In this qualitative study conducted by Irwin, et. al., “A preliminary model of work during initial examination and treatment planning appoints,” the authors discuss their findings of how technology has assisted and/or hindered the dental practices’ ability to provide effective and efficient patient care.
Researchers observed several general dentistry offices in discovery of workflow issues regarding the use of technology and software charting during initial examinations and treatment planning. Due to the lack of research of EHRs in dental practice, designs of software and other digital applications tend to follow medical processes and therefore, the need to “develop a detailed understanding of workflow and information management during initial examination and treatment planning appointments in general dentistry” was necessary. (2009)
The results of the study were discussed in terms of several models to further explain the workflow processes and interactions with technology in the dental office during the treatment of patients. The first was the “consolidated flow model” (see figure 1 below) which highlighted interactions and roles among and between individuals, tasks, and artifacts during the initial examination and treatment planning. Interactions were documented to reveal patterns of practice. The “consolidated sequence model” was more concentrated and further analyzed interactions into its component intents and goals. This also revealed “breakdowns” within processes, such as the steps required to complete digital radiography. The “consolidated artifact model” focused on the tools necessary for the dental professionals to complete patient care. This was the area that involved working with the record and its component parts relative to investigating electronic records. And the “consolidated cultural and physical models” looked at such things as physical layout of the office environment and staff relations.
Figure 1 – Consolidated flow model: A representation of individuals, roles, tasks, artifacts and interactions in the work process. The computer was present in eight of the 12 offices. Abbreviations: pt = patient; TX = treatment. Breakdowns are indicated in red.
(J. Y. Irwin, M. H. Torres-Urquidy, T. Schleyer & V. Monaco. 2009)
“The major artifacts observed during the work process were the ‘medical/dental history form’, the ‘hard tissue chart’, the ‘periodontal chart’, the ‘treatment plan form’, and the ‘routing slip’, and their corresponding equivalents on the computer. Most of the forms, especially those for data gathering, contained a mix of different data types such as free text, numbers, check boxed and graphical annotations” (2009).
Interpretation of the research revealed distinct themes that can be used to further the investigation of EHRs for the dental practice and promote its use more proficiently. While dental EHR implementation lags behind medical, continued research and evaluation such as these will improve the development of effective electronic records for dental practices.
- Collaboration: Dental personnel roles overlap to the extent that effective EHRs could improve the process to reduce redundancies.
- Workflow: Staff could move more effectively if the software moved with them as patients are escorted through dental processes.
- Communication: The improvements in collaboration and workflow will create better efficiencies in communication among and between staff as well as using EHRs.
- Information design and presentation: Dental professionals use a variety of graphs to measure different areas of the teeth, gums, and oral cavities. Software products need to provide electronic processes that allow for these tasks.
- Information content: The EHR must integrate and be interoperable with the practice management software to improve documentation.
- Data Entry: The EHR interface should allow for individual use without an additional individual to transcribe information into the record.
- Software functions: These should all work cohesively with flexibility that allows for comprehensive clinician entry.