ADA Technical Report No. 1030 – 2015 22
b. Government care-providing organizations : military, VA, public health – FQHC, prisons
What is the impact of EDR for government organizations?
The Department of Veterans Affairs (VA) manages the largest unified health care delivery system in the United States,
with almost five million unique medical patients treated in Fiscal Year 2004. The VA medical care system is
geographically dispersed, with locations in all fifty states as well as the District of Columbia, Puerto Rico, and many
other U.S. territories. Treatment is rendered in a variety of health care settings, including hospitals, outpatient clinics,
nursing homes and other long-term care facilities. VA also operates many training and education programs, including
dental and medical postgraduate resident training programs. To effectively manage patient records in this complex
environment, VA decided in the 1980s to move toward a paperless electronic health record. This migration to a fully
digital patient record was gradually implemented at most of the over 200 VA dental treatment locations.
The VA electronic dental record is fully integrated, real-time, with the VA medical record, known as the VA
Computerized Patient Record System (CPRS) and is an official component of this patient-centered record. The VA
dental record, known as Dental Record Manager (DRM), has been fully implemented nationally since Fiscal Year 2002,
with early test and implementation sites active since 1999.
DRM emphasizes those unique aspects of the patient’s dental treatment that are not adequately dealt with in the
medical record while using CPRS conventions for those aspects that are common to both the dental and medical
records. DRM is not a dental record that parallels the medical record, but, rather, is a dental enhancement to the
patient’s electronic health record.
DRM has been developed and implemented in two iterations, DRM and DRM Plus. Both versions are transaction-
based with completed transaction captures in DRM, and findings, planned, completed, and observation transactions
added in DRM Plus. DRM use graphical user interface (GUI), which followed the provider workflow to record data on
completed transactions, populate patient progress notes, and display data concerning historical patient treatment. The
completed transactions data is automatically captured and stored in linked manner in a local database. Each
completed transaction is based on a reported procedure code, either a CDT or CPT code, with all associated
information, such as patient, provider, location, tooth number, surfaces, quadrant, and ICD code, linked together in the
database. These transactions are then aggregated nationally and are available for static reporting as well as interactive
analysis.
DRM Plus, which was fully implemented nationally by the end of Fiscal Year 2005, adds diagnostic findings, planning,
head and neck lesion tracking, enhanced display graphics, enhanced automatic progress note creation, and
broadened local static reporting. HL7 messages are used to automatically send local data to the national dental
database. Additionally, DICOM standards requirements have been developed and implemented to allow the use of
digital radiographic imaging as an integrated part of the VA electronic dental record. The use of national and
international, standards has been emphasized throughout the development of the VA DRM.
c. What is the impact of EDR in dental schools?
Dental academia has many of the same issues as those previously discussed related to practice management. Dental
schools are obviously in the business of teaching and learning, and electronic record systems will be used in a way
that complements that process. Significant differences for dental academics relate to the scalability of the electronic
record system. You see, academic settings such as dental schools have a significantly larger number of providers and