Analysis of strengths, weaknesses, opportunities, and threats of electronic dental and oral records in clinics of School of Dentistry, Tehran University of Medical Sciences, Iran: A qualitative study

Document Type : Original Article


1 Assistant Professor, Department of Health Information Technology, School of Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz AND Department of Medical Informatics, School of Medical Sciences, Tarbiat Modares University, Tehran, Iran

2 Assistant Professor, Department of Health Information Management, School of Paramedicine, Hormozgan University of Medical Sciences, Bandar Abbas, Iran

3 Assistant Professor, Department of Health Information Technology, School of Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran


BACKGROUND AND AIM: The high-quality data are essential for good patient care, optimal management of oral and dental diseases, and policy-making. Electronic dental and oral records have a key role in managing data in health care organizations. Aim of this article is analyzing strengths, weaknesses, opportunities, and threats (SWOT) of electronic dental and oral record implementation in clinics of School of Dentistry, Tehran University of Medical Sciences, Tehran, Iran, from stakeholder perspectives.
METHODS: A qualitative interpretive case study was conducted at clinics of School of Dentistry in Tehran University of Medical Sciences in 2016. Data were collected through semi-structured interviews. Interviews involved asking questions and getting answers from 15 participants. They were informed about SWOT of electronic dental and oral records. Data were gathered by two researchers during two months. After fulfilling all interviews, all participants were asked to review the transcript and confirm its accuracy. All raw data and recorded interviews were transcribed, coded, and analyzed by two researchers.
RESULTS: The main features in SWOT analysis of electronic dental and oral records were respectively transparency of project implementation stages, absence of mandatory rules and standard business processes, expert and motivated specialists, and finally lack of cultural infrastructure.
CONCLUSION: Use of electronic dental and oral records can help to improve quality of information and ultimately leads to improvement in quality of care. SWOT analysis is an optimal technique for understanding SWOT of electronic dental and oral records.


Morita I, Nakagaki H, Toyama A, Hayashi M, Shimozato M, Watanabe T, et al. Behavioral factors to include in guidelines for lifelong oral healthiness: An observational study in Japanese adults. BMC Oral Health 2006; 6: 15.
St Sauver JL, Carr AB, Yawn BP, Grossardt BR, Bock-Goodner CM, Klein LL, et al. Linking medical and dental health record data: A partnership with the Rochester Epidemiology Project. BMJ Open 2017; 7(3): e012528.
Gil-Montoya JA, de Mello AL, Barrios R, Gonzalez-Moles MA, Bravo M. Oral health in the elderly patient and its impact on general well-being: A nonsystematic review. Clin Interv Aging 2015; 10: 461-7.
Petersen PE, Bourgeois D, Ogawa H, Estupinan-Day S, Ndiaye C. The global burden of oral diseases and risks to oral health. Bull World Health Organ 2005; 83(9): 661-9.
Jin LJ, Lamster IB, Greenspan JS, Pitts NB, Scully C, Warnakulasuriya S. Global burden of oral diseases: Emerging concepts, management and interplay with systemic health. Oral Dis 2016; 22(7): 609-19.
Tokede O, Ramoni RB, Patton M, Da Silva JD, Kalenderian E. Clinical documentation of dental care in an era of electronic health record use. J Evid Based Dent Pract 2016; 16(3): 154-60.
Myers C. A quality improvement initiative for clinical records in the public dental services [MSc Thesis]. Dublin, Ireland: Royal College of Surgeons in Ireland; 2014.
Charangowda BK. Dental records: An overview. J Forensic Dent Sci 2010; 2(1): 5-10.
Sidek YH, Martins JT. Perceived critical success factors of electronic health record system implementation in a dental clinic context: An organisational management perspective. Int J Med Inform 2017; 107: 88-100.
Wagner IV, Lex MacNeil MA, Esteves A, MacEntee MI. An electronic oral health record to document, plan and educate. Eur J Dent Educ 2015; 19(4): 209-16.
Petersen PE. The World Oral Health Report 2003: Continuous improvement of oral health in the 21st century--the approach of the WHO Global Oral Health Programme. Community Dent Oral Epidemiol 2003; 31(Suppl 1): 3-23.
King J, Patel V, Jamoom EW, Furukawa MF. Clinical benefits of electronic health record use: National findings. Health Serv Res 2014; 49(1 Pt 2): 392-404.
Rudman W, Hart-Hester S, Jones W, Caputo N, Madison M. Integrating medical and dental records. A new frontier in health information management. J AHIMA 2010; 81(10): 36-9.
Song M, Spallek H, Polk D, Schleyer T, Wali T. How information systems should support the information needs of general dentists in clinical settings: Suggestions from a qualitative study. BMC Med Inform Decis Mak 2010; 10: 7.
Sakuda M, Tanne K, Yoshida K, Inoue H, Ohmae H, Tsuchiya M, et al. Integrated information-processing system in clinical orthodontics: An approach with use of a computer network system. Am J Orthod Dentofacial Orthop 1992; 101(3): 210-20.
Lu X. Design and implementation of cooperative distributed dental medical information system. Proceedings of the 9th International Conference on Computer Supported Cooperative Work in Design; 2005 May 24-26; Coventry, UK. p. 799-803.
Romanov K, Aarnio M. A survey of the use of electronic scientific information resources among medical and dental students. BMC Med Educ 2006; 6: 28.
Schleyer T, Song M, Gilbert GH, Rindal DB, Fellows JL, Gordan VV, et al. Electronic dental record use and clinical information management patterns among practitioner-investigators in The Dental Practice-Based Research Network. J Am Dent Assoc 2013; 144(1): 49-58.
Gordon SM, Camargo GA, Mejia GC, Sutherland JN. Use of the dental electronic health record for research: assessing demographic and oral health characteristics data for clinic patients. J Dent Educ 2018; 82(12): 1249-57.
Asgari I. Development an Electronic Oral Health Record application for educational dental setting. J Educ Health Promot 2018; 7: 124.
Reed SG, Adibi SS, Coover M, Gellin RG, Wahlquist AE, AbdulRahiman A, et al. Does use of an electronic health record with dental diagnostic system terminology promote dental students' critical thinking? J Dent Educ 2015; 79(6): 686-96.
Acharya A, Schroeder D, Schwei K, Chyou PH. Update on electronic dental record and clinical computing adoption among dental practices in the United States. Clin Med Res 2017; 15(3-4): 59-74.
Walji MF, Taylor D, Langabeer JR, Valenza JA. Factors influencing implementation and outcomes of a dental electronic patient record system. J Dent Educ 2009; 73(5): 589-600.
Lee J, Dowd B. Effect of health information technology expenditure on patient level cost. Healthc Inform Res 2013; 19(3): 215-21.
Buyukozkan G, Ilicak O. Integrated SWOT analysis with multiple preference relations: Selection of strategic factors for social media. Kybernetes 2019; 48(3): 451-70.
Dalton J. SWOT analysis (Strengths, weaknesses, opportunities, threats). In: Dalton J, editor. Great Big Agile: An OS for Agile Leaders by Jeff Dalton. New York, NY: Springer; 2019. p. 249-52.
Shahmoradi L, Darrudi A, Arji G, Farzaneh NA. Electronic health record implementation: A SWOT analysis. Acta Med Iran 2017; 55(10): 642-9.
Pereira R, Salazar M, Abelha AN, Machado J. SWOT analysis of a portuguese electronic health record. Berlin, Heidelberg: Springer Berlin Heidelberg; 2013 p. 169-77.
Dexter PR, Perkins S, Overhage JM, Maharry K, Kohler RB, McDonald CJ. A computerized reminder system to increase the use of preventive care for hospitalized patients. N Engl J Med 2001; 345(13): 965-70.
Helms M, Moore R, Ahmadi M. Information technology (IT) and the healthcare industry: A SWOT analysis. Int J Healthc Inf Syst Inform 2008; 3(1): 75-92.
Khamis N, Ahayalimudin N, Puteh S. An overview of electronic medical record implementation in healthcare system: Lesson to learn. World Appl Sci 2013; 25(2): 323-32.
Kumar S, Aldrich K. Overcoming barriers to electronic medical record (EMR) implementation in the US healthcare system: A comparative study. Health Informatics J 2010; 16(4): 306-18.
Liebovitz D. Meaningful EHR attributes for an era of accountability, transparency, shared decision making, and value assessment. J Leg Med 2013; 34(1): 43-53.
Yogeswaran P, Wright G. EHR implementation in South Africa: How do we get it right? Stud Health Technol Inform 2010; 160(Pt 1): 396-400.
Wang T, Biedermann S. Transparency Challenges in Heath Information Technology. Journal of Healthcare Information Management 2012; 26(2): 86-91.
Meehan RA, Mon DT, Kelly KM, Rocca M, Dickinson G, Ritter J, et al. Increasing EHR system usability through standards: Conformance criteria in the HL7 EHR-system functional model. J Biomed Inform 2016; 63: 169-73.
DeAngles M. National Electronic Health Record Network Regulation and Synchronization of National and State Privacy Laws Needed to Increase Efficiency and Reduce Costs in Healthcare. J Leg Med 2015; 36(3-4): 413-9.
Goldstein MM, Blumenthal D. Building an Information Technology Infrastructure. J law med ethics 2008; 36(4): 709-15.
Takemura T, Araki K, Arita K, Suzuki T, Okamoto K, Kume N, et al. Development of fundamental infrastructure for nationwide EHR in Japan. J Med Syst 2012; 36(4): 2213-8.
Magnuson JA, Fu PC. Public health informatics infrastructure. In: Dixon BE, Grannis SJ, editors. Public health informatics and information systems. New York, NY: Springer; 2014. p. 60-88.
Boonstra A, Broekhuis M. Barriers to the acceptance of electronic medical records by physicians from systematic review to taxonomy and interventions. BMC Health Serv Res 2010; 10: 231.
Nowinski CJ, Becker SM, Reynolds KS, Beaumont JL, Caprini CA, Hahn EA, et al. The impact of converting to an electronic health record on organizational culture and quality improvement. Int J Med Inform 2007; 76(Suppl 1): S174-S183.
Thakkar M, Davis DC. Risks, barriers, and benefits of EHR systems: A comparative study based on size of hospital. Perspect Health Inf Manag 2006; 3: 5.
Cherry B. Assessing organizational readiness for electronic health record adoption in long-term care facilities. J Gerontol Nurs 2011; 37(10): 14-9.
Ballaro J, Washington E. The impact of organizational culture and perceived organizational support on successful use of Electronic Healthcare Record (EHR). Organ Dev J 2016; 34(2): 11.
Morton ME, Wiedenbeck S. A framework for predicting EHR adoption attitudes: A physician survey. Perspect Health Inf Manag 2009; 6: 1a.
Ajami S, Bagheri-Tadi T. Barriers for adopting Electronic Health Records (EHRs) by Physicians. Acta Inform Med 2013; 21(2): 129-34.
Miller RH, Sim I. Physicians' use of electronic medical records: Barriers and solutions. Health Aff (Millwood) 2004; 23(2): 116-26.
Xierali IM, Hsiao CJ, Puffer JC, Green LA, Rinaldo JC, Bazemore AW, et al. The rise of electronic health record adoption among family physicians. Ann Fam Med 2013; 11(1): 14-9.