advancing usability and functionality of electronic dental records

7/27/2019 Advancing usability and functionality of electronic dental records

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Advancing usabilityand functionality of

electronic dentalrecords

Big Hole Valley, Montana, 9/2001

Titus Schleyer, DMD, PhD

INFO-I 667October 10, 2013


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The plan

What do dentists actually do?

Dental care process, documentation anddecision-making

Learn (or practice) a skill: heuristic evaluation

Usability of four electronic dental recordsystems

Designing a novel interface based on acognitive task analysis


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What do dentists actually do?


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Patient care in dentistry and medicine

Dentistry Medicine

Patient doesnt feel sick feels sick

Initial visit lots of data few data

# of diagnoses few many

# of therapies many few

Tx type mechanical/

biological

biological/

mechanical

Life&deathsituations

few many


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Dental care process

Regularpatient

Emergencypatient

Assessmentand diagnosis

Treatmentplan

Health statusmaintenance Treatment


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Clinical documentation

medical and dental history, incl. chiefcomplaint

extraoral and intraoral exam

radiographs images

problem list

treatment plan

progress notes


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Medicalhistory


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Medicationhistory


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Hard tissue

exam andradiologyreport


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Periodontalexam


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Radiographs


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Images

me


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Treatmentplan


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Progressnotes


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Differences in Delivery System

Dentistry Medicine

# practitioners 166,000 813,000

Generalist/

specialist

70/30 35/65

Solo/grouppractice

62/38 ?

Hospitalaffiliation

few many

Annual $ $60b $1,200b


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Based on what you know and/or havelearned so far, what are possible researchissues for electronic dental records?

[Please take about 5 min. to record yourobservations.]


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Usability ofelectronic dental

records

Grand Tetons, Wyoming, 10/2001


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Ligonier, Pennsylvania, 10//2004

Learn (or practice) a skill: Heuristic evaluation


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What is heuristic evaluation?

small set of evaluators examines theinterface

judge its compliance with usabilityprinciples (heuristics)

heuristic violations merged into master list

Nielsen J, Mack RL. Usability Inspection Methods, John Wiley & Sons, Inc, New York 1994.


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Significance of heuristic evaluation

discount usability engineering method

identifies usability problems in theinterface with reference to recognizedusability principles

cheap and easy to conduct


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Heuristic evaluator training

Madison River Valley, Montana T. Schleyer 2001


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Visibility of system status

charting MOD amalgam
http://localhost/var/www/apps/conversion/tmp/scratch_8/HE%20video%20clips%20and%20images/HE_DX_MOD%20amalgam.wmv


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Match between system and realworld


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User control

report preview

Flexibility and efficiency of use
http://localhost/var/www/apps/conversion/tmp/scratch_8/HE%20video%20clips%20and%20images/HE_ES_Report%20preview.wmv


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Consistency and standards


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Error prevention

extracting a tooth
http://localhost/var/www/apps/conversion/tmp/scratch_8/HE%20video%20clips%20and%20images/HE_ES_Extracting%20and%20crowning%20tooth.wmv


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Recognition rather than recall

switching from hard tissue toperio chart
http://localhost/var/www/apps/conversion/tmp/scratch_8/HE%20video%20clips%20and%20images/HE_ES_Switching%20from%20hard%20tissue%20to%20perio%20chart.wmv


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Esthetic and minimalist design


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Help users with errors

family schedule
http://localhost/var/www/apps/conversion/tmp/scratch_8/HE%20video%20clips%20and%20images/HE_DX_Switch%20to%203D%20mode.wmv


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Help and documentation

chart legend
http://localhost/var/www/apps/conversion/tmp/scratch_8/HE%20video%20clips%20and%20images/HE_ES_Chart%20legend.wmv


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Your turn!


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Match between system and realworld


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Error prevention

prescribing Amoxicillin
http://localhost/var/www/apps/conversion/tmp/scratch_8/HE%20video%20clips%20and%20images/HE_ES_Prescription%20for%20John%20Abbott.wmv


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Visibility of system status

moving an appointment
http://localhost/var/www/apps/conversion/tmp/scratch_8/HE%20video%20clips%20and%20images/HE_ES_Move%20appointment.wmv


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Esthetic and minimalist design


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accessing the perio chart
http://localhost/var/www/apps/conversion/tmp/scratch_8/HE%20video%20clips%20and%20images/HE_ES_Perio%20exam%20access.wmv


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saving a prescription

http://localhost/var/www/apps/conversion/tmp/scratch_8/HE%20video%20clips%20and%20images/HE_ES_Saving%20prescription.wmv


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Help users with errors

family schedule
http://localhost/var/www/apps/conversion/tmp/scratch_8/HE%20video%20clips%20and%20images/HE_ES_Family%20schedule.wmv


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Limitations of heuristic evaluation

tells you about problems, but not how to fixthem

finds different types of errors than usabilitytesting

not very reliable*

*W. D. Gray and M. C. Salzman. Damaged merchandise? A review of experiments that compare usability evaluationmethods. Hum-Comput Interact 13 (3):203-261, 1998.


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Usability of electronic dental recordsystems

Research questions:

Which usability problems arecommon in dental software?

What is the rate of completed,incorrectly completed andincomplete user tasks?

Thyvalikakath T et al. A usability evaluation of four commercial dental computer-based patient record systems. J Am Dent Assoc 2008Dec;139(12):1632-42

Record a missing tooth correct path


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Record a missing tooth correct path


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Results


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User adverse events

10

20

30

40

50

0

60

ES

PW

DX

SD

70


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Usability of electronic dental records

Significant usability problems due to:

complex information design

mismatch between system and user model

difficulty in finding functionality significant cognitive effort required that did not

contribute to task completion

D i i l i t f b d


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Designing a novel interface basedon a cognitive task analysis

Research questions:

What cognitive processes dodentists engage in and whatinformation do they usewhen they treat a patient?

How can a new designsupport these processes

better than existing EDRs?

Thyvalikakath T et al. Advancing cognitive engineering methods to support user interface design for electronic health records (in review)


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Methods

think-aloud method with 3 standardized patientcases

5 dental faculty and 5 general dentists

analyze the sessions to determine:

information that dentists requested

sequence in which they reviewed information

instances of concurrent review of information items


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Results

0

5

10

15

20

25

30

35

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%Average

numberoftimeseachpatientdataaccessed

Average session time in percentage (normalized) for a case of high complexity

Average of patient data accessed in 10 high complexity cases

Patient Demographics Social History Medical HistoryMedications Medical Consult Dental HistoryIntra-oral Images Radiographs Hard Tissue ChartPeriodontal Exam Oral Pathology Consult Treatment Plan Notes

Start of End ofsession


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Results (cont.)

0

2

4

6

8

10

12

14

16

18

20

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%Averagen

umberoftimeseachpatien

tdataaccessed

Average session time in percentage (normalized) for a case of low complexity

Average of patient data accessed in 10 low complexity

cases

Patient Demographics Medical History Dental History Extra-oral ImagesIntra-oral Images Radiographs Hard Tissue Chart Periodontal ExamFinancial Informaton Treatment Plan Notes

Start End ofsessio

Visualization of information artifacts used over time


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Visualization of information artifacts used over time


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Prototype: The DMD Project

A no el approach to designing
http://www.dmdproject.com/


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A novel approach to designingEDRs


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Results

scale: 0 (least satisfaction) - 9 (most satisfaction)

Results


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Results


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A final thought

"There is a strong temptation always to keep our eyes on the

faraway, glittering objectives, and forget the rubbish

accumulated at our feet. It is a wrench to turn from the

great problems that flatter our dignity by their mere

contemplation to give our attention to the relatively

insignificant but very effective thongs that bind our ankles

at this moment. But unless we can do that, and rid ourselves

of immediate impediments, we shall stay planted exactly in

one spot. It is not merely that we wont be able to advancetoward all-important, distant goals; we may be

overwhelmed where we stand by tides of disaster we are

unable either to turn back or escape."

~Walter Dorwin Teague~

Thank You for Your Attention!


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J. Irwin

Please visit us at:

http://www.regenstrief.org

Twitter

Facebook /titusschleyer

Scribd

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Thank You for Your Attention!

Questions, comments?

H. Torres-Urquidy

P. Hernandez A. Acharya

H. Spallek

Thanks to:

T. Thyvalikakath

M. SongMargate, New Jersey, 8/1999
http://www.regenstrief.org/http://www.regenstrief.org/


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Thank you for your attention!

Contact info:

[email protected]

Download this talk:


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References

Thyvalikakath TP, Schleyer TK, Monaco V. Heuristicevaluation of clinical functions in four practice

management systems: a pilot study. J Am Dent Assoc.2007 Feb;138(2):209-10, 212-8.

Thyvalikakath T et al.A usability evaluation of fourcommercial dental computer-based patient record

systems. J Am Dent Assoc 2008 Dec;139(12):1632-42

Thyvalikakath T et al.Advancing cognitive engineering

methods to support user interface design for electronichealth records (in review)

http://www.dmdproject.com
http://www.dmdproject.com/http://www.dmdproject.com/

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