Development and validation of a rule-based algorithm to identify periodontal diagnosis using structured electronic health record data

Abstract

Aim: To develop and validate an automated electronic health record (EHR)-based algorithm to suggest a periodontal diagnosis based on the 2017 World Workshop on the Classification of Periodontal Diseases and Conditions.

Materials and methods: Using material published from the 2017 World Workshop, a tool was iteratively developed to suggest a periodontal diagnosis based on clinical data within the EHR. Pertinent clinical data included clinical attachment level (CAL), gingival margin to cemento-enamel junction distance, probing depth, furcation involvement (if present) and mobility. Chart reviews were conducted to confirm the algorithm's ability to accurately extract clinical data from the EHR, and then to test its ability to suggest an accurate diagnosis. Subsequently, refinements were made to address limitations of the data and specific clinical situations. Each refinement was evaluated through chart reviews by expert periodontists at the study sites.

Results: Three-hundred and twenty-three charts were manually reviewed, and a periodontal diagnosis (healthy, gingivitis or periodontitis including stage and grade) was made by expert periodontists for each case. After developing the initial version of the algorithm using the unmodified 2017 World Workshop criteria, accuracy was 71.8% for stage alone and 64.7% for stage and grade. Subsequently, 16 modifications to the algorithm were proposed and 14 were accepted. This refined version of the algorithm had 79.6% accuracy for stage alone and 68.8% for stage and grade together.

Conclusions: Our findings suggest that a rule-based algorithm for suggesting a periodontal diagnosis using EHR data can be implemented with moderate accuracy in support of chairside clinical diagnostic decision making, especially for inexperienced clinicians. Grey-zone cases still exist, where clinical judgement will be required. Future applications of similar algorithms with improved performance will depend upon the quality (completeness/accuracy) of EHR data.

Keywords: clinical decision support; diagnostic classification; periodontitis.

Figure 1:

Periodontal diagnosis algorithm flowchart for initial decision support tool ^, Bone Loss (BL), Clinical Attachment Loss (CAL), Pocket Depth (PD), Bleeding on Probing (BOP)

Figure 2:

Decision algorithm flowchart with approved edits (shown in yellow boxes). CAL: Clinical Attachment Loss, PD: Pocket Depth, BOP: Bleeding on Probing