Insight, Primary Care News

Deep dive: community pharmacy and dentistry in digital focus

The Fuller stocktake, published last summer, stated that engagement activities for the purposes of the report “heard very clearly” that the wider primary care team “could be much more effectively harnessed” to support patient access to primary care, with community pharmacy and dentistry noted as particular examples.

A year on from the report, let’s take a look at news, use cases, educational opportunities and research in these areas.

First, pharmacy.

We’ve seen renewed commitment from the NHS with regards to the need to expand community pharmacy services and improve existing pharmacy services – the GP Access Recovery Plan released in May highlighted plans to “invest to significantly improve the digital infrastructure between general practice and community pharmacy”. NHS England announced in the plan to launch its Pharmacy First programme by the end of 2023, with an aim to expand the role of community pharmacy.

It also shared intentions for NHSE to work with community pharmacy suppliers and general practice IT suppliers for the development and delivery of interoperable digital solutions. These solutions “will streamline referrals, provide additional access to relevant clinical information from the GP record, and share structured updates quickly and efficiently following a pharmacy consultation back into the GP patient record.”

Last August, after the publication of the Fuller stocktake, the NHS shared information on how they are working on improving information flow between pharmacies and general practice, including development of the Future Enterprise Architecture (FEA) for pharmacy IT suppliers – a “conceptual service blueprint to inform the development plans of IT suppliers working in community pharmacy”. The FEA was designed to “support technology providers to define their product roadmaps to address user priorities,” NHSE noted, “as well as work to an agreed set of NHS technologies and standards, both current and follow on.”

In October last year, we highlighted a report from the Professional Records Standards Body (PSRB) which focused on defining standards for sharing information with pharmacy, optometry, dentistry, ambulance and community services (PODAC); the report found “overwhelming support and agreement” that implementing PSRB Core Information Standard (2.0) across these settings “is important for the benefit of both care professionals and those accessing care.” James Palmer, then programme head for Digital PODAC at NHS Digital at the time, commented that endorsing the information standard for use across these systems “marks a really important step on the journey to enabling true interoperability across the wider health and care system.”

There has been investment in this area within the UK – in spring, we heard how Life Sciences Hub Wales and Digital Health and Care Wales launched a new fund to support suppliers of digital community pharmacy systems, with applications open until October 2024. Funding has been made available to develop and implement electronic prescription services in a Wales-based pharmacy through an assured patient medication record; to be able to send push notifications to the NHS Wales App to advise when medicines are prepared and ready for collection; and to help reduce paper use in community pharmacy. In June, two suppliers had already been awarded funding, with Digital Health and Care Wales’ Professor Hamish Laing commenting that it is “fantastic to see this fund moving so quickly and making its first awards just a few weeks after it was launched.”

Looking to pharmacies within NHS trusts, last week The Dudley Group NHS Foundation Trust shared that £1.2 million has been invested into their pharmacy department. New dispensing robots implemented in the department “offer a much faster dispensing output and utilise the latest engineering developments”, the trust notes, “ensuring that patients receive their medication quicker. With triple the amount of workstations able to be utilised by staff, simultaneous prescriptions can now be dispensed.” The robots also offer “remote out-of-hours dispensing, improving emergency medicine supply timeframes and reducing the number of on-call pharmacist site attendances to provide more time to respond to other clinical calls.”

In addition, the pharmacy department now features automated dispensing cabinets for controlled drugs which utilise digital authentication via fingerprint recognition, with the trust stating that these factors “have propelled the pharmacy department back to being one of the most digitally enhanced pharmacies in the country. The time saved from utilising this technology will help release more of the team to clinical ward-based work, enhancing patient-facing medicines optimisation and support for colleagues across the trust.” Ruckie Kahlon, chief pharmacist and director of medicines optimisation at The Dudley Group, commented that it is “fantastic” to see the department “showcasing the innovative technological advances being made in this field.”

To provide support to pharmacy owners with regards to digital, Community Pharmacy England has brought together regularly-updated resources for a variety of tech-related topics on their website, including patient digital services; IT policy and development; records, data security and information governance; and tech and workflows. The resources set out descriptions of services and technologies, examples, standards and technical requirements, training opportunities, and more.

In terms of future actions, June saw the House of Commons Health and Social Care Committee share its report on digital transformation in the NHS, with recommendations including close collaborations with sectors such as community pharmacy for the integration of shared care records in the future; investment to tackle outdated legacy IT systems; and the integration of digital training throughout wider learning programmes.

From Community Pharmacy England, IT policy manager Daniel Ah-Thion commented that CPE “strongly advocates for the implementation of NHS IT records standards that harmonise the underlying standards of the Shared Care Record (ShCR) and other systems”, and added an additional proposal around the creation of NHS Records Integration APIs, to enable clinical IT system suppliers “to seamlessly integrate with these records and introduce solutions that reduce the workload of pharmacy teams when it comes to accessing or modifying records as part of an expanded system.”

Daniel added: “It is important to acknowledge that the journey towards fully integrated records involves utilising the records we currently have, such as the new National Care Records Service portal and the incorporation of GP Connect integrations into pharmacy systems, as outlined in the recently published delivery plan for improving access to primary care.”

Now to digital for dentists.

The NHS Long Term Workforce Plan, published in June, shared an overarching priority around “significantly” increasing education, training, apprenticeships and alternatively routes into professional roles, with a focus on delivering more dentists alongside doctors, nurses and midwives.

We’ve yet to see how the NHS specifically plans to follow up on this priority, but looking at dentist training and education with a digital slant, an international perspective provides the example of the Institute of Digital Dentistry (iDD) in New Zealand. Described as an online training platform designed for digital dentistry, the institute places focus on the use of computer-aided design (CAD) and computer-aided manufacturing (CAM) technology.

The institute’s website, iDD Online, notes that “through our work with dental professionals and our ever-growing global online community, we’ve learned it’s prohibitively difficult to source unbiased, up-to-the-minute information about digital dentistry… Our mission is to ensure everyone globally, has easy and affordable access to the best digital dentistry training possible. To achieve this, we’re providing dental professionals from all corners of the world with the knowledge and confidence to use digital dentistry effectively and efficiently.”

iDD Online brings together a range of live and online courses in different areas of digital dentistry, including 3d printing, digital implantology, and a computer-aided design and computer-aided manufacturing technology masterclass.

Closer to home, one example of dentist tech in practice can be found at Abderdeen’s Portlethen Dental Care, a dentistry clinic offering both NHS and private care. The clinic states that it uses “cutting-edge digital technology to deliver accurate and precise treatments” and shares their belief that digital dentistry is a “large part” of “giving all our patients the very best care”. In particular, they add, technology “allows us to clearly show you the treatment plan and process and help you understand our procedures.”

The clinic highlights a range of examples of dental technology in use, including digital scanners to take 3D images of teeth “within minutes” and a 3D printer enabling the clinic to create “highly detailed models”. Intraoral cameras are used “in every surgery” to examine parts of the mouth that might otherwise be difficult to reach and to take “high-quality colour pictures”. There is a machine using digital intraoral scans to provide dental restorations in “just one visit”, and a dental cone beam CT scanner capable of producing “highly detailed images of the mouth”, which is used in diagnosis and treatment planning.

What about artificial intelligence in dentistry? Let’s take a look at a review published in Frontiers earlier this year which explores the potential use cases of AI in this area. The review states that from a dental perspective, “applications of AI can be classified into diagnosis, decision-making, treatment planning, and prediction of treatment outcomes”, with diagnosis as “the most popular” option.

In operative dentistry, for example, it notes that research has taken place on the detection of dental caries (permanently damaged areas that develop into holes); vertical root fractures; apical lesions; pulp space volumetric assessment; and evaluation of tooth wear. By learning from these characteristics, research suggests that AI algorithms could learn the pattern and provide predictions as to the future of the tooth and treatment options.

In periodontitis, or gum disease, studies have shown how AI could be “utilised to diagnose periodontitis and classify plausible periodontal disease type,” the review shares.

With regards to orthodontics, the review highlights the potential use cases for AI in treatment planning and prediction of treatment results, “such as simulating the changes in the appearance of pre- and post-treatment facial photographs. The impact of orthodontic treatment, the skeletal patterns, and the anatomic landmarks in lateral cephalograms can be clearly seen with the aid of AI algorithms, greatly assisting communication between patients and dentists.”

When it comes to oral and maxillofacial pathology, “AI has been researched mostly for tumour and cancer detection based on radiographic, microscopic and ultrasonographic images.” The review adds that “abnormal locations can also be detected from radiographs by AI, such as nerves in the oral cavity, interdigitated tongue muscles, and parotid and salivary glands.”

Finally, looking at AI in prosthodontics – described as a typical treatment process to prepare a dental crown – the review comments that the application of AI “mainly lies in the restoration design”. It notes that computer-aided design and computer-aided manufacturing has “digitalised the design work in commercialised products”, adding that although this has “dramatically increased the efficiency of the design process by utilising a tooth library for crown design, it still cannot achieve a custom-made design for individual patients.” Using AI, however, researchers have explored whether algorithms can generate an individual crown by learning from technician designs. According to the review, integrating AI with with other technologies such as CAD/CAM or 3D/4D printing “can achieve a more desirable workflow with high efficiency”.

The review’s authors go on to discuss their findings, noting that to use dental data for machine learning training, “one must be very careful with its complex, sensitive, and limited validation methods”, highlighting that dental data from electronic records is “usually of low integrity”. However, they describe AI as “among the most promising” new technologies being developed and adopted in the dental field, and state that AI in dentistry is capable of “high accuracy and efficiency if unbiased training data is used and an algorithm is properly trained. Dental practitioners can identify AI as a supplemental tool to reduce their workload and improve precision and accuracy in diagnosis, decision-making, treatment planning, prediction of treatment outcomes, and disease prognosis.”

Citation: Ding H, Wu J, Zhao W, Matinlinna JP, Burrow MF and Tsoi JKH (2023) Artificial intelligence in dentistry—A review. Front. Dent. Med 4:1085251. doi: 10.3389/fdmed.2023.1085251