{"id":"https://openalex.org/W7225406137","doi":"https://doi.org/10.64898/2026.11.04.26367297","title":"Can dental EHR data support a learning health system? Completeness, consistency, and accuracy of structured versus narrative diagnoses","display_name":"Can dental EHR data support a learning health system? Completeness, consistency, and accuracy of structured versus narrative diagnoses","publication_year":2026,"publication_date":"2026-11-06","ids":{"openalex":"https://openalex.org/W7225406137","doi":"https://doi.org/10.64898/2026.11.04.26367297"},"language":"en","primary_location":{"id":"doi:10.64898/2026.11.04.26367297","doi":"https://doi.org/10.64898/2026.11.04.26367297","is_oa":true,"landing_page_url":"https://doi.org/10.64898/2026.11.04.26367297","pdf_url":"https://www.medrxiv.org/content/medrxiv/early/2026/11/06/2026.11.04.26367297.full.pdf","source":{"id":"https://openalex.org/S3005729997","display_name":"medRxiv","issn_l":null,"issn":null,"is_oa":false,"is_in_doaj":false,"is_core":true,"listed_in":["cwts-core"],"host_organization":null,"host_organization_name":null,"host_organization_lineage":["https://openalex.org/P4310315909"],"host_organization_lineage_names":["Cold Spring Harbor Laboratory Press"],"type":"repository"},"license":"cc-by","license_id":"https://openalex.org/licenses/cc-by","version":"submittedVersion","is_accepted":false,"is_published":false,"raw_source_name":"medRxiv","raw_type":"posted-content"},"volume":null,"type":"preprint","is_traditional":true,"indexed_in":["crossref"],"open_access":{"is_oa":true,"oa_status":"green","oa_url":"https://www.medrxiv.org/content/medrxiv/early/2026/11/06/2026.11.04.26367297.full.pdf","any_repository_has_fulltext":true},"authorships":[{"author_position":"first","author":{"id":"https://openalex.org/A5056868402","display_name":"Yao-Shun Chuang","orcid":"https://orcid.org/0000-0001-9582-9222","observed_orcids":["https://orcid.org/0000-0001-9582-9222"]},"institutions":[{"id":"https://openalex.org/I919571938","display_name":"The University of Texas Health Science Center at Houston","ror":"https://ror.org/03gds6c39","country_code":"US","type":"education","lineage":["https://openalex.org/I919571938"]}],"countries":["US"],"is_corresponding":false,"raw_author_name":"Yao-Shun Chuang","raw_affiliation_strings":["The University of Texas Health Science Center at Houston;"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"The University of Texas Health Science Center at Houston;","institution_ids":["https://openalex.org/I919571938"]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5128259367","display_name":"Guo-Hao Lin","orcid":"https://orcid.org/0000-0003-1290-9994","observed_orcids":["https://orcid.org/0000-0003-1290-9994"]},"institutions":[{"id":"https://openalex.org/I180670191","display_name":"University of California, San Francisco","ror":"https://ror.org/043mz5j54","country_code":"US","type":"education","lineage":["https://openalex.org/I180670191"]}],"countries":["US"],"is_corresponding":false,"raw_author_name":"Guo-Hao Lin","raw_affiliation_strings":["University of California San Francisco;"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"University of California San Francisco;","institution_ids":["https://openalex.org/I180670191"]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5161070561","display_name":"Chun-Teh Lee","orcid":null,"observed_orcids":[]},"institutions":[{"id":"https://openalex.org/I919571938","display_name":"The University of Texas Health Science Center at Houston","ror":"https://ror.org/03gds6c39","country_code":"US","type":"education","lineage":["https://openalex.org/I919571938"]}],"countries":["US"],"is_corresponding":false,"raw_author_name":"Chun-Teh Lee","raw_affiliation_strings":["The University of Texas Health Science Center at Houston;"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"The University of Texas Health Science Center at Houston;","institution_ids":["https://openalex.org/I919571938"]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5071688888","display_name":"Ryan G. Brandon","orcid":"https://orcid.org/0000-0003-1335-2438","observed_orcids":["https://orcid.org/0000-0003-1335-2438"]},"institutions":[],"countries":[],"is_corresponding":false,"raw_author_name":"Ryan Brandon","raw_affiliation_strings":["Willamette Dental Group and Skourtes Institute;"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Willamette Dental Group and Skourtes Institute;","institution_ids":[]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5021867899","display_name":"Muhammad F. Walji","orcid":"https://orcid.org/0000-0001-5306-9683","observed_orcids":["https://orcid.org/0000-0001-5306-9683"]},"institutions":[{"id":"https://openalex.org/I919571938","display_name":"The University of Texas Health Science Center at Houston","ror":"https://ror.org/03gds6c39","country_code":"US","type":"education","lineage":["https://openalex.org/I919571938"]}],"countries":["US"],"is_corresponding":false,"raw_author_name":"Muhammad F. Walji","raw_affiliation_strings":["The University of Texas Health Science Center at Houston;"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"The University of Texas Health Science Center at Houston;","institution_ids":["https://openalex.org/I919571938"]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5055458864","display_name":"Xiaoqian Jiang","orcid":"https://orcid.org/0000-0001-9933-2205","observed_orcids":["https://orcid.org/0000-0001-9933-2205","https://orcid.org/0009-0000-0712-2164","https://orcid.org/0009-0007-8281-4479"]},"institutions":[{"id":"https://openalex.org/I919571938","display_name":"The University of Texas Health Science Center at Houston","ror":"https://ror.org/03gds6c39","country_code":"US","type":"education","lineage":["https://openalex.org/I919571938"]}],"countries":["US"],"is_corresponding":false,"raw_author_name":"Xiaoqian Jiang","raw_affiliation_strings":["University of Texas Health Science Center at Houston"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"University of Texas Health Science Center at Houston","institution_ids":["https://openalex.org/I919571938"]}]},{"author_position":"last","author":{"id":"https://openalex.org/A5161097389","display_name":"Bunmi Tokede","orcid":null,"observed_orcids":[]},"institutions":[{"id":"https://openalex.org/I919571938","display_name":"The University of Texas Health Science Center at Houston","ror":"https://ror.org/03gds6c39","country_code":"US","type":"education","lineage":["https://openalex.org/I919571938"]}],"countries":["US"],"is_corresponding":true,"raw_author_name":"Bunmi Tokede","raw_affiliation_strings":["The University of Texas Health Science Center at Houston;"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"The University of Texas Health Science Center at Houston;","institution_ids":["https://openalex.org/I919571938"]}]}],"institutions":[],"countries_distinct_count":1,"institutions_distinct_count":2,"corresponding_author_ids":["https://openalex.org/A5161097389"],"corresponding_institution_ids":["https://openalex.org/I919571938"],"apc_list":null,"apc_paid":null,"fwci":null,"has_fulltext":true,"cited_by_count":0,"citation_normalized_percentile":null,"cited_by_percentile_year":null,"biblio":{"volume":null,"issue":null,"first_page":null,"last_page":null},"is_retracted":false,"is_paratext":false,"is_xpac":false,"primary_topic":{"id":"https://openalex.org/T10350","display_name":"Electronic Health Records Systems","score":0.5835000276565552,"subfield":{"id":"https://openalex.org/subfields/3605","display_name":"Health Information Management"},"field":{"id":"https://openalex.org/fields/36","display_name":"Health Professions"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}},"topics":[{"id":"https://openalex.org/T10350","display_name":"Electronic Health Records Systems","score":0.5835000276565552,"subfield":{"id":"https://openalex.org/subfields/3605","display_name":"Health Information Management"},"field":{"id":"https://openalex.org/fields/36","display_name":"Health Professions"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}},{"id":"https://openalex.org/T14400","display_name":"Medical Coding and Health Information","score":0.36739999055862427,"subfield":{"id":"https://openalex.org/subfields/3605","display_name":"Health Information Management"},"field":{"id":"https://openalex.org/fields/36","display_name":"Health Professions"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}},{"id":"https://openalex.org/T12790","display_name":"Nursing Diagnosis and Documentation","score":0.042399998754262924,"subfield":{"id":"https://openalex.org/subfields/2922","display_name":"Research and Theory"},"field":{"id":"https://openalex.org/fields/29","display_name":"Nursing"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}}],"keywords":[{"id":"https://openalex.org/keywords/data-quality","display_name":"data quality","score":0.6110000014305115},{"id":"https://openalex.org/keywords/diagnostic-accuracy","display_name":"diagnostic accuracy","score":0.5640000104904175},{"id":"https://openalex.org/keywords/interobserver-agreement","display_name":"interobserver agreement","score":0.5720000267028809},{"id":"https://openalex.org/keywords/learning-health-systems","display_name":"learning health systems","score":0.906000018119812},{"id":"https://openalex.org/keywords/clinical-decision-support","display_name":"clinical decision support","score":0.6430000066757202}],"concepts":[{"id":"https://openalex.org/C534262118","wikidata":"https://www.wikidata.org/wiki/Q177719","display_name":"Medical diagnosis","level":2,"score":0.857699990272522},{"id":"https://openalex.org/C40993552","wikidata":"https://www.wikidata.org/wiki/Q514654","display_name":"Gold standard (test)","level":2,"score":0.646399974822998},{"id":"https://openalex.org/C41008148","wikidata":"https://www.wikidata.org/wiki/Q21198","display_name":"Computer science","level":0,"score":0.4521999955177307},{"id":"https://openalex.org/C199033989","wikidata":"https://www.wikidata.org/wiki/Q1318295","display_name":"Narrative","level":2,"score":0.4383000135421753},{"id":"https://openalex.org/C2776436953","wikidata":"https://www.wikidata.org/wiki/Q5163215","display_name":"Consistency (knowledge bases)","level":2,"score":0.4251999855041504},{"id":"https://openalex.org/C61863361","wikidata":"https://www.wikidata.org/wiki/Q470749","display_name":"Inter-rater reliability","level":3,"score":0.42500001192092896},{"id":"https://openalex.org/C198531522","wikidata":"https://www.wikidata.org/wiki/Q485146","display_name":"Sample (material)","level":2,"score":0.3813999891281128},{"id":"https://openalex.org/C17231256","wikidata":"https://www.wikidata.org/wiki/Q5156540","display_name":"Completeness (order theory)","level":2,"score":0.3707999885082245},{"id":"https://openalex.org/C154945302","wikidata":"https://www.wikidata.org/wiki/Q11660","display_name":"Artificial intelligence","level":1,"score":0.36730000376701355},{"id":"https://openalex.org/C71924100","wikidata":"https://www.wikidata.org/wiki/Q11190","display_name":"Medicine","level":0,"score":0.35519999265670776},{"id":"https://openalex.org/C204321447","wikidata":"https://www.wikidata.org/wiki/Q30642","display_name":"Natural language processing","level":1,"score":0.3440000116825104},{"id":"https://openalex.org/C19527891","wikidata":"https://www.wikidata.org/wiki/Q1120908","display_name":"Medical physics","level":1,"score":0.3188000023365021},{"id":"https://openalex.org/C509550671","wikidata":"https://www.wikidata.org/wiki/Q126945","display_name":"Medical education","level":1,"score":0.3156999945640564},{"id":"https://openalex.org/C3020144179","wikidata":"https://www.wikidata.org/wiki/Q10871684","display_name":"Electronic health record","level":3,"score":0.3084000051021576},{"id":"https://openalex.org/C169258074","wikidata":"https://www.wikidata.org/wiki/Q245748","display_name":"Random forest","level":2,"score":0.3061000108718872},{"id":"https://openalex.org/C2779530757","wikidata":"https://www.wikidata.org/wiki/Q1207505","display_name":"Quality (philosophy)","level":2,"score":0.30169999599456787},{"id":"https://openalex.org/C9652623","wikidata":"https://www.wikidata.org/wiki/Q190109","display_name":"Field (mathematics)","level":2,"score":0.2985000014305115},{"id":"https://openalex.org/C2779473830","wikidata":"https://www.wikidata.org/wiki/Q1540899","display_name":"MEDLINE","level":2,"score":0.28769999742507935},{"id":"https://openalex.org/C3019952477","wikidata":"https://www.wikidata.org/wiki/Q1324077","display_name":"Health records","level":3,"score":0.28139999508857727},{"id":"https://openalex.org/C133462117","wikidata":"https://www.wikidata.org/wiki/Q4929239","display_name":"Data collection","level":2,"score":0.27900001406669617},{"id":"https://openalex.org/C124101348","wikidata":"https://www.wikidata.org/wiki/Q172491","display_name":"Data mining","level":1,"score":0.2782999873161316},{"id":"https://openalex.org/C43214815","wikidata":"https://www.wikidata.org/wiki/Q7310987","display_name":"Reliability (semiconductor)","level":3,"score":0.27219998836517334},{"id":"https://openalex.org/C45827449","wikidata":"https://www.wikidata.org/wiki/Q5270338","display_name":"Diagnosis code","level":3,"score":0.26429998874664307},{"id":"https://openalex.org/C25343380","wikidata":"https://www.wikidata.org/wiki/Q277521","display_name":"Relation (database)","level":2,"score":0.2619999945163727},{"id":"https://openalex.org/C24756922","wikidata":"https://www.wikidata.org/wiki/Q1757694","display_name":"Data quality","level":3,"score":0.26170000433921814},{"id":"https://openalex.org/C2780310539","wikidata":"https://www.wikidata.org/wiki/Q12547192","display_name":"Imperfect","level":2,"score":0.2567000091075897},{"id":"https://openalex.org/C160735492","wikidata":"https://www.wikidata.org/wiki/Q31207","display_name":"Health care","level":2,"score":0.2549999952316284},{"id":"https://openalex.org/C15744967","wikidata":"https://www.wikidata.org/wiki/Q9418","display_name":"Psychology","level":0,"score":0.2524999976158142},{"id":"https://openalex.org/C3020000205","wikidata":"https://www.wikidata.org/wiki/Q2412849","display_name":"Narrative review","level":2,"score":0.2513999938964844}],"mesh":[],"locations_count":1,"locations":[{"id":"doi:10.64898/2026.11.04.26367297","doi":"https://doi.org/10.64898/2026.11.04.26367297","is_oa":true,"landing_page_url":"https://doi.org/10.64898/2026.11.04.26367297","pdf_url":"https://www.medrxiv.org/content/medrxiv/early/2026/11/06/2026.11.04.26367297.full.pdf","source":{"id":"https://openalex.org/S3005729997","display_name":"medRxiv","issn_l":null,"issn":null,"is_oa":false,"is_in_doaj":false,"is_core":true,"listed_in":["cwts-core"],"host_organization":null,"host_organization_name":null,"host_organization_lineage":["https://openalex.org/P4310315909"],"host_organization_lineage_names":["Cold Spring Harbor Laboratory Press"],"type":"repository"},"license":"cc-by","license_id":"https://openalex.org/licenses/cc-by","version":"submittedVersion","is_accepted":false,"is_published":false,"raw_source_name":"medRxiv","raw_type":"posted-content"}],"best_oa_location":{"id":"doi:10.64898/2026.11.04.26367297","doi":"https://doi.org/10.64898/2026.11.04.26367297","is_oa":true,"landing_page_url":"https://doi.org/10.64898/2026.11.04.26367297","pdf_url":"https://www.medrxiv.org/content/medrxiv/early/2026/11/06/2026.11.04.26367297.full.pdf","source":{"id":"https://openalex.org/S3005729997","display_name":"medRxiv","issn_l":null,"issn":null,"is_oa":false,"is_in_doaj":false,"is_core":true,"listed_in":["cwts-core"],"host_organization":null,"host_organization_name":null,"host_organization_lineage":["https://openalex.org/P4310315909"],"host_organization_lineage_names":["Cold Spring Harbor Laboratory Press"],"type":"repository"},"license":"cc-by","license_id":"https://openalex.org/licenses/cc-by","version":"submittedVersion","is_accepted":false,"is_published":false,"raw_source_name":"medRxiv","raw_type":"posted-content"},"sustainable_development_goals":[{"id":"https://metadata.un.org/sdg/3","display_name":"Good health and well-being","score":0.9074000120162964}],"study_designs":[{"id":"https://openalex.org/study-designs/observational-study","display_name":"Observational Study"}],"awards":[{"id":"https://openalex.org/G1819622050","display_name":"FullMouth: Enhancing Dental Clinical Data and Reducing Disparities through Innovative ML Approaches.","funder_award_id":"R56DE034086","funder_id":"https://openalex.org/F4320337365","funder_display_name":"National Institute of Dental and Craniofacial Research"},{"id":"https://openalex.org/G4315638444","display_name":null,"funder_award_id":"R01HS027938","funder_id":"https://openalex.org/F4320332177","funder_display_name":"Agency for Healthcare Research and Quality"}],"funders":[{"id":"https://openalex.org/F4320332177","display_name":"Agency for Healthcare Research and Quality","ror":"https://ror.org/03jmfdf59"},{"id":"https://openalex.org/F4320337365","display_name":"National Institute of Dental and Craniofacial Research","ror":"https://ror.org/004a2wv92"}],"has_content":{"grobid_xml":true,"pdf":true},"content_urls":{"pdf":"https://content.openalex.org/works/W7225406137.pdf","grobid_xml":"https://content.openalex.org/works/W7225406137.grobid-xml"},"referenced_works_count":25,"referenced_works":["https://openalex.org/W1541954861","https://openalex.org/W2006872004","https://openalex.org/W2031500001","https://openalex.org/W2034334856","https://openalex.org/W2133280951","https://openalex.org/W2134256069","https://openalex.org/W2137767404","https://openalex.org/W2148554370","https://openalex.org/W2156267802","https://openalex.org/W2158939484","https://openalex.org/W2324745248","https://openalex.org/W2809048536","https://openalex.org/W2911332241","https://openalex.org/W3002945543","https://openalex.org/W3021617239","https://openalex.org/W3095791468","https://openalex.org/W3120224639","https://openalex.org/W3156638485","https://openalex.org/W4206684792","https://openalex.org/W4221052517","https://openalex.org/W4283449551","https://openalex.org/W4285086679","https://openalex.org/W4291034558","https://openalex.org/W4321438142","https://openalex.org/W4411750533"],"related_works":["https://openalex.org/W3131188485","https://openalex.org/W2151053861","https://openalex.org/W3093325947","https://openalex.org/W4390793458","https://openalex.org/W4309646948","https://openalex.org/W2997953081","https://openalex.org/W2907193119","https://openalex.org/W4400189976","https://openalex.org/W3133066484","https://openalex.org/W2183342252"],"abstract_inverted_index":{"Introduction":[0],"Electronic":[1],"health":[2],"record":[3],"(EHR)":[4],"data":[5,301],"increasingly":[6],"drive":[7],"quality":[8,302],"monitoring":[9],"and":[10,24,49,68,109,134,139,174,197,240,253,267,289,295],"research,":[11],"yet":[12],"their":[13],"reliability":[14],"in":[15,30,158,215,234],"dentistry":[16],"is":[17],"uncertain.":[18],"We":[19],"compared":[20,120],"the":[21,45,95,113,178,200,212,227,231,251,273,277,308,314],"completeness,":[22],"consistency,":[23],"accuracy":[25,110,265],"of":[26,57,102,151,217,236,310,316],"periodontal":[27,59,118,242],"diagnoses":[28,63,70,243],"captured":[29],"two":[31,40,85,222,278],"different":[32],"formats":[33,166,213],"(structured":[34],"fields":[35,269],"versus":[36],"narrative":[37,69,190],"notes)":[38],"across":[39,210],"academic":[41],"dental":[42,299],"centers":[43],"sharing":[44],"same":[46],"EHR":[47,300],"platform":[48],"diagnostic":[50],"terminology.":[51],"Methods":[52],"In":[53],"this":[54],"retrospective":[55],"study":[56],"qualifying":[58],"encounters":[60,152],"(2021),":[61],"structured":[62,228],"were":[64,99,206],"extracted":[65],"by":[66,71,84,91,132,199,221],"SQL":[67],"a":[72,103,262],"fine-tuned":[73],"RoBERTa":[74],"NLP":[75],"model.":[76],"A":[77],"random":[78],"sample":[79],"(~20%)":[80],"was":[81,142,167,181,255],"independently":[82],"reviewed":[83],"board-certified":[86],"periodontists,":[87],"with":[88,112,116,189,226,313],"disagreements":[89],"resolved":[90],"consensus,":[92],"to":[93],"form":[94],"gold":[96,114,179],"standard.":[97],"Outcomes":[98],"completeness":[100,129],"(presence":[101],"diagnosis),":[104],"consistency":[105],"(agreement":[106,111],"between":[107,165],"formats),":[108],"standard),":[115],"ordinal":[117],"stage":[119,233,275],"using":[121],"quadratic":[122],"weighted":[123],"\u03ba.":[124],"Results":[125],"Across":[126],"4,542":[127],"encounters,":[128,163,219],"varied":[130],"widely":[131],"site":[133],"format":[135,141],"(34.7%":[136],"-":[137],"84.5%),":[138],"neither":[140,254],"consistently":[143,256],"more":[144,224,257,270],"complete;":[145],"at":[146,194],"one":[147],"site,":[148],"over":[149],"one-third":[150],"(35.8%)":[153],"had":[154],"no":[155],"documented":[156],"diagnosis":[157],"either":[159],"format.":[160],"Among":[161],"dual-documented":[162,218],"agreement":[164],"substantial":[168],"but":[169],"imperfect":[170],"(\u03ba":[171],"=":[172],"0.86":[173],"0.80).":[175],"Accuracy":[176],"against":[177],"standard":[180],"modest":[182],"for":[183,293],"both":[184,195],"sources":[185],"(all":[186],"near":[187],"50%),":[188],"notes":[191,260],"numerically":[192],"higher":[193],"sites":[196],"favored":[198],"severity-weighted":[201,264],"\u03ba,":[202],"though":[203],"raw":[204],"differences":[205],"not":[207],"significant.":[208],"Pooled":[209],"sites,":[211],"diverged":[214],"14.8%":[216],"8.4%":[220],"or":[223],"stages,":[225],"field":[229],"carrying":[230],"milder":[232,274],"67.9%":[235],"disagreements.":[237],"Conclusions":[238],"Structured":[239],"unstructured":[241],"each":[244],"matched":[245],"expert":[246],"adjudication":[247],"only":[248],"about":[249],"half":[250],"time,":[252],"complete.":[258],"Narrative":[259],"held":[261],"small":[263],"advantage,":[266],"coded":[268,311],"often":[271],"carried":[272],"when":[276],"disagreed.":[279],"These":[280],"convergent,":[281],"cross-site":[282],"patterns":[283],"appear":[284],"systematic":[285],"rather":[286],"than":[287],"site-specific":[288],"expose":[290],"latent":[291],"risks":[292],"analytics":[294],"decision":[296],"support.":[297],"Improving":[298],"will":[303],"require":[304],"workflows":[305],"that":[306],"combine":[307],"computability":[309],"entries":[312],"fidelity":[315],"free":[317],"text.":[318]},"counts_by_year":[],"updated_date":"2026-11-09T13:22:03.289127","created_date":"2026-11-07T00:00:00"}