This article was originally printed in our First Quarter 2022 issue of The Scope: Dental Edition and was authored by Danielle Mikalajunas Fogel, then an attorney with Fager Amsler Keller & Schoppmann, LLP, before she was elected to the bench as the Hon. Danielle M. Fogel, J.S.C., and Shelly Kriete, a Risk Management Consultant with MLMIC Insurance Company. Read more articles from the publication here.

Healthcare organizations have a duty to provide a safe environment for patients. But while patient safety, which includes the safe use of equipment and devices, continues to be a primary focus across the healthcare continuum, increased efficiencies in the delivery of healthcare are also necessary to both maintaining a professional organization’s financial stability and continuously improving the patient experience. Technologies like artificial intelligence, 3D printing, robotics, remote monitoring and nanotechnology seem to be constantly implemented or updated. Employing such technologies, and ensuring efficient and safe technology interoperability in dentistry, creates additional risk management considerations for dentists.

Technological advances do not come without threats to patient safety, and their implementation and operation require management strategies to mitigate both harm to patients and the resulting professional and general liability claims. Possible dangers can be related to systematic issues such as design flaws, operative failures and/or user errors such as misuse and employing workarounds. This article will focus on technology interoperability issues in dentistry and offer suggestions for leadership and risk managers alike to consider when deploying new technologies.

According to the Healthcare Information Management Systems Society, interoperability is “the ability of different information systems, devices and applications to access, exchange, integrate and cooperatively use data in a coordinated manner, within and across organizational, regional and national boundaries.” Federal mandates such as the Interoperability and Patient Access final rule (CMS-9115-F) (85 FR 25510), which went into effect on June 30, 2020, are expected to boost the exchange of data through new Application Program Interfaces (API) and Fast Healthcare Interoperability Resources (FHIR). While focused on payment data and patients’ access to their health information, the final rule is an initiative that begins to address interoperability issues on a more global level.

Whenever technology is involved in healthcare, there is the potential for failures, both systemic and those involving human error. Communication among all forms of technology needs to occur in a seamless manner so that healthcare professionals can have access to all necessary information and can provide appropriate care. Lack of data integrity and poor functionality both present risks to patient safety; if interoperability failures occur, the results can be catastrophic.

The connectivity of the systems and programs used within an organization, as well as those connected to externally, and the accurate transmission of information, both internal and external, to organizations communicating among themselves are vital to patient care and safety. And while healthcare providers usually associate computer/digital technology with interoperability, it is worth noting that interoperability factors can also apply to other devices within your organization.

Unfortunately, MLMIC Insurance Company has seen an increase in patient safety events that resulted from a lack of technology interoperability. The following case examples identify some of these risks.

Transmission Errors or Omissions

At one facility, data was not being displayed on the workstations after the data system server was moved off-site. There was no testing on the unit prior to this move. After investigation, it was found that a recent firmware update for wireless access points inadvertently caused some devices to lose the ability to operate wirelessly.

At another facility, the transmission of an imaging report indicating necessary follow-up was not directed to the appropriate module in the EHR, which created a dangerous delay in diagnosis. Similar events have occurred in which the information was transferred to the wrong patient’s record. In addition to the patient safety concerns, these errors in transmission can create privacy issues.


When a pharmacy at a facility updated its medication library, the medication choices in the computerized order entry module were not reconciled. The system was not tested before it was implemented with missing and duplicated medication choices and many incorrect dosing parameters. Fatal medication errors occurred before this issue was identified.

The volume and speed of the advancement in technologies essential to healthcare and its rapid evolution are incredible and unlikely to slow down. In addition to the burden of costs associated with adding and maintaining technology, these near-constant developments make maintaining competency and expertise challenging. It is imperative that each organization creates and maintains a robust technology program to address issues that can occur across an organization. Remaining vigilant and exercising proper leadership, expertise and oversight are critical to ensuring technology interoperability in dentistry by implementing programs to monitor connectivity and operational flow.

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