Ubiquitous Computing in Dental Offices: A Case Study

Design of computing systems in many domains focuses on ubiquitous computing, or the notion that technology is embedded in workflow and participants rely upon and easily utilize many different technologies without cognitive overload. In this post, a single case study from a thesis by Dr. Cederman-Haysom is discussed (see citation below), revealing design needs, challenges and opportunities for a private dental practice. However, the case study is informed by several kinds of data collection, including at dental schools.

One major design need that the researcher saw was the need to support ad hoc, in situ tooth and periodontal charting. When describing dental charting, participants over-viewed a detailed, orderly process. However, observations of dentists at work revealed that they were much less structured than the descriptions revealed. Dentists moved around the mouth, jumping to areas of interest and dictating the changes.  In particular, dentists often started at problem areas rather than a single common starting point.

Yet, as Dr. Cederman-Hayson points out, most dental software (including EHRs) does not support this behavior. To further emphasize the requirements for dental software, the researcher asked about other dentists–some of whom, it turned out, used strict charting procedures always starting at the same tooth.

The case study highlighted here focuses on a two-dentist, private practice, focused on interactions with a single dentist: James. At the time, they were transitioning from paper to electronic health records. This created workflow problems around infection control as they tried to maintain a sterile work environment, but needed to use the keyboard during exams. An assistant did most of the typing, and James would listen for the sound of typing as a way to know how quickly to convey information.

In particular, charting was a troublesome process:

James: “Charting is the most important procedure, and the one that
requires the most improvement for how it’s done on a computer. But
the problem is you can never really get rid of a keyboard, you can only
cut back on its use.”

Yet using a keyboard was seen as increasing the chances of infection, decreasing overall sterilization and reducing quality of care. The researcher asked James about several types of solutions, and voice software or automated data capture (for instance, by recording the weight of tools on the bracket table and registering which tools are used) were seen as the easiest, highest potential tools.

Clearly, dental EHRs do not yet support actual dental workflow. Infection control and electronic data entry required two sets of hands–one clean for data entry, one working on the patient–rather than reducing overall work demand.

Lessons Learned:

  • Maintaining a sterile work environment presents workflow challenges for dentists utilizing EHRs.
  • Voice recognition and automated data capture may offer potential design solutions in the future.
  • As design of ubiquitous computing begins to meet workflow needs, dental software will become easier and more utilitarian.

Cederman-Haysom, Timothy Gray. (2009) A participatory design approach in the engineering of ubiquitous computing systems. Thesis, University of Queensland. (opens as a PDF) Section 4.2, James: 106.