Comprehensive medical information is essential in dental care, as inaccurate or incomplete patient medical history assessments can lead to adverse treatment outcomes [1]. In addition to patient safety, the absence of accurate medical information exposes dental professionals to potential harm, as many procedures are invasive, carrying risks of occupational hazards such as cross-contamination and disease transmission [2]. The literature highlights several types of medical information as particularly relevant to dental care. Medical history, especially patients’ diagnoses and current medications, is consistently prioritized [3-5]. Information about allergies and adverse drug reactions is also essential, as overlooking these may lead to severe or even life-threatening scenarios [3,4,6]. Additionally, details such as medical treatment plans, hospitalization history, and surgical history are considered highly valuable, as they support improved care coordination and more effective treatment planning [3-5]. Together, these categories form the foundation of the medical information that dental professionals rely on to deliver care. Unfortunately, challenges arise due to inconsistencies in the documentation and communication of such information, particularly as it is often self-reported by patients [7]. This raises the question of whether health information technology can possibly address this gap and support more reliable access to critical medical information in dental care.

In dental care, patient information is primarily managed through electronic dental records (EDRs), whereas medical care relies on electronic health records (EHRs) [8-10]. The advent of such information systems has facilitated the process of recording patient information in data format, thereby giving professionals in both dental and medical care a more structured and streamlined approach to record-keeping [9,10]. This also includes the process of enabling information exchange.

To enable the exchange of patient information between EHR and EDR systems, interoperability is required [11]. Interoperability refers to the ability of different systems to exchange, process, and use patient data effectively, and it is commonly described across four levels. The technical level involves a shared technical infrastructure that allows systems to communicate. The syntactic level requires data to be structured in a standardized format for processing. The semantic level ensures that data are interpretable and meaningful across systems. Finally, the organizational level emphasizes that interoperability at the technical, syntactic, and semantic levels depends on alignment with regulatory, administrative, and policy frameworks, including agreements that enable data exchange while ensuring compliance with laws and regulations.

The literature identifies two main approaches to achieving interoperability between dental and medical care systems. Health information exchange (HIE) serves as an intermediary to facilitate data exchange between different systems [3,12-14]. Integrated EHR-EDR (IEHR), on the other hand, operates on a single-system architecture [14]. This system has become widely adopted by organizations offering integrated dental-medical care services [15].

While both IEHR and HIE aim to facilitate information exchange between dental and medical care, their feasibility depends on organizational size, infrastructure, and financial resources. IEHR can provide data conformity and reliability, but may be financially and technically restrictive for smaller organizations [4,7,14]. In contrast, HIE can offer a more flexible and cost-effective solution, though usability barriers may impede its adoption [3,12-14].

Understanding how these approaches are implemented within a specific national context is essential for assessing their real-world applicability. Here, Sweden offers a particularly instructive case due to its publicly funded health care system, high digital maturity, and ongoing efforts to advance HIE [16,17]. In fact, Sweden’s broader aim is to become a global leader in health care digitalization by 2025, a vision that includes both medical and dental care [18].

Sweden is a country divided into 21 administrative regions, each governing its publicly funded medical and dental care services autonomously [19]. Due to this decentralized administrative structure, challenges have arisen in ensuring the accessibility and exchange of patient data across regions and organizations [17,20]. Hence, the Swedish government enacted the Integrated Health and Social Care Documentation Act (2022:913), establishing a legal basis for the sharing of patient information across health care services [21]. This legal foundation was followed by the implementation of nationwide digital infrastructure, the national patient overview (nationell patientöversikt; NPÖ), and the national service platform (nationell tjänsteplattform; NTjP) [22-24]. NPÖ is a nationwide digital platform primarily provided to public health care providers, allowing authorized health care professionals to retrieve patient data across organizations and regions [23]. NTjP refers to the technical infrastructure that facilitates the exchange of patient data in a standardized and secure manner [22,24]. This concept is similar to HIE, as it acts as an intermediary layer between different systems in organizations and regions.

Currently, the digital infrastructure does not support information exchange between dental and medical care services [25]. It may pose particular challenges in regions where access to both services is already constrained, particularly in underserved or rural regions [26-29]. To illustrate the relevance and urgency of such an approach, the region of Dalarna provides a meaningful context for further discussion.

One of the most pressing issues in Dalarna is the shortage of dental professionals, with the lowest dentist-to-population ratio in Sweden [30]. Due to its vast land area, patients in remote regions may need to travel long distances to reach a general dental practice (GDP). In addition, Dalarna has an aging population, with nearly 25% of residents aged 65 years or older, compared to the national average of 19% [31]. This demographic trend places further strain on an already limited dental workforce, as older adults often require more frequent and complex dental and medical care [32]. Facilitating access to medical information in dental care in Dalarna could therefore support more effective and higher-quality care outcomes for patients.

Sweden’s digital infrastructure, the NPÖ and the NTjP, support information exchange between health care information systems across regions and organizations [22-24]. However, these platforms do not currently provide access to medical information in dental care [25]. This lack of integration presents a missed opportunity to enhance both patient safety and efficiency of dental workflows, especially in rural regions where access to medical and dental services is limited [26-29]. The Dalarna region exemplifies this challenge, facing one of the most severe shortages of dental professionals in the country. This shortage forces many residents to travel long distances for dental care [30]. Yet, addressing this gap does not necessarily require extensive structural or financial reforms. Rather, a pragmatic path forward may lie in leveraging existing infrastructure to enable dental professionals to access relevant medical information directly through their EDR systems. However, without a clear understanding of what specific medical information is needed and how it fits into dental workflows, such interoperability efforts risk being ineffective or even disruptive. Although existing literature reports the types of medical information relevant to dental care [3-5], it lacks specificity. Therefore, it is crucial to identify the specific medical information needs of dental professionals and examine how these can be supported within current workflows, systems, and organizational structures. This necessitates a sociotechnical approach that accounts for both technical components and end-users [33,34], primarily dental professionals.

This study aims to explore how current documentation workflows and EDR systems in dental care practices in the Dalarna region in Sweden support or limit the fulfillment of the medical information needs, and to examine the potential impact of having direct access to accurate and relevant medical information within EDR systems.

This study adopted an exploratory-descriptive qualitative research approach to allow for a comprehensive yet structured and contextualized examination of the experiences, challenges, and needs on the subject matter [35].

The study was decided to be conducted in GDPs operated under the Public Dental Service Dalarna (PDSD), which is administered by the regional authority Region Dalarna and is responsible for providing dental care services within the region [36]. Consequently, private dental clinics or organizations and specialist clinics were excluded.

The primary participants consisted of dental practitioners, as they are directly responsible for patient care [37]. Only dental practitioners having their main professional duties within GDPs operated by PDSD were considered. Purposive sampling was used to identify participants who were able to provide detailed, precise, and reliable information aligned with the study’s aim [38]. Conversely, other dental professionals were excluded.

Interviews were deemed the most appropriate data collection method as they offered an opportunity for participants to share their perspectives in-depth related to the subject matter [39]. The interviews followed a semi-structured format to ensure a balance between systematic inquiry and flexibility. The interviews needed to capture the sociotechnical aspects relevant to the subject matter. To achieve this, an interview guide was designed following a sociotechnical framework. The sociotechnical framework defined by Sittig et al [40] provides a comprehensive lens for evaluating health information technology by examining the interaction between information systems and the social context in which they operate. It comprises 8 dimensions, where for this study, 6 dimensions were chosen based on their alignment with the research aim [40]: (1) clinical content to identify the specific medical information considered important and what should be accessible in EDR systems; (2) people to explore experiences and challenges in obtaining medical information from patients, the medical domain, or other sources; (3) human-computer interface to assess the usability of the current EDR system regarding accessibility and documentation of medical information; (4) workflow and communication to understand how medical information is obtained and documented within current workflows, focusing on the patient and EDR system; (5) internal organizational policies, procedures, and culture to examine existing policies on documentation and retrieval of medical information within PDSD; and (6) external rules, regulations, and pressures to explore the awareness of guidelines or requirements for documenting medical information in dental care. These dimensions informed the development of the interview guide in Swedish and English (Multimedia Appendix 1 ).

Following development, the interview guide was reviewed by the co-authors, SB, ND, and the Head of Division at PDSD, to confirm its suitability. The guide was subsequently pilot-tested, which confirmed that the questions elicited comprehensive responses. Individuals involved in the review and pilot testing were excluded from the final study to avoid diluting the results. A bilingual consent form in both Swedish and English was developed in parallel (Multimedia Appendix 2).

The head of division at PDSD facilitated recruitment by distributing interview invitations to GDPs. Interviews were conducted digitally via Microsoft Teams between March 7 and July 28, 2025. Digital interviews were chosen to accommodate participants from various locations and minimize travel-related costs. All interviews were audio-recorded and transcribed using Microsoft Teams’ built-in tool. Supplementary notes were taken during each session to capture contextual and paralinguistic cues. Transcripts were carefully reviewed, compiled, and returned to participants to confirm accuracy. Interviewing concluded when data saturation was reached, meaning no new information emerged, and the data were sufficiently rich to address the study’s research questions [41].

The study was carried out in Sweden. According to the Swedish Ethical Review Act (SFS 2003:460) [46] and guidance from the Swedish Ethical Review Authority [47], the type of research presented in this article does not require formal ethical approval, as it does not involve sensitive personal data as defined by the European Union General Data Protection Regulation (EU 2016/679) [48]. Nonetheless, we emphasize that all ethical standards were strictly followed in accordance with relevant legislation, the Declaration of Helsinki [49]. Participants were fully informed about the study’s purpose, their rights, and data handling procedures. Informed consent was obtained both in writing and verbally. Participation was voluntary, and withdrawal was permitted at any time. Anonymity was guaranteed, and participants were informed that findings would be publicly disseminated.

In total, 18 interviews were conducted, after which no new information emerged beyond the 11th interview. All participants reported using the T4 EDR system, developed by Carestream [50]. Fifteen participants identified as female and three as male. Key characteristics of the participants are presented in Table 1. All participants treated diverse groups of patients and performed a broad range of general dental treatments, where 8 participants identified oral surgery as their main focus. All participants primarily used free text.

Under the sociotechnical dimension of “clinical content,” the interview data revealed three overarching categories of medical information needs: “conditions, pharmacological information, treatment history and laboratory values.” Each category contains specific types of information that participants deemed essential for providing dental care (Table 2).

Among conditions, oncological diagnoses and cardiovascular diseases were the most frequently emphasized because of the associated risks when providing invasive treatments. For patients with oncological diagnoses, participants highlighted that treatment planning and risk management are directly influenced by the potential effects of cancer on oral healing and immune response. Similarly, participants reported that patients with cardiovascular diseases require special attention due to systemic risks associated with invasive procedures:

Psychiatric and neurological disorders were also commonly mentioned due to their impact on patient cooperation and communication:

Allergies in general were also deemed important, as considerations need to be taken in relation to the materials used in dental care:

Additionally, infectious diseases were highlighted due to their relevance in maintaining a safe clinical environment for both patients and dental professionals:

Other conditions were brought up by individual participants. Though each was mentioned less frequently, they reflect the complexity of the oral-systemic health correlation in the context of coordinating dental care:

The pharmacological information theme comprises medications that participants regarded as critical, primarily due to the procedural risks associated with specific drugs. The most frequently mentioned medication category was antiresorptive agents and anticoagulants due to complications associated with dental treatments:

Additionally, several participants expressed the importance of knowing whether patients are taking psychiatric medications, since that would increase their understanding of patient behavior and anxiety-induced responses during care:

Penicillin allergies and substance abuse were also mentioned, as there were concerns about prescribing antibiotics or analgesics, particularly due to risks of adverse reactions or potential misuse by patients:

In treatment history and laboratory values, participants frequently considered ongoing oncological treatment as essential information for treatment planning and to prevent complications:

Surgical procedures were also referenced since such information is used to assess potential risks and determine whether treatment should be delayed:

Likewise, information on blood coagulation markers was commonly sought to support decisions around the timing of treatments for patients and to evaluate their bleeding risks:

The sociotechnical dimension of people focused on identifying who the participants interact with in relation to obtaining medical information. As summarized in Table 3, it revealed that medical information is predominantly derived from patient reporting, proxy reporting, or through medical consultation. In general, the findings demonstrated how human factors influence the workflow, suggesting the need for medical information to be made more accessible.

Participants reported that medical information was often obtained through verbal recall, medication lists, or by asking patients to access their online patient portal. Verbal recall relied on patients remembering their medical history; medication lists were paper documents brought in by patients; and the online patient portal was used to verify details when verbal reports were insufficient, or no list was available:

A recurring issue was incomplete or inaccurate reporting, mainly due to patients forgetting diagnoses or medications, particularly amongst the elderly or those without a caregiver:

Participants also noted that patients often unintentionally omitted relevant details or assumed they had nothing to report:

Some also faced barriers when patients were unwilling or unable to disclose their history due to communication breakdowns:

There are situations where medical information is obtained through proxy reporting, which in this case refers to: direct relatives, companions, or care home personnel. Companions refer to those physically accompanying the patient. There were challenges presented here as well:

Participants described engaging in medical consultations to obtain relevant information or seek advice on complex cases. Primary care units were the most frequent point of contact, although secondary care was also involved, depending on the patient’s condition:

However, participants often encountered coordination limitations, such as delayed or absent responses, which hindered decision-making and delayed treatments:

Some reported being redirected or denied help, further complicating access to essential information:

To cope with these challenges, some participants began asking patients to coordinate directly with their medical providers:

The sociotechnical dimension of the human-computer interface examined the interaction with the EDR system when retrieving, documenting, and managing medical information (Table 4). Overall, participants emphasized the interface’s critical role in the efficient and reliable handling of medical information, revealing both challenges and opportunities for improving usability.

All participants relied solely on free text input when documenting medical information in the EDR. This was done either in the medical history section (a structured form with predefined fields) or in progress notes (where other dental care activities are recorded).

Some participants preferred documenting directly in progress notes due to time constraints and navigational hurdles:

Most adopted an adaptive documentation behavior, using both sections to reinforce critical information:

The category current interface limitations revealed several usability issues. One major concern was information reliability, where participants questioned the accuracy and completeness of previously entered medical information in the EDR system:

Another issue was information visibility, where inconsistent documentation across sections made it difficult to locate medical details:

Manual data entry was also a major limitation. Participants described it as time-consuming and prone to errors, especially when documenting long medication lists:

The findings in design needs emphasized the need for better system integration, interface enhancements, and improved visibility of patient data. All participants expressed a strong preference for integrated external data accessibility, where medical information should be directly accessible within the EDR:

Some also emphasized the need for access control, ensuring that only authorized personnel could view sensitive data:

Additional interface improvements suggested included:

Workflow and communication focused on broader clinical activities involving interactions with both the EDR system and patients in the context of managing medical information (Table 5). Overall, the findings indicate that workflow efficiency and patient safety are strongly linked to the availability and clarity of medical information. When such information is incomplete or difficult to retrieve, it disrupts clinical routines and compromises care.

Participants overwhelmingly described the current documentation workflow as time-consuming, marked by frequent disruptions when obtaining and recording medical information:

These issues often led participants to delay treatments, which often involved canceling or rescheduling appointments:

In some instances, essential medical information would emerge during procedures, posing potential in-treatment hazards:

Finally, repeated appointments caused by information gaps contributed to patient frustration:

Having direct information accessibility was consistently identified as a key improvement. The most frequently perceived benefit was enhanced clinical time management, as direct access would reduce administrative tasks and allow more focus on patient care:

Others highlighted how improved treatment planning would be possible by enabling better scheduling and avoiding unnecessary visits:

Also, better decision-making was noted as a distinct benefit. Several participants stressed that it would reduce uncertainty, improve efficiency, and enhance patient safety:

A final point was the reduction of patients’ cognitive load, as they would no longer need to recall or bring documentation themselves:

The findings from internal organizational policies, procedures, and culture suggest a need for stronger organizational support, more equitable access to medical information, and support for consistency in information management practices (Table 6). These are in relation to managing medical information within PDSD, but also in the context of Region Dalarna.

In the category of current documentation practices, it was widely acknowledged that there are existing routines in place. The existing routines involved checking and updating information for every appointment, as well as reminding patients to bring their medication lists:

It also involved using a dedicated medical history section of EDR. Yet many participants noted inconsistencies in how these were applied, for example, documenting in progress notes or not updating medical information at all:

An initiative mentioned by participants was “Förskrivningskollen” [51], an online platform enabling authorized users to view patients’ prescribed medications. However, it was described to be inaccessible due to technical issues or not provide enough information:

The second barrier concerned EHR access inequities. While hospital-based or specialized dental clinics within PDSD have access to EHR systems, GDPs do not. Participants viewed this as an unjustified discrepancy:

Organizational support reflects how participants perceived the level of support provided for managing medical information in dental care, where organizational inaction refers to the lack of follow-through on identified issues, even after concerns were raised, and devalued captures the sense of not being prioritized by the broader organization:

The last sociotechnical dimension examined was external rules, regulations, and pressures. What can be derived from Table 7 is a need for clearer guidance and communication regarding applicable regulations in dental care regarding the subject matter.

The results show that there is uncertainty about external regulations guiding the management of medical information in dental care. While many participants demonstrated awareness of existing regulations, several assumed that obtaining and documenting medical information is standard practice:

Furthermore, the role of patient consent was perceived as crucial for retrieving medical information from both internal and external sources:

A UML activity diagram was developed to illustrate the current workflow for managing medical information in dental care based on the interview data (Multimedia Appendix 3). It outlines the key steps involved in acquiring, updating, and documenting medical information in the EDR system before proceeding with treatments. The diagram includes multiple actors, including receptionist, patient, dental practitioner, accompanying proxy, proxy, and medical care unit, each with defined responsibilities represented within separate partitions.

The workflow begins with the receptionist scheduling the appointment and reminding the patient to bring their medication list. Upon arrival, the dental practitioner checks the EDR to determine whether the patient is new or returning. For returning patients, the medical history section and progress notes are reviewed to assess whether updates are needed. If updates are required, or the patient is new, the dental practitioner checks if an accompanied proxy is present and able to provide the necessary information. If not, alternative steps may involve contacting another proxy or a relevant Medical Care Unit.

If no proxy is involved, the dental practitioner evaluates whether the patient can provide sufficient information via verbal recall, a medication list, or their online patient portal. If these sources are insufficient, attempts are made to contact a proxy or medical care unit, with the option to postpone the appointment.

Once the necessary information is obtained, it is documented in the EDR, either in the medical history section or progress notes. The dental practitioner may seek further medical consultation if needed. Once all relevant information is confirmed and documented, treatment can proceed.

A UML activity diagram of a proposed workflow reflects potential improvements if medical information were made accessible in the EDR system (Multimedia Appendix 4). This revised workflow removes several steps previously required to manage information gaps and instead introduces a more linear progression toward care provision.

The dental practitioner begins by accessing and checking the medical information of the patient in their EDR system, with the receptionist not having to remind the patient to bring their medication list. Furthermore, there is no reliance on an accompanied proxy, proxy, and medical care unit to obtain medical information. Only if further clarification or consultancy is needed does the process escalate to contacting the medical care unit.

A UML use case diagram (Figure 1) was developed to represent conceptual expectations and functional needs described by participants regarding an EDR system with access to medical information. This model also assumes that medical information is accessible via a regional database or NPÖ through NTjP, referred to as the source of the patient’s medical information in the diagram. It is important to emphasize that the use case diagram does not depict a user interface. Rather, it consolidates qualitative insights into conceptual recommendations. System-level specifications and exceptions are therefore not included.

Below follows the use case, with its corresponding process flow detailed in Table 8:

As shown in Figure 2, the UML sequence diagram depicts the interaction between the dental practitioner, the EDR system, and the source of patient’s medical information. After the dental practitioner provides credentials to the EDR system, a verification request is sent to the external source. Upon successful authorization, the EDR system sends a request and receives the patient’s medical information as a message. This may include substance abuse alerts, if applicable. The EDR system then displays the retrieved data to the dental practitioner, who may also choose to view system-generated annotations. Finally, the dental practitioner confirms that the information has been reviewed, which is logged in the system.

Certain limitations need to be declared. First, the sample consisted of 18 dental practitioners from PDSD-operated GDPs in Dalarna. Although the generalizability was limited due to the limited number of participants and the homogeneity of the sample, with most participants having fewer than five years of professional experience and working in similar clinical settings, thematic saturation was achieved in this study. Qualitative studies, besides providing an in-depth understanding of contextualized experience, may also support theoretical generalizability or, more appropriately for qualitative research, transferability when rich contextual information is provided [60]. This study supports the transferability of the findings to other contexts with similar characteristics. However, to strengthen the generalizability of these findings, future studies should include a broader and more diverse sample. A quantitative or mixed-methods study would also be valuable to validate and generalize the medical information needs identified here [61].

Future research could use quantitative methods to validate and prioritize the information needs identified in this study across a broader population of dental practitioners. Large-scale surveys using structured instruments (eg, Likert-scale items) could assess both the perceived importance and frequency of specific information needs, providing estimates of their prevalence and variability at regional or national levels. Additionally, a Delphi approach incorporating iterative rounds of quantitative scoring could facilitate structured expert consensus and systematic ranking of priorities.

This study identified a clear need to improve access to medical information within EDR systems in GDPs in Dalarna. While medical information needs such as diagnoses, medications, and allergies are widely acknowledged in the literature, this study contributed detailed insights into the types of information most relevant to dental care. Current documentation practices were found to be fragmented, inefficient, and overly reliant on patients and third parties. Usability limitations in the EDR interface further hinder information access and consistency. Collectively, these issues reflect a sociotechnical misalignment between user needs and system capabilities. To address these gaps, the study proposes leveraging Sweden’s existing interoperability infrastructure, particularly by integrating EDR systems with NPÖ via NTjP. However, achieving this requires not only technical alignment but also organizational commitment, regulatory clarity, and a user-centered system design.

Future research should validate these findings at scale and explore system design and policy solutions to ensure that medical information can be securely, efficiently, and meaningfully integrated into information systems used in dental care.