following: Yes, John Snow was a Big Data user. What do you think? One and a half centuries later, are we sufficiently integrating oral health data to make an impact on dental public health?

The preparations for the Big Data for Oral Health Knowledge; How to get the Big Answers workshop scheduled for March 14, 2015 are progressing nicely. We are excited that a few more invitees have accepted our invitation—again, just to name a few: Dr. Bill Kohn (Delta Dental), Dr. Jane Weintraub (Dean of the School of Dentistry at the University of North Carolina at Chapel Hill), Dr. Muhammad Walji (Associate Dean for Technology Services & Informatics at the School of Dentistry, University of Texas Health Science Center at Houston), Dr. Damien Walmsley (ADEE) and Dr. David DuChene (OmicronHealth).

Please feel free to share your thoughts with us.

Chris, Khalil, Lynn and Heiko

Christopher H. Fox, DMD, DMSc Executive Director International & American Associations for Dental Research

Khalil Yazdi, PhD CIO in Residence, Cloud Services Program Development at Internet2

Lynn Johnson, PhD Professor of Dentistry, School of Dentistry Associate Dean for Faculty Affairs and Institutional Effectiveness Clinical Professor, School of Information The University of Michigan

Heiko Spallek, DMD, PhD, MSBA Associate Professor, Dental Public Health Associate Dean for Faculty Affairs Executive Director, Center for Informatics in Oral Health Translational Research School of Dental Medicine, University of Pittsburgh

Big Data for Oral Health Knowledge: Toward a Complete and Sustainable Learning Health System

The preparations for the Big Data for Oral Health Knowledge; How to get the Big Answers workshop scheduled for March 14, 2015 are progressing nicely.

On January 23, 2015, I had the pleasure to attend Dr. Chuck Friedman’s talk “Toward a Complete and Sustainable Learning Health System” at the University of Pittsburgh. Chuck is the Josiah Macy Jr. Professor of Medical Education and Chair of the Department of Learning Health Sciences at the University of Michigan, he held executive positions at the Office of the National Coordinator for Health IT in the U.S. Department of Health and Human Services, including as the Deputy National Coordinator and as Chief Scientific Officer and is the former associate director for research informatics and information technology of the National Heart, Lung and Blood Institute at the NIH. At Pitt, he had served as associate vice chancellor for biomedical informatics and founding director of the Center for Biomedical Informatics.

Chuck outlined his vision about the Learning Health System (LHS), a system that can continuously and routinely study and improve itself. He pointed out that there is growing recognition that the nation requires an LHS to provide higher quality, safer, and more affordable health care–and to empower biomedical research and public health. The LHS is an ultra large-scale information infrastructure, effectively a smart grid for health that aggregates data from disparate sources, convert the data to knowledge, and disseminate that knowledge, in actionable forms, to everyone who can benefit from it. Reports from the Institute of Medicine, many journal articles, and current federal policies argue strongly for achievement of this “Big Hairy Audacious Goal” to improve individual and population health. I was amazed by his presentation that succinctly described the LHS concept, framing it as a consummate informatics challenge that invokes in equal parts people and technology. He also argued that the LHS must be viewed as an investment in infrastructure that includes, but transcends, the currently popular topic of “Big Data”.

Chuck is an excellent presenter who drew analogies between the LHS and the “moon shot” of the 1960s and the building the Panama Canal. The latter more akin to that of the LHS as it required, among several feats of engineering, the conquest of an infectious disease and creation of a new nation. Chuck concluded that solving the problems prerequisite to achieving an LHS may require a significantly new science of learning systems.

I am delighted that Chuck will present his vision of the LHS at our Workshop on March 14th stressing the imperative of the LHS and how it is currently envisioned, the features it requires to be effective and sustainable, and the key questions a science of learning systems must address. He also asks all Workshop participants to think about the following question: If we get the Big Answers from Big Data, how do we put them to use to ensure that they change practice and improve health?

We are excited that a few more invitees have accepted our invitation—again, just to drop a few names: Dr. David Clark (Behavioral and Social Sciences Research Branch, NIDCR), Dr. Ira Lamster (Professor, Department of Health Policy & Management, Dean Emeritus, College of Dental Medicine, Columbia University), Dr. Sheila Riggs (Director, Office of Community Engagement for Health, Clinical Translational Science Institute and Chair, Department of Primary Dental Care School of Dentistry, University of Minnesota) and Dr. Cecile Feldman (Dean, Rutgers School of Dental Medicine and ADEA President-Elect).

Please feel free to share your thoughts with us.

Chris, Khalil, Lynn and Heiko

Christopher H. Fox, DMD, DMSc Executive Director International & American Associations for Dental Research

Khalil Yazdi, PhD CIO in Residence, Cloud Services Program Development at Internet2

Lynn Johnson, PhD Professor of Dentistry, School of Dentistry Associate Dean for Faculty Affairs and Institutional Effectiveness Clinical Professor, School of Information The University of Michigan

Heiko Spallek, DMD, PhD, MSBA Associate Professor, Dental Public Health Associate Dean for Faculty Affairs Executive Director, Center for Informatics in Oral Health Translational Research School of Dental Medicine, University of Pittsburgh

COHRI BigMouth Dental Data Repository

During the 2014 ADEA Annual Session & Exhibition which was held in San Antonio, TX, I had a chance to talk to Dr. Muhammad Walji, Associate Professor at the Department of Diagnostic and Biomedical Sciences and Associate Dean for Technology Services & Informatics at the School of Dentistry, University of Texas Health Science Center at Houston. He explained the purpose and structure of the COHRI BigMouth Dental Data Repository which houses 1.2 million oral health records. Dr. Walji also described the data governance and what advantages faculty and students from participating schools can derive for their clinical research needs and outcomes analysis.

Please watch the interview:

If you are interested in learning more about BigMouth or how your institution can contribute please contact Dr. Muhammad Walji at the School of Dentistry, University of Texas Health Science Center at Houston.

Associate Dean, Office of Faculty Development and Information Management
Associate Professor, Dental Public Health, Center for Dental Informatics
School of Dental Medicine, University of Pittsburgh

Using the EHR for Educational Purposes

I just returned from the annual COHRI Winter Meeting which was held in Vancouver, Canada. During the meeting, I had a chance to talk to Dr. Gary Guest, Associate Dean for Patient Care, UTHSSA, Dental Clinics, San Antonio about his school’s approach for easing the transition of students from the pre-clinical to the clinical part of their education. In San Antonio, faculty attempt to use the Electronic Health Record (EHR) for distinct educational purposes in the simulation as well as in the patient care environment. Please watch the interview for a detailed description:

CU Heiko

Heiko Spallek, DMD, PhD, MSBA:
Associate Dean, Office of Faculty Affairs, School of Dental Medicine, University of Pittsburgh
Associate Professor, Dental Public Health, Center for Dental Informatics

Electronic Prescriptions in Today’s Health Care World

Most people today have accepted that storing patient information is transitioning from paper to electronic format (i.e., electronic health records (EHR) and electronic prescribing (eRx)). The University of Pittsburgh School of Dental Medicine uses eRx, increasing productivity and accessibility of patient information. Providers are able to share patient information more easily among each other and send eRxs directly to the patient’s pharmacy. The goal is to improve communication among the health care team and quality of health care delivery. This change is a shift towards the future in health care and will be beneficial for the school as well as for the patient.

Moving to a new format means that dental institutions will be confronted with new obstacles. An article came out this week by Westbrook et al. called “The safety of electronic prescribing: manifestations, mechanisms, and rates of system-related errors associated with two commercial systems in hospitals.” The study measures the rate of system-related prescribing errors in relation to the rate of preventable errors. The authors show that new types of errors specifically related to eRx have emerged, but no classification of eRx system-related errors exists. The authors are the first to analyze the rates and mechanisms affiliated with system-related eRx.

The study shows that 42% of prescribing errors are due to system-related errors. Among that percentage, 2.2% are serious mistakes. Despite this high percentage of system-related prescribing errors, the study shows that eRx prevents more prescribing errors than it creates. eRx efficiency is reduced due to system-related errors, but eRx still contributes to patient safety. Surprisingly, the most common system-related error was from the drop-down menu. As an intern in the Informatics Department, we create databases that use drop-down menus in order to reduce errors. For instance, people cannot add wrong information (such as a department name) if that information does not exist.

The next step in the eRx transitioning process will be to train users to properly use the system and to identify and report errors. Recognizing and fixing errors are key components to helping the efficiency and effectiveness of eRx. Overall, the shift to electronic format including eRx is beneficial to the University and patients alike.

Gabriella Basha

MS, Intern at the Center for Dental Informatics

Learning how to be a Chief Information Officer (CIO) in dentistry: A new online course

Just in time for the holidays, I decided to write what will be my last blog post for the year. In late January/early February, we plan to release an online continuing dental education course on information technology in dentistry. It essentially teaches you how to be the “Chief Information Officer” in a dental care delivery setting.

The course is formally titled Introduction to Health Information Technology in Dentistry and the product of two years of work by the Center for Dental Informatics. Here are the short stats:

  • designed as a full-semester, 3-credit graduate course
  • 15 sessions, each of which takes about 3 hours to complete
  • expected to award about 50-60 continuing dental education credits
  • priced at prevailing rates

So, why are we offering this course? Successfully implementing and using health information technology (HIT) requires more than just knowledge about technology. It is, essentially, a complex, socio-technical challenge. Therefore, the course delivers solid technical knowledge about informatics, as well as leadership and management skills. The course is not designed to make participants into experts in everything “technology.” Rather, it delivers a strong technology- and management-focused package to help them succeed at implementing electronic dental records (EDR) and other technologies.

The course has two main objectives. It will participants:

  1. use information systems for managing dental data and supporting clinical decision making in the context of the dental care and office workflow; and
  2. plan, evaluate technology for, administer and manage information technology implementations in dentistry.

Our premise for the course is that participants are not simply interested in becoming consumers of a fully implemented information system, but intend to acquire a deeper background for the “why” and “how” of HIT implementation in dentistry. By doing so, they will become “educated consumers” of HIT and will be able to optimize how HIT contributes to achieving their goals. Successful completion of the course will make participants competent to lead and/or substantially contribute to applying HIT to dentistry successfully in a variety of clinical care settings.

The course modules include (subject to finalization): Course introduction and overview; Dental care workflow and analysis; Overview of electronic dental records; Dental data and their representation; Controlled vocabularies, terminologies and ontologies; User-centered design methods for EDRs; Practical information design; Supporting clinical decision making with computers; Failures in Health Information Technology (HIT); Planning and implementing IT in dental practice; Requirements analysis and technology evaluation; Managing HR for IT; Introduction to hardware and software; Privacy, confidentiality and security; and a Course review session.

So, who is the course targeted at? Three main audiences:

  1. Dentists: Dental personnel will benefit from the course through a comprehensive overview of health information technology use and implementation in dental practice. A key focus of the course is how information technology can help improve patient care and support the clinical activities of the dental team. As leaders of the dental team, dentists will gain a particular understanding of how the office workflow relates to requirements for IT systems, and how to best plan and select products for, as well as manage, implementation.
  2. Dental auxiliary personnel: Auxiliary personnel often play a key role in the success of HIT systems because they are the most frequent users. Dental hygienists and assistants will mostly benefit from an understanding of system functions and usability in light of the daily use of IT applications.
  3. Non-dentists, such as information technology support personnel and consultants: Non-dental personnel will gain a basic understanding of how dental offices work and how IT can be used to support its operations.

Did this description get you mildly interested? If so, check out our marketing video:

Last but not least, you probably want to know who is teaching the course:

  • Titus Schleyer, DMD, PhD, Assoc. Professor and Director, Center for Dental Informatics
  • Thankam P. Thyvalikakath, DMD, PhD, Assistant Professor, Center for Dental Informatics
  • Heiko Spallek, DMD, PhD, MSBA, Associate Professor, Dental Public Health, Center for Dental Informatics
  • Richard A. Oldham, DDS, Graduate Student, Department of Biomedical Informatics
  • Corey Stein, BSc, Graduate Student, Department of Biomedical Informatics

There are a limited number of slots available in the course. If you’re interested, please e-mail me at

With my best wishes for Happy Holidays!


P.S. This course is not an in-depth tutorial on the functions of particular practice management or EDR systems. Rather, it uses practical examples from these systems to highlight important theoretical concepts relevant to health information technology in dentistry.

– Titus Schleyer, DMD, PhD

Assoc. Professor and Director, Center for Dental Informatics

Henry Schein buys Exan Group … and what that means for the dental software industry

Some of you may have noticed the recent press release about Henry Schein acquiring a majority interest in the Exan Group. Exan develops and markets axiUm, the practice management and electronic dental record system in use at about 45 dental schools in the US. Henry Schein, on the other hand, owns Dentrix, with about 40% of the market the leader in the same product space, mainly in private practice. Henry Schein is no stranger to acquisitions, having grown its software and technology portfolio over the years essentially by buying other companies. Acquiring Dentrix in 1997 proved a particularly strategic move. Over the years, Dentrix has become one of the crown jewels in the Henry Schein holdings. Exan was started about 25 years ago and has business segments in dental schools, large group practices, private practice, and hygiene schools and programs. Over the past 15 years, it has grown into the dominant vendor of electronic dental record software (EDR) for dental schools.

I was not aware of this impending partnership, but it is nevertheless interesting to think about how it could affect the dental software industry, specifically the segment focused on dental schools:

  • With the purchase of Exan, Schein “owns” the dental school market overnight. While there are some other software offerings suitable for and in use in some dental schools, the barrier to entry in the dental school market has always been very high. Now, it is higher. The number of customers in the US is simply not large enough to realize superior returns, unless you are close to a monopoly position. From a business perspective, Exan is now even more entrenched in that market than before.
  • Exan’s enterprise product portfolio, including axiUm, complements Dentrix’s enterprise offerings quite well. Over the last decade or so, Dentrix has significantly strengthened its software offerings for large dental care settings. Having “a leg” in the dental school market rounds out Dentrix’s presence in that space (large group practices and the Indian Health Service being some other examples). Clearly, Schein sees potential for growth, both in the US as well as internationally.
  • In terms of product innovation, I am hoping that some of the more recent improvements in usability, software architecture and other aspects in Dentrix products carry over to the Exan product line. In talking to axiUm users both at our dental school as well as across the country, it is obvious that usability is not one of the application’s strong suits. My weekly experience in using the product with students routinely exposes usability and workflow design flaws, both minor and major. Dentrix, on the other hand, has made an effort in improving usability across the board in recent years, which will be especially evident in upcoming products.
  • I’m hoping that positive changes in software engineering and change management will follow. axiUm is largely a robust product, but it is also very complex. In consequence, implementing even minor version upgrades is no trivial undertaking. I cannot tell you how many times database changes in axiUm that were either poorly or not at all documented broke existing functionality, especially reports, at our school. Other schools are no exception.
  • One very positive result of this partnership should be increasing clout for dentistry with respect to the HITECH Act and Meaningful Use regulations. As many of you know, dentistry and many other healthcare providers were not really written into the original HITECH legislation. However, both Schein and axiUm have Meaningful Use-certified products which are now being implemented according to the CMS’s EHR Incentive Program. This will enable dental schools as well as other dental care providers to participate in the Medicare/Medicaid incentives for electronic health record adoption. This should make dentistry more a player in how electronic health records are used in general in the future.
  • I also see some potential for informatics innovation diffusing from dental schools to Dentrix. Quite a few dental schools, many of them part of the Consortium for Oral Health Research and Informatics, are experimenting with diagnostic codes, standardized medical history forms, risk assessment and quality assurance. These are welcome developments since they are focused on how we can use electronic data to improve oral health, not on how we document care so we can bill and don’t get sued. In talking to Pam Reece, the Director of Enterprise and Specialty Solutions at Schein, the other day, I learned that the company is working on a caries risk assessment module for Dentrix Enterprise. If so, it might be a great opportunity may be to translate some of the academic advancements in this domain to broader practice.
  • I am not quite sure how this move will affect the growing call for integrating medical and dental data, which my colleagues made so eloquently in their new book. (Rumor has it that a second edition of this book is in preparation.) Clearly, there is a strong move in the country towards interoperability of health records, health information exchanges, and looking at care in a more holistic fashion than we have done to date. It would be interesting to see what Schein’s/Exan’s plans are for connecting to the electronic medical record industry at large.
  • Last, I have always wished for a closer connection between the EDR systems that dental students use in school and what they will encounter in practice. Well, it looks like I got my wish! Time will tell how Schein leverages its new position in dental schools with regard to marketing to graduates.

I’m going to stop here since this blog post has been going on for too long already ;-). I’d be interested in hearing your thoughts on this new development.



P.S. Disclosure: I don’t have any formal or contractual relationship with either company mentioned in this blog post.

– Titus Schleyer, DMD, PhD

Assoc. Professor and Director, Center for Dental Informatics



A new OHSU training program: NIDCR-Supported Informatics Fellowship

The Oregon Health & Science University (OHSU) Department of Medical Informatics and Clinical Epidemiology and School of Dentistry are pleased to announce fully funded training grants for individuals interested in pursuing oral health, dental, and/or craniofacial related informatics research.

  • Supported by a National Institute of Dental and Craniofacial Research (NIDCR) Training Grant
  • Training programs for those with clinical or research backgrounds
    • Post-Doctoral Fellowship with Master’s degree
    • Pre-Doctoral training leading to  PhD
    • A new addition to a well-established OHSU Biomedical Informatics training program funded by the National Library of  Medicine (NLM)

This program provides a structured research experience with the option of course work and/or pursuit of a degree. Our goal is to prepare the fellow/ trainee to enter the academic community and become an independent researcher, or to take leadership positions in the growing number academic and/or commercial efforts in oral health informatics. Start dates include Fall 2012, Winter 2013, or Fall 2013.

For admissions information contact:

Lauren Ludwig



Dental informatics rocks at the American Dental Education Association (ADEA) Annual Session in Orlando!

So, Thankam and I are currently driving from the American Dental Education Assocation (ADEA) Annual Session in Orlando to the Annual Meeting of the American Assocation of Dental Research (AADR). I wanted to take this time to tell you about what happened at the ADEA meeting with regard to dental informatics: In one short phrase, “Dental informatics rocked!”

To take a small step back, that was not always the case. I have been affiliated with what was then called the American Assocation of Dental Schools (AADS) (and is now ADEA) for over 20 years. During that time, I have watched dental informatics grow up from a concept that no one was familiar with into a domain that literally permeates all aspects of dental care, education and research.

Ample proof of that are the dental informatics events at the ADEA meeting that is coming to a close. There was a series of presentations on “Data Mining From Electronic Patient Records to Measure Patient and Student Outcomes,” 23 short talks on a variety of dental informatics topics, and the TechExpo, in which faculty and students demonstrated informatics applications hands-on. In addition, there were probably over 20 posters that focused on dental informatics either exclusively or partially, as well as quite a few exhibitors. 

The dental informatics topics at the meeting were as varied as they were interesting. In the data mining session, Muhammad Walji talked about his work on merging the EDR databases of four dental schools into a virtual data warehouse for research. Rachel Ramoni discussed how targeted selection can help identify patients with adverse dental outcomes better than traditional methods. I spoke about our work on data mining of EDRs in private practice to support outcomes, epidemiology and comparative effectiveness research, funded by an NIH grant

In the short talks, we learned about educational applications, such as online courses in dental hygiene, a visuo-audio-haptic system for training in dental caries detection, and an electronic portfolio for enhancing learning in pre-doctoral pediatric dentistry, as well as many other topics.

The TechExpo was a smorgasboard of applications, such as “A Picture Is Worth a Thousand Words: Dental Images Media Library,” “Augmented Reality in Dental Education: An Innovative Approach to 3-D Visualization,” “Dental Histology Online: Creating a Virtual Microscopy Lab to Engage Students in Interactive Computer-Assisted Instruction,” “Engaging Predoctoral Dental Students in State-of-the Art CAD/CAM Technology Through the Use of the Blue Cam” and “Using the iPad 2 to Become an Engaging Educator and More Effective Researcher.”

All in all, it was an energizing experience to see dental informatics research and development thriving at ADEA. As we would say in Germany: “Weiter so!”

All the best and keep in touch!


Titus Schleyer, DMD, PhD
Assoc. Professor and Director, Center for Dental Informatics