A free and open dental charting file format

What problem am I trying to solve?

When a new patient enters a dental office, a lot of work is being redone:

  • Basic information about the patient Like date of birth, address, contact information. Not the end of the world but we are just getting started.
  • Medical history Like current medications, previous medications, history of surgeries, allergies and other information that would be vital to the doctor
  • Dental history What what done for each tooth, when and where the procedures were done. It would also be nice to know the circumstances for the procedure (as it would be in the case notes)
  • Radiographic history The nice thing about digital radiographs is that they can be emailed from one office to another in a lossless conversion. However, now that many patients will have a long history of radiographs over the years, there is no standard way to submit all radiographs from one office to another. Therefore, you tend to see most offices just send the last set of bitewings and panoraomic and call it a day. This would give the doctor a very limited view of the patient’s history and will have to rely too much on the patient for the date and time for each procedure.

Therefore, lets make a file format that encapsulates everything and makes it easily transferable from one office to another.

But why hasn’t other companies solved this issue yet?

The main reason for this is because almost all other Dental EHR systems out there uses a relational database to store all of its data. Therefore, the export and import process from one schema to another is complex and often unsupported. This is on top of the apparent conflict of interest that prevents commercial software from making the transition from one Dental EHR to another seamless.

What is the “Clear Dental” Solution?

Lets first talk about the “files” that each patient will have. Each patient will have a folder of files which will contain the following:

Patient Name - DOB/
     personal.ini #personal information
     dental.cdcf #dental chart
     perio.cpcf #perio chart
     tmj.ini #temporomandibular joint information / charting
     hardTissue.ini #hard tissue information outside of dental.cdcf
     softTissue.ini #soft tissue information outside of dental.cdcf
     recall.ini #when to bring the patient back for exams / radiographs
     medications.json #all medications (including ones prescribed at this office)
     surgical.json #all major surgeries the patient had
     allergies.json #all allergies
     dentalPlans.json #dental plan information
     family/ #symbolic links to family members
     finance/ #financial transactions (does not get exported)
     appointments/ #appoints the patient had (does not get exported)
     images/ #folder for all images
     images/photograph/ #regular pictures
     images/photograph/extraoral/
     images/photograph/extraoral/profile.jpg #default profile picture
     images/radiograph/
     images/radiograph/bitewings/
     images/radiograph/panoramic/
     images/radiograph/cephalometric/
     .git/ #standard git repo data

Details and specifications about each file and how it relates to the patient will released soon.

Hey! You said you were making a file format! You just outlined a directory!

Indeed. Rather than making one single file for all the data, lets first of all separate it out to simple text files and images that can be read by any viewer and then use tar to put them all to a single file. Then, we compress the tar file using lzma. Both are free and open source tools that are installed on most Linux platforms including the Clear Dental version of Linux. Therefore the file format will be:

{Patient's first name}_{Patient's middle name}_{Patient's last name}[Birthday-Birthmonth-Birthyear].tar.xz

For example, lets pretend your patient’s name is John Corry Doe who was born on January 2nd on 1970. His filename would be “John_Corry_Doe[02-01-1970].tar.lzma”. If the patient has a middle initial but not a middle name like David C. Riley who was born December 18th of 2002, his filename would be: “David_C._Riley[18-12-2002].tar.lzma”.

The last “lzma” part can in theory be changed to any kind of compression including bzip2 or gzip and the OS would be able to decompress appropriately.

What about history of changes?

That is the beauty of git! By having each file be text based, git can be used to keep a history of the changes including dental chart history, medical history changes, etc. And the doctor can see when each change was made and also who made each change. Clear Dental is going to use a graphical diff tool to make it easy for anybody to compare the changes.

What’s next?

Stay tuned for updates on the specifications for each of the files outlined in the directory. All drafts are open for comments and may evolve over time.

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