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New guidelines help make exchanging electronic health information easier

Technical reports outline methods for secure exchange

In response to a 2009 resolution from the House of Delegates, the ADA Council on Dental Practice and ADA Standards Committee on Dental Informatics have approved two technical reports dedicated to the secure electronic transmission of digital radiographs and photographs.

ADA Technical Report No. 1060 for the Secure Exchange and Utilization of Digital Images in Dentistry outlines the methods for the secure exchange and utilization of electronic digital image files, including those requiring diagnostic quality, and ADA T.R. No. 1048 for Attachment of DICOM Datasets Using Email in Dentistry covers the DICOM requirements for transmitting files via email.

“These are two of the most significant technical reports we’ve ever put together,” said Dr. Scott Benjamin, co-chair of the SCDI Workgroup 12.1. “This will help dentists now by giving them a set of guidelines to consult when exchanging diagnostic information electronically.”

Dr. Benjamin stressed it is “imperative” that clinicians request that their practice management and dental imaging management programs be set up to follow the guidelines, adding, “We hope the manufacturers will conform with these reports as quickly as possible to make it beneficial to everyone.”

T.R. 1060 encompasses all diagnostic radiographs, intraoral and extra-oral photographs, video, optical impressions and oral pathology photomicrographs. It also advises against utilizing unsecure exchange transmission modes such as sending unencrypted email attachments.

T.R. 1048 illustrates the need for email technologies to enable an easier method of patient data transfer between practitioners instead of copying files onto and mailing compact disks.

Dr. Stephen Glenn, CDP chair, noted a “more secure electronic exchange of health information” as being among the most important factors in the new guidelines. He thinks the recommendations will ultimately help a practice’s coordination of care, improve clinical decision support and lead to reduced errors. The ability to share files more easily could potentially improve patient safety since patients will likely be exposed to lower radiation from fewer X-rays.

“Digital standards define a common digital format, meaning the software knows what information to expect and where it will be located within a file,” said Dr. Glenn. “Once standards are adopted, the information contained in digital images, impressions, test results and other transmissions from a sender can be seamlessly and completely utilized by a standards compliant recipient despite differences in their respective software. For instance, standardized digital images can be viewed and manipulated on a conforming system regardless of where generated.

“Standards can also help dentists make more informed purchasing decisions regarding both hardware and software. The ultimate goal in creating standards is to maintain full functionality while providing complete interoperability between health information technology systems.”

For ADA members interested in exchanging secure images electronically, both reports urge dentists to check and see how their state laws apply. T.R. 1060 points out that in some states “legal impediments” exist that make the interstate exchange of such data difficult, saying, “while some states permit remote ‘teledentistry’ clinical encounters by patients with providers in other states, some states do not permit such activity.”

Although Resolution 83H-2009 called for standards to be developed for practitioners and third-party payers, the need for guidelines in digital imaging technologies has long been in the making since dentists rely on new technology more than ever before.

In 2004, the ADA Board of Trustees passed a resolution adopting DICOM—Digital Imaging and Communications in Medicine—as the standard means for exchange of all digital dental images. The ADA Standards Committee on Dental Informatics was established in 1999 under the ADA standards program that has been in existence since the first standard was approved for dental amalgam in 1928. The ADA is currently an American National Standards Institute-accredited standards organization.

Anyone interested in participating in the standards development for dental products or informatics should contact the ADA at

ADA Technical Reports No. 1048, Attachment of DICOM Dataset Using Email, and No. 1060, Secure Exchange and Utilization of Digital Images in Dentistry, are available for download purchase from the ADA Catalog at or by calling 1-800-947-4746.