Could Dentist Participation in HIE Unlock Patient-Centered Care?

For Morgan Honea, CEO of CORHIO (a Contexture organization), the value of interoperability between healthcare and dental settings revealed itself during his earlier career running federally qualified health centers (FQHCs).

"I've spent most of my career integrating primary, oral, and behavioral healthcare in a service delivery setting," Honea told EHRIntelligence in an interview. "There are so many medical conditions that impact oral health and vice versa that creating better interoperability and insight into a whole patient's health is critical."

Now, a partnership between Colorado Dental Association (CDA) and CORHIO will explore how data sharing between dentists and healthcare providers could advance patient-centered care delivery. Dental care providers who enroll in the pilot program join CORHIO's HIE and save the implementation fee of $10,000, plus receive two months' service.

Greg Hill, executive director and CEO of CDA, noted that historically, dentistry has been entirely separate from primary care, similar to optometry. 

"Dentistry has got to be brought into that system," Hill said. "The mouth is a large portal into the body and a way in which disease gets into the body. It's been a relatively recent realization that the two systems are much more integrated and need to be thought of in a coalesced environment, so the policies and payments and things like that are catching up to that realization."

Due to a lack of data sharing between healthcare and dental providers, it is often up to patients to share personal health information with their dentist.

However, Hill noted that patients may not always remember, or even know, to tell their dental providers details about their health, which can lead to significant patient safety risks. Patients may not know the significance of certain conditions they have, or they may not understand the impact of the medications they are on.

For example, Honea said an elderly patient came into an FQHC for a tooth extraction one day. Once the procedure began, the patient started having severe blood loss because the staff did not know he was on blood thinners. The patient had to be transported from the clinic to the Denver metro area to get the bleeding under control.

"That's where HIE is a perfect use case for connecting oral health and medical health," Honea said.
"Quite frankly, a lot of times, if you have to rely on just the patient to identify those important risk factors, you may not get everything you need, which can lead to some really unfortunate outcomes."

Hill pointed out that it doesn't have to be an extreme example for health information exchange to be of value. For instance, dentists should be aware of conditions that impact gum disease and healing, such as diabetes.  

Hill said that PCPs will also benefit from dentists joining the HIE.

"Dentists can document conditions they may diagnose as part of the patient screening process back into the HIE system for healthcare providers to access," Hill said.

He noted that overall, the majority of healthcare contacts are with your dentist, as most patients go to a dentist twice a year.

"It's a great opportunity for the dentist not just to pull down the information so that they can better treat the patient, but also add back things into that healthcare record that might be beneficial on the flip side to the primary care provider," Hill said.

Enhanced data sharing between PCPs and dentists can also help support value-based care delivery models, Honea said.

"The financing system has really just perpetuated the disconnect between the rest of the healthcare ecosystem and oral health," Honea pointed out.

"When we talk about alternate payment models and the value of data sharing for supporting those types of models, I think that historically, there's been a lot of conversation about the importance of further integrating primary care and behavioral healthcare, but for all practical purposes, oral healthcare has not been central to the conversation," he explained.

The pilot program aims to connect with various dental care providers to provide feedback on how HIE can be most helpful in a dental practice.

"There are multiple practice models and specialties, and the way in which each of these may interact with this system may be a little bit different," Hill explained.

Hill also emphasized that he hopes the pilot will help develop champions around the program to communicate with the larger dental community what they've been able to utilize this for and how it's helped them.

"I think having those champions using the system will help increase utilization across the state and across our membership," Hill said.