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Dental Informatics Research: Usability of Electronic Dental Records

Sara Engler, a dental informatics intern, uses specialized software showing clusters of eye movement activity.

Electronic medical records (EMRs) provide multiple benefits to clinical care, patient outcomes, efficiency and research. Marshfield Clinic was one of the pioneering health care organizations to develop its own electronic medical record.

Recently an electronic dental record module was integrated within the Clinic’s EMR, making it one of the very few integrated record systems in the nation. Marshfield Clinic’s Dental Informatics research group, along with Information Systems staff, has been working closely to improve the medical-dental record systems.

To test the usability of the existing electronic dental record module, the Clinic turned to its friends at the Dental Clinic of Marshfield, a major contributor to the capital campaign for the Laird Center for Medical Research. The Laird Center is the home of the Biomedical Informatics Research Center (BIRC).

“We’ve been developing a system called Cattails Dental, which could talk to the Clinic’s EMR, CattailsMD” explained Amit Acharya, B.D.S., M.S., Ph.D., a dentist and dental informatics scientist at BIRC. “This system is one of the few in the country designed to be integrated with an EMR. We wanted to find out how usable it really was and improve on the design based on the external feedback.” A group of dentists and dental hygienists at the Dental Clinic of Marshfield were ready and willing to help.

“This was a very interesting thing for us to do,” said William Berry, D.D.S., a dentist and member of the Dental Clinic’s board of directors. “We’ve had our own dental record system, so we were interested in seeing what a completely new program would be like.” Dentists and physicians have agreed that a system that could cross between dental and health records would be advantageous for both disciplines and for patients. The problem is that many different dental record systems are used at dental practices.

“When we have questions about a patient’s medical records, we have to call the physician or make the request in writing, which can be very slow,” Dr. Berry noted. “If we had access to all of those things through the combined dental and health record, it would be fantastic.”

We’re not there yet, he said, as the nine dentists participating in this research gave valuable improvement ideas to reduce the complexity of the current version of Cattails Dental. The dentists also were given a demonstration of BIRC’s usability lab and equipment and experienced an eye tracking system, which showed clearly how their eyes were moving as they gazed at the computer monitors.

“You don’t really notice it at the time, but when we went back and they showed us where our eyes were looking, it was fascinating. Obviously, they want to arrange things on the computer monitor where the eye tends to look,” Dr. Berry said.

Their eye movements were charted and aggregated to produce a cluster map that clearly shows the areas of most interest. This information will be used to produce the next version of Cattails Dental, and for a scientific paper being published by Dr. Acharya and his colleagues at BIRC, Sara Engler, a dental informatics intern, and Andrea Mahnke, a usability analyst.

“I’m very interested in seeing what they come up with next,” Dr. Berry said. “I would think it will be easier to use.”