Columbia University College of Dental Medicine is leading a sea change in dental health and education through the use of big data. By gathering and analyzing multiple data streams, the new Center for Precision Dental Medicine (CPDM) will enable unprecedented research on dental and overall health, new levels of personalization in dental education, and bring oral health care into the age of precision medicine. This will bring medicine and dentistry together in ways that have not been possible until now.
“Columbia University’s Center for Precision Dental Medicine is not only leading the way towards the age of personalized dentistry. It is using digital technology and information science to stretch the boundaries of dental research, relating oral care to overall health care, and putting the ‘mouth back into the body,’” said Christian S. Stohler, DMD, DrMedDent, Dean of the Columbia University College of Dental Medicine and Senior Vice President for Dental Medicine of the Columbia University Irving Medical Center.
Columbia University College of Dental Medicine is rolling out the following initiatives over the next 20-24 months to help dissolve silos between medicine and dentistry, and increase the use of predictive analytics for better disease prevention and care, as well as to prepare dentistry for health care’s transition to a value-based system. The success of the initiatives is made possible by custom developed technologies created specifically for Columbia.
Transform Patient Care
◦ Integrate Health Records to Integrate Care: The College of Dental Medicine will be one of the first academic dental institutions to unify dental and medical patient health records in Epic electronic health records, which will be shared between all clinicians at Columbia, NewYork-Presbyterian, Weill Cornell Medicine, and Harlem Hospital. This will offer physicians and dentists, who traditionally work independently of each other, a two-way flow of information to better detect and manage interrelated chronic conditions. Because dentists are often the “first responders” to notice conditions in the mouth related to systemic diseases such as diabetes, certain types of cancer, among others, this opens possibilities for better detection and management of disease throughout the body. Clinicians will also have access to review and tailor treatment based some patients’ genomic information when voluntarily shared with the medical center.
Unleash New Possibilities to Co-Management Chronic Diseases Through Research
◦ Use Data to Drive Care: Utilizing custom developed dental instruments and equipment, Columbia University is collecting and aggregating anonymous data from each patient visit to advance studies on evidence-based connections between oral and overall health, procedures and outcomes, stress levels and health, among the range of topics. Research will help develop real-time provider feedback and predictive analytics for precision care. By tailoring treatment to address diseases rather than symptoms, care may help patients avoid some painful and costly procedures, allowing them to maintain rather than repair teeth and gum tissue.
◦ Discover Linkages Between Stress and Health Outcomes: New technologies incorporated into the CPDM will also measure data associated with stress levels. This information will enable students, providers and researchers to better understand and address comfort during care, and ultimately the connection between a person’s resilience to stress and long-term oral and overall health outcomes.
Transform Dental Education
◦ Introduce Unprecedented Level of Supervision and Feedback: Each dental chair, custom developed to Columbia University’s goals, contains two video cameras and multiple devices collecting patient and procedure data. This stream of information allows an instructor to closely observe care from multiple perspectives, including inside the patient’s mouth, in real time from faculty “touchdown” zones. This new level of monitoring makes possible close but unobtrusive instruction that does not interrupt the patient’s care, or in-the-moment intervention when necessary.
◦ Eliminate One-Size-Fits-All Instruction: Improved supervision methods enable customization of educational content to a student’s learning style and pace. New dental instruments are equipped with radio frequency identification (RFID) technology that records each procedure and how it is performed with a high level of granularity — from instrument use and sequence, to movement of the chair. This allows faculty to provide quantifiable, objective feedback to students on performance based on robust data streams and recorded video. Students also have new opportunities for self-driven learning by reviewing their own metrics and video of their work.
Transform the Business of Dental Medicine
◦ Increase Effectiveness: First-of-their-kind technologies developed for Columbia University will make possible the tracking of instrument and supply use, safety precautions, patient wait times and chair use, helping future dentists better manage their practice’s functioning and cost and improve patient satisfaction.
◦ Prepare for Dentistry’s Move Towards Value-Based Care: As the health care industry shifts toward payment for health outcomes rather than only procedures, the application of predictive analytics and precision care will help develop the technological tools to objectively determine what is best for a patient’s long-term oral and overall health, eliminating the need for some painful and costly procedures. It will also implement the option of preventative equipment maintenance as well as just-in-time inventory replacement without human monitoring.
“Having unified records, paired with data, will create the possibility for groundbreaking research and collapsing silos of oral and general health care,” said Dean Stohler. “Deep data mining could pave the way for systems of care that continually assimilate new evidence showing which treatments are most effective, offering personalized diagnoses and treatment plans based on thousands of parameters.”
The College of Dental Medicine’s Center for Precision Dental Medicine is in a new 15,000 square foot addition to Columbia’s teaching clinics, where dental students treat patients at reduced costs under faculty supervision. Each of the 48 new operatories is outfitted with a series of custom-developed technologies made with Columbia University College of Dental Medicine’s goals in mind, which include state-of-the-art dental chairs, instruments and supplies equipped with RFID tags, and additional technology that will monitor instrument sterilization and ensures infection control.
The architectural design for the new CPDM, by the distinguished firm of Pei Cobb Freed & Partners, has involved an inventive reinterpretation of the spaces within the original 1928 building by James Gamble Rogers. The architects have created an open, loft-like space with low partitions, providing unobstructed views and plentiful daylight. Raised floors and vaulted ceilings integrate indirect lighting and air distribution. All clinical support services are consolidated in a central core. Two identical wings of the fifth floor of the Vanderbilt Clinic house two practice areas, each of which is supported by its own reception area, waiting room and patient affairs office, clinical director’s office and imaging rooms. Each practice area is then organized into three neighborhoods of eight dental chairs apiece, individual faculty workstations and digital design workstations. Curvilinear partitions with translucent screening provide patient privacy while creating interactive aisles for circulation. By providing spaces where pre-clinical and clinical training are combined, the design makes it possible for CPDM to educate students in an environment where they have continual, first-hand experience of patient care.