Updated: Feb 1, 97
ORATEL

Project Code:   A2029 Project value:   2053 KECU EC contribution:   1075 KECU No of partners:   6 No of countries:   5 Duration:   36 months

Contact: Mrs Kirsten Staehr Johansen Who Europe Quality of Care Technologies Scherfigsvej 8 DK-2100 Copenhagen, Denmark Tel.: +45-39-17.18.64 Fax: +45-39-17.12.66

Overview

Purpose and objectives

1. reach a consensus on a basic minimum data set (BMDS) for quality assurance in oral health care in Europe.

2. develop final pro-active and retros-pective telematic demonstrators for monitoring, evaluation and decision support at the individual provider and other levels of the health care system, to support quality assurance in oral health care in Europe.

3. develop an inter-active multimedia teachware to support self awareness of quality assurance in health care.

The objectives of Phase I:

1. establish criteria for and carry out a state-of-the-art assessment of quality assurance practices and information systems in oral health care.

2. establish a fundamental methodology for applying quality assurance in oral health care by defining basic minimum data and indicator sets for quality assurance in oral health care and preparing a manual on this.

3. stimulate awareness and debate towards a quality assurance approach in oral health care through consensus activities with oral health care providers, ministries of health, dental faculties and association, and insurance outlets in the European region.

4. initiate development activities for telematic tools to support the quality assurance methodology described in ii., above.

A survey of oral health care practices in European EEC and EFTA countries was carried out. The sources of information considered relevant to the study were: Chief Dental Officers, Ministries of Health; dental faculties; dental associations; and health insurance systems and private health insurance outlets, each of which received a specific questionnaire.

The survey showed that a need exists for development and implementation of a European quality assurance computerised information system in oral health care. Practices seem primarily oriented towards treatment procedures and reimbursement-related practices, whereas there is room for improvement in recording and reporting oral status and quality assurance parameters.

The various partners for quality improvement emphasised great interest in the development of computerised information systems for quality documentation in oral health. Thus, the survey showed the need, at all levels, for a system based on a "bottom-up" approach.

The vast majority of software packages consist of billing and management support products for private oral health care providers with a prevalence of systems of relatively low design and development cost. Usually, quality assurance is directed to the product, while process or development aspects of quality assurance are often neglected. The use of standards is also very limited.

It is therefore evident that re-design of the knowledge base for oral health care information systems, is of paramount importance. It would also appear that there is no general platform upon which quality assurance functions could be implemented, and that any approach to implementing quality standards in oral health care computerised information system development should start with the definition of such a platform.

Further, the availability of an interactive electronic patient record system is a pre-requisite for development of the ORATEL computerised information tools. Such a system should also adhere to modern and, if possible, international IT&T standards. None of the systems available on the market today fulfil these criteria.

A manual was developed with the objective of presenting two sets of indicators for improving oral health care; these quality assurance indicators are: individual related and population related. These sets of indicators will form the basis for Phase II of ORATEL, covering development of the ORATEL software.

Results

There were two distinct sets of indicators to be identified, as follows:

1. population related indicators for quality assurance at different administrative levels (retrospective element); and
2. individual related indicators for quality assurance at the clinical level (pro-active element).

When the two sets of computerised information systems have been developed and field tested, it is expected that the Basic Minimum Set of Indicators for quality assurance in oral health care can be further reduced.

Validation of the ORATEL computerised information tools: The ORATEL tools have been distributed to sites in Denmark, Germany, Italy, Spain, Sweden and the United Kingdom for validation purposes. The test sites include clinics with varying technological levels and with differing patient age groups. The data generated will be aggregated from the various sites to simulate the use of the tools at the regional, national and supra-national levels.

Conclusions: ORATEL is more than just another health information system. It supports management and administration of dental clinics and became an integrated part of a quality assurance system which will assist the oral health care provider in improving the level of quality of care in oral heath. Its advanced educational and decision support tools can be used at all professional levels. This means that ORATEL is a bottom-up process, starting at the dental unit and ultimately serving as a tool for an international network for quality development in oral health care, was one of its main contributions

The results from its widespread use should result in: (a) lower incidences of oral diseases; (b) higher standards of public and private oral health care delivery; (c) cost effectiveness of public and private oral health care delivery; (e) self-awareness and consequent improvement of the quality in oral health care.

List of Deliverables

Year 1

• State-of-the-art quality assurance practices in oral health care (4/R/P)
• State-of-the-art quality assurance information systems in ORH (9/R/P)
• Manual on quality assurance indicators in oral health care (11/S/P)

Year 2

• Interactive multimedia teachware on quality assurance in ORH (4/T/I)
• Handbook of functional specifications for inclusion of QA in ORH (9S/I)
• Pro-active software to support quality assurance at the dental unit (11/P/I)
• Retrospective software for quality assurance support at all levels (11/P/I)

Year 3

• Draft of user manual for pro-active and retrospective softwares (4/R/P)
• Evaluation of implementation/validation of ORATEL QA system (11/R/P)
• Final report of the ORATEL project and final demonstrators (12/P/L)

List of Participants

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