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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.wmv7/27/2019 Advancing usability and functionality of electronic dental records
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Match between system and realworld
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User control
report preview
Flexibility and efficiency of use
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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.wmv7/27/2019 Advancing usability and functionality of electronic dental records
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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.wmv7/27/2019 Advancing usability and functionality of electronic dental records
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Flexibility and efficiency of use
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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.wmv7/27/2019 Advancing usability and functionality of electronic dental records
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Help and documentation
chart legend
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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.wmv7/27/2019 Advancing usability and functionality of electronic dental records
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Visibility of system status
moving an appointment
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Esthetic and minimalist design
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Flexibility and efficiency of use
accessing the perio chart
http://localhost/var/www/apps/conversion/tmp/scratch_8/HE%20video%20clips%20and%20images/HE_ES_Perio%20exam%20access.wmv7/27/2019 Advancing usability and functionality of electronic dental records
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Consistency and standards
saving a prescription
Flexibility and efficiency of use
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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.wmv7/27/2019 Advancing usability and functionality of electronic dental records
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Consistency and standards
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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
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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
Facebook /titusschleyer
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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
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Thank you for your attention!
Contact info:
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/