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Int J Comput Dent. Author manuscript; available in PMC 2008 May 5. Published in final edited form as: Int J Comput Dent. 2007 July; 10(3): 247–264. | PMCID: PMC2367256 NIHMSID: NIHMS39582 |
Supporting the Emergence of Dental Informatics with an Online Community H. Spallek,a J. Y. Irwin,b T. Schleyer,c B. S. Butler,d and P. M. Weisse aAssistant Professor, Center for Dental Informatics, School of Dental Medicine, University of Pittsburgh, Pittsburgh, PA, USA bPhD Student, Department for Biomedical informatics, University of Pittsburgh, Pittsburgh, PA, USA cAssociate Professor and Director, Center for Dental Informatics, School of Dental Medicine, University of Pittsburgh, Pittsburgh, PA, USA dAssociate Professor of Business Administration, Joseph M. Katz Graduate School of Business, University of Pittsburgh, Pittsburgh, PA, USA eReference and Information Technology Librarian, Health Sciences Library System, University of Pittsburgh, Pittsburgh, PA, USA Dental Informatics (DI) is the application of computer and information science to improve dental practice, research, education, and program administration. As an emerging field, dental informatics faces many challenges and barriers to establishing itself as a full-fledged discipline; these include the small number of geographically dispersed DI researchers as well as the lack of DI professional societies and DI-specific journals. E-communities have the potential to overcome these obstacles by bringing researchers together at a resources hub and giving them the ability to share information, discuss topics, and find collaborators. In this paper, we discuss our assessment of the information needs of individuals interested in DI and discuss their expectations for an e-community so that we can design an optimal electronic infrastructure for the Dental Informatics Online Community (DIOC). The 256 survey respondents indicated they prefer electronic resources over traditional print material to satisfy their information needs. The most frequently expected benefits from participation in the DIOC were general information (85% of respondents), peer networking (31.1%), and identification of potential collaborators and/or research opportunities (23.2%). We are currently building the DIOC electronic infrastructure: a searchable publication archive and the learning center have been created, and the people directory is underway. Readers are encouraged to access the DIOC Website at www.dentalinformatics.com and initiate a discussion with the authors of this paper. Keywords: dental research, dental informatics, Internet, information systems, online systems, information services, hypermedia, computer communication networks Dental Informatics (DI) is the application of computer and information science to improve dental practice, research, education, and program administration. 1 Unlike its parent discipline, biomedical informatics, DI is characterized as a nascent discipline, 2 which faces major challenges in establishing its status; these include the geographically dispersed and slow-growing small number of experienced and trained DI researchers as well as the lack of a dedicated professional society or standing annual conference for DI. 3 Major distinctions are found between DI researchers in Europe, who focus predominantly on the application of DI principles in dental education, 4 compared with researchers in the US whose work typically targets electronic oral health records. Further, DI has yet to be integrated with the dental research community at large. 5 The overarching goal of our research is to establish a DI e-community 6 that will surmount the existing challenges and exploit DI’s considerable potential to improve processes and outcomes in dental research, practice, and education. Challenges Facing Dental Informatics There are five major challenges and/or barriers that hamper DI from establishing itself as a discipline in its own right: Size and Geography Not only are they geographically dispersed but the number of experienced and trained DI researchers 2 is small and growth is very slow. In the US, this is because there are only two active educational programs, while in Europe such a DI program is only in the planning stage. Professional Representation There is no DI-dedicated professional society to unite all international researchers and create a cohesive vision and resource center for the field. 3 For instance, the Academy of Computerized Dentistry of North America, which is part of the International Society of Computerized Dentistry (ISCD), has about 2,000 members but no ties to the two US postgraduate programs for dental informatics. In addition, there is no international standing annual conference during which researchers can communicate their findings on a regular basis. Most DI researchers meet under the auspices of other dental meetings, none of which is all-inclusive to the DI field. Hence, presentations on DI topics are scattered among many different events, such as the American Medical Informatics Association’s (AMIA) annual symposia, the ISCD Day, which is part of the annual World Dental Federation (FDI) meeting, the German Society for Computerized Dentistry (DGCZ), and the American Dental Education Association’s (ADEA) annual sessions. 2 Literature Dental informatics literature is similarly dispersed: one study of 620 DI papers determined that the topic was spread over 176 different journals. 3 The International Journal of Computerized Dentistry, the official publication of the ISCD, is the only periodical devoted solely to a DI topic. However, this journal is not fully inclusive and reflects the focus of its parent organization, which is centered on CAD/CAM technology. For example, 122 of its 218 publications between 1998 (inaugural issue) and October 2006 are tagged with “Computer-Aided Design” or “Cerec.” Academia Unfamiliarity In general, dental students, faculty, and school administrators are not familiar with DI as an area of scientific inquiry, 6 because the field is not integrated into the dental research community at large. 5 We believe all of these challenges have the potential to be solved by establishing a global e-community for DI: the Dental Informatics Online Community (DIOC). A Solution: E-communities E-communities or “…virtual communities [are] defined as an aggregation of individuals or business partners who interact around a shared interest, where the interaction is at least partially supported and/or mediated by technology…”. 7 With an increasing number of people participating in e-communities, research has been devoted to characterize the phenomena associated with their rapid ascent into many different spheres of life. Porter’s typology of e-communities distinguishes between member-initiated and organization-sponsored e-communities. Member-initiated e-communities are characterized by grassroots efforts to establish and manage them, while organization-sponsored e-communities incorporate the mission and goals of the sponsoring commercial or non-commercial organization. 7 E-communities can also be characterized based on their social, commercial, or professional scope. 8 Today’s popular social e-communities, such as MySpace, 10 Friendster, 11 and Facebook 12,13 revolve around leisure activities or hobbies and enable members to meet new people using social software tools. Some other social e-communities have product developments or services as their shared goal. Examples are the 45,000 contributors to the online encyclopedia Wikipedia or the more than 2,000 active developers 14 who work on Apache, an open source software product that claims 67% of the Web server market. 15 Commercial e-communities focus on brand or product support or allow the trade of goods. A prime example is eBay, which provides a platform for auctions among its 168 million community members. 16Professional e-communities function around shared professional interests and can be broadly classified into expert-based knowledge networks and student-based learning communities. 7 Expert-based knowledge networks incorporate scholarly e-communities, like our DIOC, and may also be referred to as Communities of Practice (CoP). They focus on a domain of knowledge and accumulate this knowledge and expertise over time. Studies on CoP have shown that participants receive new factual information, solutions to problems, learning and insight. 17 These four benefits derive from socially embedded information and exist in the context of interpersonal and group interaction rather than the depersonalized or authoritative information found in traditional databases and documents. 18 It is important to note that CoP do not encapsulate their members, but instead help them to succeed “outside” the community. This orientation towards the outside world is crucial for the DIOC because it enables the DI research community to fulfill its responsibility to educate the wider dental community about the scope and potential contributions of dental informatics. A dental informatics e-community has the ability to: - Bring together the small number of geographically dispersed DI researchers in one unified forum allowing them to create a cohesive vision and also to bundle resources
- Emerge as a major hub for sharing successful DI projects, thus increasing the visibility of these endeavors
- Address the field’s isolation by helping to identify DI experts and potential collaborators for dental researchers
- Facilitate retrieval of DI literature using a publication archive that houses papers currently not part of the traditional biomedical literature body
- Expand the understanding of DI as an area of scientific inquiry among dental students, dental faculty and school administrators
- And lastly, act as the dedicated professional home for DI researchers by serving as an open, common, and worldwide forum for all individuals interested in the field.
Developing a Dental Informatics E-community The development and longevity of the DIOC, and attaining the goals outlined above, hinge on attracting and retaining a critical mass of members by, for instance, widely promoting the anticipated benefits of participation. Since a CoP depends on volunteers to provide content, the DIOC must not only attract members but must also foster active participation among those members for it to be a viable and valuable resource. Historically, broad participation in an e-community is difficult to achieve. In 2006, Nielsen characterized the participation inequality in multi-user communities and social networks as “90% of users are lurkers who never contribute, 9% of users contribute a little, and 1% of users account for almost all the action.” Participation inequality, while never entirely surmountable, must be recognized and addressed if a reasonable distribution of contributions is to be achieved. However, legitimate peripheral participation should not be discouraged. 19 In fact, viable e-communities thrive with a steady flow of members on the periphery as well as those members who are engaged or highly active in their commitment, even if the latter group is the dominant information provider. The purpose of this paper is to stimulate a discussion about (a) the role the DIOC can and should play in the larger framework of diverse dental informatics activities and in various organizations and (b) how members of the ISCD, as well as all other interested parties, can benefit and participate in the project. In order to initiate and nurture such a discussion, we will report our findings in summarized format from Stage One of the DIOC project, which entails an information needs assessment of the target audience and an analysis of expected benefits. In December 2005, the DIOC project received funding of US$350,000 for three years from the US National Institutes of Health (NIH). The research goals are: (1) encouraging and supporting the formation of partnerships and collaborative projects in dental informatics; (2) promoting the development of dental information resources; and (3) disseminating research results and best practices globally. The DIOC project involves three distinct project phases: Phase 1, compiling detailed requirements for the DIOC based on a completed assessment of information needs and expected benefits among our target audience. Phase 2, implementing an electronic infrastructure for the e-community based on the above-mentioned requirements. Phase 3, evaluation of the DIOC’s impact on the target audience using usage and survey data will be undertaken once the first two phases are concluded. Currently, Phase 1 is complete; its methodology and findings are discussed in this paper. Phase 2 is progressing; we will report on its results at completion. Phase 1 – Needs Assessment Phase 1 began by defining the target audience for the DIOC, which was determined to encompass, but not be limited to, researchers with a focus on DI (AMIA members, DI sections of other dental organizations), bioinformatics researchers interested in dentistry, researchers from related disciplines (biomedical informatics, education, cognitive sciences), non-informaticians (dental researchers, educators, clinicians, students), the dental information technology industry, and the Library and Information Sciences (LIS) community. A survey instrument was then developed using Dillman’s Tailored Design Method 20 and principles from Thinking About Answers. 21 The survey was iteratively revised by an expert group made up of two dental informatics fellows, two dental informatics faculty, three medical librarians and a business school faculty as well as a doctoral student. Using nine volunteers from our target population, we performed an evaluation of the draft survey using the Retrospective Thinkaloud protocol as suggested by Sudman at al. 21 This formative evaluation led to various revisions resulting in the final survey instrument that used different question formats: open-ended requiring extended text input, open-ended with short answers, and multiple-choice options. The 17 questions integrated five demographic questions, including current position, one question on expectations about the DIOC, six questions concerning professional relationships, and four questions on information-seeking behavior. The study was approved by the University of Pittsburgh’s Institutional Review Board (#0604033). We invited 2,303 individuals, via email, to undertake the Web-based survey, and included people (211) who had already signed up for the DIOC. We endeavored to match the composition of our prospective target audience by gathering email addresses from various publicly available sources (eg, AMIA-DI working group, MEDLINE, DI published papers). Each e-mail invitation included a unique access code to prevent both duplicate entries and completion by people who were not part of the target audience. Phase 2 – Implementing the DIOC We have begun to build the electronic infrastructure of the planned online community, which can be found at http://www.dentalinformatics.com. We envision that this early deployment of skeletal features and initial information offerings will attract early adopters who will be inspired to act as DIOC champions and multipliers. Phase 1 – Needs Assessment Needs assessment results reported herein are only those relating directly to the goals of this paper. The survey yielded a response rate of 11.1% (256). On average, survey respondents were 46.4 years old, held their current title for 7.9 years, and had 11.6 years at their current institution. The question about national origin elicited 249 respondents who reported coming from 30 different countries, with the following mentioned more than four times: United States (139), Germany (15), Canada (10), United Kingdom (7), Netherlands (7) and India (6). The title and position question resulted in 37 respondents identified as assistant professors, 36 full professors, 35 associate professors, 25 department chair/CEO/directors, 21 postgraduate students, 18 dental practitioners, 17 scientists, 13 consultants, 11 administrators, 7 librarians, 6 deans, 3 predoctoral students and 2 dental hygienists (231 respondents). The question “How often do you use the following information sources when trying to find professional information?” was designed to learn which information sources are currently used by our target audience. As illustrated in , electronic resources dominate, led by MEDLINE searches (196 frequent users), the Internet searches (186 frequent users) and the use of online journals (184 frequent users). We also wanted to learn to what degree our target audience collaborates. We defined collaborator as “a coauthor, co-investigator, or consultant to a specific project.” Respondents on average each worked with 10 collaborators during the past 12 months (193 respondents). Table 1 summarizes the origins of relationships with collaborators. | Table 1Responses to the origin of collaborators during the past 12 months |
When probed about attendance at professional meetings, we found, on average, respondents attend five meetings per year (245 respondents). The crucial factors when determining meeting attendance were identified as (249 respondents): relevance of the meeting agenda to general research interests (mentioned 168 times as very important; 67%), relevance to particular research projects (mentioned 122 times; 49%), and potential for networking with fellow researchers (mentioned 109 times; 44%). Survey respondents currently signed up as DIOC members were asked what benefits they expected from their involvement in the e-community. The remaining respondents were asked how they thought an e-community might benefit their research. Sixty-four percent (164 of 255 respondents) reported at least one type of expected benefit. Overall, the most frequently expected benefits from participation were general information (eg, exchange of ideas, remaining well-informed), which was mentioned by 85% of respondents, 31.1% cited peer networking (eg, finding colleagues with same interests) and 23.2% named identification of potential collaborators and/or research opportunities (23.2%). Phase 2 – Implementing the DIOC Initial marketing efforts, begun in December 2005, have resulted in 322 DIOC members (status May 17, 2007). Table 2 displays information about each component that has either been implemented or is planned for the future. The DIOC Publication Archive was made available in November 2006; its bibliography of DI research literature now stands at 958 papers. A nucleus of the DIOC Learning Center is available including a Frequently Asked Questions document about dental informatics that provides basic information about this emerging field. | Table 2Components of the Dental Informatics Online Community |
Communities of Practice, such as the DIOC, play an increasing role in newly growing disciplines because they allow the formation of expert-based knowledge networks, which in turn hasten the growth and development of the discipline. This paper describes the relationship between popular and professional e-communities focusing on the particular characteristics of scholarly e-communities. The results indicate that our sample population is familiar with the concept of e-communities. That finding is bolstered by the large number of early subscribers to the DIOC as well as the fact that the majority of respondents articulated at least one expected benefit from participation in a CoP. By making public and available the details of the planned (and partially implemented) features and functions of the DIOC (see Table 2), we are supplying the foundation for an informed discussion among the members of the ISCD and between ISCD members and the DIOC project team. The DIOC’s potential role in the larger context of dental informatics activities around the world can be appraised by these features and functions, which go beyond an “electronic meeting point for socializing” as is so often found in the social networking tools of non-scholarly e-communities. The components planned for the DIOC are compatible with the current information-seeking behavior of our respondents. For instance, respondents’ emphasis on information gathering via electronic resources versus print material indicates that they will deem valuable the DIOC’s electronic information databases. The fact that electronic searches were mentioned most frequently in our survey is consistent with others’ findings that the Internet has emerged as an important tool for dentists, 22 and that Google is becoming an important clinical information resource for physicians seeking to diagnose difficult cases. 23 All of the DIOC’s information resources will be searchable using an easy-to-use user interface and a controlled vocabulary (Medical Subject Headings (MeSH). Many aspects of the results suggest that the respondents maintain active professional relationships and, further, that they will value networking opportunities through the DIOC. For instance, respondents worked with a large number of collaborators (on average 10 during the past 12 months) and participated in an average of five conferences or professional meetings per year. The DIOC will unify DI researchers and multiply new collaboration opportunities. Individuals’ expectations of benefits play a significant role in their satisfaction with, commitment to, and, ultimately, participation in e-communities. 24 Two key benefits of the DIOC are the people and project directories that let members learn about other members and their research activities. The project directory, which is closely related to a research opportunity exchange, allows researchers to seek assistance for their projects and also become involved in the projects of others. As outlined in the planned features and functions overview, each member will have the option to create and maintain a profile that contains their research interests, institution location, cooperation partners, and publications. The profile pages, accessible by all other subscribers, will also include information contributed to the DIOC as a trace of the subscriber’s activity in order to maintain a persistent and up-to-date identity. These profile pages will enable subscribers to construct and evolve verifiable identities. 25Analysis of the expected benefits suggests that respondents’ expectations have both convergent and divergent aspects. General information about dental informatics, including introductions to DI topics and updates about recent advances, were mentioned as an expected benefit of participating in the DIOC. Access to up-to-date information was often mentioned as a hoped-for benefit. This highlights the importance of providing timely dental informatics resources as a cornerstone of the planned community. Informational benefits were widely mentioned but responses concerning social benefits varied. Fifty-eight percent mentioned some type of social benefit, others sought general information alone, and a third group favored general information in combination with peer networking and collaboration opportunities. The existing DIOC members were significantly more likely to mention social benefits than non-members. Developing a critical mass of participants for any social aspect may be a challenge. While those who expect only informational benefits are potential social participants, their involvement in the social aspects of the community is likely to be a secondary event occurring only after they have engaged the community as a satisfactory information source. A higher proportion of respondents have a more targeted informational expectation than an interest in a range of social benefits. This suggests probable value in customized interfaces that allow individuals to focus on particular aspects of the community. The interplay of informational and social benefits captures both the promise and the challenge of academic online communities. On one hand, e-communities offer clear benefits for individuals who are isolated, less connected and lack access to local institutional resources. Inclusion of such individuals increases the diversity and impact of the otherwise fragmented discipline of dental informatics. 26,27 But on the other hand, e-communities require an ongoing commitment and proactive contribution by members for any long-term worth to accrue for participants. 28 The more diverse and frequent the participation, the stronger and more indispensable will be the e-community. However, the ability and enthusiasm of individuals to contribute to a community is, in part, dependent on their local environment. 29 The paradox of an academic e-community is that the individuals best qualified to contribute are the ones least likely to perceive any benefit in doing so. The resources and benefits of the e-community are usually already available to these thought leaders in their professional environments. In short, they have no impetus to contribute. This factor does not have to impede the future success of the DIOC. By building an online base of commonly valued information resources and by providing individuals with the ability to “pick and choose” the nature of their social engagement, the DIOC will provide the infrastructure to unite a diverse group of dental informaticians who have complementary needs. By outlining the challenges that lie ahead for the emerging discipline of dental informatics, we have laid the groundwork for an intense discussion among members of the International Society for Computerized Dentistry. Proactive communication about the DIOC’s planned features and functions enables prospective members to judge the benefits of early participation in the community and at the same time permits meaningful input and feedback on the ultimate shape of the e-community. We have provided insight into the development process of the DIOC by emphasizing selected results from an earlier study that assessed the information needs of dental informaticians, researchers, educators, clinicians and other interested parties, and have also addressed the expected benefits of this community of practice. Readers and others are encouraged to access the DIOC Website at www.dentalinformatics.com and initiate a discussion with the authors of this paper. The authors would like to thank the National Library of Medicine for funding the Dental Informatics Online Community project (1 G08 LM008667-01 A1). Our thanks also go to Patrician F. Anderson, Ellen G. Detlefsen, Courtney Hatala, Reza Naderi and Xiaoqing Wang for their input during this research. Special thanks to Wendy O’Donnell who acted as editor of the final manuscript. |
 Heiko Spallek, DMD, PhD Assistant Professor at the Center for Dental Informatics, University of Pittsburgh School of Dental Medicine. Dr. Spallek’s research focuses on the development of Web-based educational resources for dental professionals. Dr. Spallek developed and directs a predoctoral course on computer applications in dentistry. As a core faculty member of the Department for Biomedical Informatics at the University of Pittsburgh, he lectures in the postgraduate training program in dental informatics, a program funded by the National Library of Medicine and National Institute of Dental and Craniofacial Research (NLM/NIDCR). Dr. Spallek is past chair of the Dental Informatics Working Group of the American Medical Informatics Association, and published the first textbook for predoctoral and continuing education on dental Internet applications in Germany (1997) and in the United States (1998). He is co-founder and a principal of S3 Web Technologies, LLC, an Internet services and consulting company for dental and medical markets. |
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