Like Pulling Teeth: Designing Clinical Decision Support to Improve Tobacco Cessation in Dental Practice

Objectives: Determine the feasibility of integrating a clinical decision support (CDS) tool into private practice dental settings.
Methods: Utilizing the Screening, Brief Intervention, and Referral to Treatment (SBIRT) framework, the CDS tool offers dental providers tailored scripts about tobacco cessation that vary based on the patient’s tobacco use and desire to quit. We analyzed whether the electronic dental record (EDR) used in private care settings supported integration of the tool, so that the clinicians can view the tailored scripts while they review the patient’s EDR.
Results: Barriers were identified during the feasibility phase: (1) limited cloud based penetration of the Electronic Dental Records (EDR) market; (2) infrequent dental office upgrades to hardware and software resulting in EDR vendors needing to write programming for multiple different releases of their software; (3) usability issues (e.g., end user having to navigate multiple screens and multiple clicks to trigger the CDS); (4) variability in documentation of tobacco use required to trigger the CDS; (5) high cost of developing the intervention across multiple EDR platforms.

To address these barriers, we devised an alternative approach using a secondary add-on software that accessed the EDR through the application program interface. This facilitated clinicians to enter additional information required for the CDS tool and to recommend the appropriate script. This approach allowed for a consistent implementation of the CDS tool, regardless of the EDR used by practices, and reduced development costs.
Conclusions: Moving towards a process such as cloud-based platforms for EDR would ensure practice EDRs are upgraded to comply with security and data standards without additional overhead to practices. We recommend future research investigates current patient care documentation in EDRs to identify gaps that need to be addressed to implement CDS, and thus support private practices to perform evidence-based dentistry.