Center for Dental Informatics University of Pittsburgh School of Dental Medicine 1 of 20 Research and informatics: What are the challenges? Titus Schleyer, DMD, PhD Bill Bartling, DMD University of Pittsburgh John Zimmerman, DDS Columbia University Grand Tetons, Wyoming, 10/2001

Center for Dental Informatics University of Pittsburgh School of Dental Medicine 2 of 20 Symposium goals help participants understand the research discipline biomedical informatics illustrate informatics research with practical and methodological examples help participants discover potential informatics research questions in their projects explore how informatics can help in solving dental research questions

Center for Dental Informatics University of Pittsburgh School of Dental Medicine 3 of 20 This is only the overture, … … the opera is: invitation-only conference, 6/12+13, 2003 at the NIH

Titus Schleyer, DMD, PhD Center for Dental Informatics University of Pittsburgh School of Dental Medicine Natchez State Park, Mississippi, 11//2001 Biomedical informatics: An overview

Center for Dental Informatics University of Pittsburgh School of Dental Medicine 5 of 20 Pop quiz! “Ceterum censeo Carthaginem esse delendam.” Who said it, when, and why?

Center for Dental Informatics University of Pittsburgh School of Dental Medicine 6 of 20 informatics = information technology informatics = bioinformatics

Center for Dental Informatics University of Pittsburgh School of Dental Medicine 7 of 20 Dental informatics “Dental informatics is research in computer and information science to improve dental practice, research, education and management.”  primarily focused on research, development, and evaluation of information models and computing applications Schleyer, T, Spallek, H, Dental informatics: A cornerstone for dental practice. Journal of the American Dental Association 2001: 132 (May):

Center for Dental Informatics University of Pittsburgh School of Dental Medicine 8 of 20 Information technology (IT) “Information Technology (IT) is concerned with all aspects of managing and processing information.”  primarily focused on the implementation, application and support of computer technology and telecommunications

Center for Dental Informatics University of Pittsburgh School of Dental Medicine 9 of 20 Where is the science in biomedical informatics? Logan Pass, Glacier National Park, 9/2001

Center for Dental Informatics University of Pittsburgh School of Dental Medicine 10 of 20 Study of Effects Model Formulation models for acquisition, representation, processing, display or transmission of biomedical information or knowledge System Development developing innovative computer-based systems that deliver information or knowledge to end users System Installation installing such systems and then making them work reliably in real- world environments studying the effects of these systems on the reasoning and behavior of health care providers, organization(s) and process(es) Model Formulation models for acquisition, representation, processing, display or transmission of biomedical information or knowledge System Development developing innovative computer-based systems that deliver information or knowledge to end users System Installation installing such systems and then making them work reliably in real- world environments Study of Effects studying the effects of these systems on the reasoning and behavior of health care providers, organization(s) and process(es) Model Formulation models for acquisition, representation, processing, display or transmission of biomedical information or knowledge System Development developing innovative computer-based systems that deliver information or knowledge to end users System Installation installing such systems and then making them work reliably in real- world environments The tower of science in informatics Friedman C. Where is the science in medical informatics? JAMIA Feb Vol. 2 No. 1; 65-67

Center for Dental Informatics University of Pittsburgh School of Dental Medicine 11 of 20 Missoula, Montana, 9/2001 Informatics and its component sciences

Center for Dental Informatics University of Pittsburgh School of Dental Medicine 12 of 20

Center for Dental Informatics University of Pittsburgh School of Dental Medicine 13 of 20 Information science … is the collection, classification, storage, retrieval, and dissemination of recorded knowledge treated both as a pure and as an applied science. Sample research questions: - Is SNODENT an accurate representation of dental diagnoses? - How can a patient’s oral health status be summarized from comprehensive data about oral health and general health?

Center for Dental Informatics University of Pittsburgh School of Dental Medicine 14 of 20 Computer science … is a discipline that involves the understanding and design of computers and computational processes. Sample research questions : - How can various pathologies on radiographs be detected using neural networks? - How can decision support systems help dentists develop optimal treatment plans?

Center for Dental Informatics University of Pittsburgh School of Dental Medicine 15 of 20 Cognitive science … is a science that draws on several fields (as psychology, artificial intelligence, linguistics, and philosophy) to develop theories of perception, thinking and learning. Sample research questions : - How should computer-based dental charting systems be designed for optimal user performance? - How can detection of early leukoplakia and OED by dentists be improved with the aid of computers?

Center for Dental Informatics University of Pittsburgh School of Dental Medicine 16 of 20 Telecommunications … is the science that deals with communication at a distance. Sample research questions : - How can a complete and comprehensive oral health record for a patient be assembled on the fly using electronic records from different providers? - What communication requirements do real-time, comprehensive teledentistry systems have?

Center for Dental Informatics University of Pittsburgh School of Dental Medicine 17 of 20 Informatics: basic + applied science Shortliffe EH, Johnson SB, Medical Informatics Training and Research at Columbia University, IMIA Yearbook 2002,

Center for Dental Informatics University of Pittsburgh School of Dental Medicine 18 of 20 Where does dental informatics fit in? Yellowstone National Park, Wyoming, 9/2001

Center for Dental Informatics University of Pittsburgh School of Dental Medicine 19 of 20 The Biomedical Informatics Realm

Center for Dental Informatics University of Pittsburgh School of Dental Medicine 20 of 20 Thank You for Your Attention! Natchez Trace, Mississippi, 11/2001 Please visit us on the Internet: Main page Conference “Dental Informatics and Dental Research” Dental informatics postgraduate program Upcoming book on computing in dentistry

Center for Dental Informatics University of Pittsburgh School of Dental Medicine 21 of 20 Some Research Challenges in Dental Informatics Logan Pass, Glacier National Park, 9/2001

Center for Dental Informatics University of Pittsburgh School of Dental Medicine 22 of 20 Comprehensive, Longitudinal Oral Health Records “one-click” view of a patient’s oral health status and history, as well as of the pertinent medical history There are few technological obstacles to realizing this vision at this time. Some organizations (such as the Veterans Administration) have implemented systems that approach this functionality.

Center for Dental Informatics University of Pittsburgh School of Dental Medicine 23 of 20 Field Data Collection for Clinical and Epidemiological Research Expensive, labor- and resource- intensive RCTs are rarely conducted in dentistry. Some data are better than no data. Many dentists have computer-stored diagnostic and treatment data. However, the data are not accessible. If they were, they would be difficult to interpret (different format and content).

Center for Dental Informatics University of Pittsburgh School of Dental Medicine 24 of 20 Develop Knowledge Representations Standardized knowledge representations enable computer-based processing and reasoning. SNODENT is still stillborn. Even if it wasn’t, it would likely not be an optimal solution (see Barac'h V, Schleyer TK. Dental concepts in the Unified Medical Language System.Quintessence Int Jan;33(1):69-74.). We need controlled vocabularies for findings, diagnoses, treatments, materials, etc.

Center for Dental Informatics University of Pittsburgh School of Dental Medicine 25 of 20 Effective and Efficient User Interfaces for Clinical Practice A keyboard and a mouse are not appropriate for chairside computing. Most dentists do not use a computer in the operatory itself. We need new methods of interacting with computers (special I/O devices, voice, etc.)

Center for Dental Informatics University of Pittsburgh School of Dental Medicine 26 of 20 Decision Support Systems Several decision support have been developed in dentistry. Most of them are “one-shot” projects which are often not evaluated. A collection of validated, integrated and high-quality decision support systems would be an enormously valuable clinical tool.

Center for Dental Informatics University of Pittsburgh School of Dental Medicine 27 of 20 Optimal Support for Transfer of Research Results to Practice Current knowledge transfer practices somewhat haphazard. We do not know much about the dynamics of behavior change in dentistry. Current state of educational software design and evaluation relatively poor. Acquisition of new knowledge should optimally be interwoven with practice.

Center for Dental Informatics University of Pittsburgh School of Dental Medicine 28 of 20 Support Collaborative Research in Dentistry Dental and craniofacial research is dispersed. Most research groups are relatively insular (both literally and figuratively). Computer-supported collaborative work infrastructures have the potential to make dental research more efficient and effective. But, we have to want to collaborate.

Center for Dental Informatics University of Pittsburgh School of Dental Medicine 29 of 20 What Can You Do? Invest in dental informatics in your school –Identify where informatics can help you –Hire a dental informatician (MS or PhD) –Establish an organizational entity responsible for informatics Educate your students about IT and informatics Participate in formulating a research agenda for informatics (see

Center for Dental Informatics University of Pittsburgh School of Dental Medicine 30 of 20 Study of Effects System Installation System Development Model Formulation