Friday, June 22, 2012

The Importance of Interoperability

Dentistry is a rapidly evolving marketplace.  The adoption and growth of technology in the field drives new treatments, and cheaper, better care.  The advent of CAD/CAM and devices like IOS's, networked diagnostic imaging devices, and tablet PCs, considered bleeding edge ten years ago, are now becoming commonplace.

While these tools offer great savings on their own, it can be frustrating trying to get them working together.  The problem presents itself in several ways.

A clinician, looking to send an x-ray must first get the scan digitized.  This used to be a trying process, but is now fairly simple.  However, if the clinician wants to send the x-ray to a specialist, they cannot simply email it, as this would most likely violate privacy regulations.  Now the dentist must cook up some form of encrypted exchange to avoid exposing themselves to liability.  While options exist (encrypted zip files, PGP, setting up a custom VPN), they are not seamless and require significant technical know how.

Another challenge that we see is vertical lock in.  Consider a hypothetical ACME co. which manufactures IOS devices, CAM appliances and an exchange network.  Now, ACME co. has a great IOS, but their CAM appliances are sub-standard.  In order to enhance the sales of their CAM appliances, ACME co. locks their IOS devices such that solutions can only be milled on ACME co. CAM appliances sent over the ACME co. exchange network.  This limits the labs any ACME co. IOS-owning clinician can work with and degrades the overall quality of care the patient receives.

Re-Inventing the Wheel

For possible answers, we should examine the medical world.  Long driven by large scale enterprises, universities, hospitals, governments, etc..., the medical industry has done a good job of establishing networked health care.  This is typically done using one or both of DICOM and HL7.

DICOM is a well known and heavily used standard.  It defines both a storage format and an exchange protocol for imaging files with embedded metadata that identifies the study, patient, anatomy, etc...  The file format is based on JPEG-2000, so it leverages a pre-existing and well-established imaging format.  While DICOM solves diagnostic imaging exchange and storage very well, it cannot be expanded beyond that.  It cannot, for example, elegantly handle a requisition.

The medical world also makes use of a format called HL7 ("Health Level 7").  HL7 is a format meant to handle requisitions, reports, bookings, etc...  However, HL7 posses a challenge, in that it avoids defining detailed taxonomy or structure.  HL7 is often defined as "a standard in search of a standard" and two systems that are fully HL7 compliant often cannot exchange information without a custom translation application or layer being built.


Dentistry has a need for complex data exchanges between various systems and providers.  The number of people working on complex dental reconstruction cases can number in the dozens, and having people manually moving data between systems drives up cost, slows down care and introduces error vectors.

Fortunately, a standard has emerged in the dental industry.  A group called OXDIG ("Open eXchange Dental Interoperability Group"), of which Brightsquid Dental Ltd. is proud to be a part, has begun defining a set of open standards called UDX ("Universal Dental eXchange") in order to facilitate seamless integration between implementing systems.

The standard already alleviates many problems faced by many dental care providers, and with new members joining from more and more types of system providers, interoperability in dentistry is suddenly achievable.  This will allow dental care providers the world over to get updates, see results, review designs, place orders from your PC or any smart device, and have all your dental appliances and systems aware of them as well.  The future isn't just smart devices, but smart devices working together seamlessly to create a smart office, allowing you and your staff to operate more efficiently, treat more patients, lower costs and make high end dental care more accessible.

If you're thinking of investing in a new technology or device for your practice, be it a practice management system, an IOS, a diagnostic imaging appliance, ask the vendor whether they support UDX.  

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