Joint ADA and Health Level 7 Collaboration On Electronic Dental Attachments Jean Narcisi, Director, Department of Dental Informatics Patrick Cannady, Manager, Department of Dental Informatics ADA Practice Institute Center for Informatics and Standards
ADA - Accredited Standards Development Organization ADA is accredited as a Standards Development Organization (SDO) through the American National Standards Institute (ANSI) ADA is recognized as a respected leader in standards activities, nationally and internationally.
ADA Standards Activities ADA Standards Committee on Dental Informatics (SCDI) Develops Standards and Technical Reports for all aspects of dental EHRs using a voluntary consensus standards development process ADA Standards Committee on Dental Products (SCDP) Develops standards for dental materials, oral hygiene products, infection control products, dental equipment and dental instruments Digital Imaging and Communications in Medicine (DICOM) Secretariat for Dentistry Standards for interoperability for radiographic and other image files
ADA Liaisons with Other Standards Entities Health Level 7 (HL7) Messaging and EHR structure International Organization for Standardization (ISO) Technical Committee (TC) 215 - Health Informatics Global SDO organized by member nations International Organization for Standardization (ISO) Technical Committee (TC) 106 International dental standards for dental materials, oral hygiene products, dental equipment, dental instruments, dental implants Accredited Standards Committee (ASC) X12 HIPAA transactions (messages) International Health Terminology Standards Development Organization (IHTSDO) SNODENT (Systemized Nomenclature for Dentistry)
Seamless Electronic Patient Records (1996:694) ADA maintains a vision: Patient health data is confidential Patient authorization of data available at time and place of care EHR architecture should be open and compatible Patient health data unencumbered by boundaries and Should contribute toward improved quality of health outcomes and patient safety EHR should be a collection of data in automated form, rather than an automated version of paper record
Standards Committee on Dental Informatics Work Groups WG 10.3 Dental Information Systems Security and Safeguards WG 10.4 Data Redundancy WG 10.9 Dissemination of Dental Laboratory Prescriptions WG 10.10 Electronic Dental Claim Attachment WG 10.11 Guidelines for Hardware and Software in Dental Practice JWG 10.12 Forensic Odontology Informatics WG 10.13 Electronic Prescription Standard WG 10.16 Dental Personal Health Record
Standards Committee on Dental Informatics Work Groups WG 12.1 Digital Imaging WG 11.1 Standard Clinical Data Architecture WG 11.2 Dental Provider s Guide to the Electronic Dental Record WG 11.5 Dental Extension to the Continuity of Care Record WG 11.6 Integration of Orthodontic Standards WG 11.7 Risk Assessment Software WG 11.8 Track and Trace for Implantable Devices WG 11.9 Core Reference Data 7
ADA SCDI Standard No.1079 Developed through the SCDI s ANSI-accredited, open, transparent process with multi-stakeholder participation Defines standard content for periodontal and orthodontic attachments Proposed standard was approved for publication by ANSI in December 2015 ADA recommended its adoption in Comments on Attachments to the NCVHS Standards Subcommittee in February 2016 NCVHS included it among its recommendations to the Secretary of HHS in June 2016 8
ADA HL7 Collaboration on Dental Attachments Under the terms of a Statement of Understanding (SOU) with Health Level Seven (HL7), ADA is responsible for dental content used in HL7 standards ADA staff brought Standard No. 1079 to the HL7 Attachments Workgroup at its May 2016 meeting in Montreal The HL7 Attachments Workgroup developed a Project Scope Statement and submitted it to the HL7 Steering Committee for approval The HL7 Attachments Workgroup is now working on a draft to be balloted in the near future 9
The HL7 Perio Attachment Guide Team The team is lead by the HL7 Attachments Workgroup Cochairs The project is being sponsored by the Department of Defense/TRICARE Other participants include DOD/TRICARE contractors Payers Payer Associations Clearinghouses Consultants There is some need for practice management system vendor participation 10
Scope of the Current ADA-HL7 Attachment Project The project is conceived as an HL7 Attachment Implementation Guide for Dental Attachments It is the clinical content payload of an attachment and may be transmitted in the X12 275 transaction BIN or BDS segments, depending on the version of the 275 The HL7 Attachment Workgroup elected to focus on the periodontal content first Orthodontic content will be added to the Guide at a later time 11
What Will It Look Like? Will follow HL7 Clinical Document Architecture (CDA) practices Will consist of a header containing claim identifier and patient demographic information Structured periodontal data encoded with a combination of LOINC and SNODENT codes A narrative, unstructured section with up to 1000 alphanumeric characters The Guide will also include use cases and examples 12
Standard Code Sets Employed In Structured Portion Of The Perio Attachment Guide LOINC Codes will be used for most measurements and observables SNODENT, an IHSTDO recognized subset of SNOMED-CT, will be used for anatomic sites and other, non-procedural clinical information not covered in LOINC (more later on SNODENT) Diagnoses to be reported using ICD-10-CM Procedures to be reported using CDT 13
Examples of Data in the Draft HL7 Periodontal Attachment Guide Element Name Measurments and Quantifiers Loinc Codes Identified Tooth Universal Numbering System (1-32 for Adult Teeth, A-T for Child Teeth, +50 for Supernumery Teeth) 32885-6 TOOTH OBSERVATION Oral Hygiene Acceptable Yes/No 62594-7 PhenX - oral Health - oral Hygiene - personal care protocol Bleeding Probing Observation Yes/No 64044-1 Clinical observation of the presence of blood, bleeding on probing, BOP Tooth [PhenX] a. Probing Position 1-6 positions per tooth with each probing site, identified as: 1 = disto-facial (buccal), 2 = mid-facial (buccal) 3=mesio-facial (buccal); 4 = mesio-lingual/palatal; 5 = mid-lingual/palatal; 6 = disto-lingual/palatal 32478-0 b Probing Depth 0-10mm, in incrememnts of full mm 32910-2 Probing Depth Tooth Measured >10mm Probing Depth indicator Tooth Mobility 0.0-3.0 in increments of o.5. 1 notation per tooth. 34005-9 Tooth mobility miller classification Furcation I-III, in increments of (roman numerals). 1 notation of furcation grade per tooth - multiple notations. 0-4 positions per tooth with each furcation site, identified as: 1 = mid-facial (buccal); 2 = mid-lingual; 3 = mesio; 4 = distal. 34015-8 Furcation Classification {tooth} Glickman classification 14
SNODENT and SNOMED CT SNODENT is an IHTSDO-recognized subset of SNOMED CT specifically for dentistry It combines unique dental content developed by the ADA with relevant SNOMED CT content All of the new content is integrated into the larger SNOMED-CT hierarchy All SNODENT concepts have SNOMED-CT identifiers SNODENT can be obtained under license from the ADA 15
Examples of SNODENT Codes Identified for Use in Perio Attachments The following SNODENT Codes are included in the draft perio guide for specifying probing sites 245665006 Distal-buccal (body structure) 288536007 Buccal-incisal (body structure) 245662009 Mesial-buccal (body structure) 245664005 Mesial-lingual (body structure) 288537003 Incisal-lingual (body structure) 245668008 Distal-lingual (body structure) SNODENT codes may be used to report extremely detailed clinical information such as anatomic sites, findings, disorders, morphologic processes, etc. 16
Use Case Examples The main use case the Attachments workgroup is attempting to develop is the reporting of periodontal data to support adjudication of claims for periodontal services The examples will include both solicited and unsolicited models, the latter of which assumes prior education from the payer regarding attachment requirements for adjudication of certain periodontal services 17
Use Case Examples, cont d It may be sent by a provider in response to a payer s request for information for service and utilization review We hope that the attachment, which is in essence a clinical document, may serve provider-to-provider information exchange needs with only minor modification 18
Project Current State Draft Guide still in development, but progressing rapidly Most of the structured data elements have been identified The American Academy of Periodontology is consulting on important points of clinical detail Completion for HL7 Balloting Process expected this year 19
Information Resources HL7 Attachments Workgroup http://www.hl7.org/special/committees/claims/ HL7 Perio Attachment Guide Wiki http://wiki.hl7.org/index.php?title=periodontal_attachment _Implementation_Guide ADA Standards Development Activities and the SCDI http://www.ada.org/en/science-research/dentalstandards/standards-committee-on-dental-informatics ADA SNODENT Home http://www.ada.org/en/membercenter/member-benefits/practice-resources/dentalinformatics/snodent IHTSDO http://www.ihtsdo.org/ 20
QUESTIONS? Jean Narcisi, Director, Dental Informatics narcisij@ada.org Patrick Cannady, Manager, Dental Informatics cannadyp@ada.org 21