Abstract
Documenting standardized dental diagnostic terms represents an emerging change for how dentistry is practiced. We focused on a mid-sized dental group practice as it shifted to a policy of documenting patients' diagnoses using standardized terms in the electronic health record. Kotter's change framework was translated into interview questions posed to the senior leadership in a mid-size dental group practice. In addition, quantitative content analyses were conducted on the written policies and forms before and after the implementation of standardized diagnosis documentation to assess the extent to which the forms and policies reflected the shift. Three reviewers analyzed the data individually and reached consensuses where needed. Kotter's guiding change framework explained the steps taken to 97 percent utilization rate of the Electronic Health Record and Dental Diagnostic Code. Of the 96 documents included in the forms and policy analysis, 31 documents were officially updated but only two added a diagnostic element. Change strategies established in the business literature hold utility for dental practices seeking diagnosis-centered care. A practice that shifts to a diagnosis-driven care philosophy would be best served by ensuring that the change process follows a leadership framework that is calibrated to the organization's culture.
Highlights
The dental profession is on the cusp of a transformative change: documenting dental diagnoses using standardized terms
A practice that shifts to a diagnosis-driven care philosophy would be best served by ensuring that the change process follows a leadership framework that is calibrated to the organization’s culture
The CEO and COO were the driving forces behind the initial changes. They established the sense of urgency, drafted the vision, and forced a guiding coalition of leaders through out the practice group and management team. They communicated the vision effectively using existing venues and an extensive training program that included the unprecedented step of suspending routine clinical and administrative services in each of the 53 offices in order to transport every eligible employee to a central training location
Summary
The dental profession is on the cusp of a transformative change: documenting dental diagnoses using standardized terms. IHTSDO notes that it is doing the work with the dental SIG “as part of the agreement with the American Dental Association (ADA)” [2] Leading this evolution, an inter professional research group of dental and health researchers representing four institutions has developed a comprehensive dental diagnostic interface terminology, the DDS terminology (formerly named the EZCodes) [3]. An inter professional research group of dental and health researchers representing four institutions has developed a comprehensive dental diagnostic interface terminology, the DDS terminology (formerly named the EZCodes) [3] This has sparked a renewed focus on the development, implementation, dissemination and research of the use of standardized diagnostic terms and codes, especially for the electronic health record (EHR) in the dental community recently [4,5,6,7,8]. We focused on a mid-sized dental group practice as it shifted to a policy of documenting patients’ diagnoses using standardized terms in the electronic health record
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