Thursday, 27 June 2013

Time to stop wasting data: The Clinical Practice Research Datalink

Let's stop wasting data

I was speaking at an event last night for general dental practitioners who are involved with, or interested in joining, studies in dental practice. One of my fellow speakers was a very engaging speaker called John Parkinson, who is director of the The Clinical Practice Research Datalink (CPRD) about which I will speak a little later.

Diagnostic codes

A little while ago I blogged about how useful it would be if dental electronic health records were to incorporate diagnostic codes to allow tracking of patient outcomes over time. The potential to observe the success or otherwise of patient management could be huge. Not only could we observe outcomes to routine treatment but potentially also conduct trials in practice using the codes to track what problems patients arrive with, any interventions we randomise them to, and the outcome.

So, for example, one of the audience last night asked the question: in a time-restricted environment is it better to provide oral hygiene advice or do a quick scale and polish, presumably for a patient with gingivitis rather than destructive periodontal disease. Well, using the SNOMED codes that I blogged about at the first encounter a dentist would record the following from a drop down box in the patient's record:

Code 66383009 Gingivitis (disorder)

Then the clinician records how it was managed. This could be as part of a randomised controlled trial - half patients are randomly allocated to scale and polish, half to oral hygiene instruction:

Code 234696006 Scale and polish teeth (procedure)


Code 58707002 Oral hygiene education (procedure)

Then, at the next visit the dentist, hygienist or therapist records whether gingivitis is present using the same code:

Code 66383009 Gingivitis (disorder)

If this data - that we probably record for thousands of patients every day anyway - were collected in this organised way then there would be a massive amount of potentially really useful data that we could use to answer the question asked by our colleague last night.

Clinical Practice Research Datalink

This is where the The Clinical Practice Research Datalink comes in. John Parkinson already churns the numbers for general medical practices using data from the last 25 years. What they can now do is to identify potential participants in research based on their medical conditions and create a pop-up that asks the clinician to ask the patient if they would be happy to take part in a trial. If the patient consents then they are randomised automatically to one treatment or another.

So imagine this as a dentist participating in a trial to find out whether you should give oral hygiene advice or a scale and polish in your short appointment: 
  • a patient attends for a dental examination. You diagnose gingivitis and click the appropriate code (as above). 
  • A pop-up screen asks you to ask the patient if they would like to participate in the trial. They consent and you click the appropriate button.
  • The pop-up then tells you that for this patient you should give oral hygiene advice. So that's what you do.
  • Then you see the patient again in 6 weeks / 6 months / 12 months and without even having to think about the trial you just record what you see. If there's gingivitis then you record it. If there isn't you don't.
  • The number crunchers process the data and in a year or two we have a massive data set that allows us with some confidence to say whether one or the other is more effective when done alone.

So why aren't we doing this?

This effortless utilisation of information for the betterment of our patients is only likely to happen if we can get dental electronic health record systems to adopt the coding that enables us to track the problems patients present with, the interventions that we use, and the outcomes some time afterwards. John Parkinson wants CPRD to facilitate this - he just needs access to the data we have on our computers. And whilst this has generally been an NHS programme because GPs are almost all in it, it doesn't mean private colleagues without NHS contracts couldn't also be joining the network. 

The CPRD could also link our records to general health records. So potentially we could research whether, say, giving dietary advice in the dental clinic results in wider benefits to the patient - like reduction in obesity-related diseases, for example. And we could also track the outcomes of treatment completed in, for example, dental hospitals once they have been discharged back into the care of a general practitioner so allowing us to understand better the long term impact of hospital dental care.

As a dental profession I think we really need to join our medical colleagues and engage with this great opportunity and we need to start by persuading the dental systems to play ball. I don't know who the best people are to help with this...but perhaps you do.

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