Sydney South West Area Community Oral Health Service goes digital

Sydney Dental Hospital in the inner city suburb of Surry Hills is an icon for the profession of dentistry in New South Wales and in Australia. This multi-storey facility, originally built in 1903, houses general and specialist dental services and facilities devoted to public oral health as well as being a key teaching annex of the University of Sydney.

The principal general practice clinic in the Hospital has recently upgraded its film-based intraoral x-ray system to a new digital imaging system. Whereas it is a simple process for small private practices to adopt these advances in new technologies, integrating this type of system in an holistic manner to provide an optimum solution is a lengthy and complex project in the larger public dental hospital system.

"Digital radiography is clearly the way of the future in dentistry," said Dr John Powers, Associate Director, Clinical Operations, Community Oral Health Service, "and we were keen to replace our filmbased radiography systems at Sydney Dental Hospital and move in that direction. However, we also needed to ensure we had the IT infrastructure in place to manage the resultant images and make them available at all of our clinics."

The Community Oral Health Clinic at Sydney Dental Hospital is one of 17 clinics operated by the Sydney South West Area Community Oral Health Service and was chosen for the digital radiography pilot project. Prior to the project commencing, the clinic only had two film based intra-oral x-ray generators in the 22-chair department and this necessitated moving patients around to have x-rays taken or sending them to the separate radiology department.

"As part of the project, we installed 22 digital x-ray units and 22 digital x-ray sensors in varying sizes in the Community Oral Health Clinic," Dr Powers said, "and the installation was a relatively simple process.

"The challenge for us was then managing the images once they've been captured. All our clinics state-wide utilise a patient management system called Information System for Oral Health (ISOH). We use ISOH for all our appointment scheduling, patient records, treatment modalities, triaging and in our call centres.

Essentially, if a patient has an x-ray taken at Sydney Dental Hospital and then presents at our clinic in Bowral, we wanted to be able to access that image instantaneously. To facilitate this, we needed the Digital Imaging System to communicate with ISOH. ISOH has always had the ability to do this but it had never been trialled in the real world. With the assistance from the product vendor, and the developers of ISOH, we've been able to achieve what we required. It's now in the trial phase and is working well."

Dr Powers said that the other clinics in the Sydney South West Area Community Oral Health Service still use film but have access through ISOH to any digital images stored on the system.

"As a result of our pilot project, digital radiographs taken from our pilot site at Sydney Dental Hospital can be viewed from any of our 17 community clinics," he said.

"We wanted to eliminate the need for normal film radiography, but we also wanted an image capture system that would allow us to store our digital radiographs to collaborate and diagnose over distances."

Dr Powers said that a number of other Area Health Services in New South Wales are waiting to see how this project progresses. "Some of the Services have already bought digital equipment and are using them as standalone units so they can changeover quickly once the project is fully bedded down," he said.

"Moving to digital x-ray has been a real impetus for us. We provided training for everyone in the clinic and we're now getting much better results. It's been a quality improvement tool for the dental services.

"Another advantage is the instant availability in real time of the images. We are under a lot of stress in the public sector to service a large population that is eligible for treatment and anything that can help us deliver care faster and more efficiently and allow us to make better clinical decisions based on good quality radiographs is a boon."

Dr Powers said that having the digital system in place has also meant incredible savings in time. Previously, the exposed film x-rays needed to be processed in a different department in the Hospital which would mean a 15 minute turnaround to view the image. In cases where multiple x-rays were taken, waiting time could be 25-30 minutes.

"The speed at which we can now acquire an image has meant we are now able to see more patients in a day," he said.

Dr Powers said that having the x-rays appear on a computer screen chairside instantly was also a great patient awareness tool and was helping people better understand their problems.

"We've worked through the infection control protocols for patient and clinician safety and developed protocols for safe handling. The staff have all been well trained and enjoy using the system so much, it has contributed to a boost in overall morale.

"Our challenge now is that everybody wants digital radiography. We've created an internal demand and all the other departments at the Sydney Dental Hospital and all the other clinics across the service want it too! At least it's a nice challenge to have."