Chen, Jung-Wei

Flaitz, Catherine M

Johnson, Kathy

Michea, Yanko

Xing, Yang

PubMed

Name not available

Oral Pathology Report System: Improving an Existing Database System

DigitalCommons@The Texas Medical Center

Oral Pathology Report System: Improving an Existing Database SystemYanko Michea MDV, Jung-Wei Chen DDS, MS2, Yang Xing MD',Kathy Johnson PhD', Catherine M Flaitz DDS, MS2.1 Department of Health Informatics, School of Health Information Science2 Division of Oral and Maxillofacial Pathology, Department of Stomatology, Dental BranchThe University of Texas Health Science Center Houston TexasIntroduction: The oral & maxillofacial surgical pathologyservice at The University of Texas Health Science Center atHouston Dental Branch (UTHSC-HDB) is dedicated to theprocessing and microscopic examination of biopsiedspecimens from the oral & maxillofacial region. . Thisservice is staffed by 3 pathologists, 2 administrative staffassistants and 2 histotechnicians. Most of the surgicalbiopsies are submitted by dentists and oral surgeons from thelocal community and Southeast Texas. In addition to regularpaper based record systems, the program stores part of theinformation on a local database. The database system is usedfor tracking the diagnostic reports for retrieval of patientmaterials, and the development of teaching and researchresourcesThe purpose of this project was to evaluate the currentinformation flow, the possibility of integrating the data entryprocess into it, and the generation of a new database systemfor this service.Methods: In order to determine the characteristics of theinformation exchange inside the oral pathology service, weconducted interviews with the professional andadministrative personnel, analyzing the current use of theexisting database, paper documents and the sequence oftasks involved in the report of a sample. We were especiallyconcemed with the data entry points and with the forms andprocedures used on this university service. A new relationaldatabase system was designed based on this diagnostic Weused MS Access® to build a database prototype.Results: The results of this analysis were documented by: aninformation flow diagram, a list describing the informationrequirements, the current data capture procedures, as well asa description of the main problems of this system. Therewere 3 main problems with the system. 1) There wasunproductive data entry redundancy, i.e., two staff assistantsentered the same data into two different systems. 2) Therewas ineffective data retrieval. Due to the age of the olddatabase, there were several design problems, mostly in theareas of inability to create specific queries and the lowsystem usability (old DOS based system). 3) The codingsystems were ambiguous. ICD-9, AFPI codes, and CPTcodes were all used. The system did not offer feedback orreferences for the coding systems, which were used in thedatabase.A new database system was designed to solve theseproblems, as well as integrating billing and sample trackingsystems. Additional design goals for the system were that itbe user friendly, interactive, intuitive, and flexible tofacilitate the formulation of generating personalizedqueries.The new database can be used on a network environment,ideally on a closed network to avoid security issues. Thesystem can register different clinical codes depending onthe context and user preferences (CPT, ICD-9 or AFPIcodes). The system GUI was designed to mimic currentpaper based formularies, in order to facilitate the learningof the system, shorten the adaptation time and allow foreasy assimilation into the present system. The users havetried the updated system and it has been favorably receivedin both design and information retrieval.Discussion: The design of databases for dental practice isnot a new idea. Since the early nineties, research on theapplication of these tools to clinical practice', research2 ormanagemene is found in the literature. Curiously, afterthis initial excitement with this technology, there have notbeen significant efforts to describe the common designissues of these systems. One of the reasons is that astandardized coding system has only recently beenimplemented, which earlier caused problems in retrieval ofinformation and billing.. Our approach was based ongeneral usability and software design principles and oncurrent trends on health informatics. The use of such toolswas effective to solve the problems that we described inthe information flow of this service and the flaws in the olddatabase.Conclusions: The evaluation of the user characteristics,the information flow and requirements of the system wasa useful resource to assess the current problems and toimprove the existing information system. More research isnecessary in order to determine common strategies to solveinformation processing and flow on dental systems.References1. Chasteen J. A computer database approach for dentalpractice. J Am Dent Assoc 1992; 123(9):26-33.2. Webster DA, Smales RJ. Large database managementin clinical dental research. Aust Dent J1991;36(5):397-400.3. Gilboe DB, Scott DA. Computer systems for dentalpractice management. A new generation ofindependent dental software. J Can Dent Assoc1991 ;57(10):782-6.AMIA 2002 Annual Symposium Proceedings 1104

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Oral Pathology Report System: Improving an Existing Database System

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