Summary of: a preliminary model of work during initial examination and treatment planning appointments

KEY POINTS * Dental team members have multiple, often overlapping roles. They use a large and varied collection of equipment and technology to complete complex tasks. * Technology often

interrupts the workflow, causes rework and increases the number of steps in work processes. * Current dental software could be greatly improved with regard to its support for all areas of

the workflow process. ABSTRACT OBJECTIVE This study's objective was to formally describe the work process for charting and treatment planning in general dental practice to inform the

design of a new clinical computing environment. METHODS Using a process called contextual inquiry, researchers observed 23 comprehensive examination and treatment planning sessions during 14

visits to 12 general US dental offices. For each visit, field notes were analysed and reformulated as formalised models. Subsequently, each model type was consolidated across all offices

and visits. Interruptions to the workflow, called breakdowns, were identified. RESULTS Clinical work during dental examination and treatment planning appointments is a highly collaborative

activity involving dentists, hygienists and assistants. Personnel with multiple overlapping roles complete complex multi-step tasks supported by a large and varied collection of equipment,

artifacts and technology. Most of the breakdowns were related to technology which interrupted the workflow, caused rework and increased the number of steps in work processes. CONCLUSION

Current dental software could be significantly improved with regard to its support for communication and collaboration, workflow, information design and presentation, information content,

and data entry. You have full access to this article via your institution. Download PDF MAIN J. Y. Irwin, M. H. Torres-Urquidy, T. Schleyer and V. Monaco _British Dental Journal_ 2009; 206:

E1 EDITOR'S SUMMARY There is no escaping the fact that technology permeates nearly every area of our modern world, and will continue to do so. The extent to which this is true in

dentistry can be seen by a quick flick through the 'Product News' pages in any issue of the _BDJ_: from digital radiography to CAD/CAM systems, there are few, if any, areas of

dentistry that remain unaffected by technological developments over the past 20 years. In many ways, these advances have been beneficial, speeding up previously lengthy processes and

enabling once complex paper filing systems to be stored electronically and accessed at the touch of a button. However, anyone who has ever felt like screaming with frustration while trying

to perform a seemingly simple task on their home computer will know that sometimes, technology can make our lives more, not less complicated! This study models and describes in detail what

many dentists have probably felt on more than one occasion. The authors' aim was to understand the processes of interaction and communication involved in initial dental examinations and

treatment planning and how technology was integrated into this workflow. What they found was that in many cases, far from helping the process to run more smoothly, existing computer

technology actually made it more complicated, causing interruptions to workflow and increasing the number of steps needed to carry out an activity. As the authors point out, clinical dental

work is highly collaborative, involving many different team members performing roles that may overlap and tasks that are complex and require many different pieces of equipment. Taking all

these factors into account and allowing for the myriad potential outcomes and occurrences is a tough task for any computer system and this study suggests that existing technology is not

quite up to the challenge. The detailed investigations and models in the paper are extremely useful for future dental software development: by clearly identifying the problems, the authors

have taken the first step towards solving them. There is no doubt that computers will continue to play an increasingly large part in general dentistry. We must get used to the fact that

technology is here to stay and indeed, it is already making some aspects of dentistry much easier. Current software may not yet reach its full potential, but research such as this paves the

way for the significant improvements that are required. You can be sure that at least some beneficial advances are just around the corner... THE FULL PAPER CAN BE ACCESSED FROM THE _BDJ_

WEBSITE ( HTTP://WWW.BDJ.CO.UK ), UNDER 'RESEARCH' IN THE TABLE OF CONTENTS FOR VOLUME 206 ISSUE 1. ROWENA MILAN, JOURNAL EDITOR AUTHOR QUESTIONS AND ANSWERS 1. WHY DID YOU

UNDERTAKE THIS RESEARCH? The long-term goal of our research is to improve patient outcomes by providing better computer-based tools to support the work of dental clinicians. Like others, we

believe that a thorough and comprehensive understanding of work processes, tasks, goals, participants and context is necessary to design useful and usable information systems. This study is

important because it is the first systematic investigation of the work environment and clinical care process in general dentistry. Our findings provide rich data for the design and

development of improved dental software and tools. 2. WHAT WOULD YOU LIKE TO DO NEXT IN THIS AREA TO FOLLOW ON FROM THIS WORK? We are using the results of this study to inform the design of

multiple computer-based tools for clinical dentistry. Currently, we are developing a speech interface for electronic dental records that allows dentists to dictate using natural language

rather than specific commands. We are also exploring the feasibility of a three-dimensional interface for charting and patient information review in general dentistry. We are designing these

projects with ardent attention to the workflow that dentists and auxiliary personnel engage in during patient care. COMMENT If one agrees, as I do, that the adoption and use of dental

software, both clinical and administrative, can improve the efficiency and efficacy of dental care, then such software must be designed in ways that will not only meet, but exceed the

current information, communication and workflow requirements of the dental team. This research takes a large step forward in helping better define these software requirements based on

formalised observations of the generalist dental team, whether in the US, UK or elsewhere. Twenty-three comprehensive initial exam and treatment planning appointments were observed in twelve

general dental practices in the USA. Eight used clinical dental software chairside, whereas the remaining used only administrative practice management software. Using contextual inquiry

analysis as a methodological framework from which to evaluate their observations, the authors identified 27 'breakdowns' (ie interruptions to workflow) that impacted the efficiency

and efficacy of the dental visits. Sixty percent of the breakdowns were associated with technologies. Recommended solutions to technology 'breakdowns' as well as suggestions for

improvements in communications, workflow, and collaboration are discussed in the paper. Dental teams, dental software developers and practice management consultants will benefit from the

researchers' comments. Information design, presentation and content were also examined, demonstrating that the unique richness of textual, graphical and symbolic data incorporated in

the paper record has not yet been duplicated or enhanced within the clinical computing environment. Transition from paper to digital dental clinical records will require developing a much

better fit between the requirements of a task and how the needed information is presented, capability to accommodate a specific type of data (eg DiagnoDent readings), and improved interfaces

to allow direct and straightforward data entry by clinicians that accommodate the flexibility with which clinicians enter data. The time has come for more effective and useful clinical

computing in dentistry. Despite noted limitations, this research takes a critical and well organised look at the gaps between how information, communication, technologies, and workflow

interact. In doing so, the authors have begun to inform the specifications for the design of a new clinical computing environment. AUTHOR INFORMATION AUTHORS AND AFFILIATIONS * Assistant

Dean Health Professions/Program Director Health Informatics, Oregon Institute of Technology, USA M. Kirshner Authors * M. Kirshner View author publications You can also search for this

author inPubMed Google Scholar RIGHTS AND PERMISSIONS Reprints and permissions ABOUT THIS ARTICLE CITE THIS ARTICLE Kirshner, M. Summary of: A preliminary model of work during initial

examination and treatment planning appointments. _Br Dent J_ 206, 24–25 (2009). https://doi.org/10.1038/sj.bdj.2008.1140 Download citation * Published: 10 January 2009 * Issue Date: 10

January 2009 * DOI: https://doi.org/10.1038/sj.bdj.2008.1140 SHARE THIS ARTICLE Anyone you share the following link with will be able to read this content: Get shareable link Sorry, a

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