Advancing cognitive engineering methods to support user interface design for electronic health records.

BACKGROUND: Despite many decades of research on the effective development of clinical systems in medicine, the adoption of health information technology to improve patient care continues to be slow, especially in ambulatory settings. This applies to dentistry as well, a primary care discipline with approximately 137,000 practitioners in the United States. A critical reason for slow adoption is the poor usability of clinical systems, which makes it difficult for providers to navigate through the information and obtain an integrated view of patient data. OBJECTIVE: In this study, we documented the cognitive processes and information management strategies used by dentists during a typical patient examination. The results will inform the design of a novel electronic dental record interface. METHODS: We conducted a cognitive task analysis (CTA) study to observe ten general dentists (five general dentists and five general dental faculty members, each with more than two years of clinical experience) examining three simulated patient cases using a think-aloud protocol. RESULTS: Dentists first reviewed the patient's demographics, chief complaint, medical history and dental history to determine the general status of the patient. Subsequently, they proceeded to examine the patient's intraoral status using radiographs, intraoral images, hard tissue and periodontal tissue information. The results also identified dentists' patterns of navigation through patient's information and additional information needs during a typical clinician-patient encounter. CONCLUSION: This study reinforced the significance of applying cognitive engineering methods to inform the design of a clinical system. Second, applying CTA to a scenario closely simulating an actual patient encounter helped with capturing participants' knowledge states and decision-making when diagnosing and treating a patient. The resultant knowledge of dentists' patterns of information retrieval and review will significantly contribute to designing flexible and task-appropriate information presentation in electronic dental records.

Evaluating the effectiveness of modeling principles for data models.

We evaluated the effectiveness of modeling principles intended to harmonize the information representation between terminology-ontology models and information models. Our study utilized dental clinical statements and sample dental record questions. We asked experts to define the equivalency (mapping) of these elements and measured their agreement. We modified the data elements and asked the experts to conduct subsequent mappings. We measured the agreement and compared the levels of agreement before and after changes, expecting that agreement would increase. The level of agreement (Kappa) before modeling was 0.3 to 0.4 and after was 0.5 (p<0.05). The difference was small but statistically significant. Our results suggest that the modeling principles improve information representation since agreement increased.

The impact of clinical information systems in dental schools.

Although Clinical Information Systems (CIS) are gaining widespread acceptance in dental schools, their impact on users is not well understood. We conducted separate qualitative studies of the impact of CIS on users in two dental schools and then compared our results. We found five themes in common. By understanding the factors that impact CIS implementation we believe that dental schools will be better prepared to manage them.

Evaluation of the Systematized Nomenclature of Dentistry using case reports: preliminary results.

The Systematized Nomenclature of Dentistry (SNODENT) is an effort of the American Dental Association (ADA) to develop a controlled terminology that addresses the needs of clinical dentistry. The ADA, collaborating with the College of American Pathologists, developed and incorporated SNODENT as a microglossary of SNOMED. However, little evidence exists of the effectiveness of its clinical coverage. We extracted diagnostic terms from clinical case reports and evaluated SNODENT's and other medical terminologies' coverage of those terms.

Government's public policy in regards to the National Health Information Infrastructure: two approaches.

Public policy conducted whether by government institutions or by legislators has a definitive impact on society as whole. This presentation analyses these two approaches: (1) describing relevant activities conducted by the National Library of Medicine (NLM) and (2) analyzing legislation that makes direct reference to the National Health Information Infrastructure (NHII).