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

Designing Clinical Data Presentation Using Cognitive Task Analysis Methods

Despite the many decades of research on effective use 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 practicing dentists in the United States. One critical reason is the poor usability of clinical systems, which makes it difficult for providers to navigate through the system and obtain an integrated view of patient data during patient care. Cognitive science methods have shown significant promise to meaningfully inform and formulate the design, development and assessment of clinical information systems. Most of these methods were applied to evaluate the design of systems after they have been developed. Very few studies, on the other hand, have used cognitive engineering methods to inform the design process for a system itself. It is this gap in knowledge – how cognitive engineering methods can be optimally applied to inform the system design process – that this research seeks to address through this project proposal. This project examined the cognitive processes and information management strategies used by dentists during a typical patient exam and used the results to inform the design of an electronic dental record interface. The resulting 'proof of concept' was evaluated to determine the effectiveness and efficiency of such a cognitively engineered and application flow design. The results of this study contribute to designing clinical systems that provide clinicians with better cognitive support during patient care. Such a system will contribute to enhancing the quality and safety of patient care, and potentially to reducing healthcare costs

Advances in Teaching & Learning Day Abstracts 2004

Proceedings of the Advances in Teaching & Learning Day Regional Conference held at The University of Texas Health Science Center at Houston in 2004

Advances in Teaching & Learning Day Abstracts 2005

Proceedings of the Advances in Teaching & Learning Day Regional Conference held at The University of Texas Health Science Center at Houston in 2005

Informatics innovation in clinical care: A visionary scenario for dentistry

Health information technology (HIT) is one of the most significant developments in health care in recent years. However, there is still a large gap between how HIT could support clinical work versus how it does. In this project, we developed a visionary scenario to identify opportunities for improving patient care in dentistry. In the scenario, patients and care providers are supported by a ubiquitous, embedded computing infrastructure that captures and processes data streams from multiple sources. Practical decision support, as well as automated background data processing (e.g., to screen for common conditions), helps clinicians provide quality care. A holistic view of clinical information technology (IT) focuses on supporting clinicians and patients in a user-centered manner. While clinical IT is still in very much a work in progress, scenarios such as the one presented may be helpful to keep us focused on the possibilities of tomorrow, not on the limitations of today

Advancing oral medicine through informatics and information technology: a proposed framework and strategy.

The implementation of information technology in healthcare is a significant focus for many nations around the world. However, information technology support for clinical care, research and education in oral medicine is currently poorly developed. This situation hampers our ability to transform oral medicine into a 'learning healthcare discipline' in which the divide between clinical practice and research is diminished and, ultimately, eliminated. This paper reviews the needs of and requirements for information technology support of oral medicine and proposes an agenda designed to meet those needs. For oral medicine, this agenda includes analyzing and reviewing current clinical and documentation practices, working toward progressively standardizing clinical data, and helping define requirements for oral medicine systems. IT professionals can contribute by conducting baseline studies about the use of electronic systems, helping develop controlled vocabularies and ontologies, and designing, implementing, and evaluating novel systems centered on the needs of clinicians, researchers and educators. Successfully advancing IT support for oral medicine will require close coordination and collaboration among oral medicine professionals, information technology professionals, system vendors, and funding agencies. If current barriers and obstacles are overcome, practice and research in oral medicine stand ready to derive significant benefits from the application of information technology

Information Technology and Computing Topics and Their Relevance to Medical Undergraduate and Graduate Program Curricula at RIT

Two healthcare domain related programs in which this author has curricular relationships are the undergraduate Diagnostic Ultrasound (DU), and the graduate Master of Science in Health Informatics (MSHI). He teaches one course in the former and is the program coordinator for the latter. The undergraduate course is titled, “Computers in Medicine”, and is a rough 50% combination of a first-semester computing hardware course taught to our IT undergrads and another 50% of material from a textbook covering all the ways in which computing has benefitted various healthcare domains like, surgery, pharmacy, imaging, dentistry, psychiatry, remote medicine and the like. The MSHI program is a 30 semester credit hour program offered in an online format with a capstone experience (no thesis required) that was designed for professionals expecting to retool themselves for continued employment in a healthcare setting. This paper will discuss the details of the DU course and the MSHI program, the kind of computing content covered in each, and the rationale for and program design input of each. In conclusion, the reader will be left with an understanding of the what, when, how and why computing topics are necessarily required by these curricula, our justification for such, and how we might use that information in the development of future healthcare-related computing courses and potential programs. Course definition and program outline documents will be attached as appendices to the paper

Decision support systems for adoption in dental clinics: a survey

While most dental clinicians use some sort of information system, they are involved with administrative functions, despite the advisory potential of some of these systems. This paper outlines some current decision support systems (DSS) and the common barriers facing dentists in adopting them within their workflow. These barriers include lack of perceived usefulness, complicated social and economic factors, and the difficulty for users to interpret the advice given by the system. A survey of current systems found that although there are systems that suggest treatment options, there is no real-time integration with other knowledge bases. Additionally, advice on drug prescription at point-of-care is absent from such systems, which is a significant omission, in consideration of the fact that disease management and drug prescription are common in the workflow of a dentist. This paper also addresses future trends in the research and development of dental clinical DSS, with specific emphasis on big data, standards and privacy issues to fulfil the vision of a robust, user-friendly and scalable personalised DSS for dentists. The findings of this study will offer strategies in design, research and development of a DSS with sufficient perceived usefulness to attract adoption and integration by dentists within their routine clinical workflow, thus resulting in better health outcomes for patients and increased productivity for the clinic