UCSF Looks to EHR Integration of Dental Records for Patient-Centered Care

Dental care is about more than polished, pearly whites; it is part of overall patient health, so EHR integration of dental records is crucial. In fact, it could be the next step to actualizing patient-centered care.

While research has found significant links between oral health and overall health in recent decades, EHR data and electronic dental records (EDRs) remain largely siloed across the country.

According to Michael Reddy, DMD, DMSc, dean of the UCSF School of Dentistry, it’s time for that integration to happen.

"For years, some of us have gotten lots of money from NIH to research oral health association with other aspects of health," Reddy told EHRIntelligence in an interview. "Now it's time to take it out of the clinical trial and move on to patients who will start to benefit."

Studies have revealed that oral health impacts a wide range of conditions. For instance, research suggests that heart disease, clogged arteries, and stroke might be linked to the inflammation and infections that oral bacteria can cause. Additionally, studies have found that people who have gum disease have a harder time controlling their blood sugar levels.

Reddy noted that knowing a patient's complete health history is key to patient safety in dental settings.

However, patients may not always remember, or even know, to tell their dental providers details about their health. Patients may not understand the significance of certain conditions they have. For example, dentists should be aware of conditions like diabetes that impact gum disease and healing.

Additionally, patients may not know the impact the medications they are on can have on their dental care.

Certain prescription drugs may impact post-operative dental care instructions or can influence dental treatment decisions, according to the American Dental Association (ADA). For instance, dentists must follow specific guidelines when performing tooth extractions on patients that take oral anticoagulants to prevent blood loss.

"When patients come to see me, some of them say, 'I take something for blood pressure and something for anxiety,'" Reddy said. "That's not very helpful for me."

While health information is key for dental care, disparate record systems present distinct challenges. A study published in Frontiers in Digital Health found that it typically takes healthcare organizations a week or more to deliver patient EHR data to dental providers.

But in December 2022, UCSF Health and UCSF Dentistry became the first academic health system in the Western half of the US to merge medical and oral health records into a single EHR system.

Integrating the records is set to streamline care coordination by providing UCSF dentists access to complete patient health histories, including medications, at the point of care.

"Integrating medical and dental records allows access to the patient's whole health history, which improves the diagnosis and treatment of patients and can improve the communication between medical specialties," said Reddy, who also serves as associate vice chancellor of Oral Health Affairs at UCSF.

Integrating medical and dental records at UCSF will allow dental providers access to patient health records instantly at the point of care. Similarly, healthcare providers will have access to patient dental records.

Reddy noted that the integration will help providers better monitor chronic diseases and prevent gaps in care.

"We may capture your blood pressure or height and weight multiple other times besides your physical, and that's now data that the medical side can use," he explained.

Additionally, patients will benefit by having access to their health and dental information in one place.

Further, Reddy said that the integration should help signal to patients that dental care is part of their overall health.

"People often think of dentistry in the prevention sense and the cosmetic sense," Reddy said. "They really haven't thought about how this is important for health and longevity also."

In addition to supporting patient-centered care, the integration is a key step in supporting collaboration and innovation among UCSF's clinical, teaching, and research programs, he noted.

"Part of being a learning health system is teaching the next generation to improve patient care," Reddy emphasized. "All six of UC's medical centers are on Epic, so now we can go ahead and pool the data and see that some problem is associated with an overall condition, which gives visibility to do deeper data analysis. With large-scale patient observation, you can do large-scale sophisticated studies."

UCSF should have complete integration of medical and dental records within a year.

"We have some patients who are already in UCSF Health's system, and some only have their dental care with us," Reddy noted. "We have to bring those together, which takes a little bit longer."

He anticipates that other academic health centers across the country will follow UCSF's lead and integrate dental and healthcare records.

"I think it's going to move fairly quickly over the next five years," Reddy projected.