As 2023 begins, health care providers in the United States must make health records more easily available or risk losing Medicare funding under the 21st Century Cures Act. While this is a win for patients, providers, and researchers, the legislation’s failure to include dental care ignores the crucial link between oral health and overall health.
As the co-founder and CEO of a technology cloud platform for dental electronic health records, I have seen firsthand how the dental industry is evolving to help patients better access their own data and connect providers across disciplines. To close health care gaps, support the rapid consolidation of dental data, and truly empower patients, future efforts to legislate health care data must include the dental industry.
For too long, policymakers and the public have treated dental care as almost optional despite the fact that dental providers can detect signs of heart disease, diabetes, cancer, lupus, eating disorders, and more, demonstrating the interconnectedness of oral health and overall health.
The 21st Century Cures Act is not the first piece of health care legislation to ignore dental care. Under the Affordable Care Act of 2010, dental care is not included as an essential health benefit for adults, and Medicare does not cover most dental care, including tooth extractions and dentures. These policy decisions have contributed to more than half of Americans delaying or forgoing dental care due to cost.
The failure to include dental care in efforts to legislate health data interoperability may be partially explained by the dental industry’s initially slow efforts to upgrade technology. Until recently, dentistry lacked standardized electronic health record systems that have been prevalent in the medical industry since the 1990s. But the industry is rapidly catching up. In the past three years, one organization, Pacific Dental Services, converted nearly 10 million patient records into EHR systems made by Epic, the country’s dominant EHR vendor. Other practices are investing in cloud-based technologies, or considering the role of artificial intelligence. The inclusion of dental care in future legislation on health care data could offer much-needed support to these ongoing efforts.
The rapid consolidation of dental data matters because it will help people more easily access their information and share records between providers, closing critical health care gaps. Digitized scheduling and records systems aid in preventive care and help providers detect and communicate underlying health issues.
For individuals with less-easily diagnosed illnesses, this can make a real difference. For instance, gingivitis — a disease that causes inflamed gums — can be an oral manifestation of a type of vasculitis called granulomatosis with polyangiitis. Doctors who treat people with vasculitis would benefit from having easy access to the dental records of patients who have gingivitis, a symptom of granulomatosis with polyangiitis, to diagnose and track disease progression of this autoimmune disorder. Digitized dental records can also relieve stress on patients, who can more easily access records online and avoid wasting time chasing down paper records.
Supporting the creation of a dental data warehouse can also benefit scientific research, which increasingly uses electronic health records for population-based studies. EHR data allow researchers to study how a disease progresses over time as a patient matures, of which oral health can be an important indicator.
Yet open data for dental research worldwide is currently hard to come by. If the 21st Century Cures Act were amended to include dental care, researchers would be able to examine the progression of oral health in specific populations as well as analyze how oral health is linked to other health issues.
Making dental data more easily accessible to researchers can also help health care providers understand the oral health impacts of novel illnesses like Covid-19. Some people with long Covid have blood clots known as venous thromboembolism and take various types of anticoagulants (blood thinners) that can make them more prone to bleeding during dental or other procedures. If researchers are able to access widespread dental data for patients with novel diseases, they can help more quickly inform clinical guidelines for emerging illnesses. This will help patients receive better care, and may also support the development of novel therapeutics.
For the same reasons that the 21st Century Cures Act passed with bipartisan support in 2016, people across the United States would benefit from being able to easily access all of their health records, including their dental records. As the dental industry works to digitize, policymakers must support this work by not leaving dental care and its records out of future efforts to legislate health care data. A much-needed shift to include oral health in health care legislation will help more people access dental care and support ongoing and future research.
This shift is needed immediately to address urgent health gaps, but it also has the potential to transform the types of care and treatments people will receive for generations to come.
Kiltesh Patel is the founder and CEO of tab32, a cloud-based technology platform focused on oral health care.
First Opinion newsletter: If you enjoy reading opinion and perspective essays, get a roundup of each week’s First Opinions delivered to your inbox every Sunday. Sign up here.