Orthodontic Informatics

Orthodontic Informatics

Data, Imaging, and Standards in Orthodontic Practice

Module 1
Data Sharing, Integration, and Transition in Orthodontic Informatics

toni magni, BME - afm@case.edu

Most Used Tool

What is arguably the most used tool by the orthodontist and their staff?
IMHO: Computers

Why?

Initial contact: Social Media, Website
Check in: Patient Management Software
Diagnosis: Digital Imaging Devices, Intraoral Scanners, etc.
Treatment Planning: Digital Planning, Clincheck, etc.
Treatment: Bracket Placement, Aligner Placement, etc.
Appliances: 3D Printing, Wire bending, etc.
Payment: Payment Processing Software, Insurance claims, Online banking, etc.

The Clinical Informatics Paradox

Medical students are trained extensively to use the tools essential for their profession.
Computers are now amongst the most utilized tools by doctors in clinical practice.
Clinical informatics is the domain that teaches the effective and safe use of computers in healthcare.

The Clinical Informatics Paradox

Medical education should logically include substantial training in clinical informatics.
Such training is largely absent from most medical school curricula.
Paradox: If clinical informatics is essential for modern medical practice and medical education is meant to prepare doctors for their work, where are all the clinical informatics classes?

The Clinical Informatics Paradox

Over just a few decades, technology became ingrained in our professions
Like osmosis, it seeped into all aspects of our lives, making it hard to notice
Pliers, wires and brackets are not used in everyday, non-clinical life, but computers are.
But computers are used very differently in clinical practice than in everyday life.

What are the Problems?

Screen capture of the Dental monitoring website dentalmonitoring.com showing their solutions: DentalMonitoring, SmileMate and DM Insights

Screen capture of the main landing page of the Dental monitoring website dentalmonitoring.com

What are the Problems?

Screen capture of the iTero website itero.com showing their solutions: iTero Element Plus Series, iTero Element 5D and iTero Element 2.

Problem 1

Sharing Data

The cartoon depicts a humorous and exaggerated scene of two people in white coats, presumably medical professionals or researchers, working at desks. They each have a computer monitor, and their desks are side by side. One medical provider leans dramatically over their desk and through their own monitor, reaching into the screen of the other providers's computer. The other doctor tries to do the same, stretching in an attempt to see the screen of their colleague. The scene suggests a struggle trying to align or synchronize something on their screens, indicating difficulties with compatibility or communication between systems or devices. The overall tone is playful and illustrates a humorous take on a technical or interoperability challenge.

Sharing Data

Humans

What's wrong with sharing data this way?

A person in a blue shirt is taking a photo of a dental X-ray displayed on a laptop screen using their smartphone. The image on the phone shows the X-ray they captured on the phone's photos app. A cup of tea and a name tag are visible on the desk beside the laptop.

Sharing Data

Collaborators

What's wrong with sharing data this way?

Efficiency: procedure is extremely inefficient
Security: clinical data on device not controlled by medical institution, maintainer of the data.
Privacy: some friend of family member might look at your phone and find sensitive data they are not supposed to see, while simply scrolling through photos.
Accuracy: procedure is error prone, it is very easy to send the wrong patient to the wrong person.

Sharing Data

Patients

Awareness of data ownership is growing and governments are adding regulations (21st Century Cures Act, Information Blocking, GDPR)
How? Doctors don't know how to give patients their data.
Lawsuits will probably come soon.

Just like there are patients who try to make money by catching medical providers make clinical mistakes, there will soon be more and more patients doing the same with how clinical data is handled.
Example of Lisy: patient wanted to sew for incorrect dosage of radiopharmaceutical. However, hospital was tracking everything, and patient couldn't go anywhere. But if patient would have accused the hospital of improper data handling, they would have scored without problems. It's like shooting blindfolded: you will hit someone, if everyone is doing it.

Sharing Data

Machine

This cartoon depicts a person in a dress and a doctor in a lab coat stand facing each other, holding two plugs that don't seem to fit together. They both have confused expressions, with question marks above their heads. In the background, on the doctor's side, a patient is reclining in a dental chair, while the person on the other side stands near an office desk with a computer. The scene humorously suggests a communication or compatibility issue between the two sides.

Sharing Data

Machine

How do i transition to a new system?

A long line of patients stands outside the dental department at the University of Illinois at Chicago (UIC). They are waiting on the sidewalk, with a nearby grassy area and trees, to re-register into the dental clinic's new practice management system. The queue formed because the new software company was unable to import basic demographic information, necessitating re-registration. A man in a blue shirt walks past the line, and several cars are parked along the adjacent road.

Patients waiting for their turn to re-register after the department switched from Windent to AxiUm.

This is one way of doing it: just re-enter all of the information by hand!
This doesn't feel like a very efficient way of using computers. Can you come up with a better way? How would you do it?
These are real world situation, guys: this is not hypothetical or imaginary problems. Whether you will own a practice, or will work with someone who does, eventually this practice will change their software. And you will have to deal with it.

Sharing Data

Machine

Data Sharing Wasted Resources

An illustration depicting a data conversion process. The diagram shows data being transformed from one format or structure to another, with arrows indicating the flow between different stages or steps of conversion. This could represent migrating data between software systems, such as converting patient records into a new format for compatibility with a new practice management system.

Sharing Data

Machine

Data Sharing Wasted Resources

A lot of time and resources spend for data conversion (import/export).
Data conversion is a tedious repetitive process: developers keep reverse engineering and don't share their work.

Problem 2

Work Ownership

Software should facilitate our work by processing data.
Sometimes possible to export raw, unprocessed data.
Almost never possible to transfer processed data (our work).

Problem 3

AI and Research

How do I crunch a lot of data?

Front pages of three scientific journals: Orthodontics & Craniofacial Resarch, American Journal of Orthodontics and Dentofacial Orthopedics and Journal of Orthodontics.

Problem 3

AI and Research

How do I crunch a lot of data?

Today's research is embarrassingly based on a tiny fraction of our population (< 100 patients)
A large fraction of orthodontic patient data is siloed behind the local network of the orthodontic practice, and their closed orthodontic software.

Problem 3

AI and Research

How do I crunch a lot of data?

We have the technology (AI, Big Data, Cloud, High Speed Internet) make all this data accessible to research.
This could potentially bump up sample size by at least 2-3 orders of magnitude.

Clinical Data Types

Raw Data: Data that is collected from the patient and stored unalterated.
Derived Data: Data that has been enahnced for easier interpretation.
Clinical Work Product: intellectual, analytical, and manual output created by clinicians during their interaction with patient data.

Current interoperability Status

Raw Data: Limited to some radiographic software.
Derived Data: Limited, or proprietary.
Clinical Work Product: Virtually inexistent.