1492 Workflow and Information Management During Charting and Treatment Planning
J. YUHANIAK, M.H. TORRES-URQUIDY, and T. SCHLEYER, University of Pittsburgh, PA, USA

Understanding how dentists and auxiliaries work together, and how they enter and retrieve data, is essential to designing usable, effective and efficient clinical information systems. User-centered design methodologies generate formal representations of existing workflow and information management useful for designing new information technology (IT) applications. Objective: 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, two researchers observed 23 comprehensive examination and treatment planning sessions during 14 visits to 12 general dental offices. For each visit, field notes were analyzed and reformulated as flow, sequence, physical, artifact and cultural models. Subsequently, each model type was consolidated across all offices and visits. Interruptions to the workflow, called breakdowns, were identified. Results: Charting and treatment planning do not occur in a clearly defined and sequenced manner; dentists and auxiliaries fluidly cooperate on these highly data-intensive tasks. Treatment planning was characterized by rapid, dynamic decision-making; five offices discarded treatment plan records after treatment completion. Communication and coordination were supported by a variety of verbal and non-verbal signals, physical artifacts and specialized technologies. Most of the breakdowns occurred because of lack of or poor integration of technology into the work environment. For instance, using voice recognition successfully required optimal environmental conditions and user effort. Offices used a variety of workarounds to compensate for technological and environmental constraints. Conclusion: Our results show that IT must be better integrated into the clinical environment to minimize technology-based interruptions in the workflow. Better role- and task-specific technology designs can potentially make teamwork in clinical care more effective and efficient. Software should make it easier to switch between clinical tasks, such as recording intraoral findings, treatment planning and review of ancillary data, such as the medical history.

Seq #170 - Dental Practice Patterns, Technology, and Quality Issues
3:00 PM-4:00 PM, Friday, 10 March 2006 Dolphin Hotel Pacific Hall
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