Hybrid dental charting system (hy decs)

E-PROCEEDING OF THE 8TH INTERNATIONAL
CONFERENCE ON SOCIAL SCIENCE RESEARCH 2019
E-PROCEEDING OF THE 8TH INTERNATIONAL CONFERENCE ON SOCIAL SCIENCE RESEARCH 2019
(ICSSR 2019). (e-ISBN 978-967-0792-36-1). 18 -19 November 2019, Imperial Heritage Hotel, Melaka,
Malaysia. Organized by https://worldconferences.net Page 1
HYBRID DENTAL CHARTING SYSTEM (HyDeCS)
Muhammad Awis Jamaluddin Johari (awis.johari@mimos.my), Muhammad Azlan Shahariman
Ahmad, (azlan.ahmad@mimos.my), Nur Izyan Nadhirah Faizulnizam
(izyan.faizulnizam@mimos.my), Lee Chee Kiam (ck.lee@mimos.my)
Healthcare and Education Solution, Corporate Technology Division, MIMOS Berhad
ABSTRACT
The electronic medical record (EMR) has become an important technology in healthcare. EMR is a
digital version of the patient record consisting of the history of medical, diagnoses, appointment dates,
prescriptions, lab results, dental history, dental charting, doctor notes and many more. EMRs save time
and space by eliminating the usage of paper records. The system is also a medium of communication
between service providers within the same organization to pass accurate information around.
Community-based programs have been introduced to reaching out to the communities besides school’s
outreach programs to achieve same objective, which is to provide dental/health treatment outside of the
clinic. Most EMR systems are complex. They include a combination of health and dental modules.
Some of these modules are not required for the community-based program. Thus, the objective of this
paper is to present a system by making use of the functionalities of EMR to create a lightweight and
hybrid electronic record management system for community-based program. This system, from here
and onward to be referred as Hybrid Dental Charting System (HyDeCS).
Field of Research: Hybrid Dental System, Electronic Medical Record, Dental Charting, Hybrid
Dental Charting, Dental System.
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Introduction
Dental charting is a process which describes the health of the teeth and gums. The charting is usually
done during dental check-ups. It is a graphic method of organizing information about the dental health.
(Mary Ellen Ellis, 2018). It deals with the management of information, communication and application
of new technologies in clinical practice and research. Information management involves the storage and
use of information generated in direct work with patients in a dental clinic, it includes the organization
of work and arranging visits and operation of dental practice. (Masic, 2012)
HyDeCS is developed using common components which are used by the dentist to make it useful and
improve the quality of care for the patients. The HyDeCS include processes from registration until the
treatment is completed for the patient. Most dental systems using web application base need network
but the HyDeCS can used in online (with network) and offline (without network). HyDeCS consists of
modules including patient information, patient treatment, patient appointment, dental disease and dental
charting. HyDeCS supports three different modes which is online mode, offline mode and outreach
mode. The online and offline mode will be used in the workspace and the outreach mode was used for
community or school program. The advantage of the HyDeCS is it is able to record all the data needed
for the dental treatment. Improved access including easy retrieval and recording with technology have
considered a significant advancement in managing dental care. (Betan, 2016). The electronic patient
records are also capable of unifying the different clinical data, which can reduce the cost of filling paper
records, and can eliminate problems such as illegible notes, lost charts and illegible prescription
orders.(Betan, 2016) HyDeCS can search data during offline (without network) which means that there
is no need to use pen and paper as the system is available all the time. Electronic patient records provide
a more reliable and refined basis for outcomes management since various patient data can be easily
combined in making clinical decisions. It can include various data formats aside from text including
imaging as part of the patient’s chart and dental history. Big data analysis can be done as various forms
of patient data is available for preventive and predictive care. Besides that, dental treatment and disease
module provide information about the cause of tooth extraction and tooth filling. (FADZHILA BINTI
SABRI, 2011). HyDeCS provides customizable charting symbols that can used by dentist based on the
dental check-ups. The graphics provide easy visualization of the dental treatment for the patient. It also
has the outreach module which allows the system to be brought out to the school or community area
and can be accessed without any network.

Methodology
This chapter will discuss about the methodology that will be used in the development of the HyDeCS.
Before involving in the development of the proposed system, the prior works are finding the problem
statement that occur from users. The information is derived from dentists and nurses who have the
expertise in this field where after this to be referred as users. Most of them, complained that the current
system is only accessible within their workspace. Besides that, they also need the system that can be
accessible when doing outreach visits either in school or community event, which is out of their
workspace. After doing some investigation and comparing with the existing dental system, most of the
current systems are only focusing on online mode which needs internet connection between client and
server as implemented by authors (Hussain, Aziz, Mohammed, & Mohtar, 2011) and certain author
implemented standalone application as author (Dhanore & Ramtekkar, 2016). Figure 1 is showing the
architecture for most of the existing system. Figure 2 is showing the architecture that have been
implemented on HyDeCS. HyDeCS system cover from outreach programme to clinic workspace. For
this paper, the author will explain more on the outreach portion.
Figure 1: Architecture: Existing System
Figure 2: Architecture: HyDeCS

Hybrid System
Definition of hybrid system is a system that can dynamically exhibit both continuous and discrete
dynamic behaviour. This feature is mostly implemented in a system that is classified as a critical system
which relates with safety, mission, business and security as mention in this paper (Hinchey & Coyle,
2010). When working in the operational field, the most critical factor is what will happen if the system
breaks down. This event will result in a lot of chaos within an organization and sometimes will affect
the production process. The most important information is the patient historical data. If the organization
is using a manual process which is pen and paper, the impact is minimal. However, when there is a
system and the data is not available when needed, it will make the process more inefficient and
unmanageable.
On this matter, author believes that most organizations have a business continuity planning (BCP) that
already includes the standard operation procedure (SOP). These plans will ensure that the organization
will continue to operate when the system breaks down.
For this paper the author will only discuss more the outreach session rather than in workplace part. As
we know, some urban areas have poor internet connection, and the method of using a mobile service
provider like simcard to get an internet is not practical to solve this problem. The method that have been
implemented in HyDeCS is by using local storage and browser called as application cache. Before going
further on how it works, HyDeCS is a web-based application client which uses HTML5 technologies.
HyDeCS is written using NW.js (previously known as node-webkit) which enables a new way of
writing applications with all Web technologies. In HyDeCS, not all information is stored in local storage
to avoid of unnecessary data and wastage of resource. Even though the main purpose of local storage is
to make the application faster by downloading only data which is required. For HyDeCS, we utilize this
technology when the user is using the system in offline mode which is no internet connection. When
the user is able to get internet connection, user need to trigger the system to upload all data that have
been entered during offline mode. All data will be up sync up to datacentre by using database replication
technology.
The way the system uploads and downloads the data will be described here onward. The author has
already done some comparison on a few tools of database replication and have been selected two tools
which is RabbitMQ and SymmetricDS, both of this tool is open source.
Typically, most of database replication built-in feature is copying of data from a database in one
computer or server to another database that might be at the same site or at different geographical
locations. The source and the target database have exactly the same amount of data. Database replication
provides a consistent copy of data across all the database nodes. However, this approach is not suitable
for outreach operation as the machine (normally laptop) that host the system has smaller amount of
CPU, memory and hard disk space. A laptop may not have enough resources to hold and process the
number of data same as Data Center. Besides, during outreach operation that is outside of premise, it
cannot access physical security like a physical exclusion zone, limited access by authorised personnel,
lock-and-key protection of assets, and always-on Heating, Ventilation, and Air Conditioning (HVAC).
It is also not possible to provide high network security feature like firewall network limitation, IDS
(Intrusion Detection System), IPS (Intrusion Prevention System) and content-level filtering. The
workaround to mitigate this risk is to reduce the amount of data to be stored in outreach system. By
introducing Messaging Queue system (in our implementation is RabbitMQ), each outreach system has
their own queue and only data relates to the outreach activity (e.g. students info of School A) is
published to its queue and is consumed to persist in that particular outreach system.

In general, most database replication built-in feature is meant for real time purpose, where the master
and the slave nodes need to be up and connected to network at the same time. This behaviour may not
be suitable for outreach system as not all the time the outreach machine is on and connects to network.
SymmetricDS allows data to be synchronized across nodes on remote networks with low bandwidth
usage and automatically handle periods of disconnected operation. With asynchronous replication in
the background and an efficient communication protocol, SymmetricDS guarantees replication by
tracking batch data through automatic recovery and retry attempts. Data can be synchronized in one
direction or both directions in a multi-master configuration. This fit very well to outreach requirements
where a clinic may have different outreach machines to cover different locations.
Project Implementation
Before installing the application, ensure that the hardware and software is meets the recommended
system requirements of:
a. A laptop with at least 2 GHz speed i7 or i5 processor
b. Operating system: Windows 10
c. Minimum 8 GB of RAM (memory) for the server.
d. Hard disk drive with at least 100GB of free disk space.
e. Support Chrome browser.
For laptop that act as client can be lower requirement on memory rather than the server specification.
Laptop server can be laptop client which is 2 in 1 purpose. An agent has been developed using Java
programming language that can manage cluster mode or stand-alone mode and installed in laptop as a
server. The difference between cluster mode and stand-alone mode is cluster mode can have more than
one user using the system simultaneously while stand-alone laptop will be the server and user at the
same time Figure 3 is showing the agent that will be used for switching the mode of the server.
In the server laptop, the software that is required to be install is Apache Tomcat Server 9.0, PostgreSQL
Server 9.4, and SymmetricDS 3.7. All the applications will start after the laptop is brought up except
Apache Tomcat which is will start up after user trigger the operation mode.
Figure 3: Outreach Agent

HyDeCS Module
HyDeCS have same modules as other dental systems which are queue management, dentist profile,
patient information which includes patient personal detail, patient treatment, patient appointment,
patient billing, dental treatment, dental disease and dental charting. But to make HyDeCS lightweight,
only certain modules will be enabled during outreach session. This is designed to limit the resources
used and to make it simple as is. Here the list of modules that is considered for outreach purpose.
a. Patient information – patient demographic and related information
Figure 4 : Patient Information (Basic)
b. Patient treatment – treatment history done for patient
Figure 5 : Patient Treatment History
Figure 6 : Patient Treatment History (Charting View)

c. Patient appointment – appointment for patient
Figure 7 : Patient Appointment (Make Appointment)
d. Dental disease – dental diseases/condition of patient
Figure 8 : Dental Disease (Diagnosis)
e. Dental charting – dental charting including base, treatment and final chart
Figure 9 : Dental Charting (Base)

Figure 10 : Dental Charting (Treatment)
Figure 11 : Dental Charting (Final)

Conclusion & Future Scope
HyDeCS not only provides an opportunity to the clinic to enhance their patient care within workspace
or outreach, but can also increase the profitability of the organization. Dentists would be able to
significantly improve the operational control and thus streamline operations. This would also improve
the response time to the demands of patient care because it can automate the process of collecting,
collating and retrieving patient information. HyDeCS is successfully developed using the required
features cross the various modules. It is fully developed using Java for backend, JavaScript and CSS
for frontend and also the PostgreSQL Server as the database. However, the future enhancements can be
carried out by adding in additional functionalities to the system. For example, the system could be more
flexible to add on more features in order to make it usable in a large dental clinic such as; adding new
modules without effecting the current system and adding a potable queue system so that dentists can
treat a larger community of patients.
References
1. Atkinson, J. C., Zeller, G. G., & Shah, C. (2002). Electronic patient records for dental school
clinics: more than paperless systems. Journal of Dental Education, 66(5), 634–642.
2. Betan, A. (2016). Free and Open Source Software for Dental Information Management System.
(July).
3. SABRI, F. B. (2012). DECISION SUPPORT SYSTEM FOR DENTAL CLINIC.
4. Mary Ellen Ellis. (2018). Dental and Periodontal Charting. Retrieved from
https://www.healthline.com/health/dental-and-periodontal-charting
5. Masic, F. (2012). Information systems in dentistry. Acta Informatica Medica, 20(1), 47–55.
https://doi.org/10.5455/aim.2012.20.47-55
6. Dhanore, P., & Ramtekkar, P. (2016). Dental Clinic Management System- A New Approach.
International Journal of Computer Science Engineering and Technology, 6(5), 176–178.
7. Hinchey, M., & Coyle, L. (2010). Evolving critical systems: A research agenda for computer-
based systems. 17th IEEE International Conference and Workshops on the Engineering of
Computer-Based Systems, ECBS 2010, 430–435. https://doi.org/10.1109/ECBS.2010.56
8. Hussain, A. R., Aziz, A. A., Mohammed, N., & Mohtar, S. (2011). ELECTRONIC PATIENT RECORD
FOR DENTAL CHARTING. 2(June), 43–54.

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