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Dentistry in the cloud: Molding electronic health records to research and education

Children receive comprehensive dental care at a University of North Carolina pediatric dental clinic. Image courtesy UNC School of Dentistry.

Facing little competition, software vendors that control a major market share often grow comfortable dictating standards, in spite of consumer needs. Higher education, in particular, struggles with this kind of one-size-fits-all model. In a clinical setting, how can dental students effectively record patient details and case specifics when the electronic record does not meet their needs, faculty's needs, or the needs of the clinic?

Building a custom electronic health record from the ground up takes time and considerable resources. It places the dental school in the position of having to become (or hire) experts in software development, which is an expensive proposition. It's a hard sell when resources are limited and technology evolves quickly.

Aside from a custom alternative, an individual dental school or clinic had slim hopes of finding a solution to meet their particular needs … until now. "We realized there was power in numbers," says Lynn Johnson, professor of dentistry and associate dean for faculty affairs and institutional effectiveness at the University of Michigan, US. Johnson, together with experts at the University of North Carolina (UNC), US, and the University of Pittsburgh in Pennsylvania, US, have partnered with Internet2 and Canada-based ICE Health Systems to develop a cloud-based electronic health record for dental education.

The collaborators, Johnson says, had little interest in pursuing another client server solution. "ICE understands both the education and research missions the system must support," she notes, "and is eager to work with Internet2 to ensure that companion products are compatible with the system."

One of ICE's first priorities is ensuring the system is fully compliant with US Health Insurance Portability and Accountability (HIPAA) and HITECH Act and other security standards. Federal regulations are as stringent for cloud solutions as they are for client servers, but the collaboration benefits significantly from Internet2's role in developing the CCM (cloud control matrix) security standard with the Cloud Security Alliance.

In addition, ICE is having a third party auditor review their policies, procedures, and practices. This is a crucial step for universities that are not comfortable letting individual schools make decisions around security. "There's a series of security standards in the world - the ISO/IEC 27000 series - that these third-party companies will audit against,"explains Johnson. "This is different from the client server world where the burden of security is on the school of the university, and not the service provider. In the cloud, the service provider needs to prove that all aspects of their service is secure."

Sample patient record and ICE interface. Image courtesy Lynn Johnson and University of Michigan School of Dentistry.

The most considerable hurdle, however, is not likely to be security. "It's going to be figuring out ways to standardize and structure the data so we can share it securely, to advance healthcare and accelerate health research faster," says Johnson. "17 years is the average timespan for actually applying research findings to patient care. We need to cut that in half, at least, if not more."

The collaboration's ultimate goal is matching patient records with research findings to provide the best point-in-time advice for patients. "Combining real patient data with the literature - no matter where the data or literature resides - that's the real nut to crack," emphasizes Johnson.

This is where Internet2's expertise comes into play. "Internet2 provides a mechanism by which a variety of companies' products can work together for the benefit of universities and health systems," says Johnson. "Internet2 helps us find the best products for each of our needs and ensures that they work together. Now we can go out and find the best drug database, for example, or the best appointment reminder system - and have them work with ICE. The power of this collaboration is unprecedented."

Testing is already underway at the three universities, and the first pilot will take place this January at a UNC pro-bono, student clinic. This will provide another opportunity to validate functions, testing what works and what doesn't against the collaboration's development priorities. Once issues are addressed, they'll turn their focus to business operations and fully transitioning to the new system.

Because Internet2 has such a broad base of universities to collaborate with, vendors are recognizing that it's not economically feasible to work with one university and then create all new efforts with another. "And it's not just software or product availability," adds Johnson, "the real potential lays in Internet2's ability to work with universities to not only source the best of the best products, but also to make those products work together."

By making ICE available via Internet2's Net+ services, the collaboration is broadening the benefits to every school that partners with Internet2. In turn, this could positively impact the 17-year gap between research findings and clinical applications, which will ultimately benefit patient care.

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