University of Pittsburgh School of Dental Medicine Dr. Heiko Spallek Center for Dental Informatics

1. University of Pittsburgh School of Dental MedicineDr. Heiko SpallekCenter for Dental Informatics

2. Dental Informatics Strategic Plan Comprehensive IT Infrastructure • Patient Care • Education • Research • Administration

3. $ For each area • Current Status • Plan • Level 1 • Level 2 • Level 3 $$ $$$

4. Patient Care • 2000: Installation of QSI* Dental Systems (predoctoral clinics) • Main areas of a clinical management system: • Patient demographics & billing area: OK • Clinical record area: none • Student progress monitoring & grading area: none • Installation uses outdated technology: • CDA requirement 2-24: “Graduates should be competent in the use of information technology resources in contemporary dental practice.” • *Quality Systems, Inc., Irvine, CA Status

5. Patient Care Plan • The paperless school! • Comprehensive multi-year effort • Different levels of IT sophistication in the 3 areas of a clinical information system

6. Patient Care • Level 1: • Keep QSI Dental Systems, but upgrade; or • Implement new system • Level 2: • Integrate our system with the UPMC hospital system • Share demographic data across healthcare providers (LHII), e.g. medical and medication history • Optional Patient Portal Layer: • Electronic scheduling and confirmation for patients • Complete electronic submission of pre-registration information • Review of account history and payment by credit card Patient Demographics and Billing

7. Patient Care • Level 1: • Complement QSI with QSI's Clinical Product Suite (CPS) • Limited diagnostic and treatment charting • 1 clinical computer workstation for 6 dental units • Level 2: • Chairside computing during patient care • Clinical findings, treatment plan, progress notes • 1 clinical computer workstation for 1 dental unit • Level 3: • More advanced clinical applications, such as imaging • Semi- or automatic recording of clinical findings • dental units with integrated computing capabilities Clinical System

8. Patient Care • Optional CAD/CAM Layer • 1-2 CAD/CAM systems • Optional Imaging Layer • Only for levels 2 and 3: • Digital cameras • Intra-oral cameras • Digital radiography Clinical System

9. Patient Care • Imaging: • Transition to digital to be implemented in phases • Competing technologies: selection based on diagnostic task and imaging volume for each area • Mostly centralized imaging for QA purposes Radiology: Digital Imaging

10. Patient Care Radiology: Digital Imaging • Capture technology to be implemented: • Radiology: combination of CCD/CMOS and SP (FMS, extra-oral): bulk of imagingSelected PAs/BWs only • Endodontics: CCD/CMOS – in each graduate cubicle • Implant clinic, urgent care, all graduate clinics, CCP clinics, pediatric dentistry, anesthesia, AEGD: CCD/CMOS

11. Patient Care Radiology: Digital Imaging • Cone Beam CT Unit: • Implant surgical treatment planning • TMJ studies, evaluation of osseous pathology • Endodontic, and apical surgery treatment planning • Orthodontic treatment planning • Pre-surgery planning: orthognathic surgery, other corrective (clefts/defect repair/reconstruction) procedures • Localization of critical anatomy (removal of impacted teeth) OSA, tongue posture & volume, tonsils, mastoid area • Evaluate nasal septum, turbinates, maxillary sinuses, upper airway

12. Patient Care Radiology: Digital Imaging • Phase 1: • Facilities modification: to continue through phase 4 • Dedicated maxillofacial cone beam CT unit in radiology; networked with oral surgery • One digital extra-oral, and intra-oral imaging unit in radiology - for patients referred from OMS • Students rotated, exposed to technology, and trained

13. Patient Care Radiology: Digital Imaging • Phase 2: • Orthodontics for extra-oral imaging only • Endodontic graduate clinic area to use intra-oral units

14. Patient Care Radiology: Digital Imaging • Phase 3: • Full implementation of an EPR (Electronic Patient Record) as network ports, viewing stations in each operatory/cubicle • Other graduate student clinics to be included

15. Patient Care Radiology: Digital Imaging • Phase 4: • Operators school-wide will have been trained in EPR use • Extensive training of first professional students, all remaining staff, faculty in digital radiology equipment and software • Most time-consuming and labor-intensive phase

16. Patient Care • Level 1: • Keep QSI Dental Systems, but augment with a customized version with grading module • Level 2: • Only for clinical system levels 2 and 3 • Students enter completed procedures • All entries are approved and graded by instructors • Students accumulate credits and grades toward clinical progression Students’ Progress and Grading

17. Patient Care Implementation

18. Education • Limited educational technology • Some syllabi and course materials available through intranet • CDA requirement 2-10: “…school must have a curriculum management plan to avoid, for instance, unwarranted repetition...” Status

19. Education • Level 1: • Presentation of learning material • Exploit new intranet • Electronic curriculum management tool • Automatic matching between lectures to find repetition and opportunities for integration • Level 2: • Development of educational software • Innovative and effective teaching tools Plan

20. Research • Rapidly growing area • Use of IT and informatics: often a core review criterion • Funding for required computing support through individual projects • Overburdened research staff: grant submission process and post-award administration • Limited involvement of students Status

21. Research • Level 1: • Integration of research into clinic • Implementation of a clinical information system • Researchers query patient data for epidemiology studies, identification of study subjects • Level 2: • Integration of the research process into the workflow of the clinical operation • Upon patient enrollment: alerts about study eligibility • Facilitate the enforcement of research protocols Clinical Research

22. Research • Level 1: • NIH: electronic grant submission • Centrally maintained information store for NIH biosketches • Reduction of overhead for the research staff • Level 2: • Easy access to the salary and benefit information • Efficient development of budget overviews • Use of intranet to • Identify researchers with matching research interests • Facilitate student involvement in faculty research Grant Submissions

23. Research • Level 1: • State-of-the-art collaborative work environment, e.g. Groove* • More research projects: group effort • Integration into office environment and research-specific workflow • Facilitates real-time data sharing, common scheduling, seamless project management • Level 2: • Site license for collaborative work environment, e.g. Groove University Department Kit • *Groove Networks, Inc., Beverly, MA Collaborative Research

24. Research • Level 1: • Centralized post-award management process • Deployment of electronic means to manage this process Post-award Administration

25. Research • Application Development/Database Support: • Point to existing expertise and resources • Maintain central personnel and infrastructure resources • Designate 1 FTE for research projects: 50% funded through school • Informational/PR Needs: • Distribution of time-sensitive information • Research opportunities • Newly funded awards • New NIH regulations and policies Personnel and PR

26. Research • Research Funding: • Since inception: $777,485 • Submitted: $3,042,511 • Plan: • Maintain leadership in the field • Add 2 additional faculty positions (1½ financed through soft money) • Add 1 applied informatician (for clinical information system) • Add 1 full-time administrative assistant financed through school Dental Informatics

27. Five members of the Executive Committee (EC) are in favor of implemeting a laptop program in the school, requiring all students to purchase a laptop upon admission. Five other members of the EC are in favor of deploying computer workstations throughout the building instead of requiring students to purchase laptops. Collect 5 strong pro and 5 con arguments for each proposal (total of 20 arguments). Be prepared to defend your arguments! In-class assignment

28. Administration • Intranet not yet utilized to fulfill its potential • Web site missing some functionality • Common problems affecting productivity • Servers hardware and facility upgrades • Resolution and response time improved through streamlining IT requests • No software asset inventory Status

29. Administration • Software upgrades and maintenance • Hardware upgrades and new systems • Server room climate control and status monitoring • Network ports and security • Multiple databases and excel documents will continue to be consolidated into database server to eliminate redundant data Core Components

30. Administration • Intranet deployment and development • Improve current utilization • Improve the functionality of current features • Develop new features • User identification and authentication • Biometric finger print authentication • Establish an enterprise-level spyware protection Productivity Enhancements

31. Administration • Delegate 10% effort of dental informatics faculty to manage a comprehensive training plan • Identify IT competencies necessary for each job • Provide qualified trainers, facilities, and courses • Encourage one-to-one training through a mentoring program • Utilize University resources Training

32. Administration • Enhancing the site through improving the look and functionality • Continuing education online registration • Online registration integrated with student and course administration Web Site

33. Administration • New administrative/junior technical phone support position that will: • Provide administrative functions, such as purchasing • Provide full-time phone service • Maintain software and hardware asset inventory • Track the status of purchase and help requests • Locate IT service to the 3rd floor of Salk Hall • Establish regular customer service surveys • Provide periodic analysis to measure affectivity • Establish a system for feedback from users • Continue to utilize the POC group feedback Support Infrastructure