Shifting the Paradigm: CAMBRA Adoption and Medical-Dental Integration Leveraging an Electronic Health Record

This study describes the integration of Caries Management by Risk Assessment (CAMBRA) into a medical-dental integrated Epic electronic health record (EHR) at Columbia University's College of Dental Medicine (CDM), with the goal of incorporating risk-based caries management into predoctoral clinical care.

A multi-phase, mixed-methods approach was used. CAMBRA protocols were embedded into the Epic EHR, including clinical decision support, automated scoring, integration with prescribing and documentation workflows, and patient education after visit summary (AVS). Stakeholder engagement strategies included faculty calibration, student education via a new Population Oral Health Management (POHM) course, and staff training. Adoption was assessed through caries risk assessment (CRA) completion rates and provider agreement with algorithm-generated risk levels.

Following EHR-integrated CAMBRA tool implementation in July of 2022, CRA completion rates rose from under 5% to a peak of 89% in March of 2024. Integration of the POHM curriculum and faculty calibration efforts were key drivers of adoption. Provider agreement with algorithm-generated caries risk levels exceeded 96% after a mandatory confirmation field was introduced in November of 2023. CRA completion rates varied by student groups, reflecting the importance of consistent faculty leadership.

Embedding CAMBRA within the EHR and aligning it with educational and clinical workflows led to rapid adoption of risk-based caries management. Success is driven by strong stakeholder engagement, curriculum integration, and robust informatics infrastructure. Ongoing faculty calibration and analytics feedback are essential to sustain performance. CDM's experience offers a replicable model for implementing evidence-based caries prevention in academic dental settings.